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Abstract: Thrombo-haemorrhagic events are the main cause of mortality in essential thrombocythemia (ET). The aim of this study was to measure soluble CD40 ligand (sCD40L) in the plasma of healthy individuals and in patients with an elevated platelet count and investigate the association of sCD40L with thrombosis in ET patients and their JAK2 V617F mutation. The plasma levels of sCD40L was measured in 75 patients. 35 patients diagnosed as ET, 25 patients diagnosed as reactive thrombocytosis (RT), 15 patients with low platelet count and 15 healthy subjects acted as the control group. 35 ET patients were assessed for JAK2 V617F status by utilizing a JAK2 V617F specific quenching probe. ET patients had the highest levels of sCD40L compared to the patients with RT and controls (225.70±79.34, 160.40±54.54 and 83.54±21.54) respectively and a tight correlation was found between the platelet count and sCD40L. Statistical analysis revealed that the JAK2 V617F mutation was associated with significantly increased levels of WBCs (p˂0.04) and sCD40L (p˂0.001) compared to JAK2 V617F negative patients. There was no significant association between JAK2 V617F mutation and thrombosis, but the level of sCD40L was significantly higher in patients with thrombosis than those without thrombosis (236.43 ± 75.93 vs 184.65 ± 62.31) respectively. Based on these findings, the presence of JAK2 mutation may changes the expression of soluble markers of endothelial and platelet activation besides the quantitative and qualitative changes in platelets. Mechanisms leading to thrombosis are more complex and multifactorial.

Abstract: Thrombo-haemorrhagic events are the main cause of mortality in essential thrombocythemia (ET). The aim of this study was to measure soluble CD40 ligand (sCD40L) in the plasma of healthy individuals and in patients with an elevated platelet count and investigate the association of sCD40L with thrombosis in ET patients and their JAK2 V617F mutation. The plasma levels of sCD40L was measured in 75 patients. 35 patients diagnosed as ET, 25 patients diagnosed as reactive thrombocytosis (RT), 15 patients with low platelet count and 15 healthy subjects acted as the control group. 35 ET patients were assessed for JAK2 V617F status by utilizing a JAK2 V617F specific quenching probe. ET patients had the highest levels of sCD40L compared to the patients with RT and controls (225.70±79.34, 160.40±54.54 and 83.54±21.54) respectively and a tight correlation was found between the platelet count and sCD40L. Statistical analysis revealed that the JAK2 V617F mutation was associated with significantly increased levels of WBCs (p˂0.04) and sCD40L (p˂0.001) compared to JAK2 V617F negative patients. There was no significant association between JAK2 V617F mutation and thrombosis, but the level of sCD40L was significantly higher in patients with thrombosis than those without thrombosis (236.43 ± 75.93 vs 184.65 ± 62.31) respectively. Based on these findings, the presence of JAK2 mutation may changes the expression of soluble markers of endothelial and platelet activation besides the quantitative and qualitative changes in platelets. Mechanisms leading to thrombosis are more complex and multifactorial.

Abstract: Thrombo-haemorrhagic events are the main cause of mortality in essential thrombocythemia (ET). The aim of this study was to measure soluble CD40 ligand (sCD40L) in the plasma of healthy individuals and in patients with an elevated platelet count and investigate the association of sCD40L with thrombosis in ET patients and their JAK2 V617F mutation. The plasma levels of sCD40L was measured in 75 patients. 35 patients diagnosed as ET, 25 patients diagnosed as reactive thrombocytosis (RT), 15 patients with low platelet count and 15 healthy subjects acted as the control group. 35 ET patients were assessed for JAK2 V617F status by utilizing a JAK2 V617F specific quenching probe. ET patients had the highest levels of sCD40L compared to the patients with RT and controls (225.70±79.34, 160.40±54.54 and 83.54±21.54) respectively and a tight correlation was found between the platelet count and sCD40L. Statistical analysis revealed that the JAK2 V617F mutation was associated with significantly increased levels of WBCs (p˂0.04) and sCD40L (p˂0.001) compared to JAK2 V617F negative patients. There was no significant association between JAK2 V617F mutation and thrombosis, but the level of sCD40L was significantly higher in patients with thrombosis than those without thrombosis (236.43 ± 75.93 vs 184.65 ± 62.31) respectively. Based on these findings, the presence of JAK2 mutation may changes the expression of soluble markers of endothelial and platelet activation besides the quantitative and qualitative changes in platelets. Mechanisms leading to thrombosis are more complex and multifactorial.

