Background: Advanced stage non-small cell lung cancer (NSCLC) is a heterogenous disease, yet, with the exception of
targeted therapies, most guidelines recommended uniform treatment irrespective of ...tumor burden or sites of metastases
and this may explain, in part, the wide range of responses to same lines of therapy. Aim of work: In this work we
tried to explore the effect of metastatic sites in on overall survival (OS), in an unselected group of Non-small cell lung
cancer patients who received different treatments line. Methods: A retrospective analysis was performed on patients
with stage IV NSCLC who received systemic treatment at UAB Cancer Center (NCI designated comprehensive cancer
center) between 2002 to 2012. The details of sites of metastases, systemic therapy and overall survival were recorded
for each patient. Result: In 409 patients who received systemic treatment, there was statistically significant lower OS
in those presenting with liver metastases (p<0.001), adrenal metastases (p=0.011) and metastases to abdominal lymph
nodes (p=0.014). There was no statistically significance difference in OS in patient presenting with pleural metastases
or effusion (p=0.908), metastases to heart or pericardium (p=0.654), metastases to bone (p=0.281), brain (p=0.717) or
skin and subcutaneous tissue (p=0.642). Conclusion: Intra-abdominal metastases confer a particularly poor prognosis
in stage IV NSCLC treated with systemic therapy and may identify patients in whom aggressive treatment beyond first
line therapy is not appropriate.
Background
It is known that nursing home patients who have sustained a previous fall are at a higher average risk for recurrent falls. Therefore, these patients require closer attention and ...monitoring for fall prevention.
Methods
We conducted a retrospective review in our Level 1 Trauma Center, who sustained a ground‐level fall in a nursing home from January 2017 to December 2018. Inclusion criteria involved patients aged 65 or older, admitted from nursing homes. Logistic regression analysis was performed to identify factors associated with recurrent fall.
Results
A total of 445 patients were identified. Among them, 47 (10.6%) patients sustained recurrent falls, The median age was 83.3 years old and. The recurrent fall group was more likely to have chronic kidney disease (CKD) (27.1% vs. 13.1%, p = 0.02) and diabetes (47.9% vs. 31%, p = 0.02). The median number of medications taken by a patient was 8.78. Overall, 176 (39.5%) patients sustained any injury, and 25 (5.6%) patients died within the study period. The presence of CKD (odds ratio OR, 2.34; 95% confidence interval CI, 1.15–4.76, p = 0.02) and polypharmacy (number of medications of 9 or above) (OR, 2.07; 95% CI, 1.12–3.82, p = 0.02) were independent risk factors for recurrent falls.
Conclusions
CKD and polypharmacy were associated with a risk of recurrent falls among nursing home patients. The incidence of falls has a multifactorial etiology, and it is important to identify such risk factors to better prevent the morbidities and mortalities associated with fall‐related injuries.
Key points
Chronic kidney disease (CKD) and polypharmacy are associated with an increased risk of recurrent falls among nursing home patients.
Understanding whether CKD is independently associated with falls in nursing homes could help identify those residents who maintain a higher risk for falls despite management of traditional fall risk factors and in whom management of CKD‐specific fall risk factors may be particularly important for fall prevention.
This data will help establish the clinical need to implement standardized protocols for those nursing home patients previously hospitalized for falls to prevent recurrence and subsequent injury, including patient/family education and medical chart designation of high‐risk fall status.
The research investigates the effectiveness of a ground improvement technique that involves the electro-cementation of an onshore calcareous sand containing 95.3% calcium carbonate through a series ...of laboratory experiments. Colloidal silica (CS) nanoparticles and alumina powder were introduced as pozzolanic materials in the sand, and a direct current (DC) was passed through the sand-silica-alumina mix inside an electrokinetic (EK) cell. The method resulted in the electro-cementation of the calcareous sand through the formation of calcium silicate hydrates (C–S–Hs) and calcium aluminate hydrates (C–A–Hs) as products of the pozzolanic reactions between Ca(OH)
2
, SiO
2
and Al
2
O
3
after electrolysis occurred. Iron-rich cements were also formed by the degradation of anodes. These newly formed compounds changed the nature of the treated soil from a granular material into a rock. Results show that the compressive strength of the resulting rock formation is significantly improved. The treatment can be considered as an artificial lithification process through which the nature of the treated soil was changed from a granular material into a rock formation. The electro-cementation achieved by the treatment was further assessed by spectroscopic analyses including FE-SEM, EDX and XRD, which confirmed the formation of cementing agents within the structure of the treated sand. Potential applications of the technique include caissons, highway construction projects, dune fixation and erosion control, in addition to liquefaction mitigation due to electrolysis of pore water and plugging the pores with cementitious materials.
