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• Percutaneous nephrolithotomy PCNL has become the gold standard for the management of large or complex Renal stones. Retrograde intrarenal surgery (RIRS) has been recently introduced as highly effective technique in management of renal stones specially with anomalous kidney and in coagulopathies. • Nowadays, achieving a high stone free rate with a lower morbidity have led RIRS to become a commonly used and important treatment modality for management of renal stones less than 2 cm.• Supine Valdivia position has been modified multiple times till we reached more ergonomic Galdakao-modified supine Valdivia (GMSV) position. • The GMSV position optimally supports ECIRS (Endoscopic Combined IntraRenal Surgery), a novel simultaneous combined antegrade and retrograde approach to the upper urinary tract for the treatment complex urolithiasis. • Multiple stones in different parts of pelvicalyceal system which are supposed to need multiple punctures to clear all the stones using classical prone PCNL was always a concern for the surgeon due to morbidity and time consumption for multiple tracks. • ECIRS in GMSV position can be introduced as a new effective, safe and time saving technique to solve this problem specially with associated ureteral stones.

Autoinflammatory skin diseases are characterized by a disequilibrium of cytokines in the local skin microenvironment, suggesting that local delivery of therapeutics, including anticytokine antibodies, may provide benefit without the unwanted off-target effects of systemically delivered therapies. Rapid diffusion of therapeutics away from the target site has been a challenge to the development of local therapies. Conjugation of high molecular weight hydrophilic polymers to cytokine neutralizing mAbs has been shown to be an effective strategy for local control of inflammation in healing burn wounds. However, the burn application is unique because the skin barrier is already breached. For the treatment of autoinflammatory skin diseases, the major challenge for local delivery lies in penetrating the stratum corneum. Here, we investigate a new therapeutic approach combining the use of tip-loaded dissolvable microneedle arrays (TL-dMNAs) for local application of polymer-conjugated antibody inhibitors of tumor-necrosis-factor-alpha (TNF-α). Specifically, intradermal delivery and pharmacokinetics of (anti-TNF-α-Ab)-(high molecular weight hyaluronic acid [HA]) conjugates from tip-loaded, obelisk-shaped dissolvable microneedle arrays were investigated in living human skin. The results indicate (1) TL-dMNAs can be successfully fabricated to integrate (anti-TNF-α-Ab)-HA at the tip portion of the microneedles while preserving the biological activity necessary for antibody ligand binding; (2) (anti-TNF-α-Ab)-HA can be effectively delivered into human skin using obelisk-shaped TL-dMNAs; and (3) polymer conjugation effectively inhibits antibody diffusion from the delivery site. Taken together, these results support the evaluation of microneedle array-based delivery of varying polymer-antibody conjugates for the treatment of inflammatory skin diseases.

Nonspecific protein adsorption can interfere with blood diagnostics, especially in point-of-care tests for which minimal sample processing is required. Here we report a non-fouling coating material for presenting capture antibodies in ELISA that significantly increased precision and accuracy compared to a commercial ELISA microplates in human plasma and model solutions containing plasma proteins. The coating was prepared by functionalizing the hydrophilic polysaccharide hyaluronic acid (HA) with a thermoresponsive polymer, poly(di(ethylene glycol)) methyl ether methacrylate (PMEO2MA). Previous studies demonstrated that these coatings were resistant to adsorption of major blood proteins, and we demonstrate that functionalization of the coatings with a monoclonal antibody against tumor necrosis factor-α (TNF-α) provided enhanced detection accuracy for this pro-inflammatory cytokine in ELISA. Three plasma-type solutions were explored in this work based either on buffer containing known concentrations of albumin, fibrinogen and immunoglobulin at sub-physiological and physiological concentrations, and non-diluted human plasma. In model solutions of plasma, even sub-physiological concentrations of plasma proteins resulted in a 20% overestimate of TNF-α concentration in the commercial ELISA kit but a 4% overestimate in HA-coated microwells. However, in human plasma, the commercial ELISA kit underestimated the analyte concentration by up to 95% while the HA-coated microwells did so by only 15% at an analyte concentration of 12.5 pg mL−1. The improvements in precision and accuracy provided by HA coatings suggests they could be used to enhance ELISA measurements in a broad range of complex biological media.

