Population parameters of Drosophila larval cooperative foraging

Cooperative foraging behavior can be advantageous when there is a common exploitable resource. By cooperating, members of the group can take advantage of the potential of increased efficiency of working together as well as equitable distribution of the product. An experimental signature of cooperative foraging is an Allee effect where at a certain number of individuals, there is a peak of fitness. What happens when there are intruders especially ones that do not contribute to any work required for foraging? Drosophila larvae secrete digestive enzymes and exodigest food. Under crowded conditions in liquid food these larvae form synchronized feeding clusters which provides a fitness benefit. A key for this synchronized feeding behavior is the visually guided alignment between adjacent larvae in a feeding cluster. Larvae who do not align their movements are excluded from the groups and subsequently lose the benefit. This may be a way of editing the group to include only known members. To test the model, the fitness benefit from cooperative behavior was further investigated to establish an Allee effect for a number of strains including those who cannot exodigest or cluster. In a standard lab vial, about 40 larvae is the optimal number for fitness. Combinations of these larvae were also examined. The expectation was that larvae who do not contribute to exodigestion are obligate cheaters and would be expelled. Indeed, obligate cheaters gain greatly from the hosts but paradoxically, so do the hosts. Clusters that include cheaters are more stable. Therefore, clustering and the benefits from it are dependent on more than just the contribution to exodigestion. This experimental system should provide a rich future model to understand the metrics of cooperative behavior.

A decade of tobacco control efforts: Implications for tobacco smoking prevalence in Eastern Mediterranean countries

BACKGROUND AND OBJECTIVES

This study aimed to assess the association between the 10-year implementation of tobacco control policies, cigarette affordability index and changes in tobacco smoking prevalence across Eastern Mediterranean (EMR) countries.

MATERIALS AND METHODS

An ecologic study was conducted using EMR countries as the analytical unit. Data from three sources were utilized: the MPOWER scale to measure tobacco control policy implementation (2010-2020), the tobacco affordability index (expressed as a percentage of GDP per capita required to purchase 2000 cigarettes, from 2010 to 2020), and national tobacco smoking prevalence data for EMR countries (2010-2023). Linear Fixed-effect regression was employed to investigate associations between changes in MPOWER scores, the cigarette affordability index, and alterations in tobacco prevalence over a decade.

RESULTS

Statistically significant inverse associations were observed between changes in MPOWER scores and tobacco smoking prevalence among both men and women in EMR countries (P-value<0.05). Each unit increase in MPOWER score corresponded to a 0.26% reduction in tobacco prevalence among men and a 0.12% reduction among women. The regression model revealed that each unit increase in the cigarette affordability index was linked to a 0.9% decrease in tobacco smoking prevalence across EMR countries (P-value<0.05). Furthermore, even after adjusting for multiple confounders, significant inverse associations were noted between tobacco monitoring (β = -0.41), health warning (β = -0.45), and changes in tobacco smoking prevalence (P-value<0.05).

CONCLUSION

This study underscored the effectiveness of enhancing the implementation of tobacco control policies and increasing the cigarette affordability index as preventive measures to reduce tobacco smoking prevalence in EMR countries over the past decade.

A comparative study of tobacco control scale score in the Eastern Mediterranean Region countries

Background

The tobacco control scale (TCS) score is used widely in European countries to evaluate the adoption of anti-tobacco policies by countries, however, data on the adoption of tobacco control programmes in the Eastern Mediterranean Region (EMR) are limited to a 2009 survey.

Aim

To compare the TCS score for measuring national tobacco control programmes in the EMR countries in 2009 and 2021.

Methods

This cross-sectional survey compared data from 21 EMR countries on 6 major indicators, including the price of cigarettes, tobacco smoke-free public places, national budget for tobacco control activities, ban on tobacco advertising, health warning labels on tobacco packets, and support for treatment of tobacco dependence. The TCS scores at the country level in 2009 were extracted from a previous study. We then calculated the TCS score in 2021 for the same countries using the WHO report on the global tobacco epidemic 2021 and the World Bank data for 2020.

Results

The average TCS score (standard deviation) for EMR countries increased from 29.7 (16.8) in 2009 to 40.7 (17.3) in 2021. The highest TCS score (83.0) was reported in Islamic Republic of Iran, followed by Yemen (72.8) and Lebanon (62.0). Five countries (Djibouti, Syrian Arab Republic, Tunisia, Bahrain, and Oman) scored less than 30. Health warning labels, smoke-free public places, and tobacco control budgets as a percentage of Gross Domestic Product per capita had all increased, but tobacco prices and cessation treatments did not improve over the past decade.

Conclusion

Tobacco control policies have been implemented and improved in most EMR countries, but there is room for further improvement. Tobacco pricing and taxation, national tobacco control program budgets, and cessation treatments require more attention.

