Image-Guided IORT after Surgical Resection of Brain Malignancies: A Feasibility Study

PURPOSE/OBJECTIVE(S)

Intraoperative radiation therapy (IORT) can be used to locally apply radiation doses to surgical cavities of resected brain metastases and glioblastoma. The miniaturized linear accelerator INTRABEAM 600® offers a low-energy system of 50kV X-rays. To date, placing the spherical applicator in the surgical bed has been done manually and without final positioning verification. Ultimately, without positional control, it must be assumed that the applicator is optimally positioned against the tissue in the tumor cavity, without any air interference or fluid underlying. Misplacements could lead to incomplete dose delivery, potentially yielding an increased risk of recurrence. Therefore, we deemed relevant to assess intraoperative imaging as a novel option for easing the applicator positioning.

MATERIALS/METHODS

A surgical environment was mimicked in two test runs with an interdisciplinary team, accounting for operating and anesthesia times. The IORT planning software Radiance (GMV Innovating Solutions, Madrid, Spain) was previously calibrated with a "cheese" phantom, using twelve different density levels from 0.3 to 1.842 g/cm3, yielding a value-to-density table with -600 to +600 HU range. Furthermore, two inserts were placed in the phantom to evaluate the quality and spatial resolution of the cone-beam CT (CBCT) imaging. The O-Arm System (Medtronic, Minneapolis, MN, USA) was employed for acquiring tomographic intraoperative imaging, once the applicator was placed in a skull-shaped phantom. Two expert radiation oncologists contoured the acquired dataset and performed the treatment calculations, based on a 30 Gy prescription dose.

RESULTS

We achieved the best possible CBCT imaging quality with the 120kV and 20mA setting parameters. This corresponds to the "HD3D (large)" O-Arm setting mode. With this, the image quality with artifact reduction, minimization of image noise and consideration of a low radiation exposure of only 0.5mSv for the patients is feasible. Approximately 15 additional minutes were accounted for contouring and planning times.

CONCLUSION

Good-quality intraoperative imaging can be obtained when performing IORT, easing the applicator positioning and resulting in a more precise target irradiation. Operating times would be minimally extended with this procedure. A clinical study will initiate based on these findings.

Missense mutations in PIEZO1, which encodes the Piezo1 mechanosensor protein, define Er red blood cell antigens

Despite the identification of the high-incidence red cell antigen Era nearly 40 years ago, the molecular background of this antigen, together with the other 2 members of the Er blood group collection, has yet to be elucidated. Whole exome and Sanger sequencing of individuals with serologically defined Er alloantibodies identified several missense mutations within the PIEZO1 gene, encoding amino acid substitutions within the extracellular domain of the Piezo1 mechanosensor ion channel. Confirmation of Piezo1 as the carrier molecule for the Er blood group antigens was demonstrated using immunoprecipitation, CRISPR/Cas9-mediated gene knockout, and expression studies in an erythroblast cell line. We report the molecular bases of 5 Er blood group antigens: the recognized Era, Erb, and Er3 antigens and 2 novel high-incidence Er antigens, described here as Er4 and Er5, establishing a new blood group system. Anti-Er4 and anti-Er5 are implicated in severe hemolytic disease of the fetus and newborn. Demonstration of Piezo1, present at just a few hundred copies on the surface of the red blood cell, as the site of a new blood group system highlights the potential antigenicity of even low-abundance membrane proteins and contributes to our understanding of the in vivo characteristics of this important and widely studied protein in transfusion biology and beyond.

P-002 Zinc restores testicular integrity and function in HAART-treated male Wistar rats via modulation of Nrf2/NFkB pathway and downregulation of caspase 3 signaling

Study question

Will zinc treatment attenuate highly active antiretroviral drugs (HAART)-induced testicular dysfunction when used concomitantly?

Summary answer

Zinc blunted HAART-induced reproductive toxicity by attenuating testicular and epididymal oxido-inflammatory injury via modulation of Nrf2/NFkB signaling and downregulation of caspase 3-mediated apoptosis.

What is known already

The use of HAART has been established to be effective in the management of HIV; however, it has also been reported to induce male reproductive dysfunction. Studies have revealed that HAART impairs fertility by reducing libido and inducing testicular and sperm damage via an oxidative stress-sensitive pathway. On the other hand, zinc has been shown to enhance reproductive function by improving testicular redox state. Till date, no study has reported the impact of zinc co-administration with HAART on testicular integrity and function, spermatogenesis and sperm quality, and sexual behaviour.

Study design, size, duration

This is a prospective experimental study using animal model. Forty sexually mature inbred male Wistar rats of comparable age and weight were used for the study. The study lasted 8 weeks.

Participants/materials, setting, methods

Animals were acclimatized for two weeks, then randomly assigned into four groups (n = 10). The control rats received 0.5mL of distilled water as vehicle, zinc-treated animals received zinc supplement, HAART-treated rats received a cock-tail of antiretroviral drugs (Efavirenz, Lamivudine, and Tenofovir), while the Zn + HAART-treated rats received treatment as zinc-treated as well as HAART-treated. The doses of drugs used were the Human Equivalent doses for rats.

