Comparative effect of deliberate hypotensive anesthesia using nitroglycerine vs. phentolamine on event related potentials and cognitive functions in patients undergoing septoplasty: a randomized controlled trial

BACKGROUND

Postoperative cognitive dysfunction is a noteworthy complication of deliberate hypotensive anesthesia. The aim of this work was to compare the effect of deliberate hypotensive anesthesia using nitroglycerine versus phentolamine on event-related potentials and cognitive function in patients undergoing septoplasty surgery.

METHODS

This prospective randomized controlled trial was conducted on 80 patients indicated for septoplasty under general anesthesia; 40 patients received intra-operative Nitroglycerine and 40 patients received intra-operative Phentolamine. Cognitive assessment (using Paired Associate Learning test (PALT) and Benton Visual Retention test (BVRT)) and P300 recording were done for all included patients pre-operatively and one week postoperatively.

RESULTS

The scores of PALT and Benton BVRT significantly declined one week following surgery in both Nitroglycerine and Phentolamine groups. There was no statistically significant difference between Nitroglycerine and Phentolamine groups in the postoperative decline in either PALT or BVRT (P-value = 0.342, 0.662 respectively). The values of P300 latency showed a significant delay one week following surgery in both Nitroglycerine and Phentolamine groups (P-value ≤ 0.001, 0.001), but in Nitroglycerine group, the delay is significantly higher than in Phentolamine group (P-value = 0.003). The values of P300 amplitude significantly decreased one week following surgery in both Nitroglycerine and Phentolamine groups (P-value ≤ 0.001, 0.001), but there was no statistically significant difference between Nitroglycerine and Phentolamine groups (P-value = 0.099).

CONCLUSION

Phentolamine is preferred over nitroglycerin in deliberate hypotensive anesthesia because it has less harmful effect on cognitive function than nitroglycerin.

Violence against healthcare workers during coronavirus (COVID-19) pandemic in Egypt: a cross-sectional study

Background

Healthcare workers are on the front lines of COVID-19 and are subject to risks. A rise in the cases of violence and aggressiveness against HCWs has been observed worldwide, adding to the already existing burnout. The purpose of this research is to determine the prevalence of workplace violence, its risk variables, and the pattern of violence directed towards healthcare workers in the context of COVID-19 pandemic. The research used a cross-sectional analytic design. Purposive sampling was utilized to identify research participants using an online survey. Form’s link was distributed to accessible social media groups such as Facebook and WhatsApp from July 2020 to the end of October 2020. A self-administered structured survey was adapted from the World Health Organization survey questionnaire about violence in healthcare settings. The Google Form’s link was distributed to the social media groups until the total sample of 405 was collected.

Results

During the COVID-19 pandemic, workplace violence against Egyptian healthcare workers was prevalent (63.2%). The most prevailing type of violence among the exposed participants was verbal violence (87.9%). Violence is more common in the (< 40 years old) age group (80.9% of exposed healthcare workers). Violence was more statistically significant against females (60.5% of the exposed healthcare workers) (p-value = 0.023). Regarding the work specialty, violence was more committed against physicians (84.3% of exposed healthcare workers) than nurses (12.8% of exposed healthcare workers). The primary perpetrators of violence were the patient’s family (74.6%). The majority of the exposed HCWs (96%) reported no physical injury from the violent event, and 71.5% deemed the violent incident preventable. The majority (90.6%) of HCWs exposed to violent incidents declared non-reporting.

Conclusions

Effective risk communication at all levels of society is critical for reducing fear, stigma, and ultimately workplace violence, as recent assaults on healthcare institutions demonstrate. To reduce violence and safeguard the safety of the medical profession, the government, health policymakers, media organizations, and community engagement groups must collaborate for healthcare workers’ safety.

