Publications by authors named "Ahmed Osman"

318 Publications

Concussion in para sport: the first position statement of the Concussion in Para Sport (CIPS) Group.

Br J Sports Med 2021 Apr 9. Epub 2021 Apr 9.

Para Football Foundation, Arnhem, The Netherlands.

Concussion is a frequent injury in many sports and is also common in para athletes. However, there is a paucity of concussion research related to para sport, and prior International Concussion in Sport (CIS) consensus papers have not substantively addressed this population. To remedy this and to improve concussion care provided to para athletes, the concussion in para sport (CIPS) multidisciplinary expert group was created. This group analysed and discussed in-depth para athlete-specific issues within the established key clinical domains of the current (2017) consensus statement on CIS. Due to the onset of the COVID-19 pandemic, the group held all meetings by video conferencing. The existing Sport Concussion Assessment Tool 5 (SCAT5) for the immediate on-field and office-based off-field assessment of concussion was evaluated as part of this process, to identify any para athlete-specific concerns. Regular preparticipation and periodic health examinations are essential to determine a baseline reference point for concussion symptoms but pose additional challenges for the interpreting clinician. Further considerations for concussion management for the para athlete are required within the remove, rest, reconsider and refer consensus statement framework. Considering return to sport (RTS), the 2017 CIS consensus statement has limitations when considering the RTS of the para athlete. Case-by-case decision making related to RTS following concussion is imperative for para athletes. Additional challenges exist for the evaluation and management of concussion in para athletes. There is a need for greater understanding of existing knowledge gaps and attitudes towards concussion among athlete medical staff, coaches and para athletes. Future research should investigate the use and performance of common assessment tools in the para athlete population to better guide their clinical application and inform potential modifications. Concussion prevention strategies and sport-specific rule changes, such as in Para Alpine Skiing and Cerebral Palsy Football, also should be carefully considered to reduce the occurrence of concussion in para athletes.
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http://dx.doi.org/10.1136/bjsports-2020-103696DOI Listing
April 2021

AGA Clinical Practice Update on The Optimal Management of the Malignant Alimentary Tract Obstruction: Expert Review.

Clin Gastroenterol Hepatol 2021 Apr 1. Epub 2021 Apr 1.

Department of Medicine, Case Western Reserve University, and University Hospitals Cleveland Medical Center, Cleveland, Ohio.

Description: The purpose of this expert review is to describe the current methodologies available to manage malignant alimentary tract obstructions as well the evidence behind the various methods (including their efficacy and safety), indications and appropriate timing of interventions.

Methods: This is not a formal systematic review but is based upon a review of the literature to provide best practice advice statements. No formal rating of the quality of evidence or strength of recommendation is carried out. Best Practice Advice 1: For all patients with alimentary tract obstruction, the decision about specific interventions should be made in a multi-disciplinary setting including oncologists, surgeons and endoscopists and take into account the characteristics of the obstruction, patient's expectations, prognosis, expected subsequent therapies, and functional status. Best Practice Advice 2: For patients who present with esophageal obstruction from esophageal cancer and who are potential candidates for resection or chemoradiation, clinicians should not routinely insert a SEMS (self-expanding metal stent) without multidisciplinary review due to high rates of stent migration, higher morbidity and mortality, and potentially lower R0 (microscopically negative margins) resection rates. Best Practice Advice 3: For patients who present with esophageal obstruction from esophageal cancer who are potential candidates for resection and who have concerns of malnutrition, clinicians may consider the use of enteral feeding tubes (either via nasogastric or percutaneous route). Clinicians should be aware of the potential risk of abdominal wall tumor seeding as well as making subsequent gastric conduit formation difficult with percutaneous endoscopic gastrostomy placement. Best Practice Advice 4: For patients who present with esophageal obstruction from esophageal cancer who are not candidates for resection, clinicians should consider either SEMS insertion or brachytherapy, as sole therapy or in combination. Clinicians should not consider the use of laser therapy or photodynamic therapy (PDT) due to the lack of evidence of better outcomes and superior alternatives. Best Practice Advice 5: For patients with malignant esophageal obstruction who are undergoing SEMS placement, clinicians should use a fully-covered (FCSEMS) or partially-covered SEMS and not an uncovered SEMS (UCSEMS), with consideration of a stent-anchoring/fixation method. Best Practice Advice 6: For patients with gastric outlet obstruction who have a life expectancy greater than 2 months, have good functional status and who are surgically fit, surgical gastrojejunostomy should be considered. Best Practice Advice 7: For patients with gastric outlet obstruction who are undergoing surgical gastrojejunostomy, a laparoscopic approach is favored over an open approach due to lower blood loss and shorter hospital stay. Best Practice Advice 8: For patients with gastric outlet obstruction who are not candidates for gastrojejunostomy (surgical or endoscopic ultrasound-guided), clinicians should consider the insertion of an enteral stent. Best Practice Advice 9: Enteral stents should not be used in patients with multiple luminal obstructions or severely impaired gastric motility, due to the limited benefit in these scenarios. Clinicians can consider placement of a venting gastrostomy in these patients. Best Practice Advice 10: Depending on the experience of the endoscopist, endoscopic ultrasound-guided gastrojejunostomy is an acceptable alternative to surgical gastrojejunostomy and enteral stent placement. Clinicians should be aware that there are currently no dedicated FDA-approved devices for EUS-guided gastrojejunostomy. Best Practice Advice 11: For patients with malignant colonic obstruction who are candidates for resection, insertion of SEMS is a reasonable choice as a "bridge to surgery" to allow for one-stage, elective resection. Best Practice Advice 12: For patients with malignant colonic obstruction who are not candidates for resection, either SEMS placement or a diverting colostomy are reasonable choices depending on the patient's goals and functional status. Best Practice Advice 13: SEMS is a reasonable option for patients with proximal (or right-sided) malignant obstructions, both as a "bridge to surgery" and in the palliative setting. Best Practice Advice 14: SEMS placement is a reasonable alternative for patients with extracolonic malignancy who are not candidates for surgery, though their placement is more technically challenging, clinical success rates are more variable and complications (including stent migration) are more frequent.
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http://dx.doi.org/10.1016/j.cgh.2021.03.046DOI Listing
April 2021

Temporal and geospatial variations among the interventional radiology physician workforce in the United States.

