Eman Mosad

Objective/Background: Chronic lymphocytic leukemia is one of the commonest leukemias affecting adults. CD39 inhibits T-cell and Natural killer (NK) cell responses by hydrolyzing adenosine triphosphate and adenosine diphosphate, suppressing the immune system. We investigated expression of CD39 on CD4+ T Lymphocytes in chronic lymphocytic leukemia (CLL) patients and its relationship with deletion 6q, its association with disease stage and survival. Methods: Thirty CLL patients and 20 matched controls were included in the study. Bone marrow studies with immunophenotyping, CD39, CD38, and ZAP-70, and detection of del 6q by FISH were performed. Results: CD39+ CD4+ T helper cells in CLL patients were significantly expressed compared with the controls ( p < .001). Levels of CD39+ CD4+ T cells were significantly expressed in high risk CLL patients. Del 6q was detected in 63.3% of patients and it correlated with CD39, CD38, and ZAP-70, and advanced stage disease. There was a significant relation between response to treatment and CD39 expression and del 6q, also there was a significant difference in overall survival (OS) between patients with and without Del 6q. Conclusion: CD39 expression on CD4+ Tcells and del 6q act as prognostic markers in CLL. Blocking or inhibition of CD39 may be a target for new immune therapy for CLL.

Background: The most common surgical procedure for breast cancer is the modified radical mastectomy (MRM), but it is associated with significant postoperative pain. Regional anesthesia can reduce the stress response associated with surgical trauma. Objectives: Our aim is to explore the efficacy of 1 mu g/kg dexmedetomedine added to an ultrasound (US)-modified pectoral (Pecs) block on postoperative pain and stress response in patients undergoing MRM. Study Design: A randomized, double-blind, prospective study. Setting: An academic medical center. Methods: Sixty patients with American Society of Anesthesiologists (ASA) physical status I-II (18-60 years old and weighing 50-90 kg) scheduled for MRM were enrolled and randomly assigned into 2 groups (30 in each) to receive a preoperative US Pecs block with 30 mL of 0.25% bupivacaine only (group 1, bupivacaine group [GB]) or 30 mL of 0.25% bupivacaine plus 1 mu g/kg dexmedetomidine (group II, dexmedetomidine group [GD]). The patients were followed-up 48 hours postoperatively for vital signs (heart rate [HR], noninvasive blood pressure [NIBP], respiratory rate [RR], and oxygen saturation [Sao2]), visual analog scale (VAS) scores, time to first request of rescue analgesia, total morphine consumption, and side effects. Serum levels of cortisol and prolactin were assessed at baseline and at 1 and 24 hours postoperatively. Results: A significant reduction in the intraoperative HR, systolic blood pressure (SBP), and diastolic blood pressure (DBP) starting at 30 minutes until 120 minutes in the GD group compared to the GB group (P < 0.05) was observed. The VAS scores showed a statistically significant reduction in the GD group compared to the GB group, which started immediately up until 12 hours postoperatively (P < 0.05). There was a delayed time to first request of analgesia in the GD group (25.4 +/- 16.4 hrs) compared to the GB group (17 +/- 12 hrs) (P = 0.029), and there was a significant decrease of the total amount of morphine consumption in the GD group (9 + 3.6 mg) compared to the GB group (12 + 3.6 mg) (P = 0.001). There was a significant reduction in the mean serum cortisol and prolactin levels at 1 and 24 hours postoperative in the GD patients compared to the GB patients (P < 0.05). Limitations: This study was limited by its sample size. Conclusion: The addition of 1 mu g/kg dexmedetomidine to an US-modified Pecs block has superior analgesia and more attenuation to stress hormone levels without serious side effects, compared to a regular Pecs block in patients who underwent MRM.

