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In this work, numerical simulation has been done to study the cooling enhancement of electronic components of cubical shapes including dummy elements inside a rectangular duct. The 12 electronic chips (3 ? 4 array) of dimensions (50 mm ? 50 mm ? 10 mm) are tested in an air duct of dimensions (350 mm ? 3500 mm ? 60 mm). The aim of the simulation is to study the influence of changing positions of the hot components on the overall cooling performance at different Reynolds numbers. Moreover, the effect of spacing between electronic components is studied. This is achieved by changing the position of the heat sources while keeping other elements as dummies to keep the flow characteristics. The Reynolds number is in the range (500-19000). The standard k-?, model is used and validated with experimental work showing good agreement. The 37 cases per Reynolds are considered, resulting in an overall 259 studied cases. It is concluded in terms of the large resulting data from this study that, increasing the spacing between elements in the cooling fluid-flow direction influences the cooling rate. Moreover, designers should be interested to operate such systems at optimized higher Reynolds values.

Childhood cancer in low-and middle-income countries is a global health priority, however, the perception that treatment is unaffordable has potentially led to scarce investment in resources, contributing to inferior survival. In this study, we analysed real-world data about the cost-effectiveness of treating 8886 children with cancer at a large resource-limited paediatric oncology setting in Egypt, between 2013 and 2017, stratified by cancer type, stage/risk, and disease status.Childhood cancer costs (USD 2019) were calculated from a health-system perspective, and 5-year overall survival was used to represent clinical effectiveness. We estimated cost-effectiveness as the cost per disability-adjusted life-year (cost/DALY) averted, adjusted for utility decrement for late-effect morbidity and mortality.For all cancers combined, cost/DALY averted was $1384 (0.5 × GDP/capita), which is very cost-effective according to WHO-CHOICE thresholds. Ratio of cost/DALY averted to GDP/capita varied by cancer type/sub-type and disease severity (range: 0.1-1.6), where it was lowest for Hodgkin lymphoma, and retinoblastoma, and highest for high-risk acute leukaemia, and high-risk neuroblastoma. Treatment was cost-effective (ratio3 × GDP/capita) for all cancer types/subtypes and risk/stage groups, except for relapsed/refractory acute leukaemia, and relapsed/progressive patients with brain tumours, hepatoblastoma, Ewing sarcoma, and neuroblastoma. Treatment cost-effectiveness was affected by the high costs and inferior survival of advanced-stage/high-risk and relapsed/progressive cancers.Childhood cancer treatment is cost-effective in a resource-limited setting in Egypt, except for some relapsed/progressive cancer groups. We present evidence-based recommendations and lessons to promote high-value in care delivery, with implications on practice and policy.Egypt Cancer Network; NIHR School for Primary Care Research; ALSAC.

Cutting fins of the plate heat sinks into multi-numbers of slides instead of one slide fin is a technique to improve the performance of the heat sink. One, two, three, and four slides have been studied numerically. The slides have been arranged in staggered arrangement. The study has been carried out on two different flow directions (impinging and parallel). The performance of the heat sink under the studied conditions has been represented through calculation of heat sink effectiveness, thermal resistance, pressure drop, pumping power, and Nusselt number. The studied range of Reynolds number is from 1333 to 5334. The results show that parallel flow gives lower thermal resistance than impinging flow for all studied cases. The pumping power required for high Reynolds number in case of parallel flow increases by around 155% with case-4 (four slides) as compared by case-1 (one slide). While it is slightly affected in case of impinging flow, using three slides with impinging flow represents an acceptable decrement in thermal resistance with low change in the required pumping power. In case of parallel flow, the resulting change in the heat sink performance, as the number of slides increases, is not proportional to the large increase in the pumping power.

Childhood cancer is a priority in Egypt due to large numbers of children with cancer, sub-optimal care and insufficient resources. It is difficult to evaluate progress in survival due to paucity of data in national cancer registry. In this study, we studied survival rates and trends in survival of the largest available cohort of children with cancer (n=15,779, aged 0-18 years) from Egypt between 2007-2017, treated at Children's Cancer Hospital Egypt-(CCHE), representing 40-50% of all childhood cancers across Egypt. We estimated 5-year overall survival (OS) for 14,808 eligible patients using Kaplan Meier method, and determined survival trends using Cox regression by single year of diagnosis, and diagnosis periods. We compared age-standardized rates to international benchmarks in England and the US, identified cancers with inferior survival, and provided recommendations for improvement. Five-year OS was 72.1% (95% CI 71.3-72.9) for all cancers combined, and survival trends increased significantly by single year of diagnosis (p

