Toll-like receptors (TLRs) have a role in chronic inflammation. Still, little is known about the expression of TLRs in hepatocellular carcinoma (HCC). Herein, we tried to assess the prognostic value of TLR2 and TLR4 expression on circulating monocytes in HCC patients and correlate their levels with some clinical, laboratory data, and treatment outcomes. Forty patients with hepatic focal lesions diagnosed radiologically as HCC by triphasic multislice CT pelviabdominal and chest, and in some patients MRI diffusion and 38 age and sex matching healthy controls were enrolled in the study. Subjects were evaluated for liver functions, alpha-fetoprotein (AFP), imaging, response to different treatments, and overall survival. TLR2 and TLR4 expression by monocytes was detected by flow cytometry. The expression of both TLR2 and TLR4 on monocytes was significantly increased in HCC patients than the controls, in patients with more progressive HCC than those with lower progression and in patients with poor response to treatment than patients with better treatment response. Moreover, their levels showed positive correlations with ALT, AST, and AFP and inverse correlations with the overall survival of HCC patients. The results of the current study suggest that increased expression ofTLR2 and TLR4 on peripheral monocytes might reflect the development and progression of HCC and can be used to indicate poor prognosis. In addition, high expression of TLR2 correlated significantly with poor response to treatment, while high expression of both TLR2 and TLR4 were associated with poor survival. Our findings will help to design more studies on the role of TLRs in HCC pathogenesis and prognosis which may provide new therapeutic targets for HCC.

Toll-like receptors (TLRs) have a role in chronic inflammation. Still, little is known about the expression of TLRs in hepatocellular carcinoma (HCC). Herein, we tried to assess the prognostic value of TLR2 and TLR4 expression on circulating monocytes in HCC patients and correlate their levels with some clinical, laboratory data, and treatment outcomes. Forty patients with hepatic focal lesions diagnosed radiologically as HCC by triphasic multislice CT pelviabdominal and chest, and in some patients MRI diffusion and 38 age and sex matching healthy controls were enrolled in the study. Subjects were evaluated for liver functions, alpha-fetoprotein (AFP), imaging, response to different treatments, and overall survival. TLR2 and TLR4 expression by monocytes was detected by flow cytometry. The expression of both TLR2 and TLR4 on monocytes was significantly increased in HCC patients than the controls, in patients with more progressive HCC than those with lower progression and in patients with poor response to treatment than patients with better treatment response. Moreover, their levels showed positive correlations with ALT, AST, and AFP and inverse correlations with the overall survival of HCC patients. The results of the current study suggest that increased expression ofTLR2 and TLR4 on peripheral monocytes might reflect the development and progression of HCC and can be used to indicate poor prognosis. In addition, high expression of TLR2 correlated significantly with poor response to treatment, while high expression of both TLR2 and TLR4 were associated with poor survival. Our findings will help to design more studies on the role of TLRs in HCC pathogenesis and prognosis which may provide new therapeutic targets for HCC.

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Objectives: To define incidence, risk factors and effect of persistent vesivoureteral reflux [VUR] after ileocecal cystoplasty in children with voiding dysfunction. Materials and methods: Between June 2008 and June 2013, children 5-18 years old, who had VUR before ileocecal cystoplasty without ureteral reimplantation, were included. Voiding cystourethrogram and pressure flow study were obtained before and 6-12 months after the operation. VUR was graded using the international reflux study committee classification. Grades I, II, and III were considered low grade. Grades IV and V were considered high grade. VUR persistence was analyzed in relation to age, sex, cause of voiding dysfunction, laterality, preoperative and postoperative maximum detrusor filling pressure, and preoperative grade of reflux. Attacks of febrile acute pyelonephritis were recorded and analyzed in relation to VUR persistence. Follow up period ranged from 12 to 55 months [mean 34.1]. Results: 25 refluxing renal units in 13 children [8 males and 5 females] were included. Age range was 6-16 years [mean 11.06]. The cause of voiding dysfunction was neurogenic in 8, dysfunctional voiding in 3, and valve baldder in 2. All of them had ileocecal cystoplasty with enforced in-situ appendicular catheterizable stoma. VUR was low grade in 4 renal units and high grade in 21. Postoperative low grade VUR was found in 13 renal units (52%), and no high grade VUR. Preoperative high grade reflux was significantly related to VUR persistence (Chi-square, p=0.023). Mean preoperative maximum detrusor filling pressure with persistent reflux was 61.1 ±5.8 cmH2O, and 72.1 ±10.3 cmH2O with cured reflux (t-test, p=0.003). 8 renal units in 6 patients had attacks of acute pyelonephritis. Persistent VUR was in 6 of them (Chi-square, p=0.007). Conclusions: Preoperative high grade VUR and low maximum detrusor filling pressure are risk factors for persistent VUR after ileocecal cystoplasty in children. Persistent VUR is a risk factor for acute pyelonephritis and may have a deleterious effect on the kidney.