Main results and the role of chance

Zinc blunted HAART-induced rise in testicular activities of gamma glutamyl transferase, lactate dehydrogenase activity, concentrations of lactate, and reduced testicular sorbitol dehydrogenase activity. Also, zinc ameliorated HAART-induced decline in the activities of testicular and epididymal superoxide dismutase, catalase, glutathione peroxidase, and glutathione-S-transferase, as well as glutathione and Nrf2 concentrations, and rescued HAART-induced increase in testicular and epididymal concentrations of uric acid, malondialdehyde, 8-OHdG, xanthine oxidase and MPO activities, and TNF-α, IL-1β, and NF-kB levels. This was associated with dampening of HAART-led upregulation of caspase 3 activity by zinc. Furthermore, zinc alleviated HAART-led reduction in spermatogenesis and sperm quality, serum nitric oxide and penile cGMP, and circulatory levels of FSH, LH, and testosterone, as well as testicular concentrations of 3β-HSD, 17β-HSD, and testosterone. In addition, zinc prevented HAART-induced sexual dysfunction and poor fertility indices.

Limitations, reasons for caution

This study was conducted in a rat model; hence findings should be extrapolated to human with care. Thus, clinical trials are recommended to validate these findings.

Wider implications of the findings

For the first time, we demonstrated the protective role of zinc treatment on HAART-induced male reproductive dysfunction. These findings provide further mechanisms through which HAART induces male infertility, and the possible protective role of zinc.

Trial registration number

not applicable

AB1146 SARS-Cov-2 VIRAL LOAD IN PATIENTS WITH AUTOIMMUNE RHEUMATIC DISEASE, A RETROSPECTIVE COMPARATIVE STUDY

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load and its impact on disease outcome in patients with autoimmune rheumatic disease (ARD) are lacking. Also, whether patients with ARD receiving immunomodulators have different viral loads compared to the general population is unknown.

Objectives

To compare the viral load of SARS-CoV-2 and its trending between patients without and with ARD.

Methods

Retrospectively, patients with ARD infected with SARS-CoV-2 were matched by age and sex at a ratio of 1:2 to patients without ARD and not receiving immunosuppression or immunomodulator drugs. Viral load was determined by the cycle threshold (CT) value measured by a number of platforms: (a) Automated Platforms - the Roche Cobas 6800 system using the Cobas SARS-CoV-2 Test targeting the E and orf1a/b genes (Roche, Switzerland) and the Xpert Xpress SARS-CoV-2 targeting the E and N genes (Cepheid, USA); (b) Manual platforms - EZ1 (QIAGEN, USA), QIAsymphony (QIAGEN, USA), and Bioneer ExiPrepTM 96 Virus DNA/RNA kits Catalogue No K4614 (Bioneer, South Korea) extraction with thermal cycling using TaqPath™ PCR COVID-19 Combo Kit targeting the N, S and orf1a/b genes (Thermo Fisher Scientific, USA) on ABI 7500 thermal cyclers. Independent samples t-test was used to compare the mean CT values of the study groups at baseline and at 5 subsequent intervals (1 – 5.9, 6 – 11.9, 12 – 17.9, 18 – 23.9 and 24 – 30 days).

Results

Mean age (SD) of 197 cases and 420 controls were 45.2 (11.8) and 44.1 (12.3) years, respectively. Females were predominant in both groups 60% vs. 52%, P=0.053. The most common ARD was rheumatoid arthritis in 82 cases (41.6%), followed by spondyloarthropathy in 33 (16.8%) and systemic lupus erythematosus in 31 (15.7%). Of the cases, 67% were on conventional synthetic disease modifying anti-rheumatic drugs (DMARDs), 15.2% on biological DMARDs and 4.6% patients were on rituximab. The mean CT values was significantly lower in the ARD group at baseline and persisted till day 24.

Table 1.

demographic characteristics and comparison of the mean CT values in the study groups at baseline and at different intervals with the corresponding OR (95% CI)

Case (N=197)Control (N=420)OR (95% CI)Mean (SD) age, years45.2 (11.8)44.1 (12.3)1.008 (0.994–1.022)Sex, female N (%)120 (60.9%)221 (52.6)0.713 (0.505–1.006)Mean (SD) CT values at Baseline22.9 (5.5)30 (5.2)0.799 (0.745–0.858)1 – 5.9 days22.1 (4.6)25.7 (6.3)0.901 (0.842–0.963)6 – 11.9 days26.9 (4.9)31.5 (3.9)0.802 (0.724–0.888)12 – 17.9 days29.6 (4.1)32.3 (3.2)0.827 (0.743–0.921)18 – 23.9 days32.1 (4)32.9 (2.5)0.903 (0.728–1.119)24 – 30 days31.2 (1.2)32.7 (2.6)0.824 (0.589–1.151)

Conclusion

Compared to patients without ARD, the viral load of SARS-CoV-2 in patients with ARD is significantly higher at baseline testing and persists till day 24. This finding may indicate that patients with ARD are at higher risk of severe SARS-CoV-2 infection and prolonged potential transmission. Clinical outcome correlation is needed.

