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The role of chemical elements in an organism is versatile and multifunctional. However, you should pay attention to the reaction of the organism on the introduction of chemical elements with different biological roles, which is predetermined by the physiological role of organs and body systems. These include the red bone marrow, which primarily responds to endogenous and exogenous factors by its functional significance. Analyzing the myelogram of birds after the various ways of copper NP introduction into the body and the different dosages, we found that, by the end of the experiment, the total numbers of bone marrow cells in all groups were lower than the initial values in the second group-12.54% lower (p  less then  0.05), in third-26.32% lower (p  less then  0.001), for the fourth-14.75% lower (p  less then  0.05), with exception for the first experimental group where this index was 45.51% higher (р  less then  0.001). We revealed the following changes in the peripheral blood the hemoglobin content by the calcium, potassium, magnesium, phosphorus, boron, cobalt, iodine, lithium, sodium, zinc, tin, and strontium in the marrowy aspirate. Moreover, compared with the first group (p  less then  0.01), increasing doses of nanopowders caused a significant rise in the arsenic and tin concentrations and a decline of iodine and strontium. We found that copper nanoparticles ambiguously affect the bone marrow hemopoiesis of poultry; increasing the dose and changing the type of introduction activating the bone marrow hematopoietic function, in particular, granulocyto-, megakaryocyto-, and erythropoiesis.Resident physicians are the first-line health service providers, subjected to prolonged working hours, sleep deprivation and high job demands. buy Zamaporvint Work stress causes reduction in productivity, suboptimal patient care and medical errors. To determine the level of stress among residents and associated factors and stressors. A cross-sectional study at Tanta University Hospitals recruited residents (n = 278), between December 2016 and February 2017. Job stress was assessed using a predesigned questionnaire. The mean age was 26.53 ± 1.35, and 46.4% were males. link2 The majority reported they work more than 48 h/week, do not get a break during work and have a night shift periodically (87%, 83.1% and 94.2%, respectively). Only 4 (1.4%) had low stress while 169 (60.8%) had moderate and 105 (37.8%) had high stress. buy Zamaporvint The study revealed a statistically significant association between high level of stress and being a single resident (p = 0.017), belonging to surgical departments (p = 0.001) and an absence of break during working hours (p = 0.001). The prime sources of stress were underpayment for the job (87.4%), serving to large number of patients (85.2%), disruption of home life due to long hours at work (83.9%), conflict of responsibilities (81.3) and complying with increasing bureaucratic procedures (78.8%) besides no available fund for research (74.8%). Medical residents experienced moderate to high level of job stress. Thus, there is a need for stress management programs during residency training period taking in consideration main sources of stress.BACKGROUND The mechanistic target of rapamycin (mTOR) pathway, containing mTOR complex 1 (mTORC1) and mTORC2, is dysregulated in multiple cancers, including hepatocellular carcinoma (HCC). Mammalian lethal with sec-13 protein 8 (mLST8) is a shared constituent of both mTORC1 and mTORC2, yet little is known regarding its role in HCC development. buy Zamaporvint METHODS mLST8 expression was detected in a total of 186 pairs of HCC and adjacent non-tumor specimens. The correlation between mLST8 level and clinicopathological features or prognostic significance were analyzed. The role of mLST8 on biological functions was also preliminarily studied. RESULTS The study revealed that the mLST8 level was dramatically higher in HCC specimens than in adjacent non-tumor specimens. mLST8 overexpression positively correlated with tumor size, differentiation, and vessel invasion. Cases with elevated mLST8 level had more unfavorable overall survival (OS) and disease-free survival (DFS) than those with downregulated mLST8 level. Multivariate analysis demonstrated that mLST8 upregulation was an independent predictive marker for OS and DFS. Calibration curves from nomogram models indicated an excellent coherence between nomogram prediction and actual situation. Decision curve analysis proved that mLST8-based nomograms presented much higher predictive accuracy when compared with conventional clinical staging systems. Mechanistically, mLST8 enhanced cell proliferation and invasion through the AKT (protein kinase B) pathway. CONCLUSIONS Our study demonstrates that mLST8 exerts an oncogenic role in HCC and may become a promising prognostic biomarker and therapeutic target for HCC patients.PURPOSE This study was designed to evaluate the use of a novel imaging technique, dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI), for detecting mesenteric peritoneal metastases. METHODS Thirty-four patients underwent preoperative conventional MRI, including T1, T2, diffusion-weighted (DWI), and delayed gadolinium MRI, as well as DCE MRI. DCE MRI involved imaging the peritoneal cavity every 9 s for 6 min. DCE images were processed to generate parametric maps of tumor vascularity. link2 Two oncologic surgeons and a radiologist reviewed conventional MRI for all tumor and then later reviewed the conventional MRI plus the DCE parametric maps. Images were reviewed