This study presents a kinetic model of the chelation of iron ions by generation 4 hydroxyl-terminated polyamidoamine (PAMAM) with ethylenediamine core (G4-OH). The coordination processes of iron ions from ferric chloride, FeCl(3), and ferrous bromide, FeBr(2), to G4-OH dendrimers were analyzed using ultraviolet-visible (UV-vis) spectroscopy, proton nuclear magnetic resonance ((1)H NMR) spectroscopy, and liquid chromatography-mass spectrometry (LC-MS). In the visible region, a charge-transfer was observed when the dendrimer was added to a ferric chloride solution. This phenomenon is a ligand-to-metal charge-transfer (LMCT) between the free electron group of the dendrimer's internal amines and the dehalogenated iron ion that takes 2 h to complete at room temperature. Analysis of potential rate laws and diffusion effects led to a second-order kinetic model for this reaction. By measuring the rate coefficients as a function of temperature (22-37 °C), an apparent activation energy of 41.5 kJ/mol was obtained using the Arrhenius method. The results of this study will fuel research of PAMAM dendrimers for environmental, pharmaceutical, and materials applications.

Tumor necrosis factor-alpha (TNF-α) specific antibodies (anti-TNF-α Ab) have been shown to be potent TNF inhibitors and effective therapeutics for a range of inflammatory diseases. Typically, these drugs are administered systemically, but systemic dosing sufficient to achieve locally effective concentrations in peripheral tissues has been associated with systemic immunosuppression and related adverse events. Here, we evaluated the use of tip-loaded dissolvable microneedle arrays (MNAs) for localized intradermal delivery of anti-TNF-α Ab. MNAs with obelisk shape microneedles that incorporate the antibody cargo in the needle tips were created from carboxymethylcellulose (CMC) using a micromilling/spin-casting fabrication method. We found that anti-TNF-α Ab integrated into MNAs using this room temperature fabrication process maintained conformationally dependent TNF-α binding activity. Further, these MNAs efficiently delivered anti-TNF-α antibodies to the dermis of human skin with clinically applicable release profiles. To evaluate MNA delivered anti-TNF-α Ab function, we applied anti-TNF-α Ab containing MNAs to established psoriasiform lesions on the skin of mice. MNA anti-TNF-α Ab treatment reduced key biomarkers of psoriasiform inflammation including epidermal thickness and IL-1β expression. Taken together, these results demonstrate efficient and biologically effective MNA delivery of anti-TNF-α Ab to the intradermal microenvironment of the skin in mice and humans, and support the development of MNA mediated antibody delivery for clinical applications. Statement of Significance Tumor necrosis factor-alpha (TNF-α) specific antibodies (anti-TNF-α Ab) have been shown to be potent TNF inhibitors and effective therapeutics for a range of inflammatory diseases. Typically, these drugs are administered systemically, but systemic dosing sufficient to achieve locally effective concentrations in peripheral tissues has been associated with systemic immunosuppression and related adverse events. Here we demonstrate efficient and biologically effective MNA delivery of anti-TNF-α Ab to the intradermal microenvironment of the skin in mice and humans. These results support the development of MNA mediated antibody delivery of therapeutic antibodies for clinical applications.

Freeform reversible embedding of suspended hydrogels enables three-dimensional printing of soft extracellular matrix biopolymers in biomimetic structures., We demonstrate the additive manufacturing of complex three-dimensional (3D) biological structures using soft protein and polysaccharide hydrogels that are challenging or impossible to create using traditional fabrication approaches. These structures are built by embedding the printed hydrogel within a secondary hydrogel that serves as a temporary, thermoreversible, and biocompatible support. This process, termed freeform reversible embedding of suspended hydrogels, enables 3D printing of hydrated materials with an elastic modulus

