Physical properties of computationally informed phyto-engineered 2-D nanoscaled hydronium jarosite

This study describes a molecular dynamics computational modelling informed bioengineering of nano-scaled 2-D hydronium jarosite. More specifically, a phyto-engineering approach using green nano-chemistry and agro-waste in the form of avocado seed natural extract was utilized as a green, economic, and eco-friendly approach to synthesize this unique mineral at the nanoscale via the reduction of iron (II) sulphate heptahydrate. The nanoproduct which was found to exhibit a quasi-2D structure was characterized using a multi-technique approach to describe its morphological, optical, electrochemical, and magnetic properties. Radial distribution function and electrostatic potential maps revealed that flavone, a phenolic compound within the avocado seed natural extract, has a higher affinity of interaction with the nanoparticle's surface, whilst vanillic acid has a higher wetting tendency and thus a lower affinity for interacting with the hydronium jarosite nanoparticle surface compared to other phytoactive compounds. XRD and HRTEM results indicated that the nanoscale product was representative of crystalline rhombohedral hydronium jarosite in the form of quasi-triangular nanosheets decorated on the edges with nanoparticles of approximately 5.4 nm diameter that exhibited significant electrochemical and electroconductive behaviours. Magnetic studies further showed a diamagnetic behaviour based on the relationship of the inverse susceptibility of the nanomaterial with temperature sweep.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

165 Cataract Surgery: What Intraoperative Factors Impact Surgical Outcomes in Low- and Middle- Income Countries (LMICs)

Aim

To describe what intraoperative factors affect the outcomes of cataract surgery in LMICs.

Method

The following databases were screened to find relevant articles: EMBASE (1974–2019), MEDLINE (1946–2019), Global health (1973–2019), PubMed, Cochrane library and Cumulative Index to Nursing and Allied Health Literature. Following this, duplicates were removed, and articles underwent screening.

Results

Perioperative checks – It has been recommended for LMICs to implement similar surgical checklists to what is used in the UK, to reduce the chance of surgical complications. Having the right team - The cataract surgery team may vary in different countries. For example, in Ethiopia the staffing model includes ophthalmologists, non-physician cataract surgeons (NPCS), ophthalmic officers, ophthalmic nurses, operating room nurses and integrated eye care workers. It is common in LMICs for NPCS to outnumber ophthalmologists. Adequately skilled professionals – It’s important to consider having vitreoretinal surgical input available should surgical complications arise. This will help to optimise outcomes. Surgical technique – Techniques performed in LMICs include ICCE (intracapsular cataract extraction), ECCE (extracapsular cataract extraction and MSICS (manual small incision surgery) and phacoemulsification. ECCE and MSICS is the most commonly used in LMICS due to comparable outcomes with phacoemulsification and cost effectiveness. Surgical training and skills transfer – Various international training programmes such as the HelpMeSee programme is designed to help train ophthalmologists and NPCS in MSICS via simulation.

Conclusions

The above factors are important considerations which influence surgical availability and success. LMICs have an increasingly aging population and cataract services will be required to adapt to the increase demand.

From Himba indigenous knowledge to engineered Fe2O3 UV-blocking green nanocosmetics

This contribution reports on the physical properties of the natural Namibian red Ochre used by the Himba Community in a form of a formulation, so called Otjize as a skin protective and beauty cream. The morphological and crystallographic studies of this red ochre validated its nano-scaled dominating phase of rhombohedral α-Fe₂O₃ nanocrystals with an additional hydrolized oxide component in a form of γ-FeOOH. The optical investigations showed that such a red ochre exhibits an exceptional UV filtration and a significant IR reflectivity substantiating its effectiveness as an effective UV-blocking & solar heat IR reflector in support of the low skin cancer rate within the Namibian Himba community. In addition, such nanocrystals exhibited a non-negligible antibacterial response against E. Coli & S. Aurus. This study seems confirming the effectiveness of the indigenous Otjize as an effective skin UV protection cream with a sound antimicrobial efficacy against e-Coli & S-Aurus.

The role of vitamin D in the age of COVID-19: A systematic review and meta-analysis

BACKGROUND

Evidence recommends that vitamin D might be a crucial supportive agent for the immune system, mainly in cytokine response regulation against COVID-19. Hence, we carried out a systematic review and meta-analysis in order to maximise the use of everything that exists about the role of vitamin D in the COVID-19.

METHODS

A systematic search was performed in PubMed, Scopus, Embase and Web of Science up to December 18, 2020. Studies focused on the role of vitamin D in confirmed COVID-19 patients were entered into the systematic review.

RESULTS

Twenty-three studies containing 11 901 participants entered into the meta-analysis. The meta-analysis indicated that 41% of COVID-19 patients were suffering from vitamin D deficiency (95% CI, 29%-55%), and in 42% of patients, levels of vitamin D were insufficient (95% CI, 24%-63%). The serum 25-hydroxyvitamin D concentration was 20.3 ng/mL among all COVID-19 patients (95% CI, 12.1-19.8). The odds of getting infected with SARS-CoV-2 are 3.3 times higher among individuals with vitamin D deficiency (95% CI, 2.5-4.3). The chance of developing severe COVID-19 is about five times higher in patients with vitamin D deficiency (OR: 5.1, 95% CI, 2.6-10.3). There is no significant association between vitamin D status and higher mortality rates (OR: 1.6, 95% CI, 0.5-4.4).

