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Considering that TLR2, TLR3 and TLR4 play very important roles in inflammatory processes, the question arises whether the presence of polymorphisms in these genes is associated with susceptibility to sepsis. The aim of this study was to examine the association of TLR2, TLR3 and TLR4 polymorphisms with clinical characteristics and outcome of critically ill patients. A follow-up study was conducted on 121 critically ill Caucasian Serbian patients. Five polymorphisms in TLRs, TLR2 (rs5743708), TLR3 (rs3775291, rs5743312) and TLR4 (rs4986790, rs4986791) were genotyped by real-time PCR. Investigated polymorphisms in TLR2 and TLR4 were not associated with the clinical characteristics and outcome of critically ill patients. TLR3 rs3775291 polymorphism was associated with patient’s outcome (p=0.018). Patients with sepsis and a TLR3 rs3775291-mutated genotype had a four-fold higher mortality rate compared to wild type and heterozygous carriers. Multivariate regression analysis showed that age, sex and TLR3 rs3775291 polymorphism are independent variables of the outcome of critically ill patients. For the first time, our preliminary findings indicate the role of TLR3 with MyD88 independent signaling and its polymorphism (TLR3 rs3775291) in sepsis and survival in critically ill Serbian patients.

IntroductionOpen reduction and fixation are the standard of care for treating mandibular fractures and usually lead to successful healing. However, complications such as delayed healing, non-union, and infection can compromise patient outcomes and increase healthcare costs. The initial inflammatory response, particularly the response involving specific CD8+ T cell subpopulations, is thought to play a critical role in healing long bone fractures. In this study, we investigated the role of these immune cell profiles in patients with impaired healing of mandibular fractures.Materials and methodsIn this prospective study, we included patients with mandibular fractures surgically treated at Charité – Universitätsmedizin Berlin, Germany, between September 2020 and December 2022. We used follow-up imaging and clinical assessment to evaluate bone healing. In addition, we analyzed immune cell profiles using flow cytometry and quantified cytokine levels using electrochemiluminescence-based multiplex immunoassays in preoperative blood samples.ResultsOut of the 55 patients enrolled, 38 met the inclusion criteria (30 men and 8 women; mean age 32.18 years). Radiographic evaluation revealed 31 cases of normal healing and 7 cases of incomplete consolidation, including 1 case of non-union. Patients with impaired healing exhibited increased levels of terminally differentiated effector memory CD8+ T cells (TEMRA) and a higher TEMRA to regulatory T cell (Treg) ratio, compared with those with normal healing.ConclusionsOur analysis of mandibular fracture cases confirms our initial hypothesis derived from long bone fracture healing: monitoring the TEMRA to Treg ratio in preoperative blood can be an early indicator of patients at risk of impaired bone healing. Radiologic follow-up enabled us to detect healing complications that might not be detected by clinical assessment only. This study highlights the potential of individual immune profiles to predict successful healing and may form the basis for future strategies to manage healing complications.

Serious complications after pancreaticoduodenectomy include rupture of pseudoaneurysms arising from pancreatic fistula and pancreatojejunostomy leakage. We report a case of successful endovascular minimally invasive treatment using a covered stent endoprosthesis of a right hepatic artery stump bleeding following pylorus-preserving pancreaticoduodenectomy that was not suitable for coil or glue embolization due to an insufficiently short neck.

Abstract The routine use of dynamic-contrast-enhanced MRI (DCE-MRI) of the liver using hepatocyte-specific contrast agent (HSCA) as the standard of care for the study of focal liver lesions is not widely accepted and opponents invoke the risk of a loss in near 100% specificity of extracellular contrast agents (ECA) and the need for prospective head-to-head comparative studies evaluating the diagnostic performance of both contrast agents. The Purpose of this prospective intraindividual study was to conduct a quantitative and qualitative head-to-head comparison of DCE-MRI using HSCA and ECA in patients with liver cirrhosis and HCC. Twenty-three patients with liver cirrhosis and proven HCC underwent two 3 T-MR examinations, one with ECA (gadoteric acid) and the other with HSCA (gadoxetic acid). Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), wash-in, wash-out, image quality, artifacts, lesion conspicuity, and major imaging features of LI-RADS v2018 were evaluated. Wash-in and wash-out were significantly stronger with ECA compared to HSCA (P