References

None

Disclosure of Interests

None declared

581 Renal Arteriovenous Fistula Percutaneous Embolization Using the Amplatzer Vascular Plug II

Introduction

Renal arteriovenous fistula (AVF) is not considered a common condition; however, it can occasionally complicate with renal impairment and heart failure secondary to high cardiac output. Recently, percutaneous embolization has overcome traditional surgery as the first line of its management, because of better success rates as well as less morbidity and mortality.

Case report

A 68-year-old male who presented with a renal AVF post left partial nephrectomy associated with a large pseudoaneurysm. This was found on a computed tomography angiography (CTA) scan, a routine follows up for his endovascular aortic aneurysm repair. Due to the patient’s co-morbidities and to avoid the potentially fatal pseudoaneurysm rupture, a minimal invasive approach was agreed in the multidisciplinary meeting. He was treated by percutaneous transcatheter embolization using the Amplatzer Vascular Plug II (AVP-II) through a right femoral arterial access. The patient recovery was uneventful, following an overnight stay he was discharged home. CTA done four and ten months later showed the AVP-II device inside the left renal artery branch feeder with no artifacts seen. There was absence of recanalization of the AVF. In the literature, adopting the transarterial route for the renal AVF treatment with AVP-II device as a single embolotherapy device has not been reported before.

Conclusions

Our report display the feasibleness of AVP-II in renal AVF treatment by arterial feeder embolization, specifically in fistulas with high flow and short communication as our case in which it showed offered multiple advantages over coils and is more cost effective.

P–075 HAART exacerbates anti-Koch-induced reproductive toxicity via suppression of androgen and down-regulation of cGMP signaling

Study question

Will highly active antiretroviral drugs (HAART) and antikochs impair reproductive function when used singly and concurrently?

Summary answer

HAART exacerbates antikoch-induced reproductive toxicity by stimulating testicular and penile oxido-inflammatory response. This was associated with suppression of androgen and down-regulation of cGMP signaling.

What is known already

Although the advent of HAART and antikochs has significantly improved the clinical status, life expectancy and quality of life of patients with HIV/tuberculosis, these drugs are with shortcomings. Studies have reported that HAART induces testicular toxicity and impairs sperm quality. Similarly, antikochs has been shown to trigger oxidative testicular and sperm damage. Available data have implicated HAART and antikoch in the pathogenesis of male infertility via oxidative stress-mediated mechanism. However, no study has reported the impact of the concurrent administration of both HAART and antikochs as seen in patients with TB/HIV co-infection on testicular function, sexual behaviour and fertility outcome.

Study design, size, duration

This is a prospective experimental study using animal model. Forty sexually mature inbred male Wistar rats of comparable age were used for the study. The study lasted 8 weeks.

Participants/materials, setting, methods

Animals were acclimatized for two weeks after which they were randomly allotted into four groups (n = 10). The control rats 0.5mL of distilled water as vehicle, anti-Koch-treated rats received a cocktail of anti-tuberculosis drugs (Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol), HAART-treated animals received a cock-tail of antiretroviral drugs (Efavirenz, Lamivudine, and Tenofovir), while the HAART+antikochs-treated rats received treatment as HAART-treated as well as antikoch-treated. The doses of drugs used were the Human Equivalent doses for rats.

Main results and the role of chance

HAART exaggerated antikoch-induced increase in testicular lactate dehydrogenase activity, concentrations of lactate and uric acid, and reduced testicular sorbitol dehydrogenase activity. Furthermore, HAART worsens antikoch-induced decline in the activities of testicular and penile superoxide dismutase, catalase, glutathione peroxidase, and glutathione-S-transferase, as well as glutathione concentration, but increased malondialdehyde levels in testicular and penile tissues, as well as penile and testicular DNA fragmentation. Similarly, HAART aggravates antikoch-driven reduction in penile cGMP, circulatory and testicular testosterone, serum prolactin, LH and FSH, impaired sperm quality, sexual behaviour, and fertility outcome.

Limitations, reasons for caution

This is a prospective study using animal model; hence findings should be extrapolated to human with care. Human studies are thus recommended.

Wider implications of the findings: This study demonstrates for the first time the impact of HAART and antikoch, when used singly or in combination, on sexual behaviour, sperm quality and penile and testicular integrity. The findings add to the available literature by providing the molecular mechanism through which HAART and/or antikoch possibly impair reproductive function.

Trial registration number

N/A

Mitochondria-targeted antioxidant MitoQ ameliorates ischaemia-reperfusion injury in kidney transplantation models

BACKGROUND

Ischaemia-reperfusion (IR) injury makes a major contribution to graft damage during kidney transplantation. Oxidative damage to mitochondria is an early event in IR injury. Therefore, the uptake, safety, and efficacy of the mitochondria-targeted antioxidant MitoQ were investigated in models of transplant IR injury.