The effects of COVID-19 pandemic and its related lockdown on female sexual function and reproductive health: An observational study in Egypt

This retrospective observational online study was carried out to evaluate the effect of the COVID-19 pandemic and its related lockdown on female sexual functions and reproductive health. It included 409 sexually active females. The sexual function was assessed using the Female Sexual Function Index (FSFI). The reproductive life was assessed by a structured self-administered questionnaire modified from Egypt Demographic and Health Survey. The study revealed a significant decrease in the overall FSFI score during the pandemic lockdown compared to the pre-pandemic score (19.3 ± 6 vs. 21.3 ± 6.4, P<0.001). Below half (41.6 %) of women were using contraception methods during the pandemic, while 27.9% had stopped taking contraception during the pandemic, 30.6% (57/186) of the pregnant women only tended to get pregnant. So, the COVID-19 pandemic and its related lockdown were associated with an elevated risk for female sexual dysfunction and altered women's reproductive health quality. Heath system should therefore develop new methods to provide basic reproductive health service, family planning services, and to ameliorate the female sexual function during COVID-19 pandemic including consults with physicians, counsellors, and psychologists, as well as health education programs, either in person or virtually via telemedicine.

Newly Diagnosed Diabetes in Patients with COVID-19: Different Types and Short-Term Outcomes

A great global concern is currently focused on the coronavirus disease 2019 (COVID-19) pandemic and its associated morbidities. The goal of this study was to determine the frequency of newly diagnosed diabetes mellitus (DM) and its different types among COVID-19 patients, and to check the glycemic control in diabetic cases for three months. After excluding known cases of DM, 570 patients with confirmed COVID-19 were studied. All participants were classified as non-diabetic or newly discovered diabetic. According to hemoglobin A1c (HbA1c) and fasting insulin, newly discovered diabetic patients were further classified into pre-existing DM, new-onset type 1 DM, and new-onset type 2 DM. Glycemic control was monitored for three months in newly diagnosed diabetic patients. DM was diagnosed in 77 patients (13.5%); 12 (2.1%) with pre-existing DM, 7 (1.2%) with new-onset type 1 DM, and 58 (10.2%) with new-onset type 2 DM. Significantly higher rates of severe infection and mortality (p < 0.001 and p = 0.046) were evident among diabetic patients. Among survived diabetic patients (n = 63), hyperglycemia and the need for anti-diabetic treatment persisted in 73% of them for three months. COVID-19 was associated with a new-onset of DM in 11.4% of all participants and expression of pre-existing DM in 2.1% of all participants, both being associated with severe infection. COVID-19 patients with newly diagnosed diabetes had high risk of mortality. New-onset DM persisted for at least three months in more than two-thirds of cases.

Ramadan fasting and liver diseases: A review with practice advices and recommendations

Ramadan fasting is obligatory for Muslim healthy adults. However, there are many exemptions from fasting; including patients, whose diseases will be aggravated by fasting. Muslim patients with different liver diseases are frequently seen in the clinics discussing their intent to fast this month with their treating physicians. To answer our patients' inquiries about the expected benefits and/or risks of fasting and delivering them the best care, we carried out this review and we draw advices and recommendations based on the available evidence. A web-based search, combining multiple keywords representing different liver diseases with Ramadan fasting had been carried out. To answer the research question: Do adult Muslim patients with different liver diseases who fast the month of Ramadan have had a deleterious effect on their health in comparison to those who did not fast? Relevant publications were retrieved. No randomized controlled trials were focusing on Ramadan fasting and liver diseases in the filtered databases, eg Cochrane library. Consequently, non-filtered databases, eg PubMed, Google Scholar and Egyptian Knowledge Bank searched and full-text high-quality research articles were carefully analysed to draw recommendations. Other relevant publications with low quality of evidence like case studies and short communications were also reviewed to address practice advices. Although Ramadan fasting was found beneficial for patients with NAFLD, it was found deleterious to patients with Child B and C cirrhosis and patients with peptic ulcer. Patients with chronic hepatitis, Child A cirrhosis and those with non-complicated liver transplant can fast with prefasting assessment and strict follow up.

Morbidity and mortality during hepatitis C treatment using sofosbuvir and daclatasvir with or without ribavirin, in a cohort of Egyptian patients

BACKGROUND

Though direct-acting antiviral agents (DAAs) therapy is associated with a high cure rate of hepatitis C virus infection, a potential risk of serious adverse events (SAEs) exists. The aim of this study was to determine the incidence and predictors of morbidity and mortality related to DAAs therapy.

