INTRODUCTION: Monocytes are the cells that play a crucial role in the pathogenesis of liver damage and liver cirrhosis (LC), and as platelets, by connecting hemostasis and inflammatory processes, participate in pathogenesis of chronic liver diseases, we aimed to investigate the presence of monocyte-platelet aggregates and platelet micro-particles (PMPs) and their role in LC. PATIENTS AND METHODS: The study included 60 patients with post-hepatitic LC and 20 healthy controls. Activated monocytes (CD11b, HLA-DR, CD14, CD16), monocyte-platelet aggregates (CD41/CD14), activated platelets (CD41/CD62) and PMPs were analyzed by flow cytometry. Their relations to the clinical and laboratory data were assessed in the studied group. RESULTS: Patients with LC had higher levels of activated platelets, activated monocytes and monocyte-platelet aggregations as compared to healthy controls. PMPs percentage showed no significant differences between patients and controls but significantly increased in both patients with no bleeding and patients with splenomegaly compared to patients without. All studied markers showed no significant differences between patients with thrombocytopenia and those with normal platelet counts and also between patients with different disease stages. Positive correlations between monocyte-platelet aggregates and both activated platelets and monocytes were demonstrated. There were significant negative correlations between PMPs and both age and prothrombin time among patients. CONCLUSIONS: The stage of post-hepatitic LC is not the only factor that affects the level of activated platelets, activated monocytes and monocyte-platelet aggregates. PMPs have no influence on thrombocytopenia but may have the potential to influence the progression of clotting activity in LC. Copyright (c) 2009 Elsevier Ltd. All rights reserved.

INTRODUCTION: Monocytes are the cells that play a crucial role in the pathogenesis of liver damage and liver cirrhosis (LC), and as platelets, by connecting hemostasis and inflammatory processes, participate in pathogenesis of chronic liver diseases, we aimed to investigate the presence of monocyte-platelet aggregates and platelet micro-particles (PMPs) and their role in LC. PATIENTS AND METHODS: The study included 60 patients with post-hepatitic LC and 20 healthy controls. Activated monocytes (CD11b, HLA-DR, CD14, CD16), monocyte-platelet aggregates (CD41/CD14), activated platelets (CD41/CD62) and PMPs were analyzed by flow cytometry. Their relations to the clinical and laboratory data were assessed in the studied group. RESULTS: Patients with LC had higher levels of activated platelets, activated monocytes and monocyte-platelet aggregations as compared to healthy controls. PMPs percentage showed no significant differences between patients and controls but significantly increased in both patients with no bleeding and patients with splenomegaly compared to patients without. All studied markers showed no significant differences between patients with thrombocytopenia and those with normal platelet counts and also between patients with different disease stages. Positive correlations between monocyte-platelet aggregates and both activated platelets and monocytes were demonstrated. There were significant negative correlations between PMPs and both age and prothrombin time among patients. CONCLUSIONS: The stage of post-hepatitic LC is not the only factor that affects the level of activated platelets, activated monocytes and monocyte-platelet aggregates. PMPs have no influence on thrombocytopenia but may have the potential to influence the progression of clotting activity in LC. Copyright (c) 2009 Elsevier Ltd. All rights reserved.

BACKGROUND: Despite of the proof of the biological function of CD154 on platelets, there has been little information about its role either in patients with stable angina or in those with acute coronary syndrome (ACS). OBJECTIVE: This study aimed to investigate the expression of CD154 on platelets and its role in ACS. METHODS: The study included 50 patients with ACS (24 patients with acute myocardial infarction (AMI) and 26 patients with unstable angina (UA)), 20 patients with stable angina (SA) and 18 healthy volunteers. CD154 and CD62 expression on platelets were analyzed by flow cytometry. Their relations to the clinical and laboratory data were assessed in the studied group. RESULTS: Patients with AMI and UA had higher levels of platelets CD154 and CD62 as compared to those with SA and among patients with AMI, UA and SA versus healthy volunteers. Platelets CD154 showed significant positive correlations with the studied pro-inflammatory markers (Ox-LDL, CRP and fibrinogen), segmental wall motion score and the studied risk factors. There were significant negative correlations between platelet CD154 and serum nitric oxide among patients. CONCLUSIONS: CD154 may be used as a marker of thrombo-embolic events. Nitric oxide may have an anti-atherogenic effect. There is an association between platelet activation and severity of coronary artery disease among patients with ACS.