Background: Hodgkin Lymphoma (HL) is a unique disease entity both in its pathology and the young patient population that it primarily affects. Several meta-analyses have demonstrated that high PD-L1 expression levels are correlated with adverse clinical and pathologic features. Objectives: The aim of this study is to evaluate the correlation between the expression of PD-L1 and clinicopathological features, as well as the prognostic significance of PD-L1 expression with regard to interim PET response in relapsing / refractory pediatric HL. Methods: We measured the expression of PD-1/PD-L1 in the baseline diagnostic samples of children with relapsing/ refractory classical HL. The results were correlated with the pathological subtypes as well as the clinical outcome. Results: Of the 88 included patients, 77% had advanced stage HL. PD-1 expression was detected in 50% of cases, whereas PD-L1 (membranous) was expressed by tumor cells in 60% of the cases, and strongly expressed in 16% of cases. Notably, PD-L1 (cytoplasmic) was detected in 55% of the cases. There was a significant differences in the expression levels of PDL-1 between the different pathological subtypes (p = 0.006). OS of patients with PD-L1expression (Cytoplasmic) was 83% vs 91% in patients with absent expression (P=0.001). There was no prognostic significance of PD-L1 expression with regard to PET response (p=0.31). Conclusion: Although PD-L1 expressions did not show statistically significance with well-established prognostic factors, our preliminary data indicate that pathological subtypes and cytoplasmic expression of PD-L1 may have a prognostic implication on survival in pediatric HL. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Objectives To study childhood cancer survival and health outcomes over the last ten years in one Egyptian hospital CCHE (Children’s cancer Hospital 57357 Egypt); determine the variations in survival by demographic, cancer type, and disease severity differences and the reasons behind these variations; and compare childhood cancer survival outcomes with results from England. Method A retrospective observational cohort study was conducted for children (age 0-18 years) with confirmed cancer diagnosis who presented at CCHE for treatment from 2007 until 2017 and were followed up until July 2018. Confirmed diagnosis of childhood malignancy followed the WHO/ICCC-3 criteria. Patients’ demographic data were extracted from hospital-based cancer registry, while disease-related and health outcomes data were extracted from hospital disease-specific registry. Health outcomes included 5-year survival rates, age-standardized mortality rates, and trends in disease relapse/progression. Five-year overall survival was calculated for each childhood cancer type using Kaplan Meier analysis. The 5-year overall survival rates at CCHE were compared to population-based 5-year survival of children with cancer in England [2001–2015]. Comparable survival was defined as 10% as inferior survival. Patients’ demographics were described for the full-analysis population, and health outcomes evaluation was done for the evaluable population, based on intention-to-treat analysis. Results A total of 15,997 children with cancer were analyzed; 58% were males and 42% females. Most of the patients (48%) were in the youngest age group [0–4 years]. Fifty-nine percent of patients had solid tumors and 41% had hematologic malignancies. The most common cancers were Leukemia, Lymphoma, CNS tumors, and Neuroblastoma. Survival was calculated for 14,553 patients, representing 92.2% of full study population. 5-year survival rates at CCHE were comparable for some cancer types; 95.6% for Hodgkin’s Lymphoma; 81% for Non-Hodgkin’s Lymphoma; 92.3% for Retinoblastoma; 82% for Renal tumors; 66.4% for CNS tumors; 65.9% for Ewing Sarcoma; 86.9% for Germ cell tumors; 61% for Rhabdomyosarcoma; 77.1% for other soft tissue tumors; and 91.2% for CML. Whereas for other cancer types, overall survival rates at CCHE were inferior; 79.9% for ALL; 53.8% for AML; 56.5% for Neuroblastoma; 56.4% for Hepatoblastoma; 49.1% for Osteosarcoma. Trends in age-adjusted mortality-rates will presented. Conclusions Studying 5-year survival in childhood cancer health outcomes at CCHE would help generate real-world evidence about those having inferior outcomes and identify priority areas that need future improvements. Making better use of the evidence generated at CCHE would enhance real-world practice through making informed decisions that are adapted to a local context setting– CCHE.

Background Nasopharyngeal carcinoma is rare in children and adolescents; however, it has a better prognosis than in adults. Nevertheless, its prognostic factors are not clearly documented. Patients and methods A prospective single-arm study was performed in 32 nonmetastatic Stages II–IV nasopharyngeal carcinoma (NPC) patients, below age 18 years. The treatment regimen included three courses of neoadjuvant chemotherapy (cisplatin and fluorouracil) followed by concomitant chemoradiotherapy (simultaneous integrated boost-intensity modulated radiotherapy [SIB-IMRT] with three cycles of cisplatin). Results All patients completed their prescribed treatment with tolerable acute side-effects. The 3-year overall (OS), event-free (EFS), local recurrence-free (LRFS), and distant metastasis-free (DMFS) survival rates were 83 ± 8, 77 ± 8, 92 ± 6 and 77 ± 9 percent, respectively. Although the median initial (pretreatment) gross tumor volume of the primary site (GTVp) increased with increasing stage, yet these differences did not rank to the level of significance. However, GTVp (with a cut-off value of 54.5 mL) was the only significant prognostic factor determining OS, EFS, LRFS and DMFS. On the other hand, age, gender, T stage, AJCC stage and footprint histopathological EBV did not have statistical significant impact on any survival rate. The late toxicity of this regimen was much lower than that reported with the conformal treatment. Conclusion Neoadjuvant chemotherapy and concomitant chemo-radiotherapy using SIB-IMRT led to excellent outcome with reduced late toxicity in juvenile nasopharyngeal carcinoma. GTVp is the sole prognostic factor that showed statistical impact on survival rates when applying this regimen.