CONCLUSION

This study found that most of the COVID-19 patients were suffering from vitamin D deficiency/insufficiency. Also, there is about three times higher chance of getting infected with SARS-CoV-2 among vitamin-D-deficient individuals and about five times higher probability of developing the severe disease in vitamin-D-deficient patients. Vitamin D deficiency showed no significant association with mortality rates in this population.

Effects of Naringenin on Experimentally Induced Rheumatoid Arthritis in Wistar Rats

Naringenin is one of the most important and abundant known flavonoids found in grapefruit and other citrus fruits. This experimental study aimed to assess the clinical effects and immune responses of naringenin in the animal model of rheumatoid arthritis (RA) according to various reports on its anti-inflammatory effects and modulation of the immune system. To this end, 40 Wistar rats in the weight range of 160-180g were randomly assigned to four groups (n=10) including healthy, control, naringenin, and methotrexate orally treated groups. To induce RA disease, a compound of 200 μl of Freund's adjuvant and collagen type II was injected subcutaneously into the rear footpads of rats. The severity of RA clinical signs was assessed based on a standard scoring method. The treatment lasted for three weeks (days7-28 after induction). The obtained data pointed out that the levels of C-reactive protein (CRP), myeloperoxidase, nitric oxide, IL-17, and IFN-γ cytokines significantly increased in the RA rats, while the level of their serum antioxidants significantly reduced, compared to the healthy rats. The inflammation of the paws and the level of CRP decreased similarly in both methotrexate and naringenin-treated groups. In the naringenin-treated group, a further decrease was detected in serum myeloperoxidase, nitric oxide, and the total antioxidant capacity occurred, as compared to the methotrexate-treated rats. Nonetheless, IL-17 and IFN-γ cytokines levels were further decreased in the methotrexate-treated group. Accordingly, it can be concluded that naringenin can be effectively used for the reduction of inflammatory effects and control of RA disease.

Pulmonary valve sarcoma in patient with coronavirus disease of 2019 (COVID-19), mimicking pulmonary thromboembolism, a very rare case

Pulmonary artery and pulmonary valve sarcoma are malignant and very rare vascular tumors with aggressive clinical course and very poor outcomes. Patients affected by coronavirus disease of 2019 (COVID‐19) are at a higher risk for thromboembolism complication. We describe a young woman with a history of coronavirus pneumonia and progressive dyspnea, hemodynamic disturbance, edema with initial evaluation, and clinical diagnosis of pulmonary thromboembolism. But further imaging study and pathology demonstrated giant sarcoma of pulmonary valve, obstructing pulmonary valve and extending to right ventricular outflow tract and main of pulmonary artery.

Correlation between albuminuria and tissue Doppler-derived left ventricular myocardial performance index in patients with type 2 diabetes

BACKGROUND

Albuminuria is considered as a significant predictor of cardiovascular morbidity and mortality in patients with diabetes mellitus. The main purpose of this study was to determine the correlation between albuminuria and global left ventricular (LV) function in patients with type 2 diabetes (T2D).

METHODS

This observational study was conducted on 80 consecutive asymptomatic patients with T2D and an LV ejection fraction ≥55%. The patients were divided into two groups depending on the presence or absence of albuminuria. Echocardiography-derived indices of the LV function were then compared between these groups.

RESULTS

The patients with albuminuria were older (mean ± SD: 60.37 ± 9.05 vs 54.52 ± 10.26 years of age, P = .01) and had higher hemoglobin A1c (HbA1c) levels (8.45 ± 1.97 vs 7.25 ± 1.93 mg/dL, P = .012) than those without albuminuria. Among the echocardiographic variables, the patients with albuminuria had higher LV Tei-index (median [lower-upper quartile]: 0.620 [0.455-0.824] vs 0.441 [0.336-0.586], P < .001), more prolonged early filling (E)-wave deceleration time (274.87 ± 75.97 vs 239.40 ± 61.35 ms, P = .032), increased interventricular septal wall thickness (1.11 ± 0.31 vs 0.95 ± 0.21 cm, P = .012), and lower mean early diastolic mitral annular velocity (7.57 ± 2.34 vs 8.68 ± 2.46 cm/s, P = .046) than those without albuminuria. Among risk factors, only albuminuria and HbA1c levels were associated with a significant increase in LV Tei-index (Beta = 0.426 and P < .001, Beta = 0.226 and P = .042, respectively).

CONCLUSION

The LV Tei-index was significantly higher in diabetic patients with than without albuminuria. Low HbA1c levels were correlated with a decrease in LV Tei-index.

High prevalence of asymptomatic nosocomial candiduria due to Candida glabrata among hospitalized patients with heart failure: a matter of some concern?