Cytokines play important roles in the growth and growth arrest of cancer cells. IL-13 via an IL-4R alpha/IL-13R alpha 1 heterocomplex receptor inhibits the growth of renal cell carcinoma cells (RCC). However, it does not inhibit the growth of glioblastoma cells that express the IL-13R alpha 2 chain. In the present studies we investigated whether melanoma cells express IL-13R alpha 1 and IL-13R alpha 2 chains as well as whether they respond to IL-13. Membrane IL13R alpha 2 was co-expressed with IL-4R alpha and IL-13R alpha 1 chains in three of six tested melanoma cell lines. Furthermore, the IL-13R alpha 2 positive cell lines, release a soluble form of IL-13R alpha 2, specifically under IL-13 but not IL-4 stimulation. The release of soluble IL-13R alpha 2 was inhibited by various metalloproteinase inhibitors and EDTA inhibits the biological response to IL-13

Cytokines play important roles in the growth and growth arrest of cancer cells. IL-13 via an IL-4R alpha/IL-13R alpha 1 heterocomplex receptor inhibits the growth of renal cell carcinoma cells (RCC). However, it does not inhibit the growth of glioblastoma cells that express the IL-13R alpha 2 chain. In the present studies we investigated whether melanoma cells express IL-13R alpha 1 and IL-13R alpha 2 chains as well as whether they respond to IL-13. Membrane IL13R alpha 2 was co-expressed with IL-4R alpha and IL-13R alpha 1 chains in three of six tested melanoma cell lines. Furthermore, the IL-13R alpha 2 positive cell lines, release a soluble form of IL-13R alpha 2, specifically under IL-13 but not IL-4 stimulation. The release of soluble IL-13R alpha 2 was inhibited by various metalloproteinase inhibitors and EDTA inhibits the biological response to IL-13

Egypt is one of the countries with very high rates of hepatitis C virus (HCV) related morbidity and mortality. However, little is known about geographical and clinical differences in genetic variability of HCV in Egypt. Using direct sequencing and phylogenetic analysis of partial core/E1 and NS5B regions of the HCV genome, HCV genotype/subtype was determined in 129 HCV-infected patients residing in three governates in south Egypt: Assuit, Sohag, and Qena. According to clinical stage of infection, patients were categorized into four groups: asymptomatic carriers, n = 16; chronic hepatitis C patients, n = 36; liver cirrhosis, n = 54; and hepatocellular carcinoma (HCC), n = 23. Genotype 4a was detected in 80.6%, whereas 1g, 4l, 4n, 4o, 4f, and 4m were identified in 7.7%, 4.7%, 3.9%, 1.6%, 0.8%, and 0.8% of cases, respectively. The prevalence of 4a differed regionally; from 88.5% (in Sohag) to 64% (in Assuit, P = 0.002). Genotypes 4l and 4n had a higher prevalence in Assuit (12.8%, 10.3%) than Sohag (0%, 0%; P or = 0.011). Difference in clinical features of determined genotypes/subtypes was observed; more carriers of non-4a variants (4l and 4n, 4f, or 4m) had chronic hepatitis compared to carriers of 4a (53.3% vs. 23.1%, P = 0.025), while more patients with 4a had liver cirrhosis (45.2% vs. 13.3%, P = 0.023). Two HCV-4o strains were isolated in this study, both from patients with HCC. In conclusion, geographical diversity of HCV was revealed in this study in southern Egypt. A further case-control study is required to confirm the trends of differential pathogenicity of HCV subtypes, indicated by this study.

Background: Caudal analgesia has been prolonged by the addition of various adjuvants. Dexmedetomidine is a highly selective α2agonist with sedative and analgesic properties. Objective: To investigate the effect of addition of dexmedetomidine to 0.25% bupivacaine for caudal analgesia in children undergoing major abdominal cancer surgery. Study Design: A randomized double-blind trial. Setting: Academic medical center. Methods: Forty pediatric patients, aged 3 – 12 years, weighting 10 – 40 kg, and of American Society of Anesthesiologists (ASA) physical status I and II scheduled for major abdominal cancer surgeries under general anesthesia combined with caudal analgesia were enrolled. They were randomly allocated into 2 groups: Group I (BD): (n = 20) received 1 mL/kg bupivacaine 0.25% with dexmedetomidine 1 μg/kg and group II (B): (n = 20) received 1 mL/kg bupivacaine 0.25%. Heart rate (HR), mean arterial pressure (MAP), and oxygen saturation (SPO2) were recorded for 120 minutes. Pain was assessed immediately postoperative and at hours 2, 4, 6, 12, 18, and 24 of postoperative period by Face, Legs, Activity, Cry and Consolability (FLACC) score. Time to first request for analgesia and total analgesic consumption [Intravenous acetaminophen 15mg/kg (perfalgan, Squibb)] in the first 24 hours were recorded. The level of sedation was recorded using Ramsay’s sedation scale. Adverse effects were recorded and treated. Results: There was significant reduction in FLACC score in group BD at 2, 4, 6, and 12 hours postoperatively compared to group B. At the eighteenth and twenty-fourth hour there was no significant difference. Time of the first rescue analgesic requirement was significantly prolonged in group BD compared to group B. The mean total consumption of rescue analgesia in the 24 hours of the postoperative period was significantly decreased in group BD (405.00 ± 215.03) mg when compared with group B (810.35 ± 200.93) mg. Limitations: This study is limited by its small sample size. Conclusion: Addition of dexmedetomidine (1 μg/kg) to caudal bupivacaine 0.25% (1 mL/kg) in pediatric major abdominal cancer surgeries achieved significant postoperative pain relief for up to 19 hours, with less use of postoperative analgesics, and prolonged duration of arousable sedation. Hemodynamic changes were statistically significant, yet of no clinical significance.

