In radiotherapy treatment couches, rigid carbon fiber couch inserts reduce set-up errors caused by couch sagging. These inserts have been described in several studies as radio-translucent with negligible radiation field attenuation. The majority of these tests were carried out with the radiation field normally incident on the center of the couch, and there appears to be no evidence in the literature of the effect of the thickest region (edge of the couch) on the attenuation and dose distribution during external beam radiotherapy. In this study, we evaluated and improved the calculated dose attenuation for the under-couch fields to reduce the skin surface dose. Using the difference between the measured and calculated attenuation doses obtained using the ion chamber and the “TPS” treatment planning system; an algorithm that identifies the influence of couch attenuation on patient dose verification. According to our results, the attenuation is affected by the gantry angle, where the maximum attenuation was at 180°, the angle at which the couch attenuates the 6 MV photon beam by 9.3 % for 10×10 cm2 field sizes, while the attenuation at 1600 and 1400 was less where the lowest attenuation recorded at 1400 at which angle the couch attenuated the 6 MV photon beam by 2.4. It would appear, therefore, that Connexion central opening couch with posterior beams results in significant decreases in the dose delivered to the target. The measured data were compared to the calculated values from the Monaco Treatment Planning System, and computed using the Monte Carlo (MC) and Collapsed Cone (CC) algorithms. The most minor agreement was observed at an angle of 1800 between the calculated and the measured attenuation for the 5 x 5 cm² field size with 6 MV and 10 MV photon beam energy where the difference was 5.3 % and 4 % for the MC and CC algorithm, respectively. Excellent agreement was observed at an angle of 160 between calculated and measured attenuation with the field sizes of 10 x 10 cm² for 6 MV, in which the difference (lose dose) was ±1.5 %.

Background: An impaired immune system in the perioperative period has important clinical implications in patients with cancer. Despite the immunosuppressive properties of opioid therapy, it is still commonly utilized in the intrathecal or epidural space for the treatment of postoperative pain. Also, intrathecal dexmedetomidine has extended analgesic efficacy in postoperative pain; it can significantly affect immune function in perioperative patients.

Objective: To investigate the effect of intrathecal morphine, dexmedetomidine, or both in combination with bupivacaine on cellular immunity and cytokine production in cancer surgical patients.

Study Design: A prospective randomized clinical study.

Setting: South Egypt Cancer Institute, Assiut University.

Methods: Ninety patients were randomly assigned to receive intrathecal morphine 0.5 mg (Group M, n= 30), dexmedetomidine 0.5 µg/kg (Group D, n= 30) or morphine 0.5 mg with dexmedetomidine 0.5 µg/kg (Group MD n= 30); 2 mL bupivacaine 0.5% was added to injected drugs in all groups. Blood samples were collected preoperative (T0), immediate postoperative (T1), 4 hours postoperative (T2), and 24 hours postoperative (T3) for measurement of CD3, CD4, CD4/CD8 and CD16+ 56 (NK), interleukin (IL)-1beta (IL-1β), IL-6, IL-10 and tumor necrosis factor alpha (TNF-α).

Results: A significant reduction in cellular immunity (CD3, CD4, CD8, CD4/CD8, CD 16+ 56) was noticed in the 24-hour postoperative period in all 3 studied groups, with a marked reduction in Group M in comparison to Group MD and Group D. Regarding inflammatory mediators, IL-10 and IL-1β showed significant reduction in Group M in …

The objective was to compare analgesic effect of combined epidural morphine-midazolam with either drug alone on postoperative pain in patients undergoing major abdominal cancer surgery.

Materials and Methods:

Eighty-four patients were allocated in prospective randomized double-blind study to receive epidural analgesia. Patients received 5 mg morphine in morphine (Mor) group, 5 mg midazolam in midazolam (Mid) group, 5 mg morphine+ 5 mg midazolam in morphine-midazolam (MM) group, 0.25% bupivacaine was added to injected solution with same volume in all groups. All groups were compared with time of first analgesic request, total analgesic consumption, number of epidural doses, postoperative Visual Analog Scale score, and adverse events.

Immune thrombocytopenia (ITP) is an acquired autoimmune disease. This study’s objective was to estimate the variations in the population of CD4⁺CD25^+High FoxP3⁺ cells (CD4⁺ regulatory T-lymphocytes; Tregs) in previously untreated children with chronic ITP managed in Assiut University Hospitals, as well as to evaluate the efficacy of high-dose dexamethasone (HD-DXM) in these patients.

Methods

In this study, we investigated the frequencies of T-lymphocyte subsets in 27 untreated children with chronic ITP.

Results

Prior to treatment, the percentages of CD4⁺CD25^High cells and Tregs were significantly lower in the chronic ITP group compared to the control group (p = 0.018 and p < 0.0001, respectively). After treatment with HD-DXM, Tregs and platelets were significantly increased in these patients (p < 0.0001 for both).

