Objective: Hysterectomy is a widely performed major gynecologic surgery. However, few studies have examined the outcomes of vaginal natural orifice transluminal endoscopic surgery (vNOTES) and compared them with those of conventional laparoscopic hysterectomy. This study assessed if vNOTES hysterectomy is both safe and feasible for patients with noncancerous conditions of the uterus.Materials and Methods: This comparative retrospective study was conducted in the department of obstetrics and gynecology at Al-Karak Governmental Hospital, Karak, Jordan. Data on hysterectomy cases were collected from hospital records for operations between January 2018 and January 2023. There were 2 groups of patients: a total laparoscopic hysterectomy (TLH) group and a vNOTES group. Data from each group were obtained on patients' demographics, indications for surgery, and intraoperative and postoperative parameters.Results: After exclusions, the TLH group had 44 cases and the vNOTES group had 16 cases. Both groups had similar general characteristics with the most-common indication for hysterectomy being fibroid uteri: similar to 1/2 of TLH cases, compared to similar to 1/3 of vNOTES cases. Patients who had TLH had significantly shorter surgery durations (151.7 +/- 50.4 minutes), compared to patients who had vNOTES (176.3 +/- 36.9 minutes); p = 0.044. vNOTES resulted in significantly longer hospital stays (1.8 +/- 0.5 days) than TLH (1.5 +/- 0.5 days); p = 0.029.Conclusions: The vNOTES approach is a novel technique which showed comparable outcomes to conventional laparoscopy. (J GYNECOL SURG 20XX:000)

Background and Objectives: breast cancer remains the most common health burden affecting females worldwide. Despite developments in breast cancer diagnostic approaches and treatment strategies, the clinical management of metastatic breast cancer remains challenging. Thus, there is a need to identify new biomarkers and novel drug targets for breast cancer diagnosis and therapy. Recently, aberrant glypican-3 (GPC3) expression in cancers has gained considerable interest in cancer research. The studies, however, have yielded contradictory results about GPC3 expression in breast cancer. Therefore, the current study aims to analyse GPC3 expression across a large panel of different breast cancer subtypes. Materials and Methods: GPC3 expression was immunohistochemically evaluated in 230 breast cancer patients along with eight normal tissues and its associations to clinical and demographic characteristics, as well as immunohistochemical biomarkers for breast cancer. Moreover, a public database consisting of breast cancer patients’ survival data and GPC3 gene expression information was used to assess the prognostic value of GPC3 in the survival of breast cancer patients. Results: GPC3 expression was only characterised in 7.5% of different histological breast cancer subtypes. None of the normal breast tissues displayed GPC3 expression. Interestingly, all cases of Paget’s disease, as well as 42.9% of intraductal and 16.7% of mucinous carcinomas were found to have GPC3 expression, where it was able to significantly discriminate Paget’s disease and intraductal carcinoma from other breast cancer subtypes. Importantly, GPC3 expression was found more often in tumours that tested positive for the expression of hormone receptors and human epidermal growth factor receptor 2 (HER2), indicating more favourable histological subtypes of breast cancer. Consequently, longer relapse-free survival (RFS) was significantly correlated with higher GPC3 mRNA expression. Conclusions: Our study proposes that GPC3 is a promising breast cancer subtype-specific biomarker. Moreover, GPC3 may have the potential to be a molecular target for the development of new therapeutics for specific subtypes of breast cancer.

Objectives: To compare the operative and postoperative outcomes of total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH). Materials and Methods: In this retrospective comparative study, we reviewed all hysterectomies performed in the Al-Karak Governmental Hospital in Al-Karak, Jordan, from September 2018 to July 2022. We enrolled 129 patients who underwent hysterectomy. The patients were divided into the TLH ( n = 39) and TAH ( n = 90) groups. Patient data were accessed through hospital records and analyzed using SPSS 25.0. Results: The most common indication for TLH was uterine fibroid, and that for TAH was abnormal uterine bleeding, although the specimen weights were comparable. There was no significant between-group difference in the patient’s demographics. Although the TLH group had longer operative time, the hospital stay was shorter and there were no reported cases of wound infection. The estimated blood loss was significantly lower in the TLH group than in the TAH group, but there was no difference between the two groups in terms of blood transfusion requirement and postoperative hemoglobin level. Conclusion: TLH and TAH had comparable overall outcomes in the Al-Karak Governmental Hospital. However, TLH was superior to TAH in terms of blood loss, and patients with TLH recovered faster without postoperative wound infection.