Clin Imaging 2021 Mar 19;78:105-109. Epub 2021 Mar 19.

Division of Interventional Radiology, NewYork-Presbyterian/Weill Cornell Medical Center, New York 10065, USA. Electronic address:

Objective: To analyze the temporal trends and state-wide geospatial variations in Vascular and Interventional Radiology (VIR) workforce in the United States.

Methods: The State Physician Workforce Data from the AAMC website was accessed for years 2015, 2017, and 2019. The variables collected for each state included total number of active physicians, total number of physicians per specialty and total number of female physicians in VIR. Comparative data was obtained for vascular surgery (VS), diagnostic radiology (DR), and radiation oncology (RO). The annual growth rate for total physicians and sub-analysis of female physicians in each state was computed for each specialty.

Results: From 2015 to 2019, the total number of active physicians in the United States grew by 1.8% per year. Growth of active physicians in VIR grew by 8.3%, DR 0.06%, VS 4.4%, and RO 1.9% per year. Colorado and Minnesota had the highest growth rate for VIR physicians (15%). VIR physicians per 100,000 people increased from 0.84 (2015) to 1.10 (2019) in the US. In comparison, VS physicians increased from 0.99 (2015) to 1.14 (2019), DR physicians decreased from 8.61 (2015) to 8.43 (2019), and RO physicians grew from 1.48 (2015) to 1.56 (2019). Women represented 6.8% of the VIR workforce in the US in 2019 and increased by a rate of 16% annually in the US from 2015 to 2019. In comparison, the number of women in VS has grown by 21%, DR by 2%, and RO by 2.4% during the same period. The state of Maryland has the highest proportion of women in VIR at 18%.

Conclusion: The number of VIR physicians is increasing at a higher rate than the national overall physician growth, and while female VIR physicians makeup a small fraction of the VIR workforce, their numbers have increased at a faster rate than overall VIR physicians.
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http://dx.doi.org/10.1016/j.clinimag.2021.03.013DOI Listing
March 2021

Corneal endothelial cells changes in different stages of Keratoconus: a multi-Centre clinical study.

BMC Ophthalmol 2021 Mar 21;21(1):143. Epub 2021 Mar 21.

Department of Ophthalmology, Faculty of Medicine, Alexandria University, Champollion Street, Al Attarin, Alexandria, Egypt.

Purpose: To assess the corneal endothelial cells morphology and count in keratoconus patients and their correlation with different stages of keratoconus.

Methods: Prospective non randomized multi-centric clinical study included 150 eyes of 150 keratoconus patients. Four centers in Egypt participated in this study included: Departments of Ophthalmology in Alexandria University, Tanta University and Port Said University and Alex I-Care hospital. Pentacam (Wavelight Oculyzer II) and specular microscopy (Tomey EM-3000) were done to all eyes. Keratoconic eyes were classified according to Amsler classification into stage 1, 2 and 3. Stage 1 included 99 eyes, stage 2 included 32 eyes & stage 3 included 19 eyes.

Results: The mean age of keratoconus patients was 24.07 ± 6.154 years. Forty five cases were males (30%) and 105 cases were females (70%). There was statistically significant difference in endothelial cell density (p < 0.001) and coefficient of variation (p = 0.012) between different stages of keratoconus eyes. Regarding cell surface area, there was statistically significant difference in cell surface area between different stages of keratoconus eyes (p < 0.001). In addition, for cell morphology, there was statistically significant difference between different stages of keratoconus eyes (p < 0.001).

Conclusions: Qualitative and quantitative structural changes were seen in endothelial cells of keratoconus eyes by using specular microscopy. For stages 1 and 2, keratoconus may not affect the corneal endothelim significantly. The endothelium in stage 3 shows significant changes regarding polymegathism and pleomorphism.
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http://dx.doi.org/10.1186/s12886-021-01913-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981969PMC
March 2021

Efficacy and Safety of Mechanical IVC Filtration for Preventing Pulmonary Embolism in High-Risk Orthopedic Patients Undergoing Total Hip or Knee Arthroplasty.

J Arthroplasty 2021 Feb 20. Epub 2021 Feb 20.

Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL.

Background: To determine the efficacy and safety of inferior vena cava (IVC) filters in preventing pulmonary embolism (PE) in high-risk patients undergoing hip or knee arthroplasty.

Methods: 2857 hip or knee arthroplasty procedures between January 2013 and December 2018 were retrospectively reviewed. Patients with a preoperative history of venous thromboembolism (VTE), either PE or deep venous thrombosis (DVT), were categorized as high-risk patients. The incidence of overall VTE, PE, and DVT were compared between patients with filters and those without. The subgroup analysis was also performed by patient risk, and filter status and the incidence of VTE, PE, and DVT were compared. Variables such as filter placement, history of hypercoagulability etcetra were evaluated as risk factors for the development of postoperative VTE.

Results: In the high-risk group, the use of IVC filters was significantly associated with a lower incidence of pulmonary embolism (0.8% vs 5.5%, P = .028). When compared with the low-risk group, the high-risk group had significantly higher incidence of PE (3.8% vs 2.0%, P = .038), DVT (11.6% vs 5.3%, P < .001), and overall VTE (15.0% vs 6.8%, P < .001). The history of VTE was associated with postoperative VTE (P < .001), PE (P = .042), and DVT (P < .001). There was no significant correlation between filter placement and postoperative VTE, DVT, or PE in the low-risk group. Filter retrieval was successful in 100% (96/96) of attempted patients with no complications.