METHODS

MitoQ uptake by warm and cooled pairs of pig and declined human kidneys was measured when preserved in cold static storage or by hypothermic machine perfusion. Pairs of pigs' kidneys were exposed to defined periods of warm and cold ischaemia, flushed and stored at 4°C with or without MitoQ (50 nmol/l to 250 µmol/l), followed by reperfusion with oxygenated autologous blood in an ex vivo normothermic perfusion (EVNP). Pairs of declined human kidneys were flushed and stored with or without MitoQ (5-100 µmol/l) at 4°C for 6 h and underwent EVNP with ABO group-matched blood.

RESULTS

Stable and concentration-dependent uptake of MitoQ was demonstrated for up to 24 h in pig and human kidneys. Total blood flow and urine output were significantly greater in pig kidneys treated with 50 µmol/l MitoQ compared with controls (P = 0.006 and P = 0.007 respectively). In proof-of-concept experiments, blood flow after 1 h of EVNP was significantly greater in human kidneys treated with 50 µmol/l MitoQ than in controls (P ≤ 0.001). Total urine output was numerically higher in the 50-µmol/l MitoQ group compared with the control, but the difference did not reach statistical significance (P = 0.054).

CONCLUSION

Mitochondria-targeted antioxidant MitoQ can be administered to ischaemic kidneys simply and effectively during cold storage, and may improve outcomes after transplantation.

852 Complete Mesocolic Excision (CME) Versus Conventional Surgery for Colon Cancer: A Systematic Review and Metaanalysis

Introduction

Complete mesocolic excision (CME) lacks consistent data to advocate operative superiority compared to conventional surgery for colon cancer. We performed a systematic review and meta-analyses, analysing peri-operative, pathological, and oncological outcomes.

Method

A systematic literature review was registered with PROSPERO and carried out using PRISMA guidelines. Outcomes reviewed included lymph node yield, R0, disease free and overall survival at five years.

Results

3039 citations were identified; 148 studies underwent full-text reviews and 34 matched our inclusion criteria. There were no significant differences between the CME and non-CME group in overall complications (13.8% vs.13.8%) or anastomotic leak (1.3% vs. 1.7%). Nodal yield was higher in the CME group, 18.7 compared to 13.6 in the non-CME group. The rate of R0 resection was 96.8% in CME compared to 95.5%. Overall survival at five years was higher in the CME group 77.8% compared to 69.7% in non-CME group.

Conclusions

CME for colon cancer was associated with no significant differences in morbidity and mortality, better lymph node yield and R0 resection compared to the non-CME group. Our meta-analysis further supported this demonstrating an improved overall and disease-free survival at five years in the CME group compared to the non-CME group.

Combination of the PI3K inhibitor Idelalisib with the conventional cytostatics cytarabine and dexamethasone leads to changes in pathway activation that induce anti-proliferative effects in B lymphoblastic leukaemia cell lines

BACKGROUND

The introduction of combined conventional cytostatics and pathway-specific inhibitors has opened new treatment options for several cancer types including hematologic neoplasia such as leukaemias. As the detailed understanding of the combination-induced molecular effects is often lacking, the identification of combination-induced molecular mechanisms bears significant value for the further development of interventional approaches.

METHODS

Combined application of conventional cytostatic agents (cytarabine and dexamethasone) with the PI3K-inhibitor Idelalisib was analysed on cell-biologic parameters in two acute pro-B lymphoblastic leukaemia (B-ALL) cell lines. In particular, for comparative characterisation of the molecular signatures induced by the combined and mono application, whole transcriptome sequencing was performed. Emphasis was placed on pathways and genes exclusively regulated by drug combinations.

RESULTS

Idelalisib + cytostatics combinations changed pathway activation for, e.g., "Retinoblastoma in cancer", "TGF-b signalling", "Cell cycle" and "DNA-damage response" to a greater extent than the two cytostatics alone. Analyses of the top-20 regulated genes revealed that both combinations induce characteristic gene expression changes.

CONCLUSION

A specific set of genes was exclusively deregulated by the drug combinations, matching the combination-specific anti-proliferative cell-biologic effects. The addition of Idelalisib suggests minor synergistic effects which are rather to be classified as additive.

FRI0061 THE ADVERSE OBSTETRIC OUTCOMES WHEN RHEUMATOID ARTHRITIS IS CONTROLLED DURING PREGNANCY: IS THE DISEASE ITSELF A PROBLEM? DATA FROM A CASE-CONTROL COHORT OF 190 PREGNANCIES AT A MULTI-NATIONALITY SPECIALIZED CENTER IN QATAR

Background:

Rheumatoid arthritis is implicated in causing adverse pregnancy outcomes including high rates of prematurity and low birth weight. But little is known about the impact of the disease when it’s controlled as most of the information is extracted from retrospective data.

Objectives:

To examine the adverse obstetric outcomes after controlling disease during pregnancy. We also took into account many confounders that might affect the outcome.

Methods:

This is an ongoing Case-Control Prospective Cohort. It is implemented in a tertiary center where cases are recruited from a single specialized pregnancy and rheumatic disease clinic to ensure standardized management. These cases were fulfilling the ACR 2010 classification criteria for rheumatoid arthritis. Disease activity was measured using CDAI once before pregnancy and once in each trimester. We excluded subjects with chronic morbidities or twin pregnancy. Data were collected in pre-specified data sheets. Routine blood tests in addition to C-reactive protein were obtained. Cases were recruited at different disease activity stages, but treatment was escalated to reach remission as possible by the third trimester. Data were analyzed using SPSS software for descriptive and comparative analyses.