Perforation is the most common surgical complication in pediatric intestinal lymphoma. During operation, many surgical decisions are debatable.To assess the outcome of surgical management of perforated pediatric intestinal lymphoma.This is a retrospective analysis of all pediatric patients (18 years old) with intestinal lymphoma treated in our hospital between July 2007 and June 2017. Risk factors for perforation, type of management and outcome in cases of intestinal perforation were analyzed.The study included 240 patients with intestinal lymphoma. Perforation developed in 16 patients (6.7%) with a median age of 5.3 (range: 2.8-15.7) years. Most of the patients (92.5%) had Burkitt lymphoma. The ileum was the most common site of perforation (n = 10). Perforation occurred at presentation (n = 2), during induction (n = 10), during maintenance chemotherapy (n = 2), or at relapse (n = 2). Primary resection anastomosis was done in 12 patients. The resected specimen showed a viable tumor in ten patients. Wound infection (25%) and dehiscence (12.5%) were the most common postoperative complications. The 5-year overall and event-free survivals of patients with perforation were 78.6% and 71.4%, respectively, compared with 85.5% and 81.2% in non-perforated patients; the difference was not significant (p = 0.374 and p = 0.270, respectively).Perforation is not an adverse prognostic factor for survival in pediatric intestinal lymphoma patients. Primary resection anastomosis seems to be a safe option if complete tumor resection is feasible.

Primary hyperoxalurias are rare inborn errors of metabolism with deficiency of hepatic enzymes that lead to excessive urinary oxalate excretion and overproduction of oxalate which is deposited in various organs. Hyperoxaluria results in serious morbid-ity, end stage kidney disease (ESKD), and mortality if left untreated. Combined liver kidney transplantation (CLKT) is recognized as a management of ESKD for children with hyperoxaluria type 1 (PH1). This study aimed to report outcome of CLKT in a pediatric cohort of PH1 patients, through retrospective analysis of data of 8 children (2 girls and 6 boys) who presented by PH1 to Wadi El Nil Pediatric Living Related Liver Transplant Unit during 2001-2017. Mean age at transplant was 8.2 ± 4 years. Only three of the children underwent confirmatory genotyping. Three patients died prior to surgery on waiting list. The first attempt at CLKT was consecutive, and despite initial successful liver transplant, the girl died of biliary peritonitis prior to scheduled renal transplant. Of the four who underwent simultaneous CLKT, only two survived and are well, one with insignificant complications, and other suffered from abdominal Burkitt lymphoma managed by excision and resection anastomosis, four cycles of rituximab, cyclophosphamide, vincristine, and prednisone. The other two died, one due to uncontrollable bleeding within 36 hours of procedure, while the other died awaiting renal transplant after loss of renal graft to recurrent renal oxalosis 6 months post-transplant. PH1 with ESKD is a rare disease; simultaneous CLKT offers good quality of life for afflicted children. Graft shortage and renal graft loss to oxalosis challenge the outcome.

Background and Aim: This is a preliminary study to evaluate the levels of protective antibodies against some of the vaccine preventable diseases, as a part of the nationwide vaccination program, in Acute Lymphocytic Leukemic children (ALL) and in their non cancer controls of matched age and sex. Methods: Serum antibody levels of measles, mumps, Varicella zoster, diphtheria, and hepatitis B surface antigen were evaluated by ELISA technique in 120 children with ALL as well as in 60 children with no malignancy as a control group. Results: A protective serum antibody level to measles, mumps, Varicella zoster, diphtheria and hepatitis B were detected in 53%, 14%, 38%, 83% and 72%, respectively of leukemic children irrelevant to phase of treatment compared to 53%, 20%, 40%, 75% and 67%, in the controls. Seropositivity rate of diphtheria was not found to be related to age in both ALL patients and controls. A significant decline in seropositivity rate to antiHBs with age in both leukemic and their controls was observed (p=0.02, 0.015 respectively). On multivariate analysis, seropositivity of varicella and mumps was positively dependent on age (P