Objectives: To define incidence, risk factors and effect of persistent vesivoureteral reflux [VUR] after ileocecal cystoplasty in children with voiding dysfunction. Materials and methods: Between June 2008 and June 2013, children 5-18 years old, who had VUR before ileocecal cystoplasty without ureteral reimplantation, were included. Voiding cystourethrogram and pressure flow study were obtained before and 6-12 months after the operation. VUR was graded using the international reflux study committee classification. Grades I, II, and III were considered low grade. Grades IV and V were considered high grade. VUR persistence was analyzed in relation to age, sex, cause of voiding dysfunction, laterality, preoperative and postoperative maximum detrusor filling pressure, and preoperative grade of reflux. Attacks of febrile acute pyelonephritis were recorded and analyzed in relation to VUR persistence. Follow up period ranged from 12 to 55 months [mean 34.1]. Results: 25 refluxing renal units in 13 children [8 males and 5 females] were included. Age range was 6-16 years [mean 11.06]. The cause of voiding dysfunction was neurogenic in 8, dysfunctional voiding in 3, and valve baldder in 2. All of them had ileocecal cystoplasty with enforced in-situ appendicular catheterizable stoma. VUR was low grade in 4 renal units and high grade in 21. Postoperative low grade VUR was found in 13 renal units (52%), and no high grade VUR. Preoperative high grade reflux was significantly related to VUR persistence (Chi-square, p=0.023). Mean preoperative maximum detrusor filling pressure with persistent reflux was 61.1 ±5.8 cmH2O, and 72.1 ±10.3 cmH2O with cured reflux (t-test, p=0.003). 8 renal units in 6 patients had attacks of acute pyelonephritis. Persistent VUR was in 6 of them (Chi-square, p=0.007). Conclusions: Preoperative high grade VUR and low maximum detrusor filling pressure are risk factors for persistent VUR after ileocecal cystoplasty in children. Persistent VUR is a risk factor for acute pyelonephritis and may have a deleterious effect on the kidney.

Objectives: To define incidence, risk factors and effect of persistent vesivoureteral reflux [VUR] after ileocecal cystoplasty in children with voiding dysfunction. Materials and methods: Between June 2008 and June 2013, children 5-18 years old, who had VUR before ileocecal cystoplasty without ureteral reimplantation, were included. Voiding cystourethrogram and pressure flow study were obtained before and 6-12 months after the operation. VUR was graded using the international reflux study committee classification. Grades I, II, and III were considered low grade. Grades IV and V were considered high grade. VUR persistence was analyzed in relation to age, sex, cause of voiding dysfunction, laterality, preoperative and postoperative maximum detrusor filling pressure, and preoperative grade of reflux. Attacks of febrile acute pyelonephritis were recorded and analyzed in relation to VUR persistence. Follow up period ranged from 12 to 55 months [mean 34.1]. Results: 25 refluxing renal units in 13 children [8 males and 5 females] were included. Age range was 6-16 years [mean 11.06]. The cause of voiding dysfunction was neurogenic in 8, dysfunctional voiding in 3, and valve baldder in 2. All of them had ileocecal cystoplasty with enforced in-situ appendicular catheterizable stoma. VUR was low grade in 4 renal units and high grade in 21. Postoperative low grade VUR was found in 13 renal units (52%), and no high grade VUR. Preoperative high grade reflux was significantly related to VUR persistence (Chi-square, p=0.023). Mean preoperative maximum detrusor filling pressure with persistent reflux was 61.1 ±5.8 cmH2O, and 72.1 ±10.3 cmH2O with cured reflux (t-test, p=0.003). 8 renal units in 6 patients had attacks of acute pyelonephritis. Persistent VUR was in 6 of them (Chi-square, p=0.007). Conclusions: Preoperative high grade VUR and low maximum detrusor filling pressure are risk factors for persistent VUR after ileocecal cystoplasty in children. Persistent VUR is a risk factor for acute pyelonephritis and may have a deleterious effect on the kidney.