Conclusions

Our results suggest that Tregs are deficient in children with

Invasive fungal infections (IFIs) are important cause of mortality in acute myeloid leukemia (AML) patients on treatment with intensive induction chemotherapy. Toll-like receptors, mainly Toll-like receptors 2 and 4 (TLR2 and TLR4), play a considerable role in the host defense against microorganisms. The involvement of TLR signaling in modulation of innate immune response is extensively discussed, but the TLR expressions profiling on adaptive immune cells are not specified. Also, the expressions of TLRs and their association with the occurrence of IFIs in patients with AML are not studied. So, the novel aim of this study was to investigate the associations between the T-lymphocyte expression of TLR2 and TLR4 and the occurrence of IFIs in AML patients treated with intensive induction chemotherapy.

We aimed to determine the levels of follicular helper T (Tfh) and follicular regulatory T (Tfr) cells in COVID-19 patients and determine whether their levels correlated with disease severity and presence of hyperglycemia. This study was carried out in 34 hospitalized COVID-19 patients and 20 healthy controls. Levels of total circulating Tfh, inducible T-cell costimulator (ICOS)+ activated Tfh, and Tfr cells were assessed in all participants by flow cytometry. Total CD4+CXCR5+ Tfh cells and ICOS+Foxp3-activated Tfh cells increased and ICOS+Foxp3+ Tfr cells decreased in COVID-19 patients, especially in diabetic patients and those with severe disease. Activated ICOS+ Tfh cells were directly correlated with lactate dehydrogenase, D-dimer, ferritin, and respiratory rate and inversely correlated with the partial pressure of carbon dioxide. COVID-19 is associated with marked activation of Tfh cells and a profound drop in Tfr …

Background and aim

Growing evidence highlighted the primary role of the immune system in the disease course of triple-negative breast cancer (TNBC). The study aim was to investigate the expression of PD-1 and CD39 on CD4⁺ and CD8⁺ cells infiltrating tumor tissue compared to their counterparts in peripheral blood and explore its association with tumor characteristics, disease progression, and prognosis in females with TNBC.

Patients and methods

The study included 30 TNBC patients and 20 healthy controls. Cancer and normal breast tissue and peripheral blood samples were collected for evaluation of the expression of PD-1 and CD39 on CD4⁺ and CD8⁺T cells by flow cytometry.

Results

A marked reduction in the percentage of CD8⁺ T lymphocytes and a significant increase in the frequencies of CD4⁺ T lymphocytes and CD4⁺ and CD8⁺ T lymphocytes expressing PD1 and CD39 were evident in tumor tissue in comparison with the normal breast tissue. The DFS was inversely related to the cancer tissue PD1⁺CD8⁺ and CD39⁺CD8⁺ T lymphocytes. Almost all studied cells were significantly increased in the tumor tissue than in peripheral blood. Positive correlations were detected among peripheral PD1⁺CD4⁺T lymphocytes and each of cancer tissue PD1⁺CD4⁺, PD1⁺CD8⁺and CD39⁺CD8⁺T cells, and among peripheral and cancer tissue CD39⁺CD4⁺and CD39⁺CD8⁺ T cells.

Conclusions

The CD39 and PD1 inhibitory pathways are synergistically utilized by TNBC cells to evade host immune response causing poor survival. Hence, combinational immunotherapy blocking these pathways might be a promising treatment strategy in …

CD45 is a transmembrane glycoprotein and protein tyrosine phosphatase expressed on the surface of all nucleated hematopoietic cells. While there is increasing evidence demonstrating the involvement of CD45 in immune system regulation, no information on CD45 expression in inflammation and sepsis is currently available. Therefore, we determined the CD45 surface expression on granulocytes, lymphocytes, and monocytes in patients with COVID-19 and healthy volunteers in both absence and presence of lipopolysaccharide (LPS). Following approval by the local ethics committee, whole blood samples were obtained from patients with COVID-19 infection on day 1 of hospital admission and healthy volunteers. Samples were incubated in absence and presence of LPS and CD45 was measured in granulocytes, lymphocytes, and monocytes using flow cytometry. In comparison with healthy individuals, COVID-19 patients showed an increased CD45 expression on the surface of granulocytes (+35%, p < 0.02) and lymphocytes (+39%, p < 0.0001), but a reduced CD45 expression on monocytes (−35%, p < 0.0001). LPS incubation of whole blood from healthy individuals increased the CD45 expression on granulocytes (+430%, p < 0.0001), lymphocytes (+32%, p = 0.0012), and monocytes (+36%, p = 0.0005), respectively. LPS incubation of whole blood samples from COVID-19 patients increased the CD45 expression on granulocytes and monocytes, and decreased the CD45 expression on lymphocytes. In conclusion, CD45 expression on leucocytes is altered: (1) in COVID-19 patients, and (2) in in vitro endotoxemia in a complex cell-specific