Background and Purpose:

Heart failure is a leading cause of hospitalization, and asymptomatic candiduria is common in hospitalized patients with low morbidity. However, in most patients, it is resolved spontaneously on the removal of the catheter. Despite the publication of guidelines, there are still controversies over the diagnosis and management of candiduria. However, in hospitalized patients with heart failure, the decision to treat candiduria is especially important since the nosocomial infections are associated with an increase in morbidity, mortality, length of hospital stay, and healthcare costs. Some species of Candida, such as Candida glabrata, are increasingly resistant to the first-line and second-line antifungal medications. The present study aimed to investigate the incidence of asymptomatic Candida urinary tract infection due to C. glabrata and antifungal susceptibility of Candida isolates in hospitalized patients with heart failure.

Materials and Methods:

In total, 305 hospitalized patients with heart failure were studied to identify asymptomatic nosocomial candiduria during 2016-17 in one private hospital in the north of Iran. The Sabouraud’s dextrose agar culture plates with a colony count of >10⁴ colony-forming unit/ml of urine sample were considered as Candida urinary tract infection. Candida species were identified based on the morphology of CHROMagar Candida (manufactured by CHROMagar, France) and PCR-RFLP method with MspI restriction enzyme. Antifungal susceptibility testing of the isolates was performed using five mediations, including itraconazole, voriconazole, fluconazole, amphotericin B, and caspofungin by broth microdilution method according to CLSI M27-S4.

Results:

In this study, the rate of asymptomatic Candida urinary tract infection was 18.8%, which was more common in people above 51 years old and females (70%). In addition to the urinary and intravascular catheter, the occurrence of candiduria in hospitalized patients had significant relationships with a history of surgical intervention, diastolic heart failure, and use of systemic antibiotics (P>0.05). Among Candida spp., non-albicans Candida species was the most common infectious agent (59.7%). Moreover, C. glabrata (n=27, 40.3%) (alone or with other species) and Candida albicans (n=27, 40.3%) were the most common agents isolated in Candida urinary tract infection. Based on the results of the in vitro susceptibility test, the C. glabrata isolates were 15%, 59%, 70%, 74%, and 85% susceptible to caspofungin, amphotericin B, itraconazole, voriconazole, and fluconazole, respectively.

Conclusion:

According to the findings, there was a high prevalence of asymptomatic Candida urinary tract infection in hospitalized patients with heart failure. Besides, it was suggested that there was a shift towards non-albicans Candida, especially C. glabrata, in these patients. Therefore, asymptomatic candiduria in hospitalized patients with heart failure should be considered significant. Furthermore, the identification of Candida species along with antifungal susceptibility is essential and helps the clinicians to select the appropriate antifungal agent for better management of such cases.

Fatal Prosthetic Valve Endocarditis Due to Aspergillus flavus in a Diabetic Patient

Aspergillus endocarditis (AE) accounts for a-quarter of all fungal endocarditis, mainly in immunocompromised hosts prior to heart-valve surgery with high mortality, even with treatment. Herein, we report a rare case of AE in a diabetic 60-year-old woman with a history of redo mitral valve prosthesis suspecious of acute endocarditis. She underwent second redo surgical mitral valve replacement in combination with mechanical aortic valve replacement. Blood cultures were negative. The explanted valve and vegetation were subjected to identification. Grown colonies were identified as Aspergillus flavus, based on conventional and molecular methods. Despite the administration of liposomal amphotericin B and improvement in her general condition shortly after initiation of therapy, the patient passed away. As AE is a late consequence of redo prosthetic valve replacement, extended follow-up, early diagnosis, repeating valve-replacement surgeries, and timely selective antifungal treatments are warranted.

A review of blood usage and wastage in a tertiary heart center

Background/Objectives: Blood is a vital resource that its utilization is ever increasing throughout the world and blood wastage is a global challenge that needs to be controlled. Most blood resources are used during complications of pregnancy, trauma, severe childhood anemia, gynecology, cancers, surgery, hematology disorders, and chronic diseases. Units that are expired, broken bags, returning the blood unit after 30 min, blood clotted units, etc., which are due to lack of awareness may result in the wastage of blood products. The objective of this study is to analyze the usage and wastage of blood and its products in Mazandaran heart center.Methods: In this retrospective study, the survey was carried out on the data that were obtained from Mazandaran heart center of Sari, Iran during 2012-2017. Data included details of usage and wastage on blood and its product units. MS Excel 2016 and SPSS 16.0 were used in analysis and diagrams.Results: A total of 35,686 blood units were consumed, which included 55.7% packed red blood cells (PRBCs), 33.9% platelets (Plts), 8.9% fresh-frozen-plasma (FFP), and 8.9% cryoprecipitates. Moreover, 823 blood units including 41.4% FFP, 37.2% PRBCs, and 21.4% Plts were wasted mostly because of inappropriate order (70.6%). Cross-match to transfusion ratio was 1.13. The intensive care unit reported the highest level of blood intake by 45.0%. The blood group O+ was the most frequent by 34.8%. In addition, blood wastage has decreased over study period by approximately 10.0%.Conclusion: Our study showed not only the increasing pattern of blood usage but also the dropping pattern of blood wastage due to hemovigilance performance and additional training in our healthcare center. We found that the main reason for the blood wastage in this center is an excessive order of blood units.