Population attributable proportion and number of cancer cases attributed to potentially modifiable risk factors in Iran in 2020

In the current study, we aimed to calculate the fraction of cancer attributable to modifiable risk factors in Iran in 2020. Population attributable fractions (PAFs) were calculated for established cancer risk factors using three data sources: the national cancer incidence reports, relative risks extracted from global and national meta-analyses, and exposure prevalence from national/subnational population-based surveys. In addition to overall cancers, the PAFs were estimated separately for each cancer site among men and women. Overall, 32.6% of cancers in 2020 in Iran were attributable to known risk factors. The PAF in men (40.2%) was twice as high as in women (21.1%). Cigarette smoking (15.4%), being overweight (5.0%), opium use (3.9%) and H. pylori infection (3.8%) were the leading causes of cancers. For men, the highest PAFs belonged to cigarette smoking (26.3%), opium use (6.8%) and being overweight (3.1%), while for women, the highest PAFs belonged to being overweight (7.2%), H. pylori infection (2.7%) and cigarette smoking (2.7%). Among Iranian men and women, the PAFs of waterpipe smoking were 2% and 0.9%, respectively. A third of incident cancers in Iran are due to modifiable exposures, mainly cigarette smoking, being overweight, and H. pylori infection. Opium consumption and waterpipe smoking collectively accounted for 8.8% of cancer occurrence in men and 1.3% in women in Iran. These emerging risk factors should be taken into consideration in future PAF studies.

Regional disparities in cancer survival in Iran: Insight from a National Surveillance of Cancer Survival in Iran (IRANCANSURV)

BACKGROUND AND OBJECTIVES

We aimed to investigate geographical disparity in cancer survival in 9 provincial population-based cancer registries in Iran from 2015 to 2016.

MATERIAL AND METHOD

In the current study, data from 90,862 adult patients (aged >15 years) diagnosed with cancer were retrieved from 9 population-based cancer registries across Iran. Five-year survival rates were estimated by applying relative survival approaches. We also applied the international cancer survival standard weights for age standardization. Finally, we calculated the excess hazard ratio (EHR) for each province adjusted for age, sex, and cancer sites to estimate the excess hazard ratio of mortality compared to the capital province (Tehran).

RESULTS

The largest gap in survival was observed in more curable cancer types, including melanoma (41.4%), ovary (32.3%), cervix (35.0%), prostate (26.7%), and rectum (21.4%), while the observed geographical disparity in lethal cancers such as lung, brain, stomach, and pancreas was less than 15%. Compared to Tehran, we found the highest excess hazard of death in Western Azerbaijan (EHR=1.60, 95% CI 1.51, 1.65), Kermanshah (EHR=1.52, 95% CI=1.44, 1.61), and Kerman (EHR=1.46, 95% CI=1.38, 1.53). The hazard ratio of death was almost identical in Isfahan (EHR=1.04, 95% CI=1.03, 1.06) and Tehran provinces.

CONCLUSION

Provinces with higher HDI had better survival rates. IRANCANSURV study showed regional disparities in cancer survival in Iran. Cancer patients in provinces with a higher Human Development Index (HDI) had a higher survival rate and lived longer compared to the patients in provinces with medium and low HDI regions.

The relationship of myocardial and liver T2* values with cardiac function and laboratory findings in transfusion-dependent thalassemia major patients: A retrospective cardiac MRI study

Introduction

Cardiac complications are the leading cause of death in thalassemia patients. It is assumed that progressive iron accumulation results in myocyte damage. Myocardial T2* measurement by cardiac MRI quantifies iron overload. We aimed to study the association between left and right ventricular (LV and RV) function and iron deposition estimation by cardiac MRI T2* in a sample of Iranian patients.

Methods

Cardiac MRI exams of 118 transfusion-dependent thalassemia major patients were evaluated retrospectively. Biventricular function and volume and myocardial and liver T2* values were measured. The demographic and lab data were registered. Poisson and chi-square regression analyses investigated the correlation between the T2* value and ventricular dysfunction.

Results

The study participants' mean (SD) age was 32.7y (9.02), and 47.46% were female. Forty-nine cases (41.52%) revealed at least uni-ventricular dysfunction. LV dysfunction was noted in 20 cases, whereas 47 patients revealed RV dysfunction. The risk of LV dysfunction was 5.3-fold higher in patients with cardiac T2* value less than 10msec (RR=5.3, 95% CI=1.6, 17.1, P<0.05). No association was found between age, liver T2* value, serum ferritin level, and chelation therapy with the risk of LV and RV dysfunction.

Conclusion

Cardiac MRI T2* measure is a good indicator of LV dysfunction. Moreover, MRI parameters, especially RV functional measures, may have a substantial role in patient management. Therefore, cardiac MRI should be included in beta-thalassemia patients' management strategies.

National and Regional Fraction of Cancer Incidence and Death Attributable to Current Tobacco and Water-Pipe Smoking in the Eastern Mediterranean Countries in 2020

INTRODUCTION

We aimed to calculate the Population Attributable Fraction (PAF) of cancers due to tobacco use in the Eastern Mediterranean Region (EMRO), where water-pipe smoking is prevalent but its effect was not considered in previous studies.

AIMS AND METHODS

We applied Levin's formula to estimate PAFs of cancers due to tobacco use (defined as all type tobacco including both cigarette and water-pipe). We also calculated PAF of water-pipe smoking separately. Exposure prevalence data were retrieved from representative national and subnational surveys. Data on cancer incidence and death were also and cancer cases were obtained GLOBOCAN 2020. We also obtained associated relative risks from published meta-analyses.