Placenta previa is associated with high morbidity and mortality rates due to major hemorrhage during surgery. Thus, a standard surgical approach with a low risk of morbidity is required. This study aimed to propose surgical steps for placenta previa with scarred uterus. All deliveries at the Al-Karak governmental hospital between January 2019 and January 2022 were retrospectively reviewed. Placenta previa cases were divided into 2 groups according to management. Group A was managed by incising the uterus at the level of the fundus to avoid disrupting the placenta, whereas group B was managed by opening the lower uterine segment and delivering the baby through the placenta after the incision. A total of 26 cases with placenta previa were included in this study. Group A (n = 12) was managed by avoiding the placenta and group B (n = 14) was managed by opening through the placenta. No differences were noted between the 2 groups regarding demographics. Patients who underwent the suggested surgical approach (Group A) had less blood loss (median = 775 cc), whereas Group B (median = 1700 cc) (P = .001) had significantly higher blood loss. The duration of hospital stay was significantly shorter in Group A (median = 2 days) than in Group B (median = 6 days) (P = .000). Incising the upper uterine segment to avoid the placenta may lead to better outcomes in terms of blood loss and its consequences.

Background and AimMonosodium glutamate (MSG) is used in food-additives, and the Food and Drug Administration has placed it under intense scrutiny following several reports that it causes glutamate neurotoxicity. Ashwagandha (ASH) roots are traditionally used for memory enhancement. This study aimed to evaluate the nootropic activity of ASH as well as its therapeutic anti-amnesic activity against MSG-induced hippocampal-dependent spatial memory impairment and hippocampal-NMDAR modulation.MethodA total of 36 rats were divided equally into six groups (n = 6 in each group); the rats in the normal and negative groups were administered daily doses of normal saline and MSG (300 mg/kg), respectively, for 21 days. Two nootropic groups were administered ASH at 300 and 500 mg/kg o.p., respectively, for 21 days. Two other treatment groups were administered daily doses of MSG 300 mg/kg o.p. as well as 300 mg/kg and 500 mg/kg o.p. of ASH for 21 days. The rats' spatial memory was assessed for five days using the MWM. Additionally, NMDAR were measured quantitatively by immunohistochemistry.ResultsWe found that the rats in the nootropic groups showed significantly enhanced nootropic activity characterized by improved hippocampal-dependent spatial memory, as well as increases in the level of NMDAR in the Cornu Ammonis 1 region of their hippocampus. Moreover, we elucidated the therapeutic potential of ASH to protect against the depression of spatial memory caused by MSG-induced neurotoxicity.ConclusionFurther, we elucidated a strong correlation between NMDAR-positive cells in the hippocampus and enhancement of spatial learning induced by long-term administration of ASH as well as a strong correlation between NMDAR positive cells in the hippocampus and depression of spatial learning induced by long-term administration of ASH and MSG.