Impact of anti-gravity locomotion (AlterG) training on structure and function of corticospinal tract and gait in children with cerebral palsy

We aimed to characterize the impact of anti-gravity locomotion training on the structure and function of the corticospinal tract (CST) in cerebral palsy (CP). Fourteen CP children participated. Nine children were trained with an antigravity treadmill (Alter-G) and five children received occupational therapy (OT). Treatments were provided for 45 min each session, 3 sessions per week for 8 weeks. Diffusion tensor imaging (DTI) was used, and fractional anisotropy (FA), mean diffusivity (MD), radial (RD) and axial (AD) diffusivity was extracted to characterize the structure of the CST. Transcranial magnetic stimulation (TMS) was used and threshold, latency, and peak-peak amplitude of the MEP signal, elicited by the TMS, were used to quantify the function of the CST. Walking ability was evaluated by measuring gait speed, endurance, balance, and mobility. The evaluations were performed before and after the interventions. The results showed that FA improved in both sides of the brain for the AlterG group, but enhanced only in the less affected side of the OT group. MD, RD, and AD mostly improved in the more affected side of the AlterG group. The enhancement of the CST function was similar in both groups. Walking speed and endurance also enhanced in both groups, but the improvement was greater in the AlterG group. Our findings demonstrate that AlterG training can improve gait ability, and simultaneously result in brain neuroplasticity. The clinical implication is that AlterG training can be used as an effective rehabilitation approach to improve gait persistently.

Levels of Blood Biomarkers among Patients with Myocardial Infarction in Comparison to Control Group

BACKGROUND

Myocardial infarction (MI) as a term for a heart attack happens due to reduced blood flow to heart myocardium and lack of oxygen supply caused by plaques in the interior walls of coronary arteries. With respect to the importance of MI etiology, we aimed to study the relationship of MI and blood examination variables.

METHODS

This study was conducted in Mazandaran Heart Center as a hospital-based case-control Comprising 894 participants including 465 cases and 429 controls, individually matched by sex and age. Considered blood markers were analyzed using routine laboratory methods and equipment.

RESULTS

Of all participants, 64.3% of the cases and 51.0% of the controls were males with a mean age of 61.2 (±13.8) in cases and 62.4 (±14.) in controls. We could not find any differences between cases and controls for total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and alkaline-phosphatase (ALP) (P>0.05). However, levels of creatine-kinase-muscle/brain (CK-MB) (P<0.0001), fasting-blood-sugar (FBS) (P<0.0001), aspartate-aminotransferase (AST) (P<0.0001), alanine-transferase (ALT) (P<0.0001) and erythrocyte sedimentation rate (ESR) (P=0.001) were significantly higher in cases compared to the controls (P<0.05). Multivariable analyses revealed that the risk of MI was associated with high levels of AST (adjusted OR=24.3, 95%CI=3.5±165.6, P=0.001) and LDL (adjusted OR=7.4, 95%CI=1.0±51.8, P=0.001).

CONCLUSION

Our investigation indicated that the levels of CK-MB, FBS, AST, ALT and ESR were significantly higher in patients with MI. Besides, our findings showed that the risk of MI in cases with high levels of AST and LDL was about 24 and 7 times more than the control group respectively.

Effects of silibinin on hepatic warm ischemia-reperfusion injury in the rat model

OBJECTIVES

Liver ischemia-reperfusion injuries (I/RI) are typically the main causes of liver dysfunction after various types of liver surgery especially liver transplantation. Radical components are the major causes of such direct injuries. We aimed to determine the beneficial effects of silibinin, a potent radical scavenger on liver I/RI.

MATERIALS AND METHODS

Thirty-two rats were divided into 4 groups. Group I: VEHICLE, the rats underwent laparotomy and received DMSO, group II: SILI, laparotomy was done and silibinin was administered. Group III: I/R, the rats received DMSO and were subjected to a liver I/R procedure and group IV: I/R+SILI, the animals underwent the I/R procedure and received silibinin. After 1 hr of ischemia followed by 3 hr reperfusion, blood was collected to evaluate the serum marker of liver injuries. Hepatic tissue was harvested to investigate glycogen content, histological changes, and vasoregulatory gene expression.

RESULTS

Results showed that serum AST, ALT, LDH, GGT, ALP, and hyaluronic acid (HA) increased significantly in I/R group compared with the VEHICLE group. Silibinin reduced this elevation except for GGT. Silibinin inhibited hepatocyte vacuolization and degeneration, endothelium damages, sinusoidal congestion and inflammation, and glycogen depletion during I/R. ET-1 mRNA was overproduced in the I/R group compared with the VEHICLE group which was decreased by silibinin. KLF2 and eNOS expression was reduced during I/R compared with the VEHICLE group. Silibinin elevated KLF2 expression but had no meaningful effect on eNOS expression.

CONCLUSION

Silibinin protected the liver from I/RI. Silibinin could improve liver circulation by preventing sinusoidal congestion, inflammation, and perhaps modification of the vasoregulatory gene expression.