RESULTS

Of the total 715 658 incident adult cancer cases that were reported in 2020 in EMRO, 14.6% (n = 104 800) was attributable to tobacco smoking (26.9% [n = 92 753]) in men versus 3.3% (n = 12 048) in women. Further, 1.0% of incident adult cancers were attributable to current water-pipe use (n = 6825) (1.7% [n = 5568]) in men versus 0.4% (n = 1257 in women).

CONCLUSIONS

PAFs of cancers due to tobacco smoking in EMRO were higher in our study than previous reports. This could be due to the neglected role of water-pipe in previous studies that is a common tobacco smoking method in EMRO. The proportion of cancers attributable to water-pipe smoking in EMRO might be underestimated due to lack of research on the risk of cancers associated with water-pipe smoking and also less developed cancer registries in EMRO.

IMPLICATIONS

In this study, we found higher PAFs for cancers due to tobacco smoking in the Eastern Mediterranean (EMR) region than previous reports. This difference could be due to ignoring the role of water-pipe smoking in previous studies. In 2020, 1% of incident cancers and 1.3% of cancer-related deaths in EMRO were attributable to water-pipe smoking. We also found a big difference in PAFs of cancers due to tobacco and water-pipe smoking across EMRO countries, with Tunisia, Lebanon, and Jordan having the highest, and Djibouti, Sudan, and Somalia having the lowest proportions of cancers attributable to tobacco and water-pipe smoking.

In-hospital mortality of COVID-19 in Iranian children and youth: A multi-centre retrospective cohort study

Background

COVID-19 presents as a mild and less severe respiratory disease among children. However, it is still lethal and could lead to death in paediatric cases. The current study aimed to investigate the clinical characteristics of children and young people hospitalized due to COVID-19 in Qazvin-Iran. We also investigated the risk factors of death due to COVID-19 in paediatric cases.

Methods

We performed a retrospective cohort study on 645 children and young people (ages 0-17) hospitalized since the beginning of the COVID-19 pandemic. The cases were confirmed with positive results of reverse transcription-polymerase chain reaction (RT-PCR). The data were retrieved from an electronic database of demographic, epidemiological, and clinical characteristics.

Results

The median age of the admitted patients was 4.0 years, 33.6% were under 12 months old, and 53.0% were female. Fever, cough, nausea/vomiting, dyspnoea, and myalgia were the most common symptoms presented by 50.5%, 47.6%, 24.2%, and 23.0% of the patients, respectively. Overall, we observed 16 cases of death and the in-hospital fatality rate was 2.5%. We also found comorbidity as an independent risk factor of death (odds ratio (OR) = 3.8, 95% confidence interval (CI) = 1.2-12.1, P-value = 0.022). Finally, we observed an increased risk of death in patients with dyspnoea (OR = 11.0, 95% CI = 2.8-43.7).

Conclusion

In-hospital mortality was relatively high in paediatric patients who were hospitalized due to COVID-19 in Iran. The risk of hospitalization, ICU admission, and death was higher among children with younger ages, underlying causes, and dyspnoea.

Decomposition of socioeconomic inequality in COVID-19 mortality in Iran: A retrospective cohort study

This study aimed to investigate the relationship between socioeconomic status and COVID-19 mortality in Iran. We performed a retrospective cohort study on data from the hospitalised COVID-19 patients in Qazvin. We collected data on education, self-reported socioeconomic status, and location of residence as a proxy for socioeconomic status (SES). We applied the Blinder-Oaxaca decomposition approach to assess the role of socioeconomic inequality in COVID-19 mortality and determine the main contributors to the observed inequality. Overall, 941 patients (48.96%) had low SES, while only 24.87% (n = 478) were classified in the high SES category. The mortality rate was significantly higher in the low SES group, and we spotted a 17.13% gap in COVID-19 mortality between the high and low SES patients (p < 0.001). Age was the main contributor to the observed inequality, responsible for 6.91% of the gap (p < 0.001). Having co-morbidities (1.53%) and longer length of stay (LOS) in hospitals (0.95%) in the low SES group were other main determinants of the inequality in COVID-19 mortality (p < 0.05). In the unexplained part of our model, the effect of increased age (10.61%) and a positive RT-PCR test result (3.43%) were more substantial in the low SES group compared to the high SES patients (p < 0.05). The low SES people had an increased risk of getting COVID-19, and the disease has been more severe and fatal among them. Increased age, co-morbidities, and LOS were identified as the main drivers of this inequality.

Trends of in-Hospital and ICU Mortality in COVID-19 Patients Over the Fourth and Fifth COVID-19 Surges in Iran: A Retrospective Cohort Study from Iran

Objective

The current study aimed to investigate the temporal trend of in-hospital and intensive care unit (ICU) mortality of coronavirus disease 2019 (COVID-19) patients over 6 months in the spring and summer of 2021 in Iran.

Design

We performed an observational retrospective cohort study.

Setting

Qazvin Province- Iran during 6 month from April to September 2021.

Participants

All 14355 patients who were hospitalized with confirmed COVID-19 in hospitals of Qazvin Province.