BACKGROUND: Titanium dioxide nanoparticles (TiO2 NPs) uptake may primarily cause adverse effects by inducing oxidative stress, resulting in cell damage, genotoxicity, inflammation, and immune response. To date, there are limited studies investigating the adverse effect of TiO2 NPs on liver health and no studies found a naturally occurring compound able to ameliorate such effect. Thus, this study investigated alpha lipoic acid (ALA) potential for reversing the biochemical and histopathological changes that TiO2 NPs exposure causes in rat liver. METHODS: Thirty adult male albino rats were divided into: control rats received distilled water, control rats treated with 50 mg/kg ALA, rats intoxicated with TiO2 NPs, and TiO2 NPs-intoxicated rats treated 50 mg/kg ALA. Rats were sacrificed before blood samples were collected to assess the liver function using parameters of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, albumin and total protein. Liver tissue homogenates were prepared to assess hepatic antioxidant and oxidative stress using parameters of superoxide dismutase (SOD), catalase (CAT), glutathione (GSH), and malondialdehyde (MDA). Liver tissue sections were used for histopathological analysis and caspase-3 immunohistochemical analysis. RESULTS: TiO2 NPs produced deleterious effects on rat liver tissue, as confirmed through biochemical results, caspase-3 immunohistochemistry, and histological alterations. TiO2 NPs intoxication induced hepatocyte vacuolation, blood vessels congestion, biliary proliferation, apoptosis, and fibrosis. However, ALA treatment of TiO2 NPs-intoxicated rats significantly alleviated deleterious impact on the liver. CONCLUSION: Administration of 600 mg/kg TiO2 NPs to rats resulted in hepatic degenerative lesions, depletion of GSH, oxidative stress, and apoptosis. However, these changes were mitigated by ALA administration. Therefore, ALA offers protection against deleterious effects of TiO2 NPs intoxication. KEYWORDS: titanium dioxide nanoparticles, TiO2 NPs, hepatotoxicity, alpha-lipoic acid (ALA), rat

Importance:Alkaptonuric shoulder arthropathy is a challenging clinical entity in arthroplasty. In this report, we describe an atypical presentation, technical considerations, a literature review, and some recommendations of significant benefits to shoulder surgeons.Objective:The author's objective in this report is to illustrate the deleterious metabolic effects of ochronosis on cartilage and the development of early arthritis.Design:This is a case report study, done in May 2021.Setting:Middle East, Jordan.Introduction:Alkaptonuria is a metabolic disease of amino acid metabolism that can affect multiple organ systems, including the musculoskeletal system. The musculoskeletal system manifestations usually involve the spine, knee, and, uncommonly, the shoulder. Tissue ochronosis caused by alkaptonuria can cause significant damage to the joint and surrounding soft tissue envelope. In this case, we presented a patient who has end-stage glenohumeral arthritis and rotator cuff arthropathy secondary to ochronosis.Case Presentation:In this case report, we present a 42-year-old male patient who presented to the clinic with severe right shoulder pain and limitations of the range of motion, especially with abduction. The patient underwent radiographic assessment, which showed a rotator cuff arthropathy combined with advanced degenerative changes of the right glenohumeral joint. The patient underwent reverse total shoulder arthroplasty. After the surgery and on follow-up later on for a period of one year and after a period of physiotherapy and rehabilitation, the patient showed remarkable improvement in the pain and range of motion.Conclusion:Alkaptonuria can have a detrimental effect on the articular cartilage and the surrounding soft tissue envelope, which might manifest clinically as early degenerative arthritis changes in a young adult patient. Shoulder involvement is extremely rare and can manifest with substantial injury to the glenohumeral joint; whenever such extensive damage is present, shoulder arthroplasty is the best treatment.

Background and Objective: Ovarian cancer is a leading cause of death in females. Since its treatment is challenging and causes severe side effects, novel therapies are urgently needed. One of the potential enzymes implicated in the progression of cancers is Cytochrome 4Z1 (CYP4Z1). Its expression in ovarian cancer remains unknown. Therefore, the current study aims to assess CYP4Z1 expression in different subtypes of ovarian cancers. Materials and Methods: Immunohistochemistry was used to characterize CYP4Z1 expression in 192 cases of ovarian cancers along with eight normal ovarian tissues. The enzyme’s association with various clinicopathological characteristics and survival was determined. Results: CYP4Z1 was strongly expressed in 79% of ovarian cancers, compared to negative expression in normal ovarian samples. Importantly, significantly high CYP4Z1 expres-sion was determined in patients with advanced-stage cancer and a high depth of invasion (p < 0.05). Surprisingly, CYP4Z1 expression was significantly associated with a low patient survival rate. Univariate analysis revealed that patient survival was strongly associated with CYP4Z1 expression, tumor stage, depth of invasion, and lymph node metastasis (p < 0.05). Multivariate analysis showed that only CYP4Z1 expression was significantly associated with patient survival (p < 0.05). Conclusions: CYP4Z1 expression is correlated with shorter patient survival and has been identified as an independent indicator of a poor prognosis for ovarian cancer patients.