In vitro and in vivo evaluation of kojic acid against Toxoplasma gondii in experimental models of acute toxoplasmosis

As current toxoplasmosis chemotherapies have many side effects along with toxicity on patients, we examined the anti-Toxoplasma effect of a biologically important natural antibiotic, kojic acid, in vitro and in vivo. Vero cells were incubated with different concentrations of kojic acid or pyrimethamine (positive control), and the cellular viability was determined. Next, Vero cells were infected with T. gondii (RH strain) and treated with drugs. Then, we calculated the infection index, T. gondii intracellular proliferation and the number and measure of plaque. Moreover, the effect of kojic acid on survival times, serum levels of IFN-γ and TNF-α and histopathological changes in the liver and spleen of Balb/c mice infected with T. gondii were determined. Kojic acid reduced the infection index, intracellular proliferation, the number and measure of plaque in vitro when compared to untreated infected cells. Kojic acid (100 mg/kg/day) also showed a better survival rate than infected untreated control mice (P < 0.05). IFN-γ and TNF-α secretions were significantly increased by kojic acid treatment in comparison to untreated groups (P < 0.05). In addition, its inhibitory effects on inflammatory alterations, apoptosis, and necrosis have been shown in sections of liver and spleen. We conclude that kojic acid exhibit potent anti-Toxoplasma activity with direct and indirect effects on the parasite, although further studies are needed before consideration of clinical trials.

Evaluation of Relationship Between Single-Nucleotide Polymorphism in TNF-Gene Promoter and Susceptibility to Atherosclerosis in Fatemeh Zahra Hospital

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A Genetic Association Study of MTHFR C677T Polymorphism with Risk of Metabolic Syndrome: A Systematic Review and Meta-Analysis

Methylenetetrahydrofolate reductase (MTHFR) is an enzyme that plays a crucial role as a methyl-group donor in demethylation of homocysteine. The aim of this systematic review and meta-analysis was to study the relationship between MTHFR gene polymorphism and metabolic syndrome (MS). We used search engines and databases such as Science Direct, Google Scholar, Embase, Cochrane Library, and PubMed to identify eligible studies up to 2018. The articles were studied based on keywords including MTHFR, mutation, variant, and polymorphism in combination with MS. Data was analyzed using Comprehensive Meta-Analysis version 2.2.064 software. After extracting the data from seven articles, the total number of subjects was 1280 in the patient group and 1374 in the control group. The odds ratio was estimated to be 1.078 for the allele model of T vs. C (95% confidence interval [CI]: 1.626-0.715), 1.157 for the allele model of CC vs. CT (95% CI: 0.829-1.615), 1.020 for the allele model of CT + TT vs. CC (95% CI: 1.611-0.646) and 0.799 for the allele model of TT vs. CC + CT (95% CI: 1.185- 0.539). As well, the results showed no statistically significant correlation between polymorphism genotypes of the MTHFR gene and MS (P<0.05). In general, this study showed that the presence of C677T polymorphism in the MTHFR gene has no effect on the incidence of MS.

Remote ischemic preconditioning to reduce contrast-induced acute kidney injury in chronic kidney disease: a randomized controlled trial

BACKGROUND

The impact of contrast-induced acute kidney injury (CI-AKI) on patients with chronic renal disease is well-known. Remote ischemic preconditioning (RIPC) is a non-invasive method that can reduce the risk of CI-AKI, but studies on RIPC have had different results. The aim of the present study was to assess the potential impact of RIPC on CI-AKI.

METHODS

In a randomized, double blinded, controlled trial, 132 patients with chronic renal dysfunction (glomerular filtration rate < 60 mL/min/m2) who underwent coronary angiography or angioplasty received adequate hydration. RIPC was performed in 66 patients by applying an upper arm blood pressure cuff. The cuff was inflated four times for 5 min to 50 mmHg above the systolic blood pressure, followed by deflation for 5 min. In the control group, the blood pressure cuff was inflated only to 10 mmHg below the patient's diastolic blood pressure. The primary endpoint was an increase in serum cystatin C ≥ 10% from baseline to 48-72 h after exposure to the contrast.

RESULTS

The primary endpoint was achieved in 48 (36.4%) patients (24 in each group). RIPC did not show any significant effect on the occurrence of the primary endpoint (P = 1). In addition, when the results were analyzed based on the Mehran risk score for subgroups of patients, RIPC did not reduce the occurrence of the primary endpoint (P = 0.97).

CONCLUSIONS

In patients at moderate-to-high risk of developing CI-AKI when an adequate hydration protocol is performed, RIPC does not have an additive effect to prevent the occurrence of CI-AKI.

TRIAL REGISTRATION

The clinical trial was registered on (Identification number IRCT2016050222935N2 , on December 19, 2016 as a retrospective IRCT).

Intra-articular effects of combined xenogenous serum rich in growth factors (SRGF) and vitamin C on histopathology grading and staging of osteoarthritis in rat model

OBJECTIVE

Osteoarthritis (OA) is one of the most common degenerative diseases especially in the knee joint. The definitive method for the treatment of this disease is not known. In recent years, use of platelet-derived products has been considered as a new therapeutic approach because of its low cost, easy to use, and minimum side effects. Serum rich of growth factors (SRGF) is one of the biological compounds used to healing and regeneration. Its effects may improve in combination with antioxidants such as vitamin C. This vitamin increases the synthesis of proteoglycans by chondrocytes. The present study investigated effect of xenogenous SRGF in combination with vitamin C on the monosodium iodoacetate-induction osteoarthritis in rats.

METHODS

Animals were randomly categorized into three groups including OA, SRGF, and vitamin C+SRGF. Treatments were performed with 3 time intra-articular injection in weekly intervals. Knee samples were taken after two weeks of the last treatment for histopathologic investigations.