Intervention

No intervention.

Main outcome measures

The trends of overall in-hospital mortality and ICU mortality were the main outcome of interest. We obtained crude and adjusted in-hospital and ICU mortality rates for each month of admission and over surge and lull periods of the disease.

Results

The overall in-hospital mortality, early mortality and ICU mortality were 8.8%, 3.2% and 67.6%, respectively. The trend for overall mortality was almost plateau ranging from 6.5% in July to 10.7% in April. The lowest ICU mortality was 60.0% observed in April, whereas it reached a peak in August (ICU mortality = 75.7%). Admission on surge days of COVID-19 was associated with an increased risk of overall mortality (Odds ratio = 1.3, 95% confidence interval = 1.1, 1.5). The comparison of surge and lull status showed that the odds of ICU mortality in the surge of COVID-19 was 1.7 higher than in the lull period (P-value < 0.001).

Conclusions

We found that the risk of both overall in-hospital and ICU mortality increased over the surge period and fourth and fifth waves of severe acute respiratory syndrome coronavirus 2 infection in Iran. The lack of hospital resources and particularly ICU capacities to respond to the crisis during the surge period is assumed to be the main culprit.

Diagnostic accuracy of two-dimensional coronary angiographic derived fractional flow reserve

Background

Non-invasive fractional flow reserve (NiFFR) is an emerging method for evaluating the functional significance of a coronary lesion during diagnostic coronary angiography (CAG). The method relies on the computational flow dynamics and the 3D reconstruction of the vessel extracted from CAG. In the present study, we sought to evaluate the diagnostic performance and applicability of 2D-based NiFFR.

Methods

In this prospective observational study, we evaluated 2D-based NiFFR in 279 candidates for invasive CAG and invasive FFR. NiFFR was calculated via 2 methods: variable NiFFR, in which the contrast transport time was extracted from the angiographic view, and fixed NiFFR, in which a prespecified frame count was applied.

Results

The final analysis was performed on 245 patients (250 lesions). Variable NiFFR had an area under the receiver operating characteristic curve of 81.5%, an accuracy of 80.0%, a sensitivity of 82.2%, a specificity of 82.2%, a negative predictive value of 91.4%, and a positive predictive value of 63.6%. The mean difference between FFR and NiFFR was −0.0244 ±0.0616 (P≤0.0001). A pressure wire-free hybrid strategy was possible in 68.8% of our population with variable NiFFR.

Conclusions

Our 2D-based NiFFR yielded results comparable to those derived from 3D-based software. Our findings should, however, be confirmed in larger trials.

Pressure wire-free hybrid strategy

Funding Acknowledgement

Type of funding source: None

Comparison between cheatham-platinum stent and self-expandable uncovered nitinol stent in patients with coarctation of aorta – a randomized controlled trial

Background

Endovascular treatment is considered the main therapeutic approach for native coarctation of aorta (CoA) in adult patients. Balloon-expandable stents (BE) have been introduced as the primary choice for coarctoplasty. However during the recent years, self-expandable (SE) stents with acceptable radial force have been suggested as an alternative. Still, no randomized controlled (RCT) trials have compared the efficacy and safety of both strategies.

Methods

The present study is a prospective, single center, parallel-group, open-label RCT on patients with native CoA (Figure). Patients were randomized into Bare Cheatham-Platinum Stents and Uncovered Nitinol Stent (SE). All patients were scheduled to be followed in 1-, 6-, 12-month and 36-month intervals. The present report, focuses on the one-year outcome of the study.

Results

Of 101 patients with native CoA referred to our center, 93 patients have been randomized into BE- (47 patients) and SE-arm (46 patients). One year follow up is scheduled to be completed on March 2020. In the preliminary analysis of 62 patients, 1 intraprocedural stent migration has occurred in each group. No aortic perforation was detected in the study. Vascular access site complications were similar between the two groups (3 (6.3%) in BE versus 1 (2.1%) in SE, p value= 0.432). One nonfatal stroke occurred in BE group. No mortality or bailout surgical repair happened in one year study in the two groups. One patient with re-coarctations were detected during one year follow up in each of the groups (p value=0.210). No aortic pseudoaneurysm or aneurysmal formation were observed in 12-month follow up aortic CT angiography.

Conclusion

The preliminary results showed no significant difference in efficacy and safety of both treatment modalities. The final result is pending.

Study Flow Chart

Funding Acknowledgement

Type of funding source: None

Investigation of uranium (VI) adsorption by polypyrrole

The purpose of this study was to investigate the adsorption of uranium (VI) ions on the polypyrrole adsorbent. Polypyrrole was synthesized by a chemical method using polyethylene glycol, sodium dodecylbenzenesulfonate, and cetyltrimethylammonium bromide as the surfactant and iron (III) chloride as an oxidant in the aqueous solution. The effect of various surfactants on the synthesized polymers and their performance as the uranium adsorbent were investigated. Adsorbent properties were characterized by scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FTIR) techniques. The effect of different parameters such as pH, contact time, initial metal ion concentrations, adsorbent dose, and the temperature was investigated in the batch system for uranium adsorption process. It has been illustrated that the adsorption equilibrium time is 7min. The results showed that the Freundlich model had the best agreement and the maximum adsorption capacity of polypyrrole for uranium (VI) was determined 87.72mg/g from Langmuir isotherm. In addition, the mentioned adsorption process was fast and the kinetic data were fitted to the Pseudo first and second order models. The adsorption kinetic data followed the pseudo-second-order kinetic model. Moreover, the thermodynamic parameters ΔG⁰, ΔH⁰ and ΔS⁰ showed that the uranium adsorption process by polypyrrole was endothermic and spontaneous.