Abstract For management of Budd-Chiari syndrome (BCS), a step-wise therapeutic approach starting with medical treatment, followed by endovascular recanalization, transjugular intrahepatic portosystemic shunt, and finally liver transplantation has been adopted. We retrospectively analyzed 51 patients with symptomatic short segment (≤ 30 mm) hepatic vein (HV)-type BCS who underwent percutaneous transluminal balloon angioplasty (PTBA) with/without stenting to determine the feasibility, clinical effectiveness, and long-term outcomes. The intervention was technically successful in 94.1% of cases (48/51)—32 patients underwent PTBA and 16 patients underwent HV stenting. Procedure-related complications occurred in 14 patients (29.1%). The clinical success rate at 4 weeks was 91.7% (44/48). Nine patients underwent reintervention, six patients due to restenosis/occlusion and three patients with clinical failure. The mean primary patency duration was 64.6 ± 19.9 months (CI, 58.5–70.8; range, 1.2–81.7 months). The cumulative 1-, 2-, and 5-year primary patency rates were 85.4, 74.5, and 58.3%, respectively. The cumulative 1-, 2-, and 5-year secondary patency rates were 93.8, 87.2, and 75%, respectively. The cumulative 1-, 2-, and 5-year survival rates were 97.9, 91.5, and 50%, respectively. Percutaneous transluminal angioplasty with and without stenting is effective and achieves excellent long-term patency and survival rates in patients with symptomatic HV-type BCS. With its lower incidence of re-occlusion and higher clinical success rate, HV angioplasty combined with stenting should be the preferred option especially in patients with segmental HV-type BCS.

Background: Voice disorders, resulting from structural or functional changes in the larynx, affect about 30% of the population. Larynx structural or functional changes that affect the speaker's functional requirements can be the cause of these disorders. In this study we aim assess voice after hyaluronidase injection in MAPLs of the vocal fold by voice handicap index. Methods: This prospective cohort research involved 24 cases diagnosed as benign vocal fold lesions who underwent vocal fold injection of the hyaluronidase (HAase) enzyme in the phoniatric unit, ENT department, faculty of medicine, Zagazig University, from June 2022 until December 2023.Results: There was significant distinction among voice handicap index scores at different periods. There wasn't a statistically significant distinction among the two studied maneuvers with regarding the voice handicap index at baseline. There was a statistically significant distinction among the two maneuvers studied with regarding the voice handicap index at 1 month. There wasn't a statistically significant distinction among the two studied maneuvers with regarding the voice handicap index at 3 months. Conclusion: In minimally associated pathological lesions (MAPLs) (Reinke's edema, polyps, & asymmetrical nodules), HAase enzyme injection is effective in improving voice, according to the results of the vocal handicap index. [ABSTRACT FROM AUTHOR]

Despite increased availability of effective drug therapy for treatment of heart failure (HF), the morbidity and mortality in chronic heart failure (CHF) are unacceptably high. Therefore, there is an urgent need to ascertain new imaging techniques to identify early sub-clinical forms of cardiac dysfunctions, to guide early relevant treatment. It seems that all the behavioral risk factors—such as tobacco, alcoholism, Western-type diet, sedentary behavior and obesity, emotional disorders, and sleep disorder are associated with early cardiac dysfunction, which may be identified by speckle-tracking echocardiography (STE). Cardiac remodeling can also occur chronologically in association with biological risk factors of CHF, such as diabetes mellitus (DM), hypertension, cardiomyopathy, valvular heart disease, and coronary artery disease (CAD). In these conditions, twisting and untwisting of the heart, cardiac fibrosis, and hypertrophy can be identified early and accurately with 2-Dimentional (2D) and 3D echocardiography (2D echo and 3D echo) with tissue Doppler imaging (TDI), strain imaging via STE, and cardiac magnetic resonance imaging (CMR). Both 2D and 3D echo with STE are also useful in the identification of myocardial damage during chemotherapy and in the presence of risk factors. It is possible that global longitudinal systolic strain (GLS) obtained by STE may be an accurate marker for early identification of the severity of CAD in patients with non-ST segment elevation MI. Left ventricular ejection fraction (LVEF) is not the constant indicator of HF and it is normal in early cardiac dysfunction. In conclusion, this review suggests that GLS can be a useful early diagnostic marker of early or pre-cardiac dysfunction which may be treated by suitable drug therapy of HF along with the causes of HF and adhere to prevention strategies for recurrence. In addition, STE may be a superior clinical tool in the identification of cardiac dysfunction in its early stages compared to ejection fraction (EF) based on conventional echocardiography. Therefore, it is suggested that the chances of either stalling or reversing HF are far better for patients who are identified at an early stage of the disease. [ABSTRACT FROM AUTHOR]

While a consensus has emerged on the importance of creativity in graphic design and multimedia field, little systematic research has attempted to understand its facilitators or inhibitors in the graphic and multimedia education across colleges and universities. The current investigation surveys a sample of experts as well as professors teaching across the Arab World concerning their perceptions on the most significant correlates of creative thinking among students. Results point to the importance of: (1) instructors' engagement; (2) appropriate use of instructional strategies, tools, and resources; (3) institutional support; (4) peer support; and (5) the removal of red-tape regulatory frameworks. Most importantly, this research highlights the need to move away from the rigid higher education creativity model assuming perfection, precision, accuracy, and optimal effectiveness to a more flexible creativity framework. The Multi-Layered Autonomous Phases Model (MLAPM) is proposed as an alternative approach to cultivating creativity at the higher education level. The MLAPM applies to all levels beginning with the students and the instructor in the classroom and all instructional tools applied, moving upward to the institutional administration levels. The model offers cost-effective, flexible, dynamic, and effective practices that improve levels of creativity and creative thinking among students without the need to invest in new costly equipment, tools, curriculum, or instructional programs.