Conclusion: The use of IVC filters is significantly associated with a lower incidence in pulmonary embolism in high-risk arthroplasty patients. High-risk patients demonstrated an incidence of postoperative VTE over two times greater than other patients. Prophylactic placement of IVC filters in hip/knee arthroplasty is safe.
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http://dx.doi.org/10.1016/j.arth.2021.02.042DOI Listing
February 2021

An Assessment of Health Priorities Among a Community Sample of Somali Adults.

J Immigr Minor Health 2021 Mar 19. Epub 2021 Mar 19.

Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.

Somali immigrants are one of the largest African populations to resettle in the United States since 1990. There is an emerging literature base of disease-specific studies among Somali immigrants. However, we are aware of no studies on the health priorities for Somalis from the community's perspective. Somali adults in Minnesota completed a survey conducted by a community-based participatory research partnership on individual and community health priorities. Data were reported as counts and frequencies. 646 participants completed the survey. The most important health issues for individuals and their families were health behaviors (22.7%), diabetes (18.2%), and hypertension (14.4%), while those of the community were diabetes (22.5%), hypertension (18.8%) and weight (15.9%). This study found a significant overlap of health priorities among Somali individuals and their families compared to the community. These health priorities underscore the need to focus on non-communicable diseases among Somali immigrants.
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http://dx.doi.org/10.1007/s10903-021-01166-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7975235PMC
March 2021

Strategies for engaging "multiple disciplinary" teams in sport- and exercise-related research.

J Sci Med Sport 2021 Mar 10. Epub 2021 Mar 10.

School of Medical and Health Sciences, Edith Cowan University, Australia.

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http://dx.doi.org/10.1016/j.jsams.2021.03.002DOI Listing
March 2021

Assessment of Human Papillomavirus Infection and Risk Factors in Egyptian Women With Breast Cancer.

Breast Cancer (Auckl) 2021 25;15:1178223421996279. Epub 2021 Feb 25.

Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA.

Numerous risk factors for breast cancer (BC) have been identified. High-risk human papilloma virus (HR-HPV) is the etiological agent of cervical cancer and in some cases of head and neck cancer, specifically oropharyngeal cancer, but the role of HR-HPV in evoking neoplasia in BC is still unclear. In this study, all women above the age of 18 visiting the oncology clinic at Al-Azhar university hospital and Ain Shams specialized hospital between the period of February 2017 and March 2018 were invited to participate. We determined the prevalence of HR-HPV genotypes 16, 18, and 31 in breast tissue samples from 72 women with treatment-naïve BC and 15 women with benign breast lesions (BBL) by quantitative real-time PCR (qRT-PCR) and primer sets targeting the E6 and E7 regions. High-risk human papilloma virus DNA was detected in 16 of 72 (22.2%) BC cases (viral load range = 0.3-237.8 copies/uL) and 0 of 15 women with BBL. High-risk human papilloma virus was detected in 14 of 16 (87.5%), 2 of 16 (12.5%), and 0 of 16 (0%) for genotypes 16, 18, and 31, respectively. Forty-three age-matched healthy Egyptian women were enrolled as controls for assessment of local risk factors that can be used to initiate a strategy of BC prevention in Egypt. Assessment of the risk factors demonstrated that low education level, passive smoking, lack of physical activity, family history of cancer, and use of oral contraception were significant risk factors for BC. In conclusion, our results lead us to postulate that HR-HPV infection may be implicated in the development of some types of BC in Egyptian women. In addition, identification of local risk factors can support practical prevention strategies for BC in Egypt.
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http://dx.doi.org/10.1177/1178223421996279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7917427PMC
February 2021

Ventriculoatrial Shunt Placement After Wire-catheter-Recanalization of Central Venous Occlusion.

J Vasc Interv Radiol 2021 Mar 10. Epub 2021 Mar 10.

Section of Interventional Radiology, University of Chicago, Chicago, IL.

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http://dx.doi.org/10.1016/j.jvir.2021.03.411DOI Listing
March 2021

Effects of Implementation of Infant-Driven Oral Feeding Guideline on Preterm Infants' Abilities to Achieve Oral Feeding Milestones, in a Tertiary Neonatal Intensive Care Unit.

Nutr Clin Pract 2021 Mar 2. Epub 2021 Mar 2.

Division of Neonatology, Department of Pediatrics, Case Western Reserve University and MetroHealth Medical Center, Cleveland, Ohio, USA.

Objective: This study examines the hypothesis that infant-driven oral feeding leads to earlier achievement of oral feeding and reduces the length of hospital stay compared with provider-driven oral feeding in premature infants METHODS: We used a retrospective chart review to compare 2 groups of premature infants born at ≤35 weeks of gestation. The control group (CG) received the Provider-Driven Oral Feeding model and the intervention group (IG) received the Infant-Driven Oral Feeding model. Postmenstrual age (PMA) upon achieving full oral feeding, PMA at first oral feeding, discharge weight, and length of hospital stay were compared between the groups.

Results: There are 208 infants in CG and 170 infants in IG. Infants in IG were born, on average, at a lower gestational age and birth weight than infants in CG. The median PMA at full oral feeding of 35 2/7 weeks (interquartile range [IQR], 34 2/7-36 2/7) for IG is significantly lower than the median of 35 5/7 weeks (IQR, 35-36 5/7) for CG, P-value < 0.001. Median PMA at first oral feeding is 34 1/7 weeks for both groups. Median PMA at discharge was 36 6/7 weeks for both groups. Median discharge weights of 2509 g (IQR, 2175-2964) for IG and 2459 g (IQR, 2204-2762) for CG are not statistically different.