Results:

Since 2017 we have recruited 215 subjects. A total of 190 completed pregnancies were analyzed in this report (114 controls and 76 cases). Five subjects were excluded as their disease was not controlled by 27 weeks of gestation. Baseline characteristics of age, baseline BMI and anemia were similar. Exposure to passive smoking was significantly higher in the control group. There was no statistical difference in the incidence of gestational diabetes, pre-eclampsia and infections. Rates of abortions and cesarean sections were significantly higher in the cases group. The incidence of PROM & low birth weight was not statistically different. Three cases of IUFD were reported among controls versus none in the cases (Table 1). Prematurity rate was numerically higher in the control group but did not reach a statistical difference. Congenital anomalies and NICU admission rates were comparable between the groups. But the incidence of neonatal morbidities was significantly higher in the control group (p. value 0.006), but the majority of morbidities were due to jaundice that resolved with phototherapy. we have evaluated the incidence of group B streptococcal Agalactae as a possible contributor to morbidities but it was similar between the groups. All cases were on DMARDs during pregnancy. Hydroxychloroquine was the most commonly used (55%) followed by sulfasalazine (40%). Steroid was used for variable duration in pregnancy in 23 cases. In most of them, it was tapered and stopped by the end of pregnancy. Biologics were used in 15 cases with few adverse outcomes including: abortion (1 case), PROM (1), maternal UTI (1), repeated URT infection (1) and neonatal bronchiolitis (1).

Table 1.

Birth Outcomes

Birth OutcomeCases (n)Controls (n)P.valueAbortion910.001IUFD030.18PROM180.09Cesarean20170.02LBW680.68Premature8250.74

Conclusion:

From this ongoing cohort we conclude that controlled RA during pregnancy carries low risk of adverse obstetric outcomes in spite the regular use of DMARDs. Although these results are reassuring, further regression models are required after recruiting more subjects.

References:

[1]Johanna M. W. Hazes. (2011). Rheumatoid arthritis and pregnancy: evolution of disease activity and pathophysiological considerations for drug use.Rheumatology, 50:1955-1968

Disclosure of Interests:

None declared

0561 Differences in Nasopharyngoscopic Airway Form Between Awake and Sleep, Sitting and Recumbent Position and Techniques

Introduction

To examine and compare the information derived from flexible fiber-optic nasopharyngoscopy in awake mimic snoring (AMS), Müller’s Maneuver (MM) and drug-induced sleep endoscopy (DISE), to determine if AMS and MM can be used in substitution for DISE as a streamlined method. We investigated their relation with the level and pattern of obstruction detected on AMS, MM and DISE.

Methods

This is a retrospective study of 15 obstructive sleep apnea patients with apnea hypopnea index from 8.3 to 105.2, ages 20 to 80 were included. Each patient underwent polysomnography and thorough a physical examination, including flexible nasopharyngoscopy with AMS, MM and DISE. Airway obstruction on these endoscopic procedures were described according to airway level and pattern of obstruction. They were classified 5 different types; Uvula type: anterior-posterior vibration of the uvula, no airway obstruction; L-R velum type: lateral (the left and right directions) airway narrowing at velum level, no airway obstruction; A-P velum type: anterior-posterior total airway obstruction at velum level; Tonsillar type: total airway obstruction at pharyngeal level; Circumferential type: circumferential total airway obstruction at velum level. AMS and MM were performed with patients in sitting and in recumbent position. DISE was performed only in recumbent position.

Results

In review of the three procedures, the results were much different. Airway was obstructed in all cases(100%, 15 of 15)in DISE, but not all cases in AMS and MM. When tonsillar type was seen in AMS, it was also seen in MM and DISE(100%, 5 of 5).

Conclusion

Flexible fiber-optic nasopharyngoscopy appears to be useful for evaluating airway obstruction. It might be not suitable to use AMS and MM in substitution for DISE(except tonsillar type). Muscle tonic relaxation of the upper airway between AMS, MM and DISE might be different (DISE>MM>AMS, recumbent>sitting).

Support

 

Implication of CDKAL1 single-nucleotide polymorphism rs 9465871 in obese and non-obese Egyptian children

INTRODUCTION

CDKAL1 single-nucleotide polymorphism rs 9465871variant is a risk locus for Type 2 Diabetes (T2DM).The study evaluated the associations of CDKAL1- rs9465871 with glycosylated hemoglobin A1C Level (HbA1c), fasting insulin level, insulin resistance and metabolic syndrome among obese and non- obese Egyptian children.

MATERIALS AND METHODS

The study included 43 obese children and 40 normal weight children. Anthropometric body measurements, bio-specimen and biochemistry assays were done. Genotyping of rs9465871 (CDKAL1) was conducted.