for tumor of the parietal peritoneum, porta hepatis, bowel serosa, upper small bowel mesentery, lower small bowel mesentery, and pelvis. Conventional MRI and DCE + MRI findings were compared to operative and histopathologic reports for tumor detection. PCI scores were calculated for surgery, MRI, and DCE. RESULTS Upper mesenteric tumor was prered with conventional MRI.BACKGROUND Intraoperative para-aortic lymph node (PALN) sampling during surgical exploration in patients with suspected pancreatic head cancer remains controversial. OBJECTIVE The aim of this study was to assess the value of routine PALN sampling and the consequences of different treatment strategies on overall patient survival. link2 METHODS A retrospective, multicenter cohort study was performed in patients who underwent surgical exploration for suspected pancreatic head cancer. In cohort A, the treatment strategy was to avoid pancreatoduodenectomy and to perform a double bypass procedure when PALN metastases were found during exploration. In cohort B, routinely harvested PALNs were not examined intraoperatively and pancreatoduodenectomy was performed regardless. PALNs were examined with the final resection specimen. Clinicopathological data, survival data and complication data were compared between study groups. RESULTS Median overall survival for patients with PALN metastases who underwent a double bypass procedure was 7.0 months (95% confidence interval [CI] 5.5-8.5), versus 11 months (95% CI 8.8-13) in the pancreatoduodenectomy group (p = 0.049). Patients with PALN metastases who underwent pancreatoduodenectomy had significantly increased postoperative morbidity compared with patients who underwent a double bypass procedure (p  less then  0.001). In multivariable analysis, severe comorbidity (ASA grade 2 or higher) was an independent predictor for decreased survival in patients with PALN involvement (hazard ratio 3.607, 95% CI 1.678-7.751; p = 0.001). CONCLUSION In patients with PALN metastases, pancreatoduodenectomy was associated with significant survival benefit compared with a double bypass procedure, but with increased risk of complications. link3 It is important to weigh the advantages of resection versus bypass against factors such as comorbidities and clinical performance when positive intraoperative PALNs are found.OBJECTIVE We sought to examine the impact of primary tumor resection on survival in HER2+ stage IV breast cancer patients in the era of HER2 targeted therapy. METHODS We conducted a retrospective cohort study of women with HER2+ stage IV breast cancer in the National Cancer Database from 2010 to 2012 comparing those who did and did not undergo definitive breast surgery. RESULTS Of 3231 patients, treatment included primary site surgery in 35.0%; chemo/targeted therapy in 89.4%; endocrine therapy in 37.7%; and radiation in 31.8%. Surgery was associated with Medicare/other government (OR 1.36, 95% CI 1.03-1.81) or private insurance (OR 1.93, 95% CI 1.53-2.42) versus none/Medicaid, radiation (OR 2.10, 95% CI 1.76-2.51), chemo/targeted therapy (OR 1.99, 95% CI 1.47-2.70), and endocrine therapy (OR 1.73, 95% CI 1.40-2.14). Non-Hispanic Black versus White patients (OR 0.68, 95% CI 0.53-0.87) were less likely to have surgery. link3 Overall mortality was associated with insurance (Medicare/other government versus none/Medicaid, HR 0.36, p  less then  0.0001), receipt of chemo/targeted therapy (HR 0.76, p = 0.008), endocrine therapy (HR 0.70, p = 0.0006), and radiation therapy (HR 1.33, p = 0.0009), NH Black versus White race/ethnicity (HR 1.39, p = 0.002), visceral versus bone-only metastases (HR 1.44, p = 0.0003), and lowest versus highest income quartile (HR 1.36, p = 0.01). Propensity score analysis showed surgery was associated with improved survival versus no surgery (HR 0.56, 95% CI 0.40-0.77). CONCLUSIONS Surgery of the primary site for metastatic HER2+ breast cancer is associated with improved overall survival in selected patients.INTRODUCTION Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease. It is a spectrum of progressive alterations, with the final step in liver fibrosis which carries a high burden of long-term mortality. link3 The scores used to predict liver fibrosis are not properly validated in morbid obesity (MO). Our aim was to evaluate the performance of seven risk scores in bariatric surgery (BS) patients. METHODS Cross-sectional analysis in a cohort of 60 patients with MO undergoing BS. Liver biopsy (LB) was taken and compared with fibrosis risk assessed by noninvasive scores APRI, FIB-4, Forns, NFS (NAFLD fibrosis score), BARD, BAAT, and Hepamet. The area under the receiver operator characteristic curve (AUROC) and measures of diagnostic accuracy were calculated; performance of fibrosis scores was evaluated at standard threshold vs those suggested by ROC analysis. RESULTS LB was available in 50 patients; 9 (18%) had significant fibrosis (F2-F4). The BARD and Forns scores best predicted the absence of fibrosis, both with negative predictive value (NPV) of 95.5%, with AUROC of 0.761 and 0.667, respectively. Modification of standard thresholds (2 for BARD and 6.9 for Forns) to those suggested by ROC analysis (3 and 3.6, respectively) improved performance of scores. Basal glucose, glycated hemoglobin (HbA1c), aspartate transaminase (AST), and gamma glutamyl transferase (GGT) were identified by logistic regression analysis as independent predictor of fibrosis. CONCLUSIONS Existing scoring systems are unable to stratify fibrosis risk in MO using established thresholds; its performance is improved if these cutoffs are modified.