Conclusion: Implementation of the Infant-Driven Feeding guideline led to earlier achievement of full oral feeding by 3 days on average while maintaining the same discharge weight but did not lead to earlier hospital discharge.
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http://dx.doi.org/10.1002/ncp.10635DOI Listing
March 2021

SOM-LWL method for identification of COVID-19 on chest X-rays.

PLoS One 2021 24;16(2):e0247176. Epub 2021 Feb 24.

Department of Computer Science, Faculty of Computing and Information Technology, King Abdulaziz University, Rabigh, Saudi Arabia.

The outbreak of coronavirus disease 2019 (COVID-19) has had an immense impact on world health and daily life in many countries. Sturdy observing of the initial site of infection in patients is crucial to gain control in the struggle with COVID-19. The early automated detection of the recent coronavirus disease (COVID-19) will help to limit its dissemination worldwide. Many initial studies have focused on the identification of the genetic material of coronavirus and have a poor detection rate for long-term surgery. The first imaging procedure that played an important role in COVID-19 treatment was the chest X-ray. Radiological imaging is often used as a method that emphasizes the performance of chest X-rays. Recent findings indicate the presence of COVID-19 in patients with irregular findings on chest X-rays. There are many reports on this topic that include machine learning strategies for the identification of COVID-19 using chest X-rays. Other current studies have used non-public datasets and complex artificial intelligence (AI) systems. In our research, we suggested a new COVID-19 identification technique based on the locality-weighted learning and self-organization map (LWL-SOM) strategy for detecting and capturing COVID-19 cases. We first grouped images from chest X-ray datasets based on their similar features in different clusters using the SOM strategy in order to discriminate between the COVID-19 and non-COVID-19 cases. Then, we built our intelligent learning model based on the LWL algorithm to diagnose and detect COVID-19 cases. The proposed SOM-LWL model improved the correlation coefficient performance results between the Covid19, no-finding, and pneumonia cases; pneumonia and no-finding cases; Covid19 and pneumonia cases; and Covid19 and no-finding cases from 0.9613 to 0.9788, 0.6113 to 1 0.8783 to 0.9999, and 0.8894 to 1, respectively. The proposed LWL-SOM had better results for discriminating COVID-19 and non-COVID-19 patients than the current machine learning-based solutions using AI evaluation measures.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247176PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7904146PMC
March 2021

Empiric Transcatheter Embolization for Acute Arterial Upper Gastrointestinal Bleeding: A Meta-Analysis.

AJR Am J Roentgenol 2021 04 10;216(4):880-893. Epub 2021 Feb 10.

Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, IL.

The purpose of this study was to conduct a meta-analysis to assess the safety and efficacy of empiric embolization compared with targeted embolization in the treatment of acute upper gastrointestinal bleeding (UGIB). We searched the PubMed and Cochrane Library databases for studies performed without language restrictions from January 2000 to November 2019. Only clinical studies with a sample size of five or more were included. Clinical success, rebleeding and complication rates, survival rates, bleeding cause, embolic materials, and vessels embolized were recorded. Empiric embolization and targeted embolization (i.e., embolization performed based on angiographic evidence of ongoing bleeding) were compared when possible. Meta-analysis was performed. Among 13 included studies (12 retrospective and 1 prospective), a total of 357 of 725 patients (49.2%) underwent empiric embolization for UGIB. The clinical success rate of empiric embolization was 74.7% (95% CI, 63.1-86.3%) among the 13 studies, and the survival rate was 80.9% (95% CI, 73.8-88.0%) for 10 studies. On the basis of comparative studies, no statistically significant difference was observed between empiric and targeted embolization in terms of rebleeding rate in 111 studies (36.5% vs 29.6%; odds ratio [OR], 1.13; 95% CI, 0.77-1.65; = .53), mortality in eight studies (23.3% vs 18.0%; OR, 1.44; 95% CI, 0.89-2.33; = .14), and need for surgery to control rebleeding in four studies (17.8% vs 13.4%; OR, 1.34; 95% CI, 0.58-3.07; = .49). The pooled embolization-specific complications were 1.9% (empiric) and 2.4% (targeted). According to all available published evidence, empiric embolization assessed with endoscopic or preprocedural imaging findings (or both) appears to be as effective as targeted embolization in preventing rebleeding and mortality in patients with angiographically negative acute UGIB. Because of its favorable safety profile, empiric embolization should be considered for patients in this clinical scenario.
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http://dx.doi.org/10.2214/AJR.20.23151DOI Listing
April 2021

Nanometallic antenna-assisted amorphous silicon waveguide integrated bolometer for mid-infrared.

Opt Lett 2021 Feb;46(3):677-680

Bolometers are thermal detectors widely applied in the mid-infrared (MIR) wavelength range. In an integrated sensing system on chip, a broadband scalable bolometer absorbing the light over the whole MIR wavelength range could play an important role. In this work, we have developed a waveguide-based bolometer operating in the wavelength range of 3.72-3.88 µm on the amorphous silicon (a-Si) platform. Significant improvements in the bolometer design result in a 20× improved responsivity compared to earlier work on silicon-on-insulator (SOI). The bolometer offers 24.62% change in resistance per milliwatt of input power at 3.8 µm wavelength. The thermal conductance of the bolometer is 3.86×10/, and an improvement as large as 3 orders magnitude may be possible in the future through redesign of the device geometry.
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http://dx.doi.org/10.1364/OL.412529DOI Listing
February 2021

Terlipressin-induced foot ischemia.

Clin Case Rep 2021 Jan 20;9(1):592-593. Epub 2020 Nov 20.