Impact of wastewater discharge diversion on some heavy metals content in Alexandria Coast Ramzy B. Nessim* Mohamed Hassan Ramadan** Amaal E. Abou-Taleb* * National Institute of Oceanography and Fisheries, Alexandria University ** Environmental Health Dept., High Institute of Public Health, Alexandria University Publisher: Bulletin of High Institute of Public Health, 2004, Vol. (34) No(3): 621-640 Abstract: Alexandria is the second largest city in Egypt and includes about 40% of the nation’s industry. In the past, Alexandria city was discharging its wastewater either into the Mediterranean Sea along the city beaches or into Lake Maryut. In 1993, these outlets were closed except two main outlets at Qayet-Bey and EL-Mex Bay. The diverted wastewater is treated primarily and discharged into the sea at EL-Mex Bay. In the mean time, Environment Law 4/1994 prohibited all polluting establishments to discharge untreated wastes, which may cause pollution, along the Egyptian sea shores. The present work aims at assessing the improvement in the levels of some heavy metals in Alexandria coastal water after the diversion and the execution of Environment Law 4/1994. The study concluded that Abou-Qir water, and to a less extent Qayet-Bey water, was characterized by high averages of dissolved Cu, Zn, Pb, and Cr. El-Agamy Bay water sustained the highest levels of Cd, Co, and Cr. Qayet-Bey water represented the highest Ni average. Qayet-Bey water sustained the highest levels of particulate Cu, Zn, and to a less extent Co, Ni, and Cr. El-Agamy water contained the highest levels of both dissolved and particulate Cd. Contrary to the case of dissolved form, spring and to a less extent summer achieved the highest concentration of particulate Zn, Cd, and Ni. The results displayed that dissolved forms of most studied metals were higher in concentration than particulate ones. Zn and Cr, on the other hand, were found in particulate form to be slightly higher than those in dissolved forms. The presence of heavy metals in considerable levels in all the studied sites indicates that Alexandria coast is still subjected to the polluting land-based sources. The study suggested some recommendations to improve the situation including: industries should be enforced to treat their wastewater to comply with Law 4/1994, environmental impact assessment should be done for the new activities, continuous monitoring of the water quality of the beaches, and fishing from polluted areas should be prohibited.

Treatability of Alexandria wastewater using pure oxygen activated sludge process Mahmoud F. El-Sharkawy Mekawy M. Akel Linda M. Saad Ghazy S. Abdel-Kerim Mohamed H. Ramadan Moetaz M. El-Sergany Environmental Health Dept., High Institute of Public Health, Alexandria University Publisher: Presented in the fifth International Conference "The Role of Engineering in Improving the Environment", 11-13 December 2004, Alexandria University, Alexandria Abstract: Alexandria is the second largest city and main port of Egypt. It lies north west of the Nile Delta. Most of the collected sewage from the city is pumped to two wastewater treatment plants. Both plants are using primary treatment technology and discharge their primary treated effluents into lake Maryut. Therefore the discharges of these plants have resulted in more deterioration of the lake. In Alexandria, the population growth had also led to an increase in land cost due to rarity of land and expansion of residential areas. Accordingly, a suitable wastewater treatment technique characterized by less land requirement, less sludge production, high efficiency, and lower gaseous emissions should be considered. This study was carried out to investigate the treatability and feasibility of applying pure oxygen activated sludge process compared to air activated sludge process. Two pilot scale activated sludge units with internal solids circulation were used. One of these units was operated with compressed air and the second was operated with pure oxygen gas. The units were fed with the primary settled effluent of the East Treatment Plant. Both units were operated at different sludge ages and detention times. At each condition, both units were evaluated. The results showed that a satisfactory effluent quality could be achieved at sludge age of 6 days and detention time ranging from 5.5 to 9 hours, and at sludge age of 6 days and detention time ranging from 2 to 3 hours for air and pure oxygen activated sludge units, respectively. The pure oxygen system produced better effluent quality at higher Food/Microorganism (F/M) ratio than that of the air unit. Pure oxygen can produce a good settling activated sludge compared with the air activated sludge system. Lower sludge quantities could be obtained for the pure oxygen system compared to the air system operated at the same sludge age. Nitrification occurred in both systems during all the applied operating conditions. The feasibility study showed that pure oxygen system is better than air system in both plants in saving the cost of land required to achieve secondary treatment, and in the cost of sludge thickening. Finally, the study ended by some recommendations which are suitable for Alexandria city.

