NRP1 overexpression in oesophageal SCC may contribute to local tumour invasiveness but the presence of the mNRP1 subtype correlates with less lymph node metastasis and better prognostic stage, suggesting that the balance between modified and unmodified NRP1 might be important for determining invasion potential.

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Purpose To assess the efficacy of primary sternal closure technique compared to vacuum-assisted closure technique in treatment of post-cardiac surgery mediastinitis in paediatric age group. Additionally, assessed postoperative need for IV drug use, hospital stay length, wound and sternal healing and survival. Hypotheses: primary sternal closure is a reliable technique for treatment of poststernotomy mediastinitis following cardiac surgery in paediatric age group. Materials and Methods A prospective randomized controlled trial included 217 pediatric patients developed post-cardiac surgery mediastinitis from 2016 to 2022. They were randomly divided into primary sternal closure group (A) and vacuum-assisted closure group (B) and operated by two cardiothoracic surgeons. Follow-up of the patients was done for 6-months duration following treatment of mediastinitis to assess postoperative need for hospitalization, IV drug use, wound complications, sternal stability and survival. Results The final analysis included 101 patients in each group. The chance of survival over 6 months after surgery was more for primary sternal closure group (175.2) days versus (157.6) days for the vacuum-assisted closure group, with significant difference Log Rank test p-value (0.005). Duration for IV antibiotics use in the primary closure group was 8.55±3.57 and it was 32.61±8.39 showing high statistically significant difference (p<0.001). Patients in the primary closure group had earlier discharge from hospital 15.77±4.18 than vacuum assisted group 42.61±8.39, with high statistically significant difference (p<0.001). Primary closure group showed better sternal stability and sternotomy wound healing on clinical follow-up. Conclusion Primary sternal closure technique is a favorable technique over vacuum-assisted closure technique for treatment of paediatric mediastinitis following cardiac surgery. The reinforced sternal closure technique is a reliable technique with promising results regarding IV drugs need, hospitalization duration, survival and sternotomy wound healing.

Background: Management of an early empyema is an important problem in thoracic surgery. As an alternative to surgical treatment empyema is in patients who developed early empyema, intra-pleural fibrinolysis has been used with favorable results. This modality of treatment may reduce known morbidities secondary to surgical procedures and may result in significant medical cost savings. Our study aim is to test the efficacy and safety of tissue plasminogen activator and Streptokinase for management of early empyema. Methods: Our study included 48 patients presented with complicated parapneumonic effusion and early empyema. Patients were divided into two groups each contains 24 patients. First group treated with intra-pleural Alteplase (tissue plasminogen activator) and the second group treated with streptokinase, both were instilled via an intercostal chest tube. Clinical and radiologic (chest radiographs (CXR) and chest computed tomography (CT) data used for evaluation of efficacy of both protocols. Results: Tissue plasminogen activator give excellent results in early empyema, it showed success rate 100%, dramatic improvement in both chest tube drain and pleural thickness with no need for further surgical intervention, Streptokinase showed success rate 83.4% in comparison to TPA. Conclusion: Intrapleural tissue plasminogen activator is safe and more efficient than Streptokinase as a chemical modality in treating patients presented with complicated pleural effusion and early empyema.