Department of Internal Medicine Hamad Medical Corporation Doha Qatar.

Terlipressin-induced peripheral ischemia is a rare side effect of the drug, which should be timely identified and treated to prevent permanent necrosis.
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http://dx.doi.org/10.1002/ccr3.3570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813015PMC
January 2021

Expression profiling of some Acute Myeloid Leukemia - associated markers to assess their diagnostic / prognostic potential.

Genet Mol Biol 2021 6;44(1):e20190268. Epub 2021 Jan 6.

Egypt-Japan University of Science and Technology (E-JUST), Basic and Applied Sciences Institute, Alexandria, Egypt.

Investigating the etiological causes of acute myeloid leukemia (AML) at the molecular level should help in identifying targets and strategies that would increase the efficacy of the current management regimens. Some genes may act as molecular diagnostics, of these ASXL1 and PHF6 are involved in regulation of gene expression, and BAX , and ARC, are pro- and anti-apoptotic molecules, respectively. In this study, peripheral blood samples were collected from 54 recently diagnosed AML patients in addition to 20 healthy individuals (the control group). Cellular RNA was extracted from all the samples and were subjected to quantitative analysis of the transcript levels of the four selected markers. Our data showed a significant elevation in the expression levels of PHF6 and ARC in AML patients, when compared to the controls (77.8% and 83.3%, respectively). On the other hand, ASXL1 and BAX exhibited increase, to a lesser extent, in the expression levels of the AML patients (52% and 55.6%, respectively). Our study also showed that the expression levels of ARC and PHF6 exhibited a concomitant increase and this could be correlated with poor prognosis of the cases. Thus, we can suggest these markers as reliable prognostic markers for prediction of AML outcomes.
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http://dx.doi.org/10.1590/1678-4685-GMB-2019-0268DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802071PMC
January 2021

The utility of 3D printed models in complex percutaneous paravalvular leak interventions.

Glob Cardiol Sci Pract 2020 Nov 30;2020(2):e202027. Epub 2020 Nov 30.

Aswan Heart Centre, Aswan, Egypt.

Paravalvular leaks (PVL) are seen in 5-17% of patients after surgical mitral and aortic valve replacement. This is usually well-tolerated in the majority of patients; however, up to 5% will require re-intervention due to either hemodynamically significant regurgitation or hemolysis requiring repeated blood transfusion. Transcatheter closure of PVLs is becoming the treatment of choice in many patients owing to the high risk of redo surgery, high rates of recurrence with the surgical approach, and substantial improvements in device technology and growing expertise in structural heart disease interventions. Careful selection of the appropriate candidates by the Heart Team with in-depth analysis of clinical and multimodality imaging data is critical to ensuring good short- and long-term outcomes. The defect is usually oval/crescentic and often serpiginous in nature, which poses significant challenges in choosing the optimal size and number of devices to implant - especially with large size defects. Generally, defects involving more than 25-30% of the sewing ring are deemed unsuitable for percutaneous closure. While the Amplatzer family of vascular plugs (e.g. AVP3 and AVP2) is commonly used for percutaneous closure of PVLs, there are currently no approved dedicated devices for this indication, except the paravalvular leak device (Occlutech) which is not universally available. Small and relatively circular defects can usually be closed using a single plug, conventionally utilizing a size that is 25-30% larger than the mean diameter of the defect. Larger and crescentic defects on the other hand frequently require more than one plug and can be quite challenging in terms of choosing the appropriate size(s). We report two cases with very large defects with irregular shape in which 3D printed modeling was extremely useful for bench testing to optimize the number and sizes of devices to be implanted.
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http://dx.doi.org/10.21542/gcsp.2020.27DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768626PMC
November 2020

Safety and efficacy of repeat Y90 radioembolization to the same hepatic arterial territory.

Br J Radiol 2021 Mar 7;94(1119):20200752. Epub 2021 Jan 7.

Section of Interventional Radiology, University of Chicago, Chicago, IL, USA.

Objective: To study the efficacy and safety of repeat transarterial radioembolization (TARE) to similar hepatic arterial territories.

Methods: Between 3/2011 and 4/2019, 26 patients (25 males and 1 Female, Mean Age: 65 yo, SD: 11.7 yo, Range: 18-83.0 yo) received TARE with Y90 glass microspheres to treat recurrent or residual primary disease in similar hepatic arterial lobe or segments. Tumor response was evaluated by imaging using the modified-RECIST criteria. Incidence of RILD and adverse events were categorized by a standardized scale using the Common Terminology Criteria for Adverse Events (CTCAE) v.4.0.

Results: Mean cumulative activity after the first treatment was 2.50 GBq (SD:1.04 GBq, Range:0.61-4.93 GBq) and second treatment was 2.27 GBq (SD:1.01 GBq, Range:0.92-5.46 GBq). Mean interval time between initial and repeat treatments was 9.6 months (Range: 1-53 months). Tumor responses were complete, partial, or progression in 73% ( = 19/26), 23% ( = 6/26), and 4% ( = 1/26) in repeat treatment patients, respectively. The incidence of RILD was 0%. Toxicity after first and second treatment was seen in 19% ( = 5/26) & 23% ( = 6/26) patients, respectively, and were all of CTCAE Grade 2. No significant predictors of treatment toxicity for repeat treatment were identified except increased MELD score ( = 0.04). Kaplan-Meier survival analysis in patients with repeat treatment showed a median survival of 15.0 months (95% CI 8.8-21.1 months) and 19.0 months (95% CI 8.1-29.9 months) in patients who only received one treatment with a value of 0.485.

Conclusion: Repeat TARE with glass microspheres was an effective and safe treatment strategy for disease management in patients with residual or recurrent disease to the similar hepatic arterial territories without any major treatment related toxicity.