RESULTS

The percentages of the CC, CT, and TT genotypes of rs9465871in the lean children were 15%, 42.5%, and 42.5%, respectively. Regarding obese children, the frequencies were 18.6%, 58.1% and 23.3% respectively with no significant statistical difference. Comparison between the CDKAL1 rs 9465871 polymorphism showed that the highest value of fasting insulin was recorded in CC genotype (22.80± 15.18 [uIU/mL] P<.014). Levels of HOMA-IR, FBS and HBA1C were highest in CC group with no statistical significant differences. However, fasting insulin level was higher in the CC group than in the TT+ CT group (P<.01). A higher level of HbA1c was found among CC group at CDKAL1-rs9465871 (5.9%) than TT+CT genotype group (5.6%), with no statistical significant difference. There was increase in the risk of type 2 diabetes the percentages were 78.6% and 46.4% respectively when comparing CC with TT+CT genotype groups ( P<.039). CC group was not associated with significant increase in metabolic syndrome.

CONCLUSION

There is a significant risk association between CDKAL1-rs9465871polymorphism and development of T2DM in a subset of the Egyptian children.

Can combined blood neutrophil to lymphocyte ratio and C-reactive protein be used for diagnosis of spontaneous bacterial peritonitis?

BACKGROUND AND OBJECTIVE

Spontaneous bacterial peritonitis (SBP) is diagnosed by the presence of ≥250 polymorphonuclear neutrophils (PMN)/mm³ in the ascites and the absence of surgically treatable cause of intra-abdominal infection. Blood neutrophil lymphocytic ratio (NLR) is an inexpensive and simple test for inflammation. C-reactive protein (CRP) is an inflammatory marker used for the diagnosis and follow-up of many diseases and morbidities. We aimed to evaluate the clinical utility of combined blood NLR and CRP as a non-invasive test for SBP diagnosis.

METHODS

Blood NLR was calculated, and CRP value determined in 180 cirrhotic patients with ascites (126 with and 54 without SBP). Sensitivity and specificity of combined blood NLR and CRP values for SBP diagnosis were estimated by receiver operator characteristic curve.

RESULTS

Both blood NLR and CRP values were significantly higher in SBP (p < 0.001). For SBP diagnosis, a blood NLR of >2.89 had a sensitivity 80.3% and specificity 88.9%. CRP >11.3 mg/dL had a sensitivity 88.9% and specificity 92.6%. In logistic regression analysis, combined blood NLR and CRP had a sensitivity 95.1% and specificity 96.3% at the same cut off values.

CONCLUSIONS

Combined NLR and CRP could be used as a novel, simple, low-cost, non-invasive test for SBP diagnosis.

An Egyptian HPAI H5N1 isolate from clade 2.2.1.2 is highly pathogenic in an experimentally infected domestic duck breed (Sudani duck)

The highly pathogenic avian influenza (HPAI) H5N1 viruses continue to cause major problems in poultry and can, although rarely, cause human infection. Being enzootic in domestic poultry, Egyptian isolates are continuously evolving, and novel clades vary in their pathogenicity in avian hosts. Considering the importance of domestic ducks as natural hosts of HPAI H5N1 viruses and their likelihood of physical contact with other avian hosts and humans, it is of utmost importance to characterize the pathogenicity of newly emerged HPAI strains in the domestic duck. The most recently identified Egyptian clade 2.2.1.2 HPAI H5N1 viruses have been isolated from naturally infected pigeons, turkeys and humans. However, essentially nothing is known about their pathogenicity in domestic ducks. We therefore characterized the pathogenicity of an Egyptian HPAI H5N1 isolate A/chicken/Faquos/amn12/2011 (clade 2.2.1.2) in Sudani duck, a domestic duck breed commonly reared in Egypt. While viral transcription (HA mRNA) was highest in lung, heart and kidney peaking between 40 and 48 hpi, lower levels were detected in brain. Weight loss of infected ducks started at 16 hpi and persisted until 120 hpi. The first severe clinical signs were noted by 32 hpi and peaked in severity at 72 and 96 hpi. Haematological analyses showed a decline in total leucocytes, granulocytes, platelets and granulocyte/lymphocyte ratio, but lymphocytosis. Upon necropsy, lesions were obvious in heart, liver, spleen and pancreas and consisted mainly of necrosis and petechial haemorrhage. Histologically, lungs were the most severely affected organs, whereas brain only showed mild neuronal degeneration and gliosis at 48 hpi despite obvious neurological clinical signs. Taken together, our results provide first evidence that this HPAI H5N1 isolate (clade 2.2.1.2) is highly pathogenic to Sudani ducks and highlight the importance of this breed as potential reservoir and disseminator of HPAI strains from this clade.