METHODS

This prospective study was conducted on a real word cohort of 1562 treatment naïve chronic hepatitis C (CHC) Egyptian patients, who received 12-weeks therapy with sofosbuvir (SOF) plus daclatasvir (DCV) ± ribavirin (RBV). The incidence and predictors of SAEs and mortality during treatment course and over the following 12 weeks were recorded.

RESULTS

The mean age of study participants was 51.38 ± 9.70 years (55.22%, males). Liver cirrhosis was defined in 72.4% of participants. SAEs were recorded in 120 participants (7.68%), including hepatic decompensation, gastrointestinal bleeding, anemia and hepatocellular carcinoma. Nine patients (0.58%) died and 69 patients (4.42%) discontinued therapy due to SAEs. Severity of cirrhosis was the significant predictor of morbidities and mortality. Hepatic decompensation was predicted by baseline serum albumin [cutoff value: 3.00 g/dL, area under the receiver operating characteristic curve (AUROC): 0.953] and serum bilirubin (cutoff value: 1.75 mg/dL, AUROC: 0.940).

CONCLUSION

The risk of morbidity and mortality related to SOF/DCV ± RBV therapy in CHC patients is small and is significantly linked to advanced cirrhosis.

Abstract P6-17-35: Withdrawn

This abstract was withdrawn by the authors.

Citation Format: Hamilton EP, Barve M, Bardia A, Beeram M, Edenfield WJ, Noonan A, Tolcher A, Bendell J, Mosher R, Xu J, Hailman E, Burris III H, Soliman HH. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-17-35.

Randomized controlled trial of polyethylene glycol versus lactulose for the treatment of overt hepatic encephalopathy

BACKGROUND

Overt hepatic encephalopathy (HE) is a frequent complication of cirrhosis and one of the most debilitating manifestations that necessitates hospitalization. Although many treatment modalities are being investigated, none of them are satisfactory. So, newer treatment modalities have to be tried.

OBJECTIVE

To evaluate the safety and efficacy of polyethylene glycol (PEG) versus lactulose in the management of HE.

PATIENTS AND METHODS

This clinical trial included 100 patients with post-hepatitis C cirrhosis who were admitted with HE. Patients were randomized into two equal groups: group I patients received lactulose and group II patients received PEG. The clinico-epidemiological characteristics of patients, Child-Pugh score, and HE scoring algorithm were registered before and 24 h after administration of the drug. Moreover, any suspected adverse effects were recorded.

RESULTS

All 100 patients received treatment. Three patients died within 24 h of admission and did not complete the follow-up period. According to intention-to-treat approach, they were considered as treatment failure. On analysis, 36/50 (72%) patients improved one grade or more in HE scoring algorithm score after 24 h of lactulose therapy versus 47/50 (94%) of those on PEG therapy (P<0.05). The time needed for resolution of HE and length of hospital stay were significantly lower in PEG group versus lactulose group (P<0.001). Both therapies were tolerated, and no significant adverse events were reported.

CONCLUSION

Both lactulose and PEG were safe and effective in the treatment of HE. PEG significantly decreased the time needed for resolution of HE and significantly shortened the hospital stay.

Abstract OT2-07-01: Phase 1/2 trial of the oncolytic virus, talimogene laherparpvec, in combination with neoadjuvant chemotherapy in stage II/III triple negative breast cancer

Background: The host anti-tumor immune response plays an important role in determining natural history and therapy response for early stage breast cancer. Tumors with high levels of lymphocytic infiltration appear to have a superior prognosis and response rate to neoadjuvant chemotherapy. However, these tumors are in the minority so methods to enhance tumor lymphocyte infiltration should be identified. The oncolytic virus, talimogene laherparpvec (TVEC) is a genetically modified HSV1 virus which selectively replicates in transformed cells while sparing normal tissue. This leads to lysis of infected tumor cells along with co-expression of GM-CSF to elicit an enhanced anti-tumor immune response. Prior data has shown TVEC can be safely combined with chemotherapy in other indications, so we launched an investigator initiated study to determine the safety and efficacy of combining TVEC with neoadjuvant dose dense chemotherapy in stage II-III TNBC.