Abstract This study aimed at evaluation of the hearing outcome of using glass ionomer bone cement GIC to manage different patterns of ossicular discontinuity. Study design: prospective clinical study. Subjects and methods: The study included 53 patients with conductive hearing loss caused by ossicular pathology rather than fixed stapes. Thirty three cases were primary surgery and 20 cases were planned 2nd stage. According to the ossicular situation during surgery the patients were classified into 6 groups. In the 1st group the 3 ossicles were articulated and mobile but the handle of malleus was amputated. GIC was used to elongate the handle by cementing a bone chip to it. In the 2nd group, the Long process of incus LPI was necrosed by the hook of the Shea piston, here,GIC was used to elongate the LPI and reconnect it with the piston. In the 3rd group, only the handle of malleus was present and a bone chip or the preserved incus was cemented with the GIC both medially to the footplate and laterally to the handle of malleus. In the 4th group The incudostapedial joint ISJ was necrosed and the GIC was used to establish the connection of the LPI to the stapes. In the 5th group, malleus to stapes assembly was established with a bone chip or incus remnant fixed in place with the GIC. In the last group GIC was used to elongate the stapes to become as lateral as the tympanic membrane. Hearing results at about one year were analyzed. Results: The Pure tone average PTA improvement was 12.2 dB. Forty eight patients showed a degree of PTA improvement, 4 cases showed no improvement and one case showed a 15 db deterioration. There was an average air -bone gap ABG improvement by 13 dB. The best improvement in the ABG was in the group with ISJ reconstruction and the least was in the group of malleus handle elongation. No complications were reported rather than that case of 15 dB hearing deterioration. The preparation, handling and cementing with the GIC is simple and easily mastered. Conclusion: GIC is a good tool available to the otologist. It can be used alone to re-establish the continuity of the ossicular chain in minor ossicular chain defects. It can also be used to stabilize other forms of re-bridging surgery.

Abstract This study aimed at evaluation of the hearing outcome of using glass ionomer bone cement GIC to manage different patterns of ossicular discontinuity. Study design: prospective clinical study. Subjects and methods: The study included 53 patients with conductive hearing loss caused by ossicular pathology rather than fixed stapes. Thirty three cases were primary surgery and 20 cases were planned 2nd stage. According to the ossicular situation during surgery the patients were classified into 6 groups. In the 1st group the 3 ossicles were articulated and mobile but the handle of malleus was amputated. GIC was used to elongate the handle by cementing a bone chip to it. In the 2nd group, the Long process of incus LPI was necrosed by the hook of the Shea piston, here,GIC was used to elongate the LPI and reconnect it with the piston. In the 3rd group, only the handle of malleus was present and a bone chip or the preserved incus was cemented with the GIC both medially to the footplate and laterally to the handle of malleus. In the 4th group The incudostapedial joint ISJ was necrosed and the GIC was used to establish the connection of the LPI to the stapes. In the 5th group, malleus to stapes assembly was established with a bone chip or incus remnant fixed in place with the GIC. In the last group GIC was used to elongate the stapes to become as lateral as the tympanic membrane. Hearing results at about one year were analyzed. Results: The Pure tone average PTA improvement was 12.2 dB. Forty eight patients showed a degree of PTA improvement, 4 cases showed no improvement and one case showed a 15 db deterioration. There was an average air -bone gap ABG improvement by 13 dB. The best improvement in the ABG was in the group with ISJ reconstruction and the least was in the group of malleus handle elongation. No complications were reported rather than that case of 15 dB hearing deterioration. The preparation, handling and cementing with the GIC is simple and easily mastered. Conclusion: GIC is a good tool available to the otologist. It can be used alone to re-establish the continuity of the ossicular chain in minor ossicular chain defects. It can also be used to stabilize other forms of re-bridging surgery.