We report a thermoresponsive chemical modification strategy of hyaluronic acid (HA) for coating onto a broad range of biomaterials without relying on chemical functionalization of the surface. Poly(di(ethylene glycol) methyl ether methacrylate) (PMEO2MA), a polymer with a lower critical solution temperature of 26 °C in water, was grafted onto HA to allow facile formation of biopolymer coatings. While the mechanism for film formation appears to involve a complex combination of homogeneous nucleation followed by heterogeneous film growth, we demonstrate that it resulted in hydrophilic coatings that significantly reduce protein adsorption despite the high fraction of hydrophobic (PMEO2MA). Structural characterization was performed using atomic force microscopy (AFM), which showed the formation of a dense, continuous coating based on 200 nm domains that were stable in protein solutions for at least 15 days. The coatings had a water contact angle of 16°, suggesting the formation of hydrophilic but not fully wetting films. Quartz crystal microbalance with dissipation monitoring (QCM-D) as well as biolayer interferometry (BLI) techniques were used to measure adsorption of bovine serum albumin (BSA), fibrinogen (Fbg), and human immunoglobulin (IgG), with results indicating that HA-PMEO2MA-coated surfaces effectively inhibited adsorption of all three serum proteins. These results are consistent with previous studies demonstrating that this degree of hydrophilicity is sufficient to generate an effectively nonfouling surface and suggest that segregation during the solubility transition resulted in a surface that presented the hydrophilic HA component of the hybrid biopolymer. We conclude that PMEO2MA-grafted HA is a versatile platform for the passivation of hydrophobic biomaterial surfaces without need for substrate functionalization.

Burns, chronic wounds, osteoarthritis, and uveitis are examples of conditions characterized by local, intense inflammatory responses that can impede healing or even further tissue degradation. The most powerful anti-inflammatory drugs available are often administered systemically, but these carry significant side effects and are not compatible for patients that have underlying complications associated with their condition. Conjugation of monoclonal antibodies that neutralize pro-inflammatory cytokines to high molecular weight hydrophilic polymers has been shown to be an effective strategy for local control of inflammation. Lead formulations are based on antibody inhibitors of tumor necrosis factor-α conjugated to hyaluronic acid having molecular weight greater than 1 MDa. This review will discuss fundamental aspects of medical conditions that could be treated with these conjugates and design principles for preparing these cytokine-neutralizing polymer conjugates. Results demonstrating that infliximab, an approved inhibitor of tumor necrosis factor-α, can be incorporated into the conjugates using a broad range of water-soluble polymers are also presented, along with a prospectus for clinical translation.