The use of cerclage wire for surgical repair of unilateral rostral mandibular fracture in horses

Fractures of the rostral mandible in horses are the most common type of jaw fractures. The present study was performed for stabilization of rostral mandibular fracture with cerclage wire. In a retrospective case series, six client-owned horses with unilateral mandibular fractures were admitted to our clinic and suffered from a major gingival wound at rostral part of mandible. Rostral mandibular fracture was diagnosed through clinical examination and radiography. Fractured region was repaired by cerclage wire under the effect of general anesthesia and wires were maintained for 6-12 weeks. The repair of mandibular fracture by cerclage wiring exhibited good fracture reduction and fixation in five horses and fair results in one horse. After twelve weeks, the fracture healing was excellent practically and cosmetically. Furthermore, the horses appeared normal without any evidence of teeth-related mastication problems, obstinate fracture-site fistula, or extreme callus formation. Radiographically, cerclage wire achieved good fracture fixation and fracture gap closure. Moreover, the formation of uniting callus was noticed at 6-12 weeks post-operatively. It was concluded that, unilateral mandibular fracture in horses can successfully be repaired by interdental wiring (IDW). All horses were returned to their usual activities without any fracture healing-related masticatory problems at the time of follow-up.

Emergence of multidrug-resistant Acinetobacter baumannii producing OXA-23 Carbapenemase in Qatar

The objective of our study was to describe the molecular support of carbapenem resistance from randomly selected clinical isolates of multidrug-resistant (MDR) Acinetobacter baumannii as a pilot study from the Hamad Medical Corporation (HMC), Qatar. Results of our report will be used to study carbapenemases using molecular techniques in all isolated MDR A. baumannii. Forty-eight MDR A. baumannii were randomly selected from isolates preserved at HMC. Identification of all isolates was confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Antibiotic resistance was tested phenotypically by Phoenix and confirmed by Etest. The molecular support of carbapenemases (bla OXA-23, bla OXA-24, bla OXA-58, bla NDM) was investigated by real-time PCR. The epidemiologic relatedness of the isolates was verified by phylogenetic analysis based on partial sequences of CsuE and bla OXA-51 genes. All 48 isolates were identified as A. baumannii and were confirmed to be resistant to most antibiotics, especially meropenem, imipenems, ciprofloxacin, levofloxacin, amikacin, gentamicin and most of the β-lactams; they were sensitive to colistin. All the isolates were positive for bla OXA-23 and negative for the other tested carbapenemase genes. Clonality analysis demonstrated that different lineages were actually circulating in Qatar; and we suggest that an outbreak occurred in the medical intensive care unit of HMC between 2011 and 2012. Here we report the emergence of MDR A. baumannii producing the carbapenemase OXA-23 in Qatar.

Association of angiotensin converting enzyme gene (I/D) polymorphism with hypertension and type 2 diabetes

OBJECTIVES

This study was conducted to determine the association of insertion/deletion (I/D) polymorphism of the ACE gene in hypertensive and T2DM subjects in Egyptian population.

BACKGROUND

The deletion (D) allele of the angiotensin-converting enzyme (ACE) gene has been studied in relation to hypertension and type 2 diabetes mellitus (T2DM) with contradictory results which might be due to ethnic and geographical variations.

METHODS

A total of 85 subjects participated in this study; hypertension (Group 1); type 2 diabetes mellitus (Group 2) and controls (Group 3). Written informed consent was obtained. for each subject: age, sex, diabetes duration and the drugs used, blood pressure (systolic and diastolic), and lipid profile. Genotyping was performed by polymerase chain reaction (PCR).

RESULTS

The frequency of DD genotype was significantly higher in hypertensive (60 %) and diabetic patients (68 %) compared to controls (33.3 %) (p=0.04, p=0.01 respectively). The DD genotype (vs DI and II genotype) in the hypertensive and diabetic groups is associated with increased risk of hypertension and/or diabetes. OR=3.00; 95%, Cl = 0.993-9.067; OR=4.250; 95%, Cl = 1.234-14.63 respectively). The D allele was more frequent in hypertensive (77.5 %) and diabetic patients (82 %) compared to controls (52.4 %) (p=0.004 and 0.002 respectively). The D allele (vs the I allele) is associated with increased risk of hypertension and diabetes OR=3.13, 95%Cl=1.405-6.978; OR= 4.14, 95% CI= 1.615-10.622 respectively).

CONCLUSION

The DD genotype and the D allele are associated with hypertension and type 2 diabetes in Egyptian patients (Tab. 5, Fig. 1, Ref. 32).

Pregnancy-related admissions to the intensive care unit

We conducted a retrospective review of obstetric patients admitted to the intensive care unit at Al-Ain hospital during period January 1(st) 1997 to December 31(st) 2002, in order to identify the indications for admission and the outcome. A total of 60 patients were admitted during the six years. The frequency of admission was 2.6 per 1000 deliveries and obstetric patients represented 2.4% of all ICU admissions. Admission was planned in 11 patients (18%) and unplanned in 49 (82%). The mean (+/-SD) duration of stay in ICU was 1.6+/-1.5 days. The leading indications for admission were haemorrhage (28.4%) and preeclampsia/eclampsia (25%). Of the 60 admissions, 47 (78.4%) followed surgery. The mean APACHE II score was 5.0+/-3.0. Twenty-two patients (37%) had blood transfusions, and only two (3.3%) required ventilation. Of the 60 patients only 28 (46.7%) were deemed to have severe illness necessitating intensive care; the remaining 32 patients were suitable for high dependency care. The mean APACHE II score and duration of stay were significantly higher in these patients. There were two deaths, representing 3.3% of obstetric intensive care unit admissions. Our findings highlight the need for establishing a high dependency unit to avoid unnecessary admission to the intensive care unit and to ensure proper management.