Background: Caudal analgesia has been prolonged by the addition of various adjuvants. Dexmedetomidine is a highly selective α2agonist with sedative and analgesic properties. Objective: To investigate the effect of addition of dexmedetomidine to 0.25% bupivacaine for caudal analgesia in children undergoing major abdominal cancer surgery. Study Design: A randomized double-blind trial. Setting: Academic medical center. Methods: Forty pediatric patients, aged 3 – 12 years, weighting 10 – 40 kg, and of American Society of Anesthesiologists (ASA) physical status I and II scheduled for major abdominal cancer surgeries under general anesthesia combined with caudal analgesia were enrolled. They were randomly allocated into 2 groups: Group I (BD): (n = 20) received 1 mL/kg bupivacaine 0.25% with dexmedetomidine 1 μg/kg and group II (B): (n = 20) received 1 mL/kg bupivacaine 0.25%. Heart rate (HR), mean arterial pressure (MAP), and oxygen saturation (SPO2) were recorded for 120 minutes. Pain was assessed immediately postoperative and at hours 2, 4, 6, 12, 18, and 24 of postoperative period by Face, Legs, Activity, Cry and Consolability (FLACC) score. Time to first request for analgesia and total analgesic consumption [Intravenous acetaminophen 15mg/kg (perfalgan, Squibb)] in the first 24 hours were recorded. The level of sedation was recorded using Ramsay’s sedation scale. Adverse effects were recorded and treated. Results: There was significant reduction in FLACC score in group BD at 2, 4, 6, and 12 hours postoperatively compared to group B. At the eighteenth and twenty-fourth hour there was no significant difference. Time of the first rescue analgesic requirement was significantly prolonged in group BD compared to group B. The mean total consumption of rescue analgesia in the 24 hours of the postoperative period was significantly decreased in group BD (405.00 ± 215.03) mg when compared with group B (810.35 ± 200.93) mg. Limitations: This study is limited by its small sample size. Conclusion: Addition of dexmedetomidine (1 μg/kg) to caudal bupivacaine 0.25% (1 mL/kg) in pediatric major abdominal cancer surgeries achieved significant postoperative pain relief for up to 19 hours, with less use of postoperative analgesics, and prolonged duration of arousable sedation. Hemodynamic changes were statistically significant, yet of no clinical significance.

Background The optimal time sequences for chemotherapy and radiation therapy after breast surgery for patients with breast cancer remains unknown. Most of published studies were done for early breast cancer patients. However, in Egypt advanced stages were the common presentation. This retrospective analysis aimed to assess the optimum sequence for our population. Methods 267 eligible patients planned to receive adjuvant chemotherapy [FAC] and radiotherapy. Majority of patients (87.6%) underwent modified radical mastectomy while, 12.4% had conservative surgery. We divided the patients into 3 groups according to the sequence of chemotherapy and radiotherapy. Sixty-seven patients (25.1%) received postoperative radiotherapy before chemotherapy [group A]. One hundred and fifty patients (56.2%) were treated in a sandwich scheme (group B), which means that 3 chemotherapy cycles were given prior to radiotherapy followed by 3 further chemotherapy cycles. A group of 50 patients (18.7%) was treated sequentially (group C), which means that radiotherapy was supplied after finishing the last chemotherapy cycle. Patients' characteristics are balanced between different groups. Results Disease free survival was estimated at 2.5 years, and it was 83.5%, 82.3% and 80% for patient receiving radiation before chemotherapy [group A], sandwich [group B] and after finishing chemotherapy [group C] respectively (p > 0.5). Grade 2 pneumonitis, which necessitates treatment with steroid, was detected in 3.4% of our patients, while grade 2 radiation dermatitis was 17.6%. There are no clinical significant differences between different groups regarded pulmonary or skin toxicities. Conclusion Regarding disease free survival and treatment toxicities, in our study, we did not find any significant difference between the different radiotherapy and chemotherapy sequences.

Objectives: Patients with painful bone metastasis treated with palliative radiation therapy (RTH) may require re-irradiation. This work aims at assessing the efficacy and safety of re-irradiation for painful bone metastases using single 8 Gy fractions versus (4 Gy × 5 fractions). Methods: From June 2011 to December 2012, previously irradiated bone metastases were re-irradiated with single 8 Gy fractions (group I) or, 4 Gy × 5 fractions (group II). Pain management index (PMI) was determined. Pearson’s r correlation coefficient was calculated between negative PMI at presentation and age, ECOG Performance Status, sex, and primary cancer site. Results: Two months after RTH, about one fifth of patients achieved no pain, mild pain in 75.5% of the remaining patients and no patient suffered from severe pain. There was no significant difference (p>0.05) between groups (I and II) regarding pain relief. Negative PMI score, was reduced to from 37% at presentation to 25%, at 2 months follow up. A strong negative association between PMI and performance status (p=0.0057, 95% confidence interval between 0.109 and 0.557) was found. Conclusion: Palliative re-irradiation with either single 8 Gy fraction or with, 4 Gy × 5 fractions was effective and safe in pain relief.