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Background: Lung cancer is one of the most frequently diagnosed malignancies. Human endogenous retrovirus-H long terminal repeat-associating protein 2 (HHLA2) is a recently discovered ligand of the B7 family. Blocking this immune checkpoint has become an important treatment option for lung cancer. Methods: The study includes 62 biopsy specimens either bronchoscopic or CT-guided biopsies diagnosed as lung cancer in Hospitals of Faculty of Medicine, Mansoura University, Egypt during the period from 2016 to 2020. Immunohistochemical Staining for HHLA2 and EGFR was performed. HHLA2 expression was assessed in different pathological types of lung Cancer, and it was correlated with other clinicopathologic parameters and patient prognosis. Results: We found a significant association between HHLA2 expression and metastasis. About 83% of patients presented with metastasis showed positive expression of HHLA2 compared to 44.4% in patients with no metastasis (p=0.02). Also, results show significant mild positive correlation between expression of HHLA2 and EGFR markers (p=0.045). The mean OS time in cases with positive HHLA2 expression was nearly half that of patients with negative expression of the markers. However, this difference was not statistically significant. But, PFS of patients was significantly lower among the group with positive expression of HHLA2 compared to the group with negative expression of HHLA2 (p= 0.01). Conclusions: This study reports that recently discovered, HHLA2 is over expressed in lung cancer associating with higher stage. It is also correlated with EGFR overexpression. HHLA2 could serve as a predictor of progression and distant metastasis. Also, it has potential to be effective immune target in lung cancer immunotherapy such as checkpoint blockade and antibody-drug conjugate treatment.

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SUMMARY A rare condition of massive intrathoracic extramedullary haematopoiesis causing spinal cord compression is presented in a 17-year-old Saudi male. Both clinical and laboratory findings, together with the computed tomographic evaluation of the lesion are described. Partial surgical resection as an alternative to radiotherapy has resulted in a dramatic response. dull aching in nature made worse by movement, exertion and cough and relieved by rest. The pain did not radiate to the chest wall or to the lower limbs.He described the pain as mild at first but later it became more severe. Four weeks prior to his hospital admission, he complained of progressive weakness of both lower limbs and finally was unable to walk or support his weight. There was no urinary or bowel disturbance. The patient had no significant past medical history, and no family history of a similar complaint was elicited.Physical examination revealed a thin, pale and ill looking young man who was less physically developed than his stated age. In the upper limbs the humeri looked short in relation to his forearms. The chest wall showed an obvious pigeon-shaped deformity and swelling of all costochondral junctions. The spleen was palpable two fingers breath below the costal margin but the liver was not enlarged. The positive findings on CNS examination were confined to his lower limbs. He had a spastic paraparesis with grade 4 diffuse and bilateral muscle weakness. Hyperreflexia and extensor plantar responses with a sensory level corresponding to D7 were elicited. Laboratory investigations gave the following results: haemoglobin 10 gmJdl, HCT 36%, MCV 62/,um3, MCH 20/pg, MCHC 30%, and normal WBC and differential. The blood film showed hypochromia, microcytosis, polychromasia, target cells, poikilocytosis, anisocytosis, and nucleated erthrocytes. Sickle test was negative. Serum iron was normal. His chest radiograph ( fig la) showed a paraspinal well demarcated mass at the level of T4 on the right side and a similar mass at T10 level. Myelogram demonstrated a total block at T7/T8 due to an extradural posteriorly placed mass. The extent of the mass was confirmed by a CT scan, (fig ib); it was found to extend from T4 to T8. Cellulose acetate haemoglobin electrophoresis in alkaline medium demonstrated haemoglobin F and haemoglobin A2 without haemoglobin A. By the Sniger's alkali denaturation, haemoglobin F was 72%. 780

The stochastic method is used to predict ground motions for Yanbu metropolitan area which has been affected by several earthquakes with the maximum magnitude of 6.8 in 1121 AD. The stochastic method has been used for simulating the time domain history for the peak ground acceleration (PGA), peak ground velocity (PGV), and peak ground displacement (PGD) at Yanbu metropolitan area. In addition, the response spectra at 3, 5, and 10 % of the damped pseudo-spectral acceleration (PSA) have been calculated at Al-Majd Sporting Club, Al-Maktabah, and Al-Shate Secondary School sites within the Yanbu metropolitan area. The results show that the values of PGA range from 137 to 388 cm/s 2 , PGV values vary from 8.96 to 25.5 cm/s, and PGD values range from 6.7 to 20.9 cm. The values of pseudospectral acceleration and predominant period are 974.53 cm/ s 2 (with 5 % damping) at 0.14 s for Al-Majd Sporting Club, 487.06 cm/s 2 at 0.19 s for Al-Maktabah site, and 700.83 cm/s 2 at 0.14 s for Al-Shate Secondary School. It is cleared that the values of ground motion parameters are amplified due to the presence of thick sections of very soft to soft sediments to more than six times those of the hard rocks. Furthermore, the estimated predominant periods from this study are correlated well with that of multichannel analysis of surface wave (MASW) approach. These results should be taken into account during design and construction of civil engineering structures within the Yanbu metropolitan area.