Advances In Knowledge: Although safety and efficacy of repeat radioembolism has been studied, no study has focused on repeat treatment to similar hepatic arterial territories. The current study shows that repeat treatment to the same hepatic arterial territory is as safe as single treatment to the same territory.
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http://dx.doi.org/10.1259/bjr.20200752DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8011251PMC
March 2021

Hybrid angiography-CT for transarterial radioembolization: a pictorial essay.

Abdom Radiol (NY) 2021 Jan 4. Epub 2021 Jan 4.

Department of Radiology, Section of Vascular and Interventional Radiology, University of Chicago Medicine, 5841 S Maryland Ave, MC2026, Chicago, IL, USA.

Although hybrid angiography-CT (Angio-CT) has a long history of use for interventional oncology procedures, its applications for transarterial radioembolization (TARE) are not as well described in the literature. This pictorial essay demonstrates a single-institution experience with the utilization of an Angio-CT system for TARE treatment of hepatocellular carcinoma. Procedural images and clinical data for twenty-four patients who underwent initial angiographic mapping with hepatopulmonary shunt fraction assessment and or administration of Yttrium-90 (Y-90) microspheres using the Angio-CT system to date were reviewed. Cases were reviewed for examples that highlight the specific utility of Angio-CT. Three representative TARE cases were selected which illustrate unique advantages and applications of the Angio-CT system when performing TARE. These include the ability to optimally delineate hepatic vascular anatomy, accurately calculate liver volumes for dosimetry, and improve the detection and characterization of equivocal lesions. Angio-CT has unique advantages which can be applied to TARE treatment of patients with HCC. The technology has potential to be an especially effective tool for those who aim to be at the cutting edge of the rapidly growing field of interventional oncology.
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http://dx.doi.org/10.1007/s00261-020-02914-8DOI Listing
January 2021

Technique-Based Evaluation of Clinical Outcomes and Aortic Remodelling Following TEVAR in Acute and Subacute Type B Aortic Dissection.

Cardiovasc Intervent Radiol 2021 Apr 3;44(4):537-547. Epub 2021 Jan 3.

Department of Diagnostic and Interventional Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, UK.

Introduction: To evaluate the clinical outcomes and aortic remodelling rates following thoracic endovascular aortic repair (TEVAR) for acute or subacute type B aortic dissection (TBAD) based on technique.

Material And Methods: All TEVARs for acute/subacute TBAD between 01/01/2008 and 01/06/2020 were included. TEVARS were grouped by technique (TEVAR only, PETTICOAT and STABILISE). Aortic remodelling was assessed at three aortic levels on follow-up CT. Thirty-day technical/clinical success rates, re-intervention rates and complications were recorded.

Results: A total of 29 patients were included. The median age was 55 years (31-82). The median duration from initial presentation to TEVAR was 7 days (0-84). Intra-procedural complications included one aortic rupture from balloon moulding in a STABILISE case. Thirty-day mortality, stroke, spinal cord ischaemia and visceral ischaemia were 3% (n = 1), 3% (n = 1), 3% (n = 1) and 3% (n = 1), respectively. (All occurred in acute TBAD.) Overall survival was 50.5 months (18-115). Median follow-up was 31 months (1-115). Six patients (21%) required re-intervention, with a median time of 5 months (5-46) from first TEVAR. Overall complete aortic remodelling rates were: 89% at the proximal descending thoracic aorta, 78% at the distal thoracic aorta and 50% at the infra-renal abdominal aorta. At the infra-renal aorta, the STABILISE group (n = 11) had a higher complete aortic remodelling rate (82%) compared to TEVAR alone (n = 12) (20%).

Conclusion: Endovascular intervention for acute and subacute TBAD is safe with a high rate of technical success. STABILISE results in higher aortic remodelling at the infra-renal aorta (82%) compared to TEVAR alone (20%) but risks aortic rupture from balloon moulding.
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http://dx.doi.org/10.1007/s00270-020-02749-2DOI Listing
April 2021

Radiation Dose during Transarterial Radioembolization: A Dosimetric Comparison of Cone-Beam CT and Angio-CT Technologies.

J Vasc Interv Radiol 2021 03 24;32(3):429-438. Epub 2020 Dec 24.

Department of Radiology, University of Chicago, Chicago, IL 60637.

Purpose: To evaluate the radiation dose differences for intraprocedural computed tomography (CT) imaging between cone-beam CT and angio-CT acquired during transarterial radioembolization (TARE) therapies for hepatocellular carcinoma.

Materials And Methods: A retrospective cohort of 22 patients who underwent 23 TARE procedures were selected. Patients were imaged in both cone-beam CT and angio-CT rooms as a part of their conventional treatment plan. Effective dose contributions from individual CT acquisitions as well as the cumulative dose contributions from procedural 3D imaging were evaluated. Angiography dose contributions were omitted. Cone-beam CT images were acquired on a C-arm Philips Allura system. Effective doses were evaluated by coupling previously published conversion factors (effective dose per dose-area product) to patient's dose-area product meter readings after the procedure. Angio-CT images were acquired on a hybrid Canon Infinix-i Aquilion PRIME system. Effective doses from angio-CT scans were estimated using Radimetrics. Comparisons of a single patient's dose differential between the 2 technologies were made.

Results: The mean effective dose from a single CT scan was 6.42 mSv and 5.99 mSv in the cone-beam CT room and the angio-CT room, respectively (P = .3224), despite the greater field of view and average craniocaudal scan coverage in angio-CT. The mean effective dose summed across all CTs in a procedure was 12.89 mSv and 34.35 mSv in the cone-beam CT room and the angio-CT room, respectively (P = .0018).