Introduction: Open reduction and fixation are the standard of care for treating mandibular fractures and usually lead to successful healing. However, complications such as delayed healing, non-union, and infection can compromise patient outcomes and increase healthcare costs. The initial inflammatory response, particularly the response involving specific CD8+ T cell subpopulations, is thought to play a critical role in healing long bone fractures. In this study, we investigated the role of these immune cell profiles in patients with impaired healing of mandibular fractures. Materials and methods: In this prospective study, we included patients with mandibular fractures surgically treated at Charité – Universitätsmedizin Berlin, Germany, between September 2020 and December 2022. We used follow-up imaging and clinical assessment to evaluate bone healing. In addition, we analyzed immune cell profiles using flow cytometry and quantified cytokine levels using electrochemiluminescence-based multiplex immunoassays in preoperative blood samples. Results: Out of the 55 patients enrolled, 38 met the inclusion criteria (30 men and 8 women; mean age 32.18 years). Radiographic evaluation revealed 31 cases of normal healing and 7 cases of incomplete consolidation, including 1 case of non-union. Patients with impaired healing exhibited increased levels of terminally differentiated effector memory CD8+ T cells (TEMRA) and a higher TEMRA to regulatory T cell (Treg) ratio, compared with those with normal healing. Conclusions: Our analysis of mandibular fracture cases confirms our initial hypothesis derived from long bone fracture healing: monitoring the TEMRA to Treg ratio in preoperative blood can be an early indicator of patients at risk of impaired bone healing. Radiologic follow-up enabled us to detect healing complications that might not be detected by clinical assessment only. This study highlights the potential of individual immune profiles to predict successful healing and may form the basis for future strategies to manage healing complications. [ABSTRACT FROM AUTHOR]

Background: Short stature can generate emotional and social stress in children and adolescents and their parents. Aim: To assess the effect of growth hormone (GH) therapy on quality of life (QoL) among growth hormone deficiency (GHD) and idiopathic short stature (ISS) children. Patients and methods: This cross–sectional study was conducted at the Suez Canal University endocrinology outpatient clinic in Ismailia City, Egypt, 194 children participated in this study. After receiving GH therapy for a year, children with ISS and GHD who met the inclusion and exclusion criteria were selected at random from the endocrinology outpatient clinic at Suez Canal University in Ismailia City, Egypt. A WHOQoL-BREF QoL evaluation was utilized in conjunction with health-related quality of life, and an Arabic translation of the questionnaire was used. Results: This study included 194 children, 107 children with ISS, and 87 children with GHD. Group with ISS had a significantly higher mean of age (13.5±2.8) years than the GHD group (8.5±1.5) years with P value less than 0.001. So, most of the children in ISS group at preparatory school (11–14 years old), while GHD group were at primary school (8–10 years old) with statistically significant difference (P <0.001). So, most of children in ISS group at preparatory school, while GHD group were at primary school with statistical significant difference (P <0.001). Most of children in ISS group have rural residence, positive consanguinity and positive family history of short stature, while GHD group had urban residence, negative consanguinity, and negative family history of short stature with statistical significant differences (P <0.001). Children with ISS had significantly lower height Z score before and after GH therapy as P value less than 0.001. Both groups showed statistically significant increase in height Z score after versus before GH therapy as P value less than 0.001. Mean WHOQoL-BREF domains scores showed a statistical significant increase after GH TTT, in both groups. Conclusion: Our findings indicate that a year of GH treatment significantly improved physical, social, psychological and environmental QoL, whereas the physical effects—which are to be expected given the noticeable increase in height—seem to have less of an influence. This is probably connected to the mild physical effects of baseline short height. But there is a correlation between the change in QoL and the height gain in SD, which amply illustrates the role of statural rise in improving QoL. [ABSTRACT FROM AUTHOR]