RESULTS

In the OA group, surface fibrillation and irregularity, multiple clefts, loss of chondrocytes, proteoglycan depletion with Toluidine blue staining were detected. In the treated group with SRGF/vitamin C, the severity of degenerative lesions was decreased. Chondrocytes had proliferated and matrix proteoglycan increased in compared to the SRGF and OA groups. Also, osteoarthritis stage was markedly reduced in this group rather than two other groups.

CONCLUSION

The results of this study show the synergic effect of vitamin C and growth factors on accelerating articular repair.

Leiomyosarcoma of the inferior vena cava presenting as a cardiac mass

Primary tumors of the inferior vena cava (IVC) are rare. The most common primary malignancy is leiomyosarcoma (LMS), with a severe prognosis. Right-atrium (RA) involvement is seen in about 20 percent of cases. We report the case of a 53-year-old woman admitted to the intensive care unit because of progressive dyspnea with lower limb edema. Echocardiography demonstrated a large mass in the RA. At open-heart surgery, the tumor appeared located in the IVC infrahepatic segment, completely obstructing the lumen and extending into the suprahepatic portion and the RA. Histopathological examination concluded to LMS.

The use of 99mTc-phytate for assessment the protective effect of vitamin E against hepatotoxicity induced by methotrexat in rat

In this study, we investigated the protective effect of vitamin E against methotrexate (MTX)-induced hepatotoxicity by quantitative liver 99mTc-phytate uptake and liver imaging and to compare its effect with histopathology in rat. Rats were divided into five groups as control, solvent, Vit E (100 mg/kg), MTX (20 mg/kg), Vit E + MTX and. Vit E was intraperitoneally administrated for 17 days before MTX injection and continued for 4 days. 99mTc-phytate was injected through the tail of rats after the drug administration. The percentage of the injected dose per gram of liver and spleen tissues (%ID/g) was calculated. Liver imaging was obtained with gamma camera. In other experiment, liver of treated rats were assessed for histopathology. 99mTc-phytate uptake per gram tissue of the livers as %ID/g in control, solvent, MTX, Vit E, Vit E + MTX and MTX groups were 8.99% ± 1.37, 8.53% ± 2.91, 8.65% ± 3.84, 3.22% ± 1.09 and 8.38% ± 2.68. Vit E administration with MTX resulted in a significant increasing in the level of %ID/g. Vit E treatment improved the shape of live in planner image. Histophatological examinations showed a protective effect of Vit E against MTX-induced hepatoxicity in rats. The results showed that Vit E significantly attenuates the MTX-induced hepatotoxicity in rats, and 99mTc-phytate uptake in liver as well as liver image to be acceptable techniques for assessment of liver and spleen damages and/or their tissues protective effects in animal model.

Modal instability induced by stimulated Raman scattering in high-power Yb-doped fiber amplifiers

Modal instability (MI) and stimulated Raman scattering (SRS) are the main obstacles in the power scaling of fiber lasers and amplifiers. In the power scaling of a high-power ytterbium (Yb)-doped master oscillator power amplifier system, a new type of MI has occurred. Experimentally, it is shown that just at the onset of the SRS effect, MI takes place, and the degradation of the beam quality is observed. By the spectra and beam quality measurements, it is revealed that this type of MI can be mitigated firmly by suppressing the SRS effect in high-power Yb-doped fiber amplifiers.

Effect of Enalapril on Preventing Anthracycline-Induced Cardiomyopathy

Anthracycline (ANT) is a topoisomerase-interacting agent that is used in most malignancy treatments. We investigated the efficacy of enalapril (angiotensin-converting enzyme inhibitor) in the prevention of ANT-induced cardiomyopathy. In this randomized, single-blind, and placebo-controlled study, 69 patients with a newly diagnosed malignancy for which ANT therapy was planned were randomly assigned to either a group receiving enalapril (n = 34) or placebo (n = 35). Echocardiography studies were performed before chemotherapy and at 6 months after randomization. Additionally, troponin I and creatinine kinase-MB (CK-MB) were measured 1 month after the initiation of chemotherapy. In the enalapril group, the mean left ventricular ejection fraction (LVEF) (p = 0.58) was the same at baseline and 6 months after randomization. Conversely, LVEF significantly decreased in the control group (p < 0.001). Additionally, LV end systolic volume and left atrial diameter were significantly increased compared with the baseline measures in the control group. According to the tissue Doppler study, the mitral annuli early diastolic (e') and peak systolic (s') velocities were significantly reduced, and the E (the peak early diastolic velocity)/e' ratio was significantly increased in the control group. Furthermore, the TnI and CK-MB levels were significantly higher in the control group than in the enalapril group. Enalapril appears efficacious in preserving systolic and diastolic function in cancer patients treated with ANTs.

The effect of intravenous N-acetylcysteine on prevention of atrial fibrillation after coronary artery bypass graft surgery: a double-blind, randomised, placebo-controlled trial

BACKGROUND

Atrial fibrillation (AF) is one of the most frequently occurring dysrhythmias after coronary artery bypass graft (CABG) surgery.

AIM

The aim of this study was to evaluate the effect of intravenous N-acetylcysteine (NAC) on the prevention of AF after CABG surgery.