Conclusions: The mean effective dose per CT scan is comparable between cone-beam CT and angio-CT when considered in direct comparison for a single patient.
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http://dx.doi.org/10.1016/j.jvir.2020.10.021DOI Listing
March 2021

miR-150-PTPMT1-cardiolipin signaling in pulmonary arterial hypertension.

Mol Ther Nucleic Acids 2021 Mar 4;23:142-153. Epub 2020 Nov 4.

National Heart and Lung Institute, Imperial College London, London, UK.

Circulating levels of endothelial miR-150 are reduced in pulmonary arterial hypertension (PAH) and act as an independent predictor of patient survival, but links between endothelial miR-150 and vascular dysfunction are not well understood. We studied the effects of endothelial miR-150 supplementation and inhibition in PAH mice and cells from patients with idiopathic PAH. The role of selected mediators of miR-150 identified by RNA sequencing was evaluated and . Endothelium-targeted miR-150 delivery prevented the disease in Sugen/hypoxia mice, while endothelial knockdown of miR-150 had adverse effects. miR-150 target genes revealed significant associations with PAH pathways, including proliferation, inflammation, and phospholipid signaling, with PTEN-like mitochondrial phosphatase (PTPMT1) most markedly altered. PTPMT1 reduced inflammation and apoptosis and improved mitochondrial function in human pulmonary endothelial cells and blood-derived endothelial colony-forming cells from idiopathic PAH. Beneficial effects of miR-150 and were linked with PTPMT1-dependent biosynthesis of mitochondrial phospholipid cardiolipin and reduced expression of pro-apoptotic, pro-inflammatory, and pro-fibrotic genes, including , , transforming growth factor β (), and . In conclusion, we are the first to show that miR-150 supplementation attenuates pulmonary endothelial damage induced by vascular stresses and may be considered as a potential therapeutic strategy in PAH.
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http://dx.doi.org/10.1016/j.omtn.2020.10.042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7733016PMC
March 2021

Female pelvic congestion syndrome: how can CT and MRI help in the management decision?

Br J Radiol 2021 Feb 4;94(1118):20200881. Epub 2020 Dec 4.

Radiology, Faculty of Medicine - Ain shams University, Cairo, Egypt.

Objective: Diagnosis of female pelvic congestion syndrome (PCS) is challenging. Although invasive venography is the gold-standard for diagnosis, however, CT and MRI are important in the assessment. In this study, we tried to highlight the role of CT and MRI as non-invasive tools in the diagnosis and management of PCS.

Methods And Material: This was a retrospective study of 50 patients confirmed clinically to have PCS. These patients had already done CT and MRI before venography or surgery.

Results: The mean age of the patients was 48 years ± 12 years SD. Vaginal discharge and pelvic heaviness were the commonest symptoms (46 and 42% respectively). The commonest risk factor was multiparity (56%) followed by the RVF uterus (26%). No significant difference was found between CT, MRI, and venography as regarding the diameter of the ovarian vein, diameter, and the number of the varicose veins. The sensitivity of CT and MRI was 94.8 and 96%. CT and MRI discovered five cases with local pelvic obstructing cause,14 cases with evidence of vascular compression syndrome, and the rest 31 cases diagnosed to have primary non-obstructing PCS which was effective in decision-making with the surgery indicated in the first group while stenting of the vascular obstruction followed by bilateral ovarian veins coiling was the better option for the second group and only bilateral coiling was needed for the last group.

Conclusion: CT and MRI play important roles in the diagnosis and even management decision in cases of PCS.

Advances In Knowledge:: Identification of the importance of diagnostic radiology before management decisions of cases with PCS.
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http://dx.doi.org/10.1259/bjr.20200881DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7934308PMC
February 2021

Registered Reports: response from the Chinese PRO SIG.

Qual Life Res 2020 Dec 17;29(12):3185-3186. Epub 2020 Nov 17.

College of Dentistry, New York University, New York, USA.

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http://dx.doi.org/10.1007/s11136-020-02696-yDOI Listing
December 2020

Yttrium-90 Radioembolization Therapy for Combined Hepatocellular and Cholangiocarcinoma.

Gastrointest Tumors 2020 Oct 28;7(4):144-150. Epub 2020 Jul 28.

Section of Interventional Radiology, University of Chicago, Chicago, Illinois, USA.

Purpose: To report outcomes of transarterial radioembolization (TARE) using glass microspheres for the treatment of mixed hepatocellular-cholangiocarcinoma (HCC-CC) in a propensity-matched study.

Material And Methods: Between 2013 and 2019, 10 consecutive patients with histologically confirmed HCC-CC received TARE of a targeted territory using glass microspheres as a primary initial treatment. Baseline demographics in addition to tumor distribution, Child Pugh score, and BCLC were recorded. Tumor response was assessed according to modified RECIST criteria. The HCC-CC cohort was matched to the HCC cohort, and objective response and survival analysis was performed.

Results: In the HCC-CC cohort, patients had a 70% objective response rate (ORR), and in the HCC cohort, patients had a 90% ORR after matching ( = 0.54). The median overall survival (OS) for HCC patients was 12.3 months (95% CI: 6.0-17.4 months) in the matched population, and for HCC-CC patients, the median OS was 15.2 months (95% CI: 2.7-20.2 months) ( = 0.98). The median progression-free survival (PFS) for HCC patients was 11.6 months (95% CI: 2.53-19.3 months) in the matched population, and for HCC-CC patients, the median PFS was 15.2 months (95% CI: 2.7-20.2 months) ( = 0.94). The median transplant-free survival (TFS) for HCC patients was 12.3 months (95% CI: 6.0-17.4 months) in the matched population, and for HCC-CC patients, the median TFS was 15.2 months (95% CI: 2.7-20.2 months) ( = 0.98).

