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Non-alcoholic steatohepatitis (NASH) is a worldwide health problem. Alternate-day fasting (ADF), although thought to be aggressive, has proven safety and efficacy. We aimed to evaluate the effect of short-term ADF against already established high-fat-fructose (HFF)-induced NASH, independent of the amount of calorie intake, and to study the effect of ADF on lipogenesis, apoptosis, and hepatic inflammation. Male Sprague Dawley rats were divided into two groups: (1) negative control and (2) NASH group fed on HFF for 9 weeks, and then randomized into two subgroups of either HFF alone or with ADF protocol for 3 weeks. The ADF could improve HFF-related elevation in serum lactate dehydrogenase and could decrease the mRNA expression of lipogenesis genes; acetyl CoA carboxylase, peroxisome proliferator-activated receptor γ, and peroxisome proliferator-activated receptor α; apoptotic genes caspase-3, p53, and inflammatory cyclo-oxygenase 2; and immunohistochemical staining for their proteins in liver with upregulation of LC3 and downregulation of P62 immunoexpression. Moreover, ADF ameliorated HFF-induced steatosis, inflammation, ballooning, and fibrosis through hematoxylin and eosin, Oil Red O, and Sirius Red staining, confirmed by morphometric analysis, without significant weight loss. Significant correlation of morphometric parameters with levels of gene expression was found. These findings suggest ADF to be a safe effective therapeutic agent in the management of NASH

Background and objectives: Hepatocyte ultra-structure is influenced by feeding status, circadian rhythm, and zone location. The goal of the present study was to study the effect of overnight fasting on the hepatocyte ultrastructure and the zonal heterogeneity and to discuss the functional correlation.Methods: A total of 14 male albino rats were divided into two groups: negative control group fed ad libitum and overnight fasting rats for 16 hours. The different subcellular structures of both centrilobular and periportal hepatocytes in both control and fasted groups were compared by transmission electron microscopy. Morphometric analysis of the electron micrographs was also done using imageJ software.Results: The lysosomes surface density, mitochondrial volume and surface densities were significantly higher in periportal hepatocytes however surface density of smooth endoplasmic reticulum (SER) and peroxisomes were significantly higher in centrilobular hepatocytes of the control group. Fasting caused a significant decrease in the surface density of rough endoplasmic reticulum and glycogen volume density but with significant increase in SER surface density with more mitochondrial fusion and stronger mitochondrial ER contacts, isolation membranes, and autophagosomes. The zonal differences were maintained after fasting. The organelles appeared normal with no signs of degeneration.Conclusion: The organelles appeared normal with no signs of degeneration and the zonal differences were maintained after fasting. The change in hepatocyte ultrastructure after fasting may be related to autophagy.

Background: DLCL with aberrations in MYC, BCL2 and/or BCL6 due to genetic alterations or protein expression is a high grade B-cell lymphomas with poor prognosis if received standard RCHOP chemotherapy. So that, different regimens are needed for better prognosis.Aim of the Study: Identify the association of protein, genetic expression of MYC, BCL2, and/or BCL-6 in cases of DLBCL, if MYC IHC could be used as a screening test to determine DHL or THL status, and to determine if the DHL or THL biology are related to any clinic-pathological features.Material and Methods: Thirty patients who were diagnosed with primary DLBCL from July 2015 to July 2018. The cases were collected from General surgery department-Faculty of medicine- Benha University and Assiut faculty of medicine-Al-Azhar University were identified after applying exclusion and inclusion criteria. Clinico-pathological data was obtained by review of medical records and biopsy specimens for IHC and FISH were obtained from the Departments of general surgery. The FISH test (for MYC, BCL2, and BCL-6) and IHC (for CD10, KI 67, MYC, BCL2, and BCL-6) were per-formed. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 16 (p-valueResults: Double hit gene rearrangements by FISH were detected in 3/30 (10%) patients. MYC IHC was positive in 6/30 (20%) cases, and 3 of these 6 cases (50%) were FISH positive. Sensitivity, specificity and concordance of MYC IHC as a screening tool were 100%, 73.6% and 50%, respec-tively. BCL2 staining was positive in 14/30 (46.6%) cases, and only 3 of the 14 cases (21.4%) were FISH positive. 6/30 (20%) cases were positive for both MYC and BCL2 by IHC (double protein expresser status) and 3 of these 6 (50%) cases were positive by FISH. DHL biology showed an association with many clinico-pathological parameters including elevated serum Lactate dehydrogenase, stage III,IV, Bone marrow infiltration, extranodal involvement, and overall survival.Conclusion: The association between MYC IHC and FISH in the current study was statistically significant. The sensitivity of MYC in our study was 100%, we can propose that it can be used as an effective screening test if similar results can be validated in larger studies. The current study supports the practice of routinely testing for MYC and BCL2 status in all cases of DLBCL, irrespective of clinical features of the disease, to identify the high-risk DHL subset of patients, who can be candidates for more intense newer chemotherapy regimens and for prognostic purposes.

Objectives: comparing minimally invasive posterior cervical foraminotomy versus anterior cervical discectomy and fusion to determine the best approach in cases of cervical radiculopathy.Methods: This study carried out in Zagazig University Hospital, Neurosurgery Department during the year from 2017 to 2019. It was an interventional prospective study. The sample size was 24(12for each group) all patients suffering from cervical radiculopathy examined and had full radiological and laboratory investigations fulfilling the inclusion criteria and all of them will be included in the study as a comprehensive sample and divided randomizally into two groups.Results: 24 patients with posterolateral or foraminal cervical disc will be divided into two groups (12) for each and treated surgically.Conclusion: Posterior microscopic cervical foraminotomy is a safe and effective motion preserving approach for treatment of cervical radiculopathy in well selected cases. It has comparable outcomes to the ACDF approach with avoidance of possible complications associated with anterior approaches.

