Early invasive revascularization strategy was more effective than a non-invasive strategy at one year in patients with unstable CAD

Purpose - compare the phenotype and genotype correlation of cytolysin and gelatinase production in clinical isolates Enterococcus spp. Materials and methods - 100 Enterococcus strains collected over a period of one year from inpatients of two Bulgarian university hospitals, were tested for phenotype production of cytolysin and gelatinase. Multiplex PCR was performed to screen the presence of gelE and cylA virulence genes. Results – 17% of the enterococcal isolates demonstrated only cytolysin production phenotypically. Gelatinase activity was found in 21% of the isolates. Only E. faecalis showed combined phenotypic production of cytolysin plus gelatinase (21%). Forty-five percent of the tested enterococci were identified negative for both hemolysin and gelatinase activity. GelE was the most prevalent virulent gene (48% of the isolates). CylA gene was present alone only in four non-invasive E. faecalis isolates. Twenty-six percent of the isolates possessed both cylA and gelE genes and 21% did not harbor any of the virulence factors genotypically. Conclusion - our results prove that it is appropriate to perform both phenotypic and genotypic analysis of the enterococci virulence profile in parallel in order to better characterize the strains, which in turn may serve to develop more effective methods to limit the spread of infections caused by these microorganisms.

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Abstract 1787: Vertebral Artery Stent Placement for Symptomatic Patients: One-Year Follow-up

Circulation ◽

10.1161/circ.116.suppl_16.ii_379-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Samir N Patel ◽

J. Stephen Jenkins ◽

Christopher J White ◽

Paul McMullan ◽

J.P. Reilly ◽

...

Keyword(s):

Vertebral Artery ◽

Stent Placement ◽

Clinical Success ◽

High Morbidity ◽

Symptom Resolution ◽

Non Invasive ◽

Procedural Success ◽

Repeat Angiography ◽

One Year

Background : Symptomatic vertebral artery stenosis (VAS) has a five-year stroke risk of 30%–35%. Mortality associated with posterior circulation (PC) strokes is high, ranging from 20%–30%. Surgical revascularization is rarely performed due to high morbidity and mortality. Endovascular revascularization with stents offers a potential treatment option for these patients. Methods : One hundred nine patients (116 arteries, 70% male) underwent stent placement for extracranial (91%) and intracranial (9%) VAS from 1995–2006. Symptoms included vertigo (63%), visual changes (31%), syncope (11%), ataxia (7%), and drop attack (5%). Four patients had asymptomatic critical stenosis. Sixty-one patients (56%) had bilateral VAS, 74 patients (69%) had concomitant carotid disease, and 43 patients (39%) had a prior stroke. Procedural success was defined as residual stenosis of ≤ 20% without peri-procedural stroke or death. Clinical success was defined as procedural success with symptom resolution. Restenosis was defined as angiographic narrowing within the stent of ≥ 70% or > 50% with recurrent symptoms, or evidence of severe stenosis on non-invasive imaging (ultrasound, CT, or MR). Results : Procedural and clinical success was achieved in 108 (99.1%) and 95 (94.3%) patients, respectively. At one year, follow-up was obtained in 91 patients (83.5%), 6 patients (5.5%) had died, 5 patients (5.3%) experienced a PC stroke, and 47 patients (43.1%) underwent repeat angiography and/or non-invasive imaging. Eighty-seven of the 91 patients were initially symptomatic, 69 (79.3%) of which were symptom-free at one year. Three of those that had recurrent symptoms never achieved clinical success, 9 had developed restenosis, and 7 underwent successful re-intervention. At median follow-up of 31 months (lower and upper quartiles of 13.0 and 51.8 months), 72.5% were alive and 71.6% remained symptom-free. Conclusion : Our data demonstrates that stenting for VAS can be successfully performed in 99% of patients without peri-procedural stroke or death and is associated with durable symptom resolution in approximately 80% of patients at one year. In these high-risk patients, endovascular therapy for symptomatic VAS appears to be safe and effective at relieving symptoms.