Talkha power plant is the only power plant located in El-Mansoura. It generates electricity using two different methods by steam turbine and gas turbine. Both plants drew water from River Nile (208 m3 /h). The Nile raw water passes through different treatment processes to be suitable for drinking and operational uses. At Talkha power plant, there are two purification plants used for drinking water supply (100 m3/h) and for water demineralization supply (108 m3/h). This study aimed at studying the efficiency of the water purification plants. For drinking water purification plant, the annual River Nile water characterized by slightly alkaline pH (7.4-8), high annual mean values of turbidity (10.06 NTU), Standard Plate Count (SPC) (313.3 CFU/1 ml), total coliform (2717/100 ml), fecal coliform (0-2400/100 ml), and total algae (3 x 10(4) org/I). The dominant group of algae all over the study period was green algae. The blue green algae was abundant in Summer and Autumn seasons. The pH range, and the annual mean values of turbidity, TDS, total hardness, sulfates, chlorides, nitrates, nitrites, fluoride, and residual chlorine for purified water were in compliance with Egyptian drinking water standards. All the SPC recorded values with an annual mean value of 10.13 CFU/1 ml indicated that chlorine dose and contact time were not enough to kill the bacteria. However, they were in compliance with Egyptian decree (should not exceed 50 CFU/1 ml). Although the removal efficiency of the plant for total coliform and blue green algae was high (98.5% and 99.2%, respectively), the limits of the obtained results with an annual mean values of 40/100 ml and 15.6 org/l were not in compliance with the Egyptian decree (should be free from total coliform, fecal coliform and blue green algae). For water demineralization treatment plant, the raw water was characterized by slightly alkaline pH. The annual mean values of conductivity, turbidity, and TDS were 354.6 microS/cm, 10.84 NTU, and 214.6 mg/I, respectively. There was an increase in the results of conductivity, turbidity, total hardness, and TDS in carbon filter effluent which was attributed to the desorption of adsorbed ions on the carbon media. The removal efficiencies of turbidity, total hardness, and TDS indicated the high efficiency of the cationic filter. The annual removal efficiencies of conductivity, turbidity, chloride, and TDS proved the efficiency of the anionic filter for removing the dissolved and suspended ions. All of the recorded values of the pH, conductivity, turbidity, chlorides, hardness, and TDS of the mixed bed effluent indicated that the water at this stage was of high quality for boiler feed. The study recommended adjustment of coagulant and residual chlorine doses as well as contact time, and continuous monitoring and maintenance of the different units.

There are two wastewater primary treatment plants in Alexandria (west and east). The produced primary sludge is mechanically dewatered and transported to sludge disposal site 9N where composting is carried out. However, prior to 1970, composting played a very minor role in sludge or solid wastes treatment because of greatly unfavorable balance between its economics and those of the principal competing option, namely landfill disposal. This study aims at monitoring and evaluating the composting process of demitted sludge produced from Alexandria wastewater treatment plants. Ten batches of sludge were composted. During the composting process the batches were been investigated and followed up to 3 months. Representative samples (10 for each batch) were taken from these batches at the start of windrowing and after each turning (4-15 days) and were analyzed for physical; chemical; bacteriological; and parasitological characteristics, heavy metals, and plant nutrients. Results revealed that C/N ratio of the final compost product comply with the decree of the Minister of Agriculture No. 100 11967, while moisture, C%, and TKN did not. Heavy metals, faecal coliforms, and helminthes complied with the decree No. 222/2002 for the Minister of Housing, Utilities, and Urban Communities. Moisture had positive correlation with both C and VS and negative correlation with pH. Temperature had negative correlation with TKN. Both total and faecal coliforms had negative correlation with temperature and positive correlation with C, N, and VS. It is recommended to optimize the quality of the produced sludge compost by use bulking agent rich in carbon and nitrogen as Hay or Rice straw, instead of the matured sludge compost.

New Borg Al-Arab city includes 9 residential areas and 4 industrial zones. The four industrial zones are occupied by 266 running factories belonging to different industrial sectors. All the domestic sewage as well as the industrial wastewater is treated at an oxidation pond treatment plant and the plant effluent is used in irrigation of silviculture areas. The plant consists of 2 pond complexes. Each complex comprises 9 facultative ponds, arranged in 3 parallel series. Raw wastewater is pre-treated through screens and grit removal before entering the primary ponds. The study aims at assessment of the performance of the waste stabilization ponds. The results revealed that pre-treatment units were not functioning properly. The retention time was calculated to be 6 days in each pond of the first complex and 3 days in each pond of the second complex. The mean BOD surface loading rate was calculated to be 676 kg/ha/d for the first complex and 1584 kg/ha/d for the second. The plant was hydraulically and organically overloaded. The percentage removal of BOD, COD, SS, and NH3-N had an annual mean of 57%, 56%, 44%, and 39%, respectively for the first complex and 21%, 42%, 39%, and 25%, respectively for the second. Faecal coliforms were reduced by about 1 log10 unit in both complexes. The final pond effluent was not complying with the Egyptian law for reuse in irrigation. The study proposed some recommendations which can improve the efficiency of the plant as well as the effluent quality.