Study design: The study is a phase 1 (2 dose levels of TVEC, 3+3 design) and phase 2 single arm Simon two stage combination trial. Primary endpoints of phase 1 is safety of intratumoral TVEC (DL1=106 PFU x 5 injections, DL2=106 PFU x 1 then 108 PFU x 4 injections) administered q2-3 weeks concurrently with weekly paclitaxel followed by standard dose dense AC x 4 and local therapy as indicated. Phase 2 primary endpoint is pCR rate of the study treatment, secondary endpoints include DFS, OS, immune correlates in resected tumor specimens. Eligibility criteria includes females &gt;17 years old, newly diagnosed T2-3N0-3 TNBC, adequate organ function, primary tumor amenable to injection with TVEC, no immunosuppressive or autoimmune conditions, no inflammatory or bilateral/multifocal disease. Sample size is up to 49 patients (12 phase 1, 37 phase 2) with 80% power to detect increase in pCR rate from 30% to 50% with one sided p=.1 in phase 2.

Study status: This novel Amgen supported investigator initiated study activated to accrual 3/2017 and first patient on study was on 5/2017. The study is currently open only at the Moffitt Cancer Center. Target study completion date 8/2021. (NCT02779855)

Citation Format: Soliman HH, Hogue D, Han H, Lee C, Ismail-Khan R, Khong H, Niell B, Czerniecki B. Phase 1/2 trial of the oncolytic virus, talimogene laherparpvec, in combination with neoadjuvant chemotherapy in stage II/III triple negative breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT2-07-01.

Abstract P3-06-02: Tackling bone metastatic breast cancer growth with novel bone-seeking matrix metalloproteinase-2 inhibitors

Background. Despite medical advances, currently there is no treatment for breast to bone metastasis. The progression of bone metastatic breast cancer is critically dependent on interactions with the surrounding microenvironment. Therefore, identifying the underpinning molecular mechanisms is vital for the development of new therapies.

Rationale. Gene expression analysis and validation in human and murine specimens of bone metastases revealed matrix metalloproteinases, such as MMP-2, are highly expressed in the bone metastatic microenvironment. Genetic ablation of MMP-2 demonstrated the importance of this MMP in driving the growth of the osteolytic bone metastatic breast cancer by regulating the bioavailability of transforming growth factor β (TGFβ). These data support the rationale for the development of a highly specific MMP-2 inhibitor for the eradication of active bone metastatic breast cancer.

Methods. We utilized a novel chemical approach to synthesize bone seeking MMP inhibitors (BMMPIs) on a bisphosphonic backbone, with specificity for MMP-2 in the nanomolar range (IC50=140 nM).

In vitro, we tested the effect of BMMPIs at varying doses (1nM-100μM) on the viability of the major cellular components of the cancer-bone microenvironment, namely breast cancer cells (PyMT, 4T1), osteoblasts (MC3T3) and osteoclasts (primary monocytes and RAW 264.7). In vivo, mice were intratibially inoculated with either luciferase expressing 4T1 or PyMT (1x105) cells. Mice (n=10/group) then received vehicle, zoledronate (1 mg/kg) or BMMPIs (1 mg/kg). Tumor growth was determined via luminescence quantitation. Cancer induced bone disease was measured ex vivo by μCT, Xray and histomorphometry. MMP activity in vivo and ex vivo was determined via specific activatable MMP probes. Pharmacokinetic and pharmacodynamic studies were performed. Plasma and bone marrow supernatants were collected from PyMT-R221A tumor bearing mice treated with ML115 (5mg/Kg) at 0.25, 0.5, 1, 2, 4, 8, 24 hours and three weeks (n=3 mice/time point).

Currently, we are investigating the BMMPIs ability to impact the metastatic process through an in vivo model of intracardiac inoculation.