Urinary Beta-2Microglobulin: An Indicator of Renal Tubular Damage after Extracorporeal Shock Wave Lithotripsy

PURPOSE

This study aims to determine extracorporeal shock wave lithotripsy (ESWL)-induced renal tubular damageand the affecting factors by measuring urinary beta2microglobulin (β2M) excretion.

MATERIALS AND METHODS

This is a cross-sectional study conducted on 91 patients with renal stones who underwentESWL during 2012. Urinary beta2microglobulin was measured immediately before and after the procedure foreach patient and analyzed based on different variables to evaluate factors affecting ESWL-induced renal tubularinjury.

RESULTS

Mean ± SD urinary beta2-microglobulin values, before and after ESWL were 0.08 ± 0.07 and 0.22 ± 0.71mg/dL respectively, the average difference between which was equal to 0.14 ± 0.07 mg/dL. These figures exhibiteda 166.66% rise in the urinary β2M concentration after ESWL which was statistically significant (P < .001). Multivariateanalysis showed that hypertension (P = .05) and the history of ESWL (P = .02) were predictive factors ofhigher post-ESWL urinary beta2-microglobulin excretion.

CONCLUSION

Urinary excretion of beta2-microglobulin increased significantly immediately after ESWL. Thesechanges could indicate that ESWL is a contributing factor to renal tubular damage. It also seems that in patientswith hypertension and a previous history of ESWL the likelihood of this injury is higher than others.

Ovarian vein thrombosis

Ovarian vein thrombosis is a well-known but rare entity, which can occur during the post-partum period. This condition has also been associated with inflammatory and malignant processes within the pelvis. Untreated, complications of ovarian vein thrombosis can be significant due to the associated sepsis and risk of pulmonary embolism. Diagnosis can be made with confidence using ultrasound, computed tomography or magnetic resonance imaging. Treatment of ovarian vein thrombosis is particularly important in the post-partum patients, with anticoagulation therapy being the current recommendation.

A Randomized Controlled Trial on the Hemostasis of Femoral Artery Using Topical Hemostatic Agent

Objective: Evaluation of the effect of using a topical hemostatic agent named “ChitoHem®” on different factors on patients undergoing diagnostic coronary angiography. Methods: The present blind, randomized, controlled study included 124 patients randomly divided into 2 groups. In the treatment group following femoral sheath removal, ChitoHem® powder and in the control group conventional hemostatic procedure was applied. Results: In the treatment group, time to hemostasis, ambulation, and the use of sandbag were significantly shorter compared with the control group, respectively (4.6 ± 1.3 vs 12.4 ± 4.4 minutes, 3.5 ± 2.7 vs 23.0 ± 1.73 hours and 1.6 vs 98.4%; P < .05). There were no significant differences in hematoma formation and re-bleeding between the 2 groups. Conclusion: It was exhibited ChitoHem® topical hemostatic powder used on treatment patients undergoing diagnostic coronary angiography was statistically superior at reducing the time to hemostasis and ambulation as well as the use of sandbags compared with manual compression in control group.

Mechanical loading affects the energy metabolism of intervertebral disc cells

Research has shown that mechanical loading affects matrix biosynthesis of intervertebral disc (IVD) cells; however, the pathway(s) to this effect is currently unknown. Cellular matrix biosynthesis is an energy demanding process. The objective of this study was to investigate the effects of static and dynamic compressive loading on energy metabolism of IVD cells. Porcine annulus fibrosus (AF) and nucleus pulposus (NP) cells seeded in 2% agarose were used in this experiment. Experimental groups included 15% static compression and 0.1 and 1 Hz dynamic compression at 15% strain magnitude for 4 h. ATP, lactate, glucose, and nitric oxide (NO) contents in culture media, and ATP content in cell-agarose construct were measured using biochemical assays. While the total ATP content of AF cells was promoted by static and dynamic loading, only 1 Hz dynamic loading increased total ATP content of NP cells. Increases in lactate production and glucose consumption of AF cells suggest that ATP production via glycolysis is promoted by dynamic compression. ATP release and NO production of AF and NP cells were significantly increased by dynamic loading. Thus, this study clearly illustrates that static and dynamic compressive loading affect IVD cell energy production while cellular responses to mechanical loading were both cell type and compression type dependent.

Can MRI predict the diagnosis of endometrial carcinosarcoma?

AIM

To ascertain whether magnetic resonance imaging (MRI) can be used to suggest a diagnosis of endometrial carcinosarcoma.