Background A correlation was detected between the chemokine CXC ligand 13 (CXCL13) and lupus nephritis, but there is no data recorded in the literature about a relationship with other disease manifestations in systemic lupus erythematosus (SLE). Therefore, we sought to investigate the relationship between CXCL13 and overall disease activity and other disease manifestations in SLE. Patients and Methods Fifty-seven SLE patients (51 female, 6 male) aged 18–60 years, fulfilling≥4 SLICC classification criteria for the classification of SLE, were enrolled in a cross-sectional study. Disease activity was scored using the SLE Disease Activity Index (SLEDAI) scoring system. The serological workup included routine lab investigations (full blood count, liver and kidney function tests, and urinalysis) as well as ESR, CRP, anti-ds DNA, C3, C4, 24-h urine protein, and creatinine clearance. Plasma CXCL13 levels were detected by ELISA. Results CXCL13 levels were elevated in active SLE patients. A significant positive correlation was found between the total score of SLEDAI and CXCL13 levels (r=0.547, p-value <0.0001). A statistically significant difference was found regarding the mean CXCL13 levels between the patient groups (classified according to SLEDAI score) (inactive <3, mild/moderate ≥3–12, severe ˃12) (p-value<0.001). The anti-ds DNA antibody titre showed a significant positive correlation with CXCL13 levels (r=0.335, p-value<0.05). The complement levels (C3, C4) showed a significant negative correlation with CXCL13 levels (p-value<0.001). Also there was a significant positive correlation between 24-h urine protein and urinary casts and CXCL13 levels (p-value<0.05). Conclusion Our study revealed elevated levels of serum CXCL13 in active SLE patients. We demonstrated a highly significant positive correlation between serum CXCL13 levels in active SLE patients and SLE disease activity, which supports the role of CXCL13 in the pathogenesis of SLE disease and its activity. Among the variants used in calculating the SLEDAI score, we detected significant relations between level of serum CXCL13 and each of total and extra-renal SLEDAI score. Hintergrund Eine Beziehung zwischen dem Chemokin-CXC-Liganden 13 (CXCL13) wurde festgestellt, um mit der Lupusnephritis zu korrelieren, aber es wurden keine Daten in der Literatur über ihre Beziehung mit anderen Krankheitsmanifestationen im systemischen Lupus erythematodes (SLE) aufgezeichnet. Deshalb haben wir versucht, die CXCL13-Relation mit der gesamten Krankheitsaktivität und ihrer Beziehung zu anderen Krankheitsmanifestationen in SLE zu untersuchen. Patienten und Methoden Fünfundfünfzig SLE-Patienten (51 weiblich, 6 männlich) im Alter von 18–60 Jahren, die≥4 SLICC-Klassifizierungskriterien für die Klassifizierung von SLE erfüllen, wurden in einer Querschnittsstudie eingeschrieben. Die Krankheit Aktivität wurde mit dem SLE-Krankheit Aktivität Index (SLEDAI) Scoring-System bewertet. Die serologische Aufarbeitung umfasste die Routine-Laboruntersuchungen (Vollblutbild, Leber- und Nierenfunktionstests und Urinanalyse) neben ESR, CRP, Anti-ds-DNA, C3, C4, 24 h-Protein im Urin und Kreatinin-Clearance. Die Plasma-CXCL13-Spiegel wurden durch ELISA nachgewiesen. Ergebnisse CXCL13-Werte wurden bei aktiven SLE-Patienten erhöht. Eine signifikante positive Korrelation zwischen der Gesamtpunktzahl der SLEDAI- und CXCL13-Werte (r=0,547, P-Wert<0,0001). Ein statistischer signifikanter Unterschied zu den mittleren CXCL13-Werten zwischen den Patientengruppen (klassifiziert nach SLEDAI-Score) (inaktiv<3, mild/mäßig ≥ 3–12, sever ˃12) (P-Wert<0,001). Der Anti-ds-DNA-Antikörper-Titer zeigte eine signifikante positive Korrelation mit den CXCL13-Werten (r=0,335, P-Wert<0,05). Die Komplement-Niveaus (C3, C4) zeigten eine signifikante negative Korrelation mit den CXCL13-Werten (P-Wert<0,001). Eine signifikante positive Korrelation zwischen Harn-24-Stunden-Protein und Harn-Casts und CXCL13-Konzentrationen (P-Wert<0,05). Schlussfolgerung Unsere Studie ergab eine erhöhte Serum-CumCL13 bei aktiven SLE-Patienten. Wir zeigten eine signifikante positive Korrelation zwischen den Serum-CXCL13-Werten bei aktiven SLE-Patienten und der SLE-Erkrankung, die die Rolle von CXCL13 bei der Pathogenese der SLE-Erkrankung und ihrer Aktivität unterstützt. Unter den Varianten, die bei der Berechnung der SLEDAI-Punktzahl verwendet wurden, wurden signifikante Beziehungen zwischen dem Serum CXCL13 und jedem der gesamten und extra-renalen SLEDAI-Score nachgewiesen.