Conclusions: While outcomes of combined HCC-CC are poor and optimal treatment remains undefined, TARE appears to represent an effective locoregional treatment with survival outcomes similar to that of HCC treated by TARE.
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http://dx.doi.org/10.1159/000508386DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7590772PMC
October 2020

Hepatocellular Carcinoma: A Contemporary Approach to Locoregional Therapy.

Am J Gastroenterol 2020 11;115(11):1733-1736

Center for Liver Diseases, Department of Internal Medicine, University of Chicago Medicine, Chicago, Illinois, USA.

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http://dx.doi.org/10.14309/ajg.0000000000000931DOI Listing
November 2020

Frequency of CD4+ regulatory T cells, CD8+ T cells, and human papilloma virus infection in Egyptian Women with breast cancer.

Int J Immunopathol Pharmacol 2020 Jan-Dec;34:2058738420966822

Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA.

Several subsets of regulatory CD4+ T cells (CD4+ Tregs) have been described in peripheral blood and tumor microenvironment of breast cancer (BC) patients and may play a role in the progression of BC. High-risk human papilloma virus (HR-HPV) has a causal role in cervical, head, and neck tumors but the role of HR-HPV in evoking neoplasia in BC is still unclear. In this study we assessed the prevalence of CD4+CD25+ FOXP3+ regulatory T cells (CD4+Tregs) and CD3+ CD8+ T cells by flow cytometry in peripheral blood from a total of 55 Egyptian women, including 20 treatment-naïve BC, 15 with breast benign lesions (BBL), and 20 healthy volunteers (HV). HR-HPV genotypes type 16, 18, and 31 were investigated in breast tissue from all BC and BBL patients using Real-Time PCR. HR-HPV was detected in 4/20 (20%) and 0/15 (0%) BC and BBL patients respectively. The frequency of CD4+ Tregs was significantly higher in BC compared to BBL and HV, ( < 0.001). In addition, we observed a significantly higher frequency of CD3+ CD8+ T cells in peripheral blood of patients with late stage III BC compared to early stage I and II BC ( = 0.011). However, there was no significant association between the ratio of CD8+ T cell to CD4+ Tregs frequencies and the expression of Estrogen Receptor (ER), Progesterone Receptor (PR), and Human Epidermal Growth Factor Receptor 2 (HER2). These results lead us to postulate that the association between the frequency of CD4+ Tregs and CD8+ T cells in the peripheral blood may be a prognostic or predictive parameter in Egyptian women with BC. In addition, HR-HPV infection may be implicated in the development of some types of BC in Egyptian women.
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http://dx.doi.org/10.1177/2058738420966822DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7786412PMC
October 2020

Improved Utilization Following Conversion of a Fluoroscopy Suite to Hybrid CT/Angiography System.

J Vasc Interv Radiol 2020 11 9;31(11):1857-1863. Epub 2020 Oct 9.

Division of Interventional Radiology, Department of Radiology, University of Chicago, Billings Hospital, P220, 5841 South Maryland Avenue, MC2026, Chicago, IL 60637.

Purpose: To assess changes in operational utilization following conversion of a single IR suite to a hybrid CT/angiography (Angio-CT) system at an academic tertiary care center.

Materials And Methods: The total number of interventional procedures and diagnostic CT examinations performed in 29 rooms (20 diagnostic radiology, 7 IR, 2 shared between divisions) was calculated in the 24 months before conversion of an IR suite to Angio-CT and 12 months after conversion. The total number of IR procedures (global IR/month) and diagnostic CT scans per month (global CT/month) in both before and after conversion periods was calculated and defined as baseline institutional growth. This was compared against the change in the number of IR procedures performed in the before and after periods in the converted room (Angio-CT/month) as well as the number of diagnostic CT scans performed in the shared rooms (shared CT/month).

Results: The percent change in global CT and global IR from the before to the after periods was 39.2% and 3.1%, respectively. Shared CT per month and Angio-CT per month increased by 46.7% and 12.0% across the same time periods, respectively. The ratio of the percent increase in Angio-CT per month to percent increase in global IR per month was 3.87. The ratio of the percent increase in shared CT per month to percent increase in global CT per month was 1.19.

Conclusions: Operational utilization improved in both diagnostic radiology and IR sections following conversion of a conventional fluoroscopic IR suite to an Angio-CT room.
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http://dx.doi.org/10.1016/j.jvir.2020.05.028DOI Listing
November 2020

Hybrid CT-angiography to facilitate lower extremity sharp venous recanalization: a novel approach to a common procedure.

CVIR Endovasc 2020 Oct 8;3(1):51. Epub 2020 Oct 8.

Department of Radiology, Section of Vascular and Interventional Radiology, University of Chicago Medicine, 5841 S. Maryland Ave, Chicago, IL, 60637, USA.

Background: Post-thrombotic syndrome due to chronic venous occlusion is associated with high morbidity and healthcare costs. Sharp venous recanalization has been used with success when conventional techniques fail to cross the occlusion, permitting endovascular reconstruction with angioplasty and stenting. However, manipulation of a needle, especially in extra-anatomic locations, risks damage to adjacent structures, thus necessitating adequate imaging guidance.

Case Presentation: This report describes the novel use of hybrid CT-angiography in a successful recanalization of a complex iliofemoral chronic venous occlusion, after multiple failed attempts with traditional recanalization techniques. The procedure was performed without complications, and stent patency was confirmed at three-month follow-up with patient-reported improvement in severe post-thrombotic syndrome.

Conclusions: This case demonstrates effective incorporation of hybrid CT-angiography to facilitate complex sharp venous recanalization for chronic lower extremity thrombosis, as an alternative to standard fluoroscopic techniques requiring multiple projections with or without cone-beam CT. Further studies are needed to understand the implications of this strategy.
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http://dx.doi.org/10.1186/s42155-020-00145-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7544786PMC
October 2020