Swallowwort (
Cynanchum acutum
L., family Asclepiadaceae) is a perennial invasive species of profound medicinal potentiality. The spread of
C. acutum
in diverse habitats differing in water status and ...extent of salinity might point to appreciable resistance of the plant to drought and salt stress. The response of
C. acutum
to water stress under controlled nutrient supply on sand culture was investigated to assess the effect of water status of the soil on plant use efficiency of water and nutrients. Plants were subjected to water regime (% field capacity) of: 100, 35, 25, 12.5 and 5 for 10 days in a greenhouse. Whereas plant fresh weight was reduced under the impact of water stress, dry weight exhibited its maximum under moderate drought and this was associated with the allocation of greater proportions of plant biomass to root and stem at the expense of leaves. The increase in photosynthetic pigments of stressed plants is related to the drought-induced P deprivation. The rates of photosynthesis and transpiration and the stomatal conductance were progressively inhibited under drought stress; but sub-stomatal CO
2
concentration showed a minimum at 12.5% field capacity. Soluble sugars and starch were deprived whereas proline was accumulated in the leaves under drought stress. Drought stress affected the uptake and partitioning of minerals within the plant and increased use efficiency of water and minerals, particularly P.
Breast cancer (BC) is a heterogenous disease with multiple pathways implicated in its development, progression, and drug resistance. Autophagy, a cellular process responsible for self-digestion of ...damaged organelles, had been recognized as eminent player in cancer progression and chemotherapeutic resistance. The haploinsufficiency of Beclin 1 (BECN1), autophagy protein, is believed to contribute to cancer pathogenesis and progression. In our study, we investigated the expression of BECN1 in a BC female Egyptian patient cohort, as well as its prognostic role through evaluating its association with disease free survival (DFS) after 2 years follow up and association of tumor clinicopathological features. Twenty frozen female BC tissue samples and 17 adjacent normal tissue were included and examined for the expression levels of BECN1. Although the tumor tissues showed lower expression 0.73 (0–8.95) than their corresponding normal tissues 1.02 (0.04–19.59), it was not statistically significant, p: 0.463. BECN1 expression was not associated with stage, nodal metastasis or tumor size, p:0.435, 0.541, 0.296, respectively. However, statistically significant negative correlation was found between grade and BECN1 mRNA expression in the studied cases, p:0.028. BECN1 expression had no statistically significant association with DFS,
P
= 0.944. However, we observed that triple negative (TNBC) cases had significantly lower DFS rate than luminal BC patients, p: 0.022, with mean DFS 19.0 months, while luminal BC patients had mean DFS of 23.41 months. Our study highlights the potential role of BECN1 in BC pathogenesis, showing that BECN1 expression correlates with poorer differentiation of BC, indicating its probable link with disease aggressiveness. DFS two years follow up showed that TNBC subtype remains associated with less favorable prognosis.
Despite national programs covering the cost of treatment for tuberculosis (TB) in many countries, TB patients still face substantial costs. The end TB strategy, set by the World Health Organization ...(WHO), calls for "zero" TB households to be affected by catastrophic payments by 2025. This study aimed to measure the catastrophic healthcare payments among TB patients in Egypt, to determine its cost drivers and determinants and to describe the coping strategies. The study utilized an Arabic-validated version of the TB cost tool developed by the WHO for estimating catastrophic healthcare expenditure using the cluster-based sample survey with stratification in seven administrative regions in Alexandria. TB payments were considered catastrophic if the total cost exceeded 20% of the household's annual income. A total of 276 patients were interviewed: 76.4% were males, 50.0% were in the age group 18-35, and 8.3% had multidrug-resistant TB. Using the human capital approach, 17.0% of households encountered catastrophic costs compared to 59.1% when using the output approach. The cost calculation was carried out using the Egyptian pound converted to the United States dollars based on 2021 currency values. Total TB cost was United States dollars (USD) 280.28 ± 29.9 with a total direct cost of USD 103 ± 10.9 and a total indirect cost of USD 194.15 ± 25.5. The direct medical cost was the main cost driver in the pre-diagnosis period (USD 150.23 ± 26.89 pre diagnosis compared to USD 77.25 ± 9.91 post diagnosis,
= 0.013). The indirect costs (costs due to lost productivity) were the main cost driver in the post-diagnosis period (USD 4.68 ± 1.18 pre diagnosis compared to USD 192.84 ± 25.32 post diagnosis,
< 0.001). The households drew on multiple financial strategies to cope with TB costs where 66.7% borrowed and 25.4% sold household property. About two-thirds lost their jobs and another two-thirds lowered their food intake. Being female, delay in diagnosis and being in the intensive phase were significant predictors of catastrophic payment. Catastrophic costs were high among TB households in Alexandria and showed wide variation according to the method used for indirect cost estimation. The main cost driver before diagnosis was the direct medical costs, while it was the indirect costs, post diagnosis.
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•Novel fourteen iodoquinazoline derivatives were designed and synthesized.•In vitro cytotoxic activities were evaluated against five human cell lines HCT-116, MCF-7, HepG2, A549 and ...VERO normal cells.•In vitro VEGFR-2 and EGFRT790M kinase assays were carried out for all compounds.•In silico Molecular docking and ADMET studies were carried out for the most potent compounds 13e, 13d and 7c.