MATERIALS AND METHODS

A retrospective imaging review was performed of the MRI images of 39 patients with endometrial carcinosarcoma. Anteroposterior and longitudinal dimensions of the uterus and measurement of the endometrial thickness were taken in the sagittal plane. The ratio of antero-posterior measurement to endometrial thickness was calculated. The same measurements were taken on 50 patients with endometrial adenocarcinoma. A two-tailed t-test and receiver operator characteristic analysis were performed on these measurements for both patient groups.

RESULTS

There was a statistically significant difference between the longitudinal (p=0.0084) and anteroposterior (p=0.00036) dimensions of the uterus of the two groups. There was also a statistically significant difference between the ratios of anteroposterior dimension to endometrial thickness (p=0.00018). The optimal cut-off ratio above which the radiologist should be alerted to a potential diagnosis of endometrial carcinosarcoma was shown to be 0.63.

CONCLUSION

MRI can be helpful in suggesting a diagnosis of endometrial carcinosarcoma with the help of some simple measurements.

Recurrent ovarian carcinoma presenting as a solitary metastasis to the kidney

Unusual sites for recurrent ovarian metastases include extrahepatic solid organs (except the spleen), bone and the abdominal wall. We report a rare renal recurrence of ovarian malignancy and its imaging features.

Metastatic gestational trophoblastic tumour presenting as spontaneous subcapsular renal haematoma

We describe a rare case of metastatic choriocarcinoma, which presented with acute left loin pain due to a subcapsular haematoma secondary to a bleeding renal metastasis. The renal metastasis was embolised to prevent further bleeding. To our knowledge, presentation of gestational trophoblastic tumour (GTT) with such symptoms has not been described in the recent literature. Our case illustrates that, although rare, non-gynaecological symptoms can be the first presentation of metastatic choriocarcinoma in the appropriate clinical settings. It also demonstrates that the acute bleed from a renal metastasis can be effectively managed by embolisation.

New developments in the use of tricyclic antidepressants for the management of pain

In recent years, tricyclic antidepressant drugs have experienced a resurgence in their use as valuable pharmacological tools in the treatment of pain. Along with the evolution in our understanding of their analgesic mechanisms of action, there have been concurrent breakthroughs regarding their indications for use and modes of administration. This review focuses on recent advances in our understanding of how antidepressant drugs exert their antinociceptive effects, and new developments regarding their clinical application.

Cyclooxygenase-2 and antagonists in pain management

Non-steroidal anti-inflammatory drugs are widely used for the treatment of pain and inflammation by inhibiting the formation of prostaglandins. However, their use is limited by their side-effects, including gastrointestinal, renal function, cardiovascular and platelet function. Cyclooxygenase activity is the principal target for the action of non-steroidal anti-inflammatory drugs. Two isoforms of cyclooxygenase have been characterized: (i) cyclooxygenase-1, which is found in many tissues and is generally constitutively expressed and synthesizes prostanoids that mediate homeostatic functions; and (ii) cyclooxygenase-2, the inducible isoform, which is mainly expressed at sites of injury or inflammation and synthesizes prostanoids that mediate inflammation, pain and fever. These findings led to the development of selective cyclooxygenase-2 inhibitors, with comparable anti-inflammatory and analgesic properties to traditional non-steroidal anti-inflammatory drugs, but with significantly fewer side-effects. However, these new selective cyclooxygenase-2 inhibitors are not risk free, and care should be taken when using these drugs, especially with elderly patients with multiple medical problems. Finally, the future is bright for the broader usage of these agents in the treatment of diseases other than inflammation and pain, such as Alzheimer's disease, colonic polyp and colon cancer, just to name a few.

Evaluation of accommodative Insufficiency with the Visual Analogue Scale (VAS)

PURPOSE

The purpose of this study was to evaluate whether asthenopic symptoms in schoolchildren diagnosed with accommodative insufficiency (AI) and graded with the Visual Analogue Scale (VAS) could be correlated with the degree of accommodative deficiency in these children, and to investigate if VAS grading of the asthenopic symptoms could be used as an instrument to indicate the level of improvement of AI.

METHODS

Forty-nine children (mean age 10.2 years +/- 2.7) diagnosed with AI graded their degree of asthenopia on the VAS before and after a 12-week treatment period wearing individually dispensed reading glasses.

RESULTS

The improvement in accommodation after treatment was statistically significant (p < 0.001) and 83.7% of the children obtained normal accommodative amplitude in relation to age. The reduction in asthenopic symptoms as graded with the VAS was also statistically significant (p < 0.001) after treatment and 89.9% of the children obtained a normal VAS score. However, no correlation between the degree of accommodative deficiency and the VAS grading could be found, neither before nor after treatment.

DISCUSSION

Based on these results we conclude that the visual analogue scale (VAS) cannot be used as an instrument to indicate the degree of accommodative deficiency nor can it be used to indicate the level of improvement during the course of treatment. However, the VAS can be used as an instrument to verify and document whether or not asthenopic symptoms are present, and therefore also to indicate when symptoms have been relieved.

