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Abstract This is a single arm prospective phase II study conducted to assess the efficacy of fractionated weekly cisplatin-based neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer (MIBC) who are unfit for the standard 21-days chemotherapy regimen due to impaired renal function. Twenty-five patients were recruited between February 2015 and July 2017. Inclusion criteria were; age ≥18 years old, histopathologically-proven urothelial bladder cancer, stage T2-T4a, calculated glomerular filtration rate (GFR) of 40-60 ml/min, no metastasis and with adequate organ function. Chemotherapy given was cisplatin (35 mg/m2 d1, d8, and q21) plus gemcitabine (1,000 mg/m2 d1, d8, and q21) for three cycles followed by local therapy. Median age was 63 years (Mean±SD; 60.76 ±1.67 years). Most patients (21/25; 84%) were males. Almost half of the patients (13/25; 52%) had T3.Treatment was well-tolerated. All patients completed the scheduled 3 Cycles. 3 (12%) patients developed complete response, 10 (40%) partial response, 6 (24%) stable disease, while 6 (24%) developed progression. Median survival was 23 months (95% CI; 18.1-27.89). Fifteen (60%) patients underwent surgery, while 5 (20%) patients underwent bladder preservation. Four (16%) patients were shifted to palliative care and 1(4%) patient declined any further treatment. In conclusion, fractionated weekly cispaltin-gemcitabine neoadjuvant chemotherapy in MIBC patients with impaired renal function is feasible and safe with good clinical response. Further larger studies are warranted.

Abstract This is a single arm prospective phase II study conducted to assess the efficacy of fractionated weekly cisplatin-based neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer (MIBC) who are unfit for the standard 21-days chemotherapy regimen due to impaired renal function. Twenty-five patients were recruited between February 2015 and July 2017. Inclusion criteria were; age ≥18 years old, histopathologically-proven urothelial bladder cancer, stage T2-T4a, calculated glomerular filtration rate (GFR) of 40-60 ml/min, no metastasis and with adequate organ function. Chemotherapy given was cisplatin (35 mg/m2 d1, d8, and q21) plus gemcitabine (1,000 mg/m2 d1, d8, and q21) for three cycles followed by local therapy. Median age was 63 years (Mean±SD; 60.76 ±1.67 years). Most patients (21/25; 84%) were males. Almost half of the patients (13/25; 52%) had T3.Treatment was well-tolerated. All patients completed the scheduled 3 Cycles. 3 (12%) patients developed complete response, 10 (40%) partial response, 6 (24%) stable disease, while 6 (24%) developed progression. Median survival was 23 months (95% CI; 18.1-27.89). Fifteen (60%) patients underwent surgery, while 5 (20%) patients underwent bladder preservation. Four (16%) patients were shifted to palliative care and 1(4%) patient declined any further treatment. In conclusion, fractionated weekly cispaltin-gemcitabine neoadjuvant chemotherapy in MIBC patients with impaired renal function is feasible and safe with good clinical response. Further larger studies are warranted.

Abstract This is a single arm prospective phase II study conducted to assess the efficacy of fractionated weekly cisplatin-based neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer (MIBC) who are unfit for the standard 21-days chemotherapy regimen due to impaired renal function. Twenty-five patients were recruited between February 2015 and July 2017. Inclusion criteria were; age ≥18 years old, histopathologically-proven urothelial bladder cancer, stage T2-T4a, calculated glomerular filtration rate (GFR) of 40-60 ml/min, no metastasis and with adequate organ function. Chemotherapy given was cisplatin (35 mg/m2 d1, d8, and q21) plus gemcitabine (1,000 mg/m2 d1, d8, and q21) for three cycles followed by local therapy. Median age was 63 years (Mean±SD; 60.76 ±1.67 years). Most patients (21/25; 84%) were males. Almost half of the patients (13/25; 52%) had T3.Treatment was well-tolerated. All patients completed the scheduled 3 Cycles. 3 (12%) patients developed complete response, 10 (40%) partial response, 6 (24%) stable disease, while 6 (24%) developed progression. Median survival was 23 months (95% CI; 18.1-27.89). Fifteen (60%) patients underwent surgery, while 5 (20%) patients underwent bladder preservation. Four (16%) patients were shifted to palliative care and 1(4%) patient declined any further treatment. In conclusion, fractionated weekly cispaltin-gemcitabine neoadjuvant chemotherapy in MIBC patients with impaired renal function is feasible and safe with good clinical response. Further larger studies are warranted.

Chinese medicine formulas used against SARS-CoV-2 in China. Significant data are showing that glycyrrhizin and licorice extract have multiple beneficial activities in combating most features of SARS-CoV-2. Purpose: The aim of current review was to highlight recent progresses in research that showed the evidence of the potential use of glycyrrhizin and licorice extract against COVID-19. Methodology: We have reviewed the information published from 1979 to October 2020. These studies demon- strated the effects , use and safety of glycyrrhizin and icorice extract against viral infections,bacterial infections, inflammatory disorders of lung ( in vitro and in vivo). These studies were collated through online electronic databases research (Academic libraries as PubMed, Scopus, Web of Science and Egyptian Knowledge Bank). Results: Pooled effect size of articles provides information about the rationale for using glycyrrhizin and licorice extract to treat COVID-19. Fifty studies demonstrate antiviral activity of glycyrrhizin and licorice extract. The most frequent mechanism of the antiviral activity is due to disrupting viral uptake into the host cells and dis- rupting the interaction between receptor- binding domain (RBD) of SARS-COV2 and ACE2 in recent articles. Fifty studies indicate that glycyrrhizin and licorice extract have significant antioxidant, anti-inflammatory and immunomodulatory effects. Twenty five studies provide evidence for the protective effect of glycyrrhizin and licorice extract against inflammation-induced acute lung injury and cardiovascular disorders. Conclusion: The current study showed several evidence regarding the beneficial effects of glycyrrhizin and licorice extract in combating COVID-19. More randomized clinical trials are needed to obtain a precise conclusion