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Evaluation of Transient Elastography in Prediction Of De novo Recurrence of Hepatocellular Carcinoma after Radiofrequency Ablation

QJM ◽

10.1093/qjmed/hcab107.013 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Nadia abdelaty Abdelkader ◽

Moustafa Hamed Abdelaleem ◽

Mohammed El-Gharib Abo El- maaty ◽

Heba Ismail Aly ◽

Sayed Ahmed Sayed

Keyword(s):

Hepatocellular Carcinoma ◽

Radiofrequency Ablation ◽

Transient Elastography ◽

P Value ◽

Hepatic Decompensation ◽

Non Invasive ◽

Prediction Of Mortality ◽

The Mean ◽

One Year

Abstract Background Hepatocellular carcinoma (HCC) is the sixth most common malignancy worldwide and it is also a common cause of death in patients with chronic liver disease. The curative treatment options for HCC that are currently available are surgical resection, liver transplantation and radiofrequency ablation .Despite progressive improvements in the efficacy of RFA, the survival of patients with HCC who undergo RFA remains disappointing, mainly due to frequent intrahepatic recurrence of HCC after RFA. Aim of the work To evaluate the role of transient elastography (as an indirect indicator to degree of liver fibrosis) in prediction of denovo recurrence of hepatocellular carcinoma after radiofrequency ablation in hepatitis C related hepatocellular carcinoma .And to compare between transient elastography and other non invasive fibrosis indices in prediction of denovo recurrence of hepatocellular carcinoma after radiofrequency ablation hepatitis C related hepatocellular carcinoma Patients and methods This prospective cohrt study was conducted on hepatocellular carcinoma patient, who underwent radiofrequency ablation in Tropical Medicine Department in Eldemerdash and Ain Shams Specialized Hospital, HCC clinic Ain Shams University Hospitals, Cairo, Egypt between march, 2017 and May, 2019. Data of the patient, who underwent radiofrequency ablation during the study period, were reviewed and the patients who fulfilled the inclusion criteria were enrolled into this study. The patients who fulfilled the inclusion criteria and underwent radiofrequency ablation were followed up for 12 months. Results TE revealed 28 patients with F4 and only 2 patients with F3, the mean measurement of liver stiffness was (22.45 ± 10.36) KPa. There was a significant negative correlation between LS and denovo recurrence of HCC (mean of LS in patients with complete response was 17.19 ± 3.32 and the mean of LS in patient with denovo recurrence was 36,94 ± 5.93,with the The best cut off value ≥24.65 (p value < 0.001)). There was no significant correlation between CDC, FIB4, API scores and denovo recurrence of HCC. Also it was found that the LS was significantly associated with prediction of manifestation of hepatic decompensation after RFA (means of LS in patient without manifestation decompensation after RFA (p value <0.001) .Regarding prediction of mortality, LS at cut off value > 42 .75 (p value = 0,031) was significantly associated with prediction of mortality after one year of RFA. As regard serum non invasive fibrosis indices our results showed correlation between FIB4 score and hepatic decompensation after one year of intervention (the mean of FIB4 score in patients ascites and jaundice was 6.05 ± 4.71 (p value = 0.05) ).Therewas no statistically significant correlation between CDS and API with hepatic decompensation after RFA .As regard role of serum non invasive fibrosis indices in prediction of mortality after RFA, FIB4 score, CDS and API were statistically non significant. Conclusion Our data suggest that LS measurement is a useful predictor of HCC de novorecurrence overall survival and possibility of hepatic decompensation after RFA

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The impact of direct-acting antivirals on liver fibrosis in Egyptian hepatitis C virus patients: a single center experience

QJM ◽

10.1093/qjmed/hcab107.007 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Nadia Abdelaaty Abdelkader ◽

Amira Mahmoud AlBalakosy ◽

Ahmed Fouad Helmy Sherief ◽

Mohamed Soliman Gado

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Liver Fibrosis ◽

Transient Elastography ◽

Liver Stiffness ◽

Treatment Unit ◽

Non Invasive ◽

One Year ◽

The Impact

Abstract Background Hepatitis C virus (HCV) infection affects approximately 170 million people worldwide, causing liver cirrhosis and hepatocellular carcinoma (HCC) and leading to liver transplantation and ultimately death. Accurate evaluation of liver fibrosis in patients with chronic liver diseases is crucial, as liver fibrosis is important in order to make therapeutic decisions, determine prognosis of liver disease and to follow-up disease progression. Multiple non-invasive methods have been used successfully in the prediction of fibrosis; however, early changes in noninvasive biomarkers of hepatic fibrosis under effective antiviral therapy are widely unknown. The aim of this study is to evaluate changes of transient elastography values as well as FIB-4 and AST to platelet ratio index (APRI) in patients treated with DAAs. Objectives The aim beyond this study is to evaluate the changes in liver stiffness in hepatitis C Egyptian patients before and at least one year after treatment with DAAs using transient elastography and non-invasive liver fibrosis indices as FIB-4 and APRI scores. Patients and methods The present study was conducted on 100 patients with chronic hepatitis C patients attended to Ain Shams University Hospitals, Viral hepatitis treatment unit between October 2017 and December 2018, who were followed-up during treatment and after treatment for at least one year (retrospective and prospective study). Total number of cases during the study period was 117 patients. 17 patients were excluded from the study due to missed follow-up. Eventually, 100 patients were enrolled in the study fulfilling the inclusion criteria. Results The mean age of our patients is 47.9 years with Male predominance (52 males and 48 females). There was a significant improvement of, platelets counts, ALT and AST levels, which in turn cause significant improvement in FIB-4 and APRI scores. There was a significant improvement of liver stiffness after end of treatment, regardless of the DAA regimen used, as evidenced by Fibroscan. Conclusion Fibrosis regression –assessed by non-invasive markers of fibrosis is achievable upon removal of the causative agent.