Results. BMMPIs significantly impacted the viability of breast cancer cells and osteoclasts in vitro (p&lt;0.05) compared to control. In vivo, BMMPIs significantly reduced the growth of bone metastatic breast cancer compared to control and the standard of care bisphosphonate, zoledronate. MMP activity was also lower in the BMMPI treated groups (using tumor burden to normalize values). μCT/Xray/Histomorphometry analysis also illustrated the significant beneficial effects of the BMMPIs in reducing the size of osteolytic lesions (up to 80% by μCT; p&lt;0.05).

ML115 is rapidly cleared from the plasma and accumulates selectively in the bone marrow microenvironment over time.

Conclusions. MMP-2 specific BMMPIs prevent bone metastatic breast cancer growth by impacting cancer cell viability and cancer induced osteolysis. Given that bisphosphonates are well tolerated in the clinical setting, we predict that BMMPIs could be translated to the clinical setting for the treatment and eradication of bone metastatic breast cancer.

Citation Format: Tauro M, Laghezza A, Tortorella P, Soliman HH, Lynch CC. Tackling bone metastatic breast cancer growth with novel bone-seeking matrix metalloproteinase-2 inhibitors [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-06-02.

Higher Grades and Repeated Recurrence of Hepatic Encephalopathy May Be Related to High Serum Manganese Levels

Hepatic encephalopathy is a serious complication of liver failure. Until now, the precise pathophysiologic mechanisms are not fully determined. It has been demonstrated that manganese plays an important role in the pathogenesis of hepatic encephalopathy. Therefore, we studied manganese levels in serum of cirrhotic patients with hepatic encephalopathy in relation to grading and recurrence of hepatic encephalopathy. One hundred persons were enrolled in the study, 80 cirrhotic patients with or without encephalopathy and 20 healthy controls. Hepatic encephalopathy was diagnosed clinically and by laboratory findings. Serum manganese levels were measured in all participants. The grading of hepatic encephalopathy was significantly correlated to the severity of liver dysfunction. The mean serum manganese level was significantly higher in cirrhotic patients than in controls and in cirrhotic patients with encephalopathy than in those without encephalopathy. It was also significantly higher in patients with advanced grading of hepatic encephalopathy. Serum manganese level was positively correlated to number of recurrences of encephalopathy during a 6-month follow-up period. Serum manganese levels were able to predict recurrence of hepatic encephalopathy within 6 months following the episode. Serum manganese levels are positively correlated to the modified Child-Pugh score of cirrhosis as well as grading and number of recurrences of hepatic encephalopathy. Higher manganese levels seem to be related to worsening of the condition, and its measurement may be used as a predictor of repeated recurrences.

Abstract OT1-2-02: PROMIS: Prospective study of MammaPrint in breast cancer patients with an intermediate recurrence score (PROMIS)

Background: Gene expression profiling offers the potential to improve prognostic accuracy, treatment choice, and health outcomes in women diagnosed with early-stage breast cancer. Numerous gene-profiling assays are now available, which can be applied to a single tumor specimen to provide physicians with a more complete basis for treatment decisions.

· MammaPrint is a 70-gene profile to estimate whether patients are at high or low risk of developing metastases within the first 10 years after curative surgery

· BluePrint is an 80-gene molecular subtyping profile that discriminates between three breast cancer subtypes: Luminal, HER2, and Basal

· TargetPrint provides a quantitative measurement of estrogen receptor (ER), progesterone receptor (PR), and HER2

· Oncotype DX measures expression of five reference genes and 16 cancer-related genes, quantifying the risk of distant recurrence in patients with ER+ early breast cancer who are treated with adjuvant hormonal therapy, and predicting clinical benefit with adjuvant chemotherapy

Trial design: PROMIS is a prospective study that will investigate the additional value of MammaPrint, BluePrint and TargetPrint in women with an intermediate Oncotype DX score. An initial CRF – capturing baseline patient characteristics, pathology information, Oncotype DX score and the recommended treatment plan – will be completed before receiving the MammaPrint result. A second CRF – capturing the actual treatment – will be completed within 4 weeks after receiving the MammaPrint result.