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Abstract Background: The intersphincteric resection the most extreme form of a sphincter-preserving alternative for the abdominoperineal resection. Aim of the Work: We investigated oncological, functional outcomes and morbidity after ISR. Methods: This retrospective study included 164 patients who underwent ISR with between 2010 and 2015, Male 56.1%, Female 43.9%, with a median age was 54.5 years, Median follow-up time was of 48 months, Average surgical time was 230 min, Median blood loss was 700 mL and median hospital stay was nine days. Mean tumour size was 34 mm. The surgical procedure through a laparotomy (72.6%), laparoscopically (27.4%). Neoadjuvant radiotherapy 89.6% {long-course radiotherapy 74.4%, short-course radiotherapy 15.2%}, neoadjuvant chemotherapy 28.7% and adjuvant chemotherapy 70.1%. Colonic J-pouch 16.5%, Transverse coloplasty 15.9%, a side-to-end anastomosis 26.8% and straight coloanal anastomosis 40.9%. Partial-ISR 36.6%, subtotal-ISR 37.2%, total-ISR 26.2%, diverting ileostomy 6.7%. Results: Operative mortality 1.2%, morbidity 14.6% (anastomotic leakage 3.7%, anastomotic stenosis 1.8%, a recto-vaginal fistula 2.4% bowel obstruction 3%, surgical site infection 3%. Respiratory tract infection 1.2%, local 7.9%, distant recurrence 15.2%, 5-year overall 79.8%, disease-free survival 75.8%, R0 resection 95.1%. Pathologic complete response 11%. Circumferential margin involvement 2.4%. Median number of lymph nodes 17. Mean distal margin 20 mm, after 12 months Median Wexner score 6. Incontinence for (flatus 11%, liquid 4.9%, solid 4.3%). Median bowel motions in a 24-h were 3. Faecal urgency 17.7%. Stool fragmentation 18.9%. Difficult evacuation 17.7%, lifestyle alteration 14.6%. Difficulty Feces/flatus discrimination 43.3%. Nocturnal soiling in 17.1%. Daytime soiling 11%. Pad wearing 23.8%. Anti-diarrhoea medication loperamide 14%. Conclusion: ISR is a feasible surgical procedure for low rectal cancer. Oncologic and functional, outcomes after are acceptable.

Abstract Background: The intersphincteric resection the most extreme form of a sphincter-preserving alternative for the abdominoperineal resection. Aim of the Work: We investigated oncological, functional outcomes and morbidity after ISR. Methods: This retrospective study included 164 patients who underwent ISR with between 2010 and 2015, Male 56.1%, Female 43.9%, with a median age was 54.5 years, Median follow-up time was of 48 months, Average surgical time was 230 min, Median blood loss was 700 mL and median hospital stay was nine days. Mean tumour size was 34 mm. The surgical procedure through a laparotomy (72.6%), laparoscopically (27.4%). Neoadjuvant radiotherapy 89.6% {long-course radiotherapy 74.4%, short-course radiotherapy 15.2%}, neoadjuvant chemotherapy 28.7% and adjuvant chemotherapy 70.1%. Colonic J-pouch 16.5%, Transverse coloplasty 15.9%, a side-to-end anastomosis 26.8% and straight coloanal anastomosis 40.9%. Partial-ISR 36.6%, subtotal-ISR 37.2%, total-ISR 26.2%, diverting ileostomy 6.7%. Results: Operative mortality 1.2%, morbidity 14.6% (anastomotic leakage 3.7%, anastomotic stenosis 1.8%, a recto-vaginal fistula 2.4% bowel obstruction 3%, surgical site infection 3%. Respiratory tract infection 1.2%, local 7.9%, distant recurrence 15.2%, 5-year overall 79.8%, disease-free survival 75.8%, R0 resection 95.1%. Pathologic complete response 11%. Circumferential margin involvement 2.4%. Median number of lymph nodes 17. Mean distal margin 20 mm, after 12 months Median Wexner score 6. Incontinence for (flatus 11%, liquid 4.9%, solid 4.3%). Median bowel motions in a 24-h were 3. Faecal urgency 17.7%. Stool fragmentation 18.9%. Difficult evacuation 17.7%, lifestyle alteration 14.6%. Difficulty Feces/flatus discrimination 43.3%. Nocturnal soiling in 17.1%. Daytime soiling 11%. Pad wearing 23.8%. Anti-diarrhoea medication loperamide 14%. Conclusion: ISR is a feasible surgical procedure for low rectal cancer. Oncologic and functional, outcomes after are acceptable.