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Liposome Photosensitizer Formulations for Effective Cancer Photodynamic Therapy

Pharmaceutics ◽

10.3390/pharmaceutics13091345 ◽

2021 ◽

Vol 13 (9) ◽

pp. 1345

Author(s):

Sherif Ashraf Fahmy ◽

Hassan Mohamed El-Said Azzazy ◽

Jens Schaefer

Keyword(s):

Reactive Oxygen Species ◽

Photodynamic Therapy ◽

Adverse Effects ◽

Cellular Uptake ◽

Treatment Effectiveness ◽

State Of The Art ◽

Oxygen Species ◽

Chemotherapeutic Drugs ◽

Invasive Strategy ◽

Non Invasive

Photodynamic therapy (PDT) is a promising non-invasive strategy in the fight against that which circumvents the systemic toxic effects of chemotherapeutics. It relies on photosensitizers (PSs), which are photoactivated by light irradiation and interaction with molecular oxygen. This generates highly reactive oxygen species (such as 1O2, H2O2, O2, ·OH), which kill cancer cells by necrosis or apoptosis. Despite the promising effects of PDT in cancer treatment, it still suffers from several shortcomings, such as poor biodistribution of hydrophobic PSs, low cellular uptake, and low efficacy in treating bulky or deep tumors. Hence, various nanoplatforms have been developed to increase PDT treatment effectiveness and minimize off-target adverse effects. Liposomes showed great potential in accommodating different PSs, chemotherapeutic drugs, and other therapeutically active molecules. Here, we review the state-of-the-art in encapsulating PSs alone or combined with other chemotherapeutic drugs into liposomes for effective tumor PDT.

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HDR brachytherapy and supervoltage external beam therapy of cervical cancer: Protection of the intestinal tract during the treatment

Archive of oncology ◽

10.2298/aoo0201013l ◽

2002 ◽

Vol 10 (1) ◽

pp. 13-17 ◽

Cited By ~ 1

Author(s):

Sasa Ljubenkovic

Keyword(s):

Small Bowel ◽

Standard Technique ◽

Acute Radiation ◽

Watery Diarrhoea ◽

Radiation Enteritis ◽

High Dose ◽

Non Invasive ◽

Dose Volume ◽

Patient Table ◽

One Year

BACKGROUND: During radiotherapy in most of the irradiated patients occur the symptoms of acute radiation enteritis, less frequently cystitis or proctitis. The aim of this work was to apply non invasive exclusion methods to reduce the small bowel volume within the pelvic high dose volume and indirectly to reduce the number and severity of acute radiation enteritis METHODS: A total number of 183 patients were enrolled in our prospective randomised investigation we performed at the Clinic of Oncology in Knez Selo during one year. Ninety patients from E-group were irradiated with the standard technique two opposite parallel fields on the Mevatron-7445 linear accelerator (SIEMENS) patient-table, while 93 from C-group were irradiated under special conditions on our unique patient-table (PT) manufactured at our special demands by the Jugorendgen Ei-Ni? factory Brachytherapy was administered with RALT technique in both groups with isotope machine BUCHLER. RESULTS: Individual application of exclusion techniques led to protection of over 50% of the small bowel (118-1065 cm3) in 30/43 (70%) patients, and even in 10/43 (23%) more than 90% of the small bowel was protected (118-835 cm3), which would otherwise be irradiated with conventional techniques. None of the patients from E-group (out of 90) had more than 8 stools a day (G3), while in C-group there were 20 such cases Seventy-seven percent of the patients from E-group had formed stool, while the percent in C-group was 29. In C-group 40% of the patients had so called "watery stools"; in E-group the percent was 4. Out of 53 patients from K-group with mobile small bowel, 21 (40%) had "watery diarrhoea". CONCLUSION: Measures to prevent radiation enteritis should be taken before (surgical) or during (non invasive) radiotherapy. At the Clinic of Oncology in Knez Selo, individual application of small bowel exclusion techniques using the unique patient-table (JUGORENDGEN Ei-Ni?) led to protection of the small bowel during radiotherapy of uterine malignancies, which was reflected in a significantly reduced number and severity of acute enteritis symptoms.

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