PURPOSE:Triple-negative breast cancer (TNBC) is characterized by high mortality rate, and its clinical management is difficult and complex. Therefore, there is a need for extensive efforts aimed at accelerating the discovery of novel therapies for TNBC. CYP4Z1 has been implicated in the development of breast cancer. The current study aimed at characterizing the expression of CYP4Z1 on TNBC.MATERIALS AND METHODS:Using immunohistochemistry, CYP4Z1 expression was evaluated on 122 TNBC samples, four samples of breast cancers expressing ER, PR, and HER-2, and four samples of normal breast tissues. The association between the enzyme and various histopathological features and survival of patients were determined.RESULTS:CYP4Z1 was strongly expressed in 83.3% of various histopathological subtypes of TNBC, when compared to negative expression in normal breast tissues. Interestingly, there were marked variations in CYP4Z1 expression with respect to histopathology subtype, histological grade, histological stage and tumor diameter. There was a high incidence of CYP4Z1 expression in patients with advanced grades, late stages and larger tumor sizes. Importantly, CYP4Z1 expression was correlated with the survival of TNBC patients, but it was an independent determinant of the poor prognosis of TNBC (p< 0.05).CONCLUSION:CYP4ZI may be a potential biomarker or target for evolving new CYP4Z1-targeted treatments.

Introduction: The use of Electronic Cigarettes (ECs) has been increased over the last years but their long term effects on health and microbiota has not yet been explored fully. Aim: To examine the oral and nasal microbial profile and antibiotics susceptibility in the ECs users, smokers and non-smokers and to assess the microbial contamination of the ECs juice. Materials and Methods: Nasal and oral swabs were collected from 30 non-smokers, 30 tobacco smokers and 30 from candidates who have been using ECs for more than six months. Nasal Methicillin Susceptible Staphylococcus aureus (MSSA) and Methicillin Resistant Staphylococcus aureus (MRSA), and oral Streptococcus viridans and Candida albicans were isolated and identified using standard laboratory methods. ECs juice was also cultured to test for microbial presence and the antibiogram for all isolated bacteria was carried out by disc diffusion or broth dilution methods according to Clinical and Laboratory Standard Institute (CLSI) guidelines. The statistical analysis was performed with Stata Statistical Software: Release 13. Results: MSSA was isolated from 9 (30%) non-smokers, 5 (16.7%) ECs users and 2 (6.7%) smokers, respectively. Only 1 (3.3%) MRSA was isolated from a smoker. Streptococcus viridians was detected in 14 (46.7%) non-smokers, 9 (30%) ECs user and 5 (16.7%) smokers. Candida albicans was isolated from 7 (23.3%) smokers, 3 (10%) ECs users and in 1 (3.3%) non-smokers. When both groups of ECs users and smokers were compared to non-smokers; the statistical intergroups difference in carriage of MSSA and Streptococcus viridans using Chi-Square test was only significant in the smokers group (p-value <0.05), while the difference in carriage of MRSA and Candida albicans in both ECs users and smokers was not statistically significant compared to non-smokers (p-value <0.05). The cultures of ECs juices showed no growth. The highest resistance among MSSA isolates was for fusidic acid (43.8%) and the least was for mupirocin and linezolid (0%). Among Streptococcus viridans, the highest resistance was to penicillin (68%) and the least was for vancomycin (7.1%). Conclusion: The effect of ECs on carriage of MSSA and Streptococcus viridans commensals was not significant compared to non-smokers. Therefore, ECs might be less harmful on microbiota compared to tobacco smoking.