Tribological behavior of artificial hip joint under the effects of magnetic field in dry and lubricated sliding

In recent years, there is an increasing utilization and demand to use magnetic fields in bioengineering applications due to its beneficial effects. Although in the last decade more attention has been given by tribologists to the electromagnetic processes taking place between sliding surfaces, which influence the tribological behaviors, but no attention has been concern with the sliding surfaces of the artificial implant joints. Therefore, the present work aims to elucidate the tribological behavior of an artificial joint implant under the effect of magnetic fields. Experimental investigation was carried out on a specially designed and constructed hip simulator on which the variations in the coefficients of friction and wear rates of the sliding surfaces were evaluated under the influence of a medium strength magnetic field suitable to apply in the human body. A realistic Ti-alloy implanted stem was used with an inserted head made from surgical grade stainless steel. This head was allowed to rub against UHMWPE sockets. The utilized type of prosthesis was "The JRI Modular Muller Standard-Total Hip Design". The performed experimental tests were conducted under both dry and lubricated sliding conditions using physiological saline solution. The designed simulator allows the coefficients of friction and the wear rates to be evaluated under realistic physiological loading and motion cycles encountered during normal walking of the human body. Comparative results are presented between the artificial joint performance in the presence and absence of the applied magnetic field. The experimental results have indicated that the presence of a medium strength magnetic field of 270 Gauss strength between rubbing surfaces resulted in high beneficial reductions in friction and wear rate of UHMWPE sliding on stainless steel either under dry or saline lubricating conditions. Therefore recommendation was forward to subject artificial implants made of stainless steel/UHMWPE combination of material to such medium strength magnetic field in animal clinical trials aiming to prolong the implant life. Scanning investigation of rubbing surfaces has revealed that the transfer of polymer to the counterface plays a dominant role in dictating the frictional and wear behaviors under dry sliding condition. Smooth molecular profile of the polymer-transferred leads to progressive reductions in friction and wear while the lumpy polymer transfer, formed at the beginning of sliding, increases both friction coefficient and wear. Two action mechanisms dominate the sliding process; adhesive and abrasive mechanisms. The presence of saline lubricant retards the formation of the beneficial polymer transfer thus leading to faster abrasion of the polymeric counterface which explains the relatively rapid and progressive increases in friction and wear.

Fate of cartilage material used in middle ear surgery light and electron microscopy study

OBJECTIVE

To evaluate the fate of autograft and homograft cartilage used in the middle ear.

METHOD

Animal experimental study was carried out on 20 healthy guinea pigs by implanting small pieces of auto- and homograft costal cartilage in the middle ears for different periods of time (1, 3 and 6 months). The grafts were removed and examined by light and electron microscopy. Cartilage autografts, obtained from seven human cases at revision tympanoplasty, were also examined by light and electron microscopy.

RESULTS

In the animal experimental study the chondrocytes were degenerated while the matrix was preserved in both auto- and homograft specimens. The homografts were as good as the autografts as in both cases the cartilage matrix was preserved. In the human specimens obtained after 10-15 months of implantation (six cases), the matrix was preserved, the lacunae were empty and the chondrocytes were degenerated. The specimen removed after 31/2 years (one case) showed viable chondrocytes of big size with defined cell organelles.

CONCLUSION

This work provides evidence for the beneficial role of cartilage in middle ear surgery as the matrix retained its structure. There is also a possibility for the chondrocytes to remain viable for a long time after implantation. It seems also that homograft cartilage is a good option during tympanoplasty and is comparable to autografts. In the animal study the homografts were as good as the autografts as in both cases cartilage matrix was preserved.

Günther vena caval filter: results of long-term follow-up

A Günther vena caval filter was implanted in the inferior vena cava in 59 patients to prevent pulmonary embolism. This newly available device, which can be inserted percutaneously via a 10-French introduction system, has three filtering planes. No complications occurred at the puncture site. Follow-up included clinical examinations (54 patients), plain radiographs (50 patients), and CT scans (41 patients); these examinations were performed up to 21 months after implantation. Caudal migration of the filter occurred in 35 (70%) of the 50 patients who had radiographs, but no cranial or oblique movement occurred. Occlusion of the filter was noted in three (7%) of 41 patients who had CT examinations. Thromboemboli were seen inside the filter in 16 (39%) of the 41 patients who had CT scans. Recurrent pulmonary embolism was not observed after filter implantation. The Günther vena caval filter seems to be a satisfactory device for preventing pulmonary embolism.

Recurarisation following a suxamethonium-alcuronium sequence in patients with atypical cholinesterase

Alcuronium 10 mg was administered to maintain muscle relaxation in two patients before recovery from suxamethonium neuromuscular blockade to facilitate tracheal intubation. This sequence resulted in a markedly prolonged block which could not be antagonised adequately by neostigmine 0.05 mg/kg; initial antagonism was followed rapidly by prolonged recurarisation. Estimation of plasma cholinesterase activity revealed that the two patients were homozygous for the atypical and silent genes. respectively.