Magnetic resonance imaging of the lumbar spine in asymptomatic professional fast bowlers in cricket

Low back injuries account for the greatest loss of playing time for professional fast bowlers in cricket. Previous radiological studies have shown a high prevalence of degeneration of the lumbar discs and stress injuries of the pars interarticularis in elite junior fast bowlers. We have examined MRI appearance of the lumbar spines of 36 asymptomatic professional fast bowlers and 17 active control subjects. The fast bowlers had a relatively high prevalence of multi-level degeneration of the lumbar discs and a unique pattern of stress lesions of the pars interarticularis on the non-dominant side. The systems which have been used to classify the MR appearance of the lumbar discs and pars were found to be reliable. However, the relationship between the radiological findings, pain and dysfunction remains unclear.

Metastatic spinal cord syndromes: imaging appearances and treatment planning

Metastatic spinal cord syndromes usually result from neural compression by adjacent vertebral disease but are occasionally caused by intradural or intramedullary disease. MRI is the most accurate method for evaluation of such syndromes. Knowledge of the relevant imaging appearances and therapeutic options enables the radiologist to make an accurate assessment of the extent of disease and contribute information relevant to treatment planning.

[Mixed cryoglobulinemia with monoclonal IgA and biclonal IgM during hepatitis C virus infection]

Cryoglobulins are immunoglobulins that precipitate at low temperature and dissolve when warmed. According to Brouet, their classification relies upon the immunochemical study: type I comprises monoclonal immunoglobulins (IGG), when types II and III include both monoclonal and polyclonal components. During C hepatitis, the presence of a cryoglobulin, essentially made of mixed G-IGG and M-IGG, is a common feature with a prevalence of 40 to 80%. The authors report a case of a 63-year patient who presented with a vascular purpura and a peripheral polyneuropathy in a context of C hepatitis infection. The cryoglobulin found was composed of a monoclonal kappa A-IgG associated with a biclonal kappa and lambda M-IgG. No decrease of normal IgGs was found. This type of cryoglobulin does not belong to Brouet's classification, and argues for a new and more pertinent classification to be proposed.

A single intravenous injection of KRN5500 (antibiotic spicamycin) produces long-term decreases in multiple sensory hypersensitivities in neuropathic pain

Neuropathic pain is a significant clinical problem. Currently, there are no drugs that produce complete amelioration of this type of pain. We have previously shown that KRN5500, a derivative of the antibiotic spicamycin, produces a prolonged (7-day), and significant reduction in neuropathic pain, but not nociceptive pain. Herein, we provide further evidence for the efficacy of this drug in inhibiting pain after IV injection in a spared nerve injury model of neuropathic pain. A single IV dose of the drug produces an increase in pain thresholds to punctuate mechanical stimuli and to cold stimuli over a period of 7 days, whereas IV injection of the vehicle is without any effect. No change in pain threshold was observed in the contralateral foot. In addition, a significant antiallodynic effect to mechanical stimuli was observed at 1, 2, 4, and 6 wk. The drug may be a potential candidate for cancer-related neuropathic pain as well as a marker for discovery of effective analgesics for neuropathic pain.

IMPLICATIONS

We examined the effect of a novel drug (KRN5500) on nerve damage pain. After the successful effects of this drug in a single human, we have shown that the drug infused as a single application at different doses in a rat model of nerve damage pain produces pain relief in this model for many weeks.

Recognition of DNA-arginine photoadduct by anti-DNA autoantibodies in systemic lupus erythematosus

BACKGROUND & OBJECTIVES

Studies have been carried out to synthesize and characterize the photoconjugate between positively charged amino acid, arginine and DNA fragments and their role in the induction of anti-DNA antibodies.

METHODS

Calf thymus DNA fragments of about 200 base pairs (bp) were covalently crosslinked with arginine under UV light. The amino acid was found to be covalently photoconjugated to DNA and resulted in the formation of a crosslink. The photoadduct was characterized by various physicochemical methods.

RESULTS

Photoaddition of arginine to 200 bp DNA rendered the nucleic acid conformer thermodynamically more stable than the native form. After systematic characterization of the photoadduct, it was used as an antigen for the generation of antibodies in experimental animals. The photoadducts were found to be immunogenic in rabbits, inducing high titre antibodies. The DNA-arginine photoadduct showed higher binding with SLE sera known to have high level of anti-DNA antibodies.

INTERPRETATION & CONCLUSION

Naturally occurring anti-DNA autoantibodies were found to recognize DNA-arginine photoadduct. The recognition of DNA-arginine photoadduct by anti-DNA autoantibodies points to the role of modified DNA in the induction of anti-DNA antibodies in autoimmune disorders.

Introducing music as a means of habilitation for children with cochlear implants

OBJECTIVE

To investigate the feasibility, methods and the primary results of utilizing music as a means of habilitation of children with cochlear implant.

STUDY DESIGN

A habilitation program based on music training is developed. The results are presented as a case-series.

METHODS

Music Training Program is introduced as a new habilitation program. Methods of training (based on Orff method) and measuring the outcomes are introduced in this paper. Effects of this program on other habilitation programs and overall hearing related skills of children were also investigated by open questioning of the parents and the habilitation staff.

RESULTS

Twenty-three children, (age: 2.5-12.5 years) were selected. All children showed appreciable progress in playing a musical instrument. The effects on other habilitation processes were significant and all parents expressed their satisfaction with the program, as they perceived its benefits.