The Child-Turcotte-Pugh score (CTP) is the standard tool for hepatic reserve assessment in hepatocellular carcinoma (HCC). Recently, we reported that integrating plasma insulin-like growth factor-1 (IGF-1) level into the CTP score was associated with better patient risk stratification in two U.S. independent cohorts. Our current study aimed to validate the IGF-CTP score in patients who have different demographics and risk factors. We prospectively recruited 100 Egyptian patients and calculated their IGF-CTP score compared to CTP score. C-index was used to compare the prognostic significance of the two scoring systems. Finally, we compared our results with our U.S. cohorts published data. IGF-CTP score showed significant better patient stratification compared to CTP score in the international validation cohort. Among CTP class A patients, who usually considered for active treatment and clinical trial enrollment, 32.5% were reclassified as IGF-CTP class B with significantly shorter OS than patients reclassified as class A with hazard ratio [HR] = 6.15, 95% confidence interval [CI] = 2.18-17.37. IGF-CTP score showed significantly better patient stratification and survival prediction not only in the U.S. population but also in international validation population, who had different demographics and HCC risk factors.

Summary: The hepatitis C virus (HCV) core protein is able to accumulate genetic p53 mutations and may be considered co‐oncogenic. This study investigates 1p36.3 telomere deletion in B‐non‐Hodgkin's lymphoma (NHL) patients with chronic HCV infection using fluorescence in situ hybridization (FISH) in relation to survival to assess Ki‐67 antigen expression. A study group and a control group of 100 patients with B‐NHL (50 HCV positive and 50 HCV negative) and 60 control bone marrow biopsies were subjected to FISH for the detection of 1P36.3 deletion and to immunohistochemical staining with Ki‐67 antigens. 1p36.3 deletion by FISH was detected in 40% of the study group, and Ki‐67 was expressed in approximately 74% of patients. A significant difference was found between positive and negative HCV patients in their overall survival, the qualitative expression of Ki‐67 and the quantitative detection of 1p36.3 deletion by FISH. The overall survival was shorter with the presence of an 1p36 deletion by FISH and HCV positive. We concluded that the coexistence of Ki‐67 positivity, HCV positivity and 1p36.3 deletion may contribute to infection‐related cancers at the 1p36.3 locus.

Carvedilol is a novel β-adrenoreceptor blocker, with antioxidant properties inhibiting lipid peroxidation and preventing the depletion of endogenous antioxidants. Moreover, carvedilol was reported to enhance the expression of Bcl-2 gene, which has antioxidant and antiapoptotic effects. There are few researches testing the protective effect of carvedilol on the development of diabetic cardiomyopathy and nephropathy. In this study, we induced diabetes mellitus in male Wistar albino rats. We investigated carvedilol, as well as vitamin E, administrated in healthy and diabetic rats for 6 weeks to compare their effects on biochemical parameters and the expression of Bcl-2 protein in both myocardial and renal tissues by immunohistochemistry. The study showed that the diabetic rats not only had renal dysfunction and more myocardial damage, but also showed lower expression of Bcl-2 protein. Carvedilol and vitamin E treatments were associated with better renal function and less myocardial damage, lower blood glucose, and lipid peroxidation, higher antioxidant capacity, better serum lipids, and higher expression of Bcl-2 protein in diabetic rats. These results indicate that carvedilol and vitamin E treatments partly protect against myocardial and renal damage probably via their antioxidant and antiapoptotic properties in diabetic rats.