Background Non-alcoholic fatty liver disease (NAFLD) is a worldwide disease that progresses into steatohepatitis (NASH) that has no current effective treatment. This study aimed, for the first time, to investigate the effect of Dasatinib; a tyrosine kinase inhibitor showing anti-PDGFR activity with a macrophage modulating efficacy, on NASH. Methods NASH was induced, in C57BL/6 mice by western diet (WD). Control groups received either DMSO or Dasatinib. After 12 weeks, WD-fed mice received DMSO, Dasatinib (4 mg/kg) or Dasatinib (8 mg/kg) once daily, for four weeks. Serum was examined for ALT and lipid profile. Immunohistochemical staining for SREBP1 (lipogenesis marker), iNOS, arginase-1, CD68, CD163 (macrophage polarization markers), TGF-β (fibrosis marker) and ASMA (a marker for activated hepatic stellate cell), hepatic mRNA expression for SREBP-1, iNOS, arginase-1, TGF-β and PDGFA genes; and western blotting for phosphorylated PDGFR α and β, SREBP1, iNOS, arginase-1, IL1α, COX2, TGF-β and ASMA were performed. Liver sections were stained also for H & E, Oil red O and Sirius red. Results Dasatinib could ameliorate the WD-induced disturbance of serum ALT, lipid profile and significantly reduced hepatic expression of PDGFA, phosphorylated PDGFR α and β, IL1α, COX2, SREBP-1, iNOS, CD68, TGF-β and ASMA but increased expression for arginase-1 and CD163 (M2 macrophage markers). Moreover, Dasatinib reduced the steatosis, inflammation, hepatocellular ballooning, hepatic fibrosis and the high NAFLD activity scoring induced by WD. Conclusion Dasatinib can prevent the progression of WD-induced NASH by attenuating lipogenesis, and inducing M2 macrophage polarization with antifibrotic activity.

Objective In order to enhance awareness and promote registry for inborn errors of metabolism (IEMs) in Egypt, we aimed to evaluate the prevalence and main clinical findings of IEMs detectable by tandem mass spectrometry (MS/MS) among high risk pediatric patients presenting to our tertiary care facility at Cairo University Children's Hospital over a period of 5 years and to compare the disease burden in Egypt in the absence of a national screening program for inherited metabolic disorders with other populations. Methods During this period 3380 Egyptian children were suspected of having IEMs based on clinical/laboratory presentation and were analyzed by MS/MS. Confirmatory testing was performed according to flagged analyte by MS/MS using a different sample type such as plasma or urine or by a different technique such as GC/MS. Results A relatively high number of patients (203/3380 (6%)) were confirmed with 17 different types of IEMs. Averages for age at diagnosis for different disorders ranged from 2.5 months to 6.6 years with general developmental delay and irreversible neurological damage being the most common presenting features (75.9% and 65.5%, respectively). Amino acid disorders (127/203 (62.6%)), mainly phenylketonuria (100/203 (49.3%)), were the most encountered, followed by organic acidemias (69/203 (34%)), while fatty acid oxidation defects (7/203 (3.4%)) were relatively rare. 88% of patients were born to consanguineous parents. Conclusions The development of a nationwide screening program for IEMs is mandatory for early detection of these potentially treatable disorders, prompt and properly timed therapeutic intervention and prevention of the devastating neurological outcomes.

Background and aim of work Liver fibrosis is a major health problem associated with high morbidity and mortality, particularly in Egypt. It is mainly regulated by hepatic stellate cells, which acquire a fibrogenic character in response to oxidant stress and inflammatory cytokines. We tried to test the efficacy of Saussurea lappa ( Sl ) root extract on the reversion of the already established liver fibrosis as this extract was reported to have anti-inflammatory and antioxidant activities. Materials and methods A total of 24 albino rats were divided into four groups: negative control group, carbon tetrachloride (CCl 4 ) fibrosis model group, spontaneous resolution group, CCl 4 followed by Sl root extract group. In all rats, serum alanine transaminase, aspartate transaminase, liver malonaldehyde and liver reduced glutathione were measured. Histopathological assessment were carried out through haematoxylin and eosin (H&E), sirius red staining and α-smooth muscle actin immunohistochemical staining with evaluation of the fibrosis grade and percentage of the area occupied by collagen fibres. Results Administration of Sl root extract for 4 weeks, after 8 weeks of CCl 4 injection, caused a significant decrease in CCl 4 -induced rise in plasma levels of alanine transaminase and aspartate transaminase, liver malonaldehyde and the percentage of collagen area and an increase in liver glutathione with almost preserved liver architecture, less inflammatory infiltration, less collagen deposition, fewer thinner septa, less bridging fibrosis and less positive reaction for α-smooth muscle actin as compared with the spontaneous resolution group. Conclusion These data indicate that Sl root extract can accelerate matrix degradation and reversion from liver fibrosis induced by CCl 4 in rats. This might be through antioxidant, anti-inflammatory activities and through inhibition of the activated hepatic stellate cells or probably inducing their apoptosis.