Eligibility: Women aged ≥18 years with histologically proven invasive stage I-II, node negative or node positive (N1), hormone receptor positive, HER2 negative breast cancer, who received an Oncotype DX intermediate score (18-30) and who signed informed consent.

Objectives:

Primary objective:

Assess the impact of MammaPrint on chemotherapy + endocrine versus endocrine alone treatment decisions in lymph node negative, hormone receptor positive, HER2 negative breast cancer patients, who received an Oncotype DX intermediate score

Secondary objectives:

Assess the impact of MammaPrint on chemotherapy + endocrine versus endocrine alone treatment decisions in lymph node positive (N1), hormone receptor positive, HER2 negative breast cancer patients, who received an Oncotype DX intermediate score

Assess the distribution of MammaPrint Low and High Risk in patients with an intermediate recurrence score

Assess concordance of TargetPrint ER, PR and HER2 results with Oncotype DX ER, PR and Her2 and with locally assessed IHC/FISH ER, PR and HER2

Compare clinical subtype based on IHC/FISH ER, PR, HER2 and Ki-67 (if available) with BluePrint molecular subtype

Statistical methods: A sample size of 820 lymph node negative, hormone receptor positive, HER2 negative breast cancer patients is required to detect a 20% overall treatment change (5% significance and 90% power). A McNemars test will be performed for the comparison of the two proportions treated (before and after), both expressed as a percentage.

Accrual: A total of 150 out of 820 have been enrolled from multiple institutions in the US.

Clinical trial registry number: NCT01617954.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr OT1-2-02.

Can Lactobacillus acidophilus improve minimal hepatic encephalopathy? A neurometabolite study using magnetic resonance spectroscopy

BACKGROUND AND STUDY AIMS

Minimal hepatic encephalopathy (MHE) is diagnosed when hepatic patients perform worse on psychometric tests compared to healthy controls. This study aimed to evaluate probiotics as alternative therapy in MHE.

PATIENTS AND METHODS

This is an open-label randomised controlled trial, performed in the Department of Tropical Medicine and Infectious Diseases, Tanta University Hospitals, from March 2010 to January 2012. A total of 90 patients with MHE were allocated by simple randomisation to three parallel equal groups. Group A received lactulose, group B a probiotic (Lactobacillus acidophilus) and group C served as the control. After informed consent, patients were tested for gut micrecology, fasting blood ammonia, liver functions and magnetic resonance spectroscopy (MRS) examination to study brain metabolites, mainly choline (Cho), myo-inositol (mI), glutamine+glutamate (Glx) and creatinin (Cre). Patients who developed overt encephalopathy were excluded from analysis. The whole battery of investigations was repeated in the same order after 4weeks.

RESULTS

The probiotic was better tolerated than lactulose. The relative risk reduction (RRR) of developing overt encephalopathy was 60% in the case of lactulose and 80% in the case of probiotic, with a number needed to treat (NNT) of 2.4 and 2.3, respectively. The differential but not total microecology count was significantly shifted towards saccharolytic rather than proteolytic bacteria. The mI/Cre and (Cho+mI)/Glx ratios were significantly increased and the Glx/Cre ratio was significantly reduced after 1month-follow-up in the probiotic group compared to the lactulose group and in both treatment groups compared to the control group.

CONCLUSION

Both probiotic and lactulose therapy can improve blood ammonia and psychometric tests in MHE and reduce the risk of developing overt encephalopathy. MRS showed more improvement in the levels of brain neurometabolites in the probiotic group.