Herein, we report the synthesis of a series of new fourteen iodoquinazoline derivatives 7a-c to 13a-e and their evaluation as potential anticancer agents via dual targeting of EGFRT790M and VEGFR-2. The new derivatives were designed according to the target receptors structural requirements. The compounds were evaluated for their cytotoxicity against HepG2, MCF-7, HCT116 and A549 cancer cell lines using MTT assay. Compound 13e showed the highest anticancer activities with IC50 = 5.70, 7.15, 5.76 and 6.50 µM against HepG2, MCF-7, HCT116 and A549 cell lines correspondingly. Compounds 7c, 9b and 13a-d exhibited very good anticancer effects against the tested cancer cell lines. The highly effective six derivatives 7c, 10, 13b, 13c, 13d and 13e were examined against VERO normal cell lines to estimate their cytotoxic capabilities. Our conclusion revealed that compounds 7c, 10, 13b, 13c, 13d and 13e possessed low toxicity against VERO normal cells with IC50 prolonging from 41.66 to 53.99 μM. Also compounds 7a-c to 13a-e were further evaluated for their inhibitory activity against EGFRT790M and VEGFR-2. Also, their ability to bind with both EGFR and VEGFR-2 receptors was examined by molecular modeling. Compounds 13e, 13d, 7c and 13c excellently inhibited VEGFR-2 activity with IC50 = 0.90, 1.00, 1.25 and 1.50 µM respectively. Moreover, Compounds 13e, 7c, 10 and 13d excellently inhibited EGFRT790M activity with IC50 = 0.30, 0.35, 0.45 and 0.47 µM respectively. Finally, our derivatives 7b, 13d and 13e showed good in silico calculated ADMET profile.
Context The need for competent surgeons to provide high-quality surgical interventions is crucial. The challenge of worsening the outcome has a great negative impact on the rate of training, ...especially in complex or long-duration procedures. Custodiol cardioplegia is an attractive solution for many cardiac surgeons, as a single dose provides a long period of myocardial protection.
Aims We aimed to evaluate the benefit of custodiol cardioplegia in comparison with the conventional one in supporting training programs.
Settings and design A retrospective study was conducted in the period from March 2016 to January 2021. The study included 240 adult patients who underwent open-heart surgeries and required cardioplegia and cardiopulmonary bypass.
Patients and methods Patients were divided into two groups: group A (120 patients) received conventional cardioplegia. Group B (120 patients) received custodial cardioplegia.
Statistical analysis used The patient's data were analyzed using the Statistical Package for Social Sciences (SPSS), version 21 for Windows (SPSS Inc., Chicago, Illinois, USA). Comparison between groups was done by χ2 test. Quantitative data were presented as mean±SD. Qualitative data were presented as numbers and percentages. Student t test and χ2 test were used to compare between two groups. A P value less than 0.05 was considered statistically significant.
Results The preoperative patient characteristics were comparable among both groups regarding the demographic data, the comorbidities, and cardiac parameters. There was a significant difference between both groups in cross-clamp (133.35 vs. 124.81 min) and total bypass (162.41 vs. 154.7 min) times (P<0.001). The mechanical ventilation, intensive care, and hospital stay times were significantly prolonged in the conventional group (P<0.05). The 30-day mortality was lower in the custodial group but was not significant (P=0.207).
Conclusion The use of custodiol is more effective than cold cardioplegia in protecting the myocardium and thus supporting training programs.
This study investigated the role of KATP channels in morphine‐induced antinociception and hepatic oxidative stress in acute and inflammatory pain. The KATP channel modulators (KATP channel opener, ...diazoxide 100 mg/kg, p.o, and KATP channel blocker, glibenclamide, 3 mg/kg i.p.) were administered with morphine (80 mg/kg, i.p.). Antinociception was assessed by the tail‐flick and formalin tests in rats and measured by the area under the curve values and the maximum percent effect for 3 h. The indices of hepatic oxidative stress: glutathione, glutathione peroxidase, and malondialdehyde were then determined in the liver homogenates obtained from the treated animals. In both tests, glibenclamide antagonized morphine‐induced antinociception, whereas diazoxide augmented it in the tail‐flick test only. In the formalin test, glibenclamide alone has a significant hyperalgesic effect, whereas diazoxide decreased the number of flinches. Coadministration of glibenclamide with morphine antagonized the hepatotoxic effect of morphine in both animal models. In the tail‐flick test, glibenclamide administered alone significantly increased malondialdehyde's level. Coadministration of diazoxide with morphine increased glutathione level in the formalin test. Diazoxide administered alone exacerbated the hepatic oxidative stress in both animal models. These findings suggest a role of KATP channel modulators on morphine‐induced antinociception and hepatic oxidative stress. The administration of glibenclamide may prevent morphine‐induced hepatotoxicity. The effectiveness of diazoxide in the management of pain is limited due to its deleterious effect on the liver. However, the interaction of the KATP channel modulators with morphine depends on the differential sensitivity to the pain stimulus.