METHODS

In a double-blind, randomised controlled trial, a total of 150 patients who were scheduled for on-pump CABG surgery were randomly assigned into two groups. In group A, patients received an intravenous NAC infusion (50 mg/kg) after induction of anaesthesia. These patients additionally received two intravenous doses of NAC on postoperative days 1 and 2. Patients in group B received normal saline (as a placebo) with the same volume, during the same time interval. During the first three days after surgery, postoperative AF (POAF) was assessed by continuous electrocardiogram monitoring; serum high-sensitivity C-reactive protein (hsCRP) level was also assessed before and three days after surgery.

RESULTS

During follow-up, 17 patients (17/141, 12.1%) developed POAF. POAF occurred in four (5.6%) patients in the NAC group and 13 (18.8%) patients in the placebo group (OR 0.23; 95% CI 0.08-0.82; p = 0.02). In the multivariable logistic regression analysis, the only predictor of AF after CABG surgery was the use of NAC (OR 0.21; 95% CI 0.06-0.73; p = 0.01). Also, the hsCRP level trend in the NAC group was different from the trend in the control group (group time interaction or interaction effect) (p < 0.001).

CONCLUSIONS

It seems that perioperative intravenous NAC therapy can be effectively used to reduce inflammation and the incidence of POAF after CABG surgery. The clinical trial registration number: IRCT2015040921669N1.

Uric Acid and Coronary Artery Disease, Two Sides of a Single Coin: A Determinant of Antioxidant System or a Factor in Metabolic Syndrome

INTRODUCTION

Uric acid has antioxidant activity and it is expected to protect against coronary artery disease (CAD). Contradictory, it is a component of metabolic syndrome and so a risk factor for CAD. The associations of plasma total antioxidant capacity (TAOC) and uric acid (UA) as well as other risk factors were investigated relative to the occurrence and severity of CAD.

MATERIALS AND METHODS

The study population consisted of 148 males and 152 females aged 35-76 years who were classified as CAD cases and controls according to the results of coronary angiography. The severity of CAD was scored on the basis of the number and the extent of lesions at coronary arteries. The concentrations of UA and TAOC were measured by using of FRAP and enzymatic uricase methods.

RESULTS

The prevalence of hypertension, cigarette smoking and diabetes mellitus was more frequent in CAD cases than controls. Patients with CAD when compared with the controls had increased levels of glucose, triglycerides, creatinine, UA, TAOC and decreased levels of HDL- cholesterol. Serum UA was high positive correlate of serum total and LDL-cholesterol, triglyceride, creatinine, BUN, bilirubin, TAOC and negative correlate of glucose and HDL-C. TAOC and its major determinant UA but not bilirubin and albumin are significantly associated with the prevalence and severity of CAD. In multivariate analysis and in the absence of hypertension, UA but not TAOC would remain and be associated with CAD by the OR of 1.57 (1.07-2.29), p=0.02. If the results adjusted for all major risk factors including hypertension, neither TAOC nor UA would remain in the regression equation.

CONCLUSION

The results suggest that TAOC and UA but not bilirubin and albumin are associated with CAD significantly. But, the correlation is not independent and is attributed to the metabolic syndrome. The measurement of UA and TAOC will not improve the prognostic power beyond the classical risk factors.

Early herniorrhaphy of large traumatic abdominal wounds in horses and mules

REASONS FOR PERFORMING STUDY

Surgical treatment of traumatic abdominal hernias is usually delayed for 2-3 months following injury. The residual defects are then repaired by herniorrhaphy or mesh herniorrhaphy.

OBJECTIVE

To describe the outcome following herniorrhaphy (without a mesh) within 21 days of initial injury to repair external traumatic lateral abdominal hernias in horses and mules.

STUDY DESIGN

Descriptive case series.

METHODS

Twenty-two cases were included. Surgical treatment involved exposure of the hernia sac and closing of the abdominal wall defect with interrupted Mayo mattress or cruciate sutures after reduction of the herniated organ into the peritoneal cavity. Data collected included cause and site of the hernia, surgical findings, immediate and long-term post operative complications, return to use, duration of convalescence and hernia recurrence.

RESULTS

Falling while crossing impassable pathways was the most common initial cause of the hernia (9/11 horses and 10/11 mules). Adhesion formation to underlying viscera was found intraoperatively in 2 cases. Uncomplicated healing occurred in all animals except 3 with suture abscesses and one with a subcutaneous seroma. At the time of follow-up (6-24 months after surgery), complete recovery without recurrence of herniation was achieved and animals had returned to their previous use.

CONCLUSION

Herniorrhaphy within 21 days using interrupted Mayo mattress or cruciate pattern sutures can be effective for treating external traumatic abdominal hernias in horses and mules. The Summary is available in Chinese - see Supporting Information.

Protective effects of thymol against nephrotoxicity induced by cisplatin with using 99mTc-DMSA in mice

BACKGROUND

In this study, we investigated the protective effect of thymol as a natural compound against cisplatin-induced nephrotoxicity by quantitative renal 99mTc-DMSA uptake and compared its effect with histopathology in mice.