DISCUSSION

The necessity of adding Music Training Program to the routine habilitation may be summarized as follows: Music is a feature of sound, which should be mastered. The psychological effects of being able to accomplish a hearing-related task can add to the self-esteem of children and help prevent and reduce anxiety. Music is a habilitation method: Introducing new concepts of sound, like temporal and frequency-related characteristics, is a crucial part of the habilitation of a child with cochlear implant. Practising new concepts needs motivation, too. We emphasize on using all means of rehabilitation and encourage teaching music to cochlear implant children between 4 and 5 years of age having approximately 4 months of experience with cochlear implant.

The effects of KRN5500, a spicamycin derivative, on neuropathic and nociceptive pain models in rats

We studied the effects of a spicamycin derivative, KRN5500, on two animal models of neuropathic pain (Chung and Bennett models) and a nociceptive pain model by using Complete Freund's adjuvant. After the establishment of mechanical allodynia by using the previously mentioned models, a single intraperitoneal injection of KRN5500 produced significant attenuation of mechanical allodynia in both neuropathic pain models. However, this effect was not observed in rats that had a nociceptive injury (Complete Freund's adjuvant). Furthermore, this experimental drug did not alter the mechanical pain threshold (by using von Frey filament test) on normal, uninjured rats. We have demonstrated that KRN5500 may have value in the treatment of neuropathic pain.

Lack of pre-emptive analgesic effects of local anaesthetics on neuropathic pain

We investigated the significance of pre-emptive analgesia using a well-known model of neuropathic pain in rats. Lignocaine, bupivacaine or saline was applied locally to the left L5-L6 spinal nerve before or 4 days after nerve injury. Mechanical allodynia was then evaluated before and after injury. Pre- and post-injury treatment with local anaesthetics both resulted in a two- to threefold increase in the pain threshold, as manifested by a significant increase in von Frey measurements. However, this effect lasted only 24 h. Our study in rats questions the beneficial effect of a single dose of local anaesthetic as pre-emptive analgesia.

Role of ROS modified human DNA in the pathogenesis and etiology of cancer

The effect of hydroxyl radical, generated by ultraviolet (UV) irradiation of hydrogen peroxide, on human placental DNA was monitored by UV spectroscopy, melting temperature studies, S1 nuclease digestibility and hydroxyapatite column chromatography. Immunological data indicated that reactive oxygen species (ROS) modified human DNA induced high titer antibodies. In ELISA, serum antibodies from various cancer patients showed a higher recognition of ROS-human DNA as compared to native DNA. Retarded mobility of the immune complex formed between IgG, isolated from cancer sera, and ROS-human DNA provided convincing evidence for antigen-antibody interaction. Oxidative lesions in DNA of cancer patients were probed using anti-ROS-human DNA IgG. DNA from cancer patients were found to inhibit anti-ROS-human DNA IgG activity in the range of 40% to 57%. These binding results indicate the presence of oxidative lesions in the cancer patient's genome.

The anti-allodynic effects of amitriptyline, gabapentin, and lidocaine in a rat model of neuropathic pain

The management of patients with neuropathic pain is challenging. There are only a few reports regarding the acute effects of the commonly used adjuvant drugs amitriptyline (AMI), gabapentin (GBP), and lidocaine (LDC) on neuropathic pain behaviors in animal models. Thus, the purpose of this study was to investigate the acute effects of AMI, GBP, and LDC on behavioral signs of mechanical allodynia and the site of action of these drugs using a rat model of neuropathic pain. Under general anesthesia with halothane, neuropathic injury was produced in rats by tightly ligating the left L5 and L6 spinal nerves. In Experiment 1, baseline mechanical allodynia data were recorded, and the animals were randomly divided into five groups: Group 1 received saline intraperitoneally (IP), Group 2 received AMI (1.5 mg/kg IP); Group 3 received GBP (50 mg/kg IP), Group 4 received an IV saline infusion for 10 min, and Group 5 received LDC (10-mg/kg IV infusion) for 10 min. Measurements of mechanical allodynia were repeated 0.5, 1, 2, and 4 h and 1, 3, and 7 days after treatment. In Experiment 2, rats were prepared similarly to the first experiment, and a single unit activity of continuous discharges of injured afferent fibers was recorded from the left L5 fascicles before and until 1 h after treatment. All animals developed neuropathic pain behavior within 7 days after surgery. All three tested drugs were effective in increasing the threshold for mechanical allodynia as early as 30 min after treatment, and the effect lasted for at least 1 h. Furthermore, AMI and LDC reduced the rate of continuing discharges of injured afferent fibers, whereas GBP did not influence these discharges. Our findings clearly demonstrate an attenuation of neuropathic pain behavior in rats treated with AMI, GBP, or LDC. Finally, the site of action of LDC seems to be primarily in the periphery, and that of GBP is exclusively central, whereas that of AMI seems to have both peripheral and central components.

IMPLICATIONS

In the present study, we examined the effectiveness of three drugs commonly used for the treatment of neuropathic pain. Systemic injections of amitriptyline, gabapentin, or lidocaine produced pain-relieving effects in this established model for neuropathic pain in rats, which supports their clinical use in managing patients with neuropathic pain syndromes.