Ashraf Abu-Seida

Mixed phenotype acute leukemia (MPAL) is a rare type of leukemia with a limited number of studies conducted to characterize its clinical spectrum and most importantly the best treatment modality. MPAL blasts show more than one phenotype either myeloid/monocytic with T- or B-lymphoid or extremely rare triple lineage associated phenotypic markers. This study aimed to characterize MPAL cases with special emphasis on comparing adult and pediatric age groups, exploring treatment regimens, and clinical outcome. Among 2571 acute leukemia patients, 102 MPAL cases fulfilling the 2008/2016 WHO diagnostic criteria of MPAL were recruited in the study. The incidence of MPAL was 4% of acute leukemia patients. Pediatric cases were 54 (53%) while adults were 48/102 (47%). Myeloid/B-lymphoid phenotype was found in 86/102 (84%), with BCR-ABL fusion gene transcript detected in 14/102(13.7%) patients. ALL-like treatment showed better response rates as compared with the myeloid based regimen (p = 0.001). MPAL behaves in a manner that resembles in clinical features, their lymphoid progenitor counterpart leukemias both in adults and pediatric patients with superior treatment response to ALL-like regimen, especially in adults.

Mixed phenotype acute leukemia (MPAL) is a rare type of leukemia with a limited number of studies conducted to characterize its clinical spectrum and most importantly the best treatment modality. MPAL blasts show more than one phenotype either myeloid/monocytic with T- or B-lymphoid or extremely rare triple lineage associated phenotypic markers. This study aimed to characterize MPAL cases with special emphasis on comparing adult and pediatric age groups, exploring treatment regimens, and clinical outcome. Among 2571 acute leukemia patients, 102 MPAL cases fulfilling the 2008/2016 WHO diagnostic criteria of MPAL were recruited in the study. The incidence of MPAL was 4% of acute leukemia patients. Pediatric cases were 54 (53%) while adults were 48/102 (47%). Myeloid/B-lymphoid phenotype was found in 86/102 (84%), with BCR-ABL fusion gene transcript detected in 14/102(13.7%) patients. ALL-like treatment showed better response rates as compared with the myeloid based regimen (p = 0.001). MPAL behaves in a manner that resembles in clinical features, their lymphoid progenitor counterpart leukemias both in adults and pediatric patients with superior treatment response to ALL-like regimen, especially in adults.

This study aimed at determining if differential responses to locomotor tasks in children with spastic hemiplegia occur on account of step-length asymmetry patterns [symmetrical step-length (S-SL); affected side short (AFF), and non-affected short (Non-AFF)] observed during on-ground walking. Thirty-two children (5-8 years) were assessed for spatial/temporal measures of gait while walking on the ground with self-selected speed. Data from on-ground walking were compared against three locomotor tasks that were examined on a treadmill: self-imposed walking velocity with bodyweight support of 0% (BWS-0%), self-imposed walking velocity with a BWS of 20% (BWS-20%), and fastest walking velocity with a BWS of 20% and a manually-guided response of the non-affected leg (MGR). The primary outcome measures were the spatial (step length) and temporal (single-limb support time) symmetry indices. The step-length asymmetry subgroups responded differently to the locomotor tasks. The MGR produced spatial symmetry in the S-SL and Non-AFF groups and temporal symmetry in the AFF group. The BWS-0% and BWS-20% treadmill walking conditions were insufficient to remediate either spatial or temporal walking asymmetry. In conclusion, acute responses to locomotor tasks are not consistent among asymmetry subgroups, suggesting that they might need individual treatment plans. In spite of the differences in walking characteristics between asymmetry subgroups, the improvement in gait-symmetry arose out of changes in affected and non-affected sides together.

BACKGROUND: Femoral arterial cannulation to initiate veno-arterial ECMO may result in ipsilateral limb ischemia due to reduced distal blood flow below the insertion point of the cannula. We retrospectively studied adult patients supported with femoral VA-ECMO for cardiogenic shock between 2015 and 2019 at our tertiary care hospital.

RESULTS: The study included 65 adult patients supported with femoral VA-ECMO for refractory cardiogenic shock. The studied patients had a mean age of 37.9 ± 14.87 years, mostly males (70.8%), a mean BSA of 1.77 ± 0.27 m, and a mean BMI of 26.1 ± 6.7 kg/m. Twenty-one (32.3%) patients developed acute lower limb ischemia. The patients who developed acute limb ischemia had significantly frequent AKI (< 0.001) without significant use of haemodialysis (p = 0.07) and longer ICU stay (p = 0.028) compared to the patients without limb ischemia. The hospital mortality occurred in 29 (44.6%) patients without significant difference between the patients with and without acute limb ischemia. The occurrence of acute limb ischemia was significantly correlated with failed percutaneous cannulation (p = 0.039), while there was no significant statistical correlation between the cut-down technique and occurrence of limb ischemia (p = 0.053). The occurrence of femoral cannulation site bleeding was significantly correlated with failed percutaneous cannulation (p = 0.001) and cut-down technique (p = 0.001).

CONCLUSION: Acute vascular complications are frequent after femoral VA-ECMO. Failed percutaneous femoral cannulation has been, in this study, identified as the most important risk factor for acute limb ischemia and cannulation site bleeding. A careful approach during femoral cannulation is recommended to prevent occurrence of acute limb ischemia and femoral cannulation site bleeding.