The impact of H. pyiori eradication on response to oral iron therapy in patients with iron deficiency anemia

Infection with Helicobacter pylori has been associated with Iron deficiency anemia (IDA). We assessed the effect of eradication of H. pylori infection on response to oral iron treatment. Twenty patients with IDA of no obvious cause, unresponsive to oral iron therapy with positive gastric biopsy for H. pyJoril infection received sequential eradication therapy for 10 days followed by oral iron therapy. Treated patients were followed up at 6 weeks and 12 weeks post eradication to assess dynamic changes in hemoglobin, serum ferritin and transferrin saturation. While 65% of anemic H. pylori infected cases had pangpstritis, 35% had antral gastritis. In the antrum severe and moderate gastritis were found in 40% and 45% of cases, respectively. Hemoglobin and serum ferritin level correlated inversely with grade of gastritis (P <0.001). Improvement in hematological parameters and serum iron profile was observed 6 weeks and 12 weeks post successful H. eradication oral iron therapy. In conclusion, eradication of H. pylori infection enhances the response to oral iron supplementation in patients with refractory IDA. Screening and eradication of H. pylori should be a standard procedure for patients with IDA.

Expression of the signal transducer and activator of transcription factor 3 and Janus kinase 3 in colorectal carcinomas, colonic adenomas and ulcerative colitis

BACKGROUND AND STUDY AIMS

Despite the growing understanding of the involvement of protooncogenes and tumour suppressor genes in the oncogenesis of CRC, the exact biological and molecular mechanisms underpinning this process remain poorly understood. The signal transducer and activator of transcription (STAT3) has been implicated in the regulation of growth and malignant transformation. Accumulating evidences have come to indicate that abnormalities in the Janus kinase (JAK)/STAT pathway are involved in oncogenesis of several cancers. The aim of this study was to investigate the expression of JAK3 and STAT3 in both normal and activated forms by immunohistochemistry in adenomas of the colon, ulcerative colitis and CRC compared to normal colonic mucosa.

PATIENTS AND METHODS

Tissues from 30 cases with primary CRC and seven cases with ulcerative colitis (UC), removed by colectomy, were included. In addition, tissues from 10 colonic adenomas, 15 CRC and eight cases with UC, obtained by endoscopic biopsies, were examined histopathologically. Immunohistochemical evaluation of STAT3, p-STAT3, JAK3 and p-JAK3 expression in tissue sections was completed. Statistical analysis and correlation of data were then performed.

RESULTS

Normal colonic mucosa showed expression of STAT3 only. Immunoreactivity of p-JAK3 increased significantly (p<0.05) and correlated with the degree of dysplasia in colonic adenomas. Immunoreactivity of p-STAT3 increased significantly (p<0.05) and correlated with the degree of dysplasia in cases with UC. In CRC a significant positive correlation was found between p-STAT3 expression and grading, STAT3, JAK3 and p-JAK3 and TNM or Dukes' staging, and p-STAT3 and nodal status excluding distant metastasis (p<0.05).

CONCLUSION

JAK3 and STAT3, and particularly their activated forms, were found to correlate significantly with the degree of dysplasia in adenomas and UC, indicating their potential role in colorectal carcinogenesis. They also correlate with anaplasia and invasion, suggesting a definitive role in progression of CRC.

A cross-cultural evaluation of depression in children in Egypt, Kuwait, and the United States

The English version of the Arabic Children's Depression Inventory, constructed by Abdel-Khalek, was applied to a sample of 535 U.S. students (11 to 18 years old). Cronbach coefficients alpha were .88, .90, and .89 for boys, girls, and all subjects, respectively. Seven factors were extracted by principal axis factor analysis (Negative mood and self-depreciation, Fatigue, Lack of loneliness, Sleep problems, Weak concentration, Pessimism, and Feeling happy), denoting clear factorial structure; however, the scale was intended to be unidimensional. Sex and racial differences for this American sample were not statistically significant but the correlation of depression scores with age was .22. The scale appears useful in studying depression in American school children and adolescents. Also, cross-cultural differences in childhood depression between samples from Egypt and Kuwait of previous studies and the present American sample were examined. Based on the effect size, female Kuwaiti had a lower mean depression score than either the Egyptian or American groups. The scale can be used in cross-cultural research.

Perceptions of indigenous workers following participation in a disaster relief project

A survey design was used to elicit workers' perceptions of providing crisis outreach services to survivors of the 1993 flood in Illinois. Findings highlight the benefits of recruiting local workers in disaster relief work. Positive outcomes of the experience include both personal and professional growth.