Objectives: The present study included 40 participants to investigate the association of circadian locomotor output cycles kaput (CLOCK) rs4580704 polymorphism with myocardial infarction (MI) cases. Materials and Methods: In this study, we enrolled 20 male and 20 female cases with MI. Genomic DNA extraction was done from lymphocytes using conventional techniques, employing the QIAamp DNA Blood Mini Kit (Qiagen, Hilden, Germany) from lymphocytes. Genotyping was conducted through TaqMan singlenucleotide polymorphism genotyping assays, employing real-time polymerase chain reaction (PCR) on a 7500 Real-Time PCR System (Applied Biosystems, Foster City, CA, USA). This streamlined approach ensures accurate and efficient analysis of genetic markers associated with MI across gender groups. Results: The study revealed significant associations between body mass index (BMI), hypertension, obesity, current smoking, and type 2 diabetes among both male and female MI patients. However, age, systolic blood pressure (SBP), and diastolic blood pressure (DBP) did not exhibit significant differences between genders. Analysis of CLOCK rs4580704 polymorphism indicated no variance in genotype and allele frequencies between male and female MI patients. When considering both genders, CLOCK rs4580704 polymorphism was significantly associated with BMI, hypertension, obesity, current smoking, and type 2 diabetes (P = 0.02, P = 0.02, P = 0.04, and P = 0.02, respectively). Nevertheless, logistic regression analysis showed no significant differences among MI cases across the various models of CLOCK rs4580704 polymorphism. Conclusion: No significant association was found between CLOCK rs4580704 polymorphism and MI in both genders. However, significant links were identified between this polymorphism and various cardiovascular risk factors including BMI, SBP, DBP, hypertension, obesity, current smoking, and type 2 diabetes in MI cases. These findings underscore the potential influence of CLOCK rs4580704 polymorphism on cardiovascular risk profiles among individuals with MI. [ABSTRACT FROM AUTHOR]

Abstract Background T2 mapping and DWI are newly quantitated method for disk degeneration assessment; they were used in the determination of an early stage of intervertebral disk degeneration. T2 mapping was quantitatively sensitive for detecting the early stage and aging-related changes in intervertebral disk degeneration. Furthermore, T2 mapping and apparent diffusion coefficient values (ADC) in lumbar intervertebral disks indirectly correlated with the Pfirrmann grades in IVDD and age-related disk degeneration. The aim of this study is to evaluate the sensitivity of T2 mapping and apparent diffusion coefficient in the determination of an early stage of intervertebral disk degeneration. Results T2 relaxometry values were found to decrease with the increased disk degeneration except in grade V where it was found to be increased again. There was a negative correlation between T2 values and semi-quantitative grading (Pfirrmann Grading) of disk degeneration and T2 values were significantly different when comparing grade I to V. A T2 value of nucleus pulposus (NP) was more sensitive than annulus fibrosus (AF) and entire of the disk. ADC values were found to decrease with the increased degree of disk degeneration; there was a weakly significant negative correlation between age and T2 mapping values, ADC values of nucleus pulposus, and entire of disk. Conclusion T2 mapping was significantly different when comparing grade I to V while ADC value had a significant weak negative correlation with age, so T2 mapping and to a little extent ADC can be used for quantitative analysis of early disk generation seeking for early diagnosis and better management.

The exact pathophysiology of heart failure (HF) is not yet known. Western diet, characterized by highly sweetened foods, as well as being rich in fat, fried foods, red meat and processed meat, eggs, and sweet beverages, may cause inflammation, leading to oxidative dysfunction in the cardiac ultra-structure. Oxidative function of the myocardium and how oxidative dysfunction causes physio-pathological remodeling, leading to HF, is not well known. Antioxidants, such as polyphenolics and flavonoids, omega-3 fatty acids, and other micronutrients that are rich in Indo-Mediterranean-type diets, could be protective in sustaining the oxidative functions of the heart. The cardiomyocytes use glucose and fatty acids for the physiological functions depending upon the metabolic requirements of the heart. Apart from toxicity due to glucose, lipotoxicity also adversely affects the cardiomyocytes, which worsen in the presence of deficiency of endogenous antioxidants and deficiency of exogenous antioxidant nutrients in the diet. The high-sugar-and-high-fat-induced production of ceramide, advanced glycation end products (AGE) and triamino-methyl-N-oxide (TMAO) can predispose individuals to oxidative dysfunction and Ca-overloading. The alteration in the biology may start with normal cardiac cell remodeling to biological remodeling due to inflammation. An increase in the fat content of a diet in combination with inducible nitric oxide synthase (NOSi) via N-arginine methyl ester has been found to preserve the ejection fraction in HF. It is proposed that a greater intake of high exogenous antioxidant restorative treatment (HEART) diet, polyphenolics and flavonoids, as well as cessation of red meat intake and egg, can cause improvement in the oxidative function of the heart, by inhibiting oxidative damage to lipids, proteins and DNA in the cell, resulting in beneficial effects in the early stage of the Six Stages of HF. There is an unmet need to conduct cohort studies and randomized, controlled studies to demonstrate the role of the HEART diet in the treatment of HF.