The steroidogenesis capacity and adaptive response of follicular granulosa cells (GCs) to heat stress were assessed together with the underlying regulating molecular mechanisms in Egyptian buffalo. In vitro cultured GCs were exposed to heat stress treatments at 39.5, 40.5, or 41.5 °C for the final 24 h of the culture period (7 days), while the control group was kept under normal conditions (37 °C). Comparable viability was observed between the control and heat-treated GCs at 39.5 and 40.5 °C. A higher release of E2, P4 and IGF-1 was observed in the 40.5 °C group compared with the 39.5 or 41.5 °C groups. The total antioxidant capacity was higher in response to heat stress at 39.5 °C. At 40.5 °C, a significant upregulation pattern was found in the expression of the stress resistance transcripts (SOD2 and NFE2L2) and of CPT2. The relative abundance of ATP5F1A was significantly downregulated for all heat-treated groups compared to the control, while TNFα was downregulated in GCs at 39.5 °C. Expression analyses of stress-related miRNAs (miR-1246, miR-181a and miR-27b) exhibited a significant downregulation in the 40.5 °C group compared to the control, whereas miR-708 was upregulated in the 39.5 and 40.5 °C groups. In conclusion, buffalo GCs exhibited different adaptive responses, to the different heat stress conditions. The integration mechanism between the molecular and secretory actions of the GCs cultured at 40.5 °C might provide possible insights into the biological mechanism through which buffalo GCs react to heat stress.

The steroidogenesis capacity and adaptive response of follicular granulosa cells (GCs) to heat stress were assessed together with the underlying regulating molecular mechanisms in Egyptian buffalo. In vitro cultured GCs were exposed to heat stress treatments at 39.5, 40.5, or 41.5 °C for the final 24 h of the culture period (7 days), while the control group was kept under normal conditions (37 °C). Comparable viability was observed between the control and heat-treated GCs at 39.5 and 40.5 °C. A higher release of E2, P4 and IGF-1 was observed in the 40.5 °C group compared with the 39.5 or 41.5 °C groups. The total antioxidant capacity was higher in response to heat stress at 39.5 °C. At 40.5 °C, a significant upregulation pattern was found in the expression of the stress resistance transcripts ( and ) and of . The relative abundance of was significantly downregulated for all heat-treated groups compared to the control, while was downregulated in GCs at 39.5 °C. Expression analyses of stress-related miRNAs (miR-1246, miR-181a and miR-27b) exhibited a significant downregulation in the 40.5 °C group compared to the control, whereas miR-708 was upregulated in the 39.5 and 40.5 °C groups. In conclusion, buffalo GCs exhibited different adaptive responses, to the different heat stress conditions. The integration mechanism between the molecular and secretory actions of the GCs cultured at 40.5 °C might provide possible insights into the biological mechanism through which buffalo GCs react to heat stress.

This paper proposes an adaptive dynamic Mho distance relay based on a phase comparator scheme for protecting interconnected transmission networks compensated with a Thyristor Controlled Series Capacitor (TCSC). The proposed relay uses an impedance index factor to initiate the fault detection subroutine. The RMS of the positive sequence current of the faulted loop and the TCSC terminal current are compared for TCSC zone identification. A phase comparator for ground and phase distance elements is proposed, relying on the positive sequence voltage as a polarized memory quantity, while the operating and polarizing quantities are developed using estimated TCSC impedance to mitigate its negative impact. The proposed scheme is easy in implementation and independent on synchronized data transfer, as minimum communication requirements are needed. To evaluate the performance of the proposed scheme, extensive simulation studies were carried out on an IEEE9 bus system compensated with TCSC for different firing angles covering four modes of TCSC operations, different fault types, and fault locations. In addition, an IEEE-39 bus network, as a large interconnected system, is tested for validation purposes. The achieved results designate the precision of the proposed scheme. Moreover, the results indicate its effectiveness for fault resistance tolerance, close-in three phase faults, and stable power swing phenomenon compared with conventional relays.

This paper proposes an adaptive dynamic Mho distance relay based on a phase comparator scheme for protecting interconnected transmission networks compensated with a Thyristor Controlled Series Capacitor (TCSC). The proposed relay uses an impedance index factor to initiate the fault detection subroutine. The RMS of the positive sequence current of the faulted loop and the TCSC terminal current are compared for TCSC zone identification. A phase comparator for ground and phase distance elements is proposed, relying on the positive sequence voltage as a polarized memory quantity, while the operating and polarizing quantities are developed using estimated TCSC impedance to mitigate its negative impact. The proposed scheme is easy in implementation and independent on synchronized data transfer, as minimum communication requirements are needed. To evaluate the performance of the proposed scheme, extensive simulation studies were carried out on an IEEE9 bus system compensated with TCSC for different firing angles covering four modes of TCSC operations, different fault types, and fault locations. In addition, an IEEE-39 bus network, as a large interconnected system, is tested for validation purposes. The achieved results designate the precision of the proposed scheme. Moreover, the results indicate its effectiveness for fault resistance tolerance, close-in three phase faults, and stable power swing phenomenon compared with conventional relays.