MATERIALS AND METHODS

Mice were divided into six groups as control, cisplatin (7.5 mg/kg, intraperitoneally), thymol+cisplatin (thymol; 50 and 150 mg/kg+cisplatin; 7.5 mg/kg) and thymol (50 and 150 mg/kg). Thymol was orally administrated for two days before cisplatin injection and continued for 4 days. (99m)Tc-DMSA was injected through the tail of mice after the drug administration. The percentage of the injected dose per gram of kidney tissue (%ID/g) was calculated. In other experiment, kidneys of treated mice were assessed for histopathology.

RESULTS

99mTc-DMSA uptake per gram tissue of the kidneys as %ID/g was 85.27±21.81, 45.55±5.50, 65.02±32.21 and 88.46±20.46 in the control, cisplatin, thymol (50 mg/kg)+cisplatin and thymol (150 mg/kg)+cisplatin. Thymol administration with cisplatin resulted in a significant increase in the level of %ID/g. Histopathological examinations showed a protective effect of thymol against cisplatin nephrotoxicity in mice.

CONCLUSION

The results showed that thymol significantly attenuates the cisplatin-induced nephrotoxicity in mice, and 99mTc-DMSA uptake in kidney is a suitable method for assessment of nephrotoxicity in mice.

Prevalence of acute blood transfusion reactions in Mazandaran Heart Center, Sari, Iran, 2010-2012

Introduction:

Although blood transfusion is life saving for patients, it is responsible for a series of complications and exposes the patients to a variety of risks. Therefore knowing different adverse effects of blood transfusion represents a great issue in managing recipient patients.

Aim:

The aim of the present work was to study the prevalence of blood transfusion complications among patients in the Mazandaran Heart Center, Sari, Iran, during a period of 2 years.

Material and Methods:

A retrospective review of all reported and evaluated acute transfusion reactions during a 2 years period in Mazandaran Heart Center was performed. Associated clinical signs and symptoms were evaluated.

Results:

In 9193 transfused blood products, there was 34 (0.4%) acute transfusion reactions. The commonest were discomfort and restlessness(0.16%), dyspnea(0.16%), rigors (0.13%), fever (0.08%), chest pain(0.06%), rash or urticaria (0.04%), nausea and vomiting(0.03%), palpitation(0.03%), hypertension(0.03%)flashing(0.02%), hypotension(0.02%).

Conclusion:

Acute transfusion reaction is seen in %0.4 of transfused patients therefore, we recommend a well-structured program for monitoring adverse reactions associated with blood transfusion and blood product administration (Hemovigilance program).

Concordance between peri-areolar blue dye and peri-incisional radiotracer injections for sentinel node mapping in patients with a history of primary breast cancer excisonal biopsy

BACKGROUND

We evaluated the concordance between peri-areolar blue dye and peri-incisional radiotracer injections for axillary sentinel node mapping of patients with the history of previous breast lesion excisional biopsy.

METHODS

80 patients with the history of previous excisional biopsy of the breast lesions were included. All patients received two injections of 99mTc-antimony sulfide colloid in both ends of incision line in an intradermal fashion. 2 mL patient blue V dye was injection to all patients in the peri-areolar area of the index quadrant after induction of anesthesia. All blue or hot nodes were harvested as sentinel lymph nodes.

RESULTS

At least one sentinel node could be detected during surgery in 79 patients. In total 94 sentinel nodes were detected. All detected sentinel nodes were hot. In three patients sentinel nodes were detected by gamma probe but not blue dye. The tumor location in all of these patients was in the upper lateral quadrant and the incision line was extended into the axillary tail of the breast in all of them. 91 out of 94 sentinel nodes were stained blue, which amounts to 95.8% concordance between blue dye and radiotracer on a per node analysis.

CONCLUSIONS

Single peri-areolar injection in the index quadrant would suffice for sentinel node mapping of patients with history of excisional biopsy. Care should be taken in patients with large excisional biopsy in the extreme proximity to axilla.

The effect of ubiquinone on functional recovery and morphometric indices of sciatic nerve regeneration

A common cause of peripheral nerve injury is trauma. The positive effect of antioxidants on the improvement of nerve regeneration has currently become a focus of attention. In this experiment, the effect of intraperitoneal administration of ubiquinone (CoQ10) on an acute experimentally sciatic nerve crush was studied in a rat model. Forty-five male Wistar rats, weighing between 160-180 g were used. The rats were randomly divided into two experimental groups (n=20). Each group was further subdivided into four subgroups of five animals each. Functional studies confirmed the faster recovery of regenerated axons in the treatment group compared to the un-treated group (P<0.05). Morphometric indices of the regenerated fibers showed the number and diameter of the myelinated fibers to be significantly higher in the treatment group than the un-treated group (P<0.05). Intraperitoneal administration of CoQ10 (10 mg/kg/day) in the early inflammatory stage of sciatic nerve crush was found to improve nerve regeneration.

Association between Serum Iron and the Severity of Coronary Artery Disease

BACKGROUND

Coronary Artery Disease (CAD) is the most important cause of mortality in the world. About half of cardiovascular risk factors have not been completely understood. Oxidation of LDL by oxidants such as iron plays a central role in atherogenesis. As a result, evaluation of the iron stores is important in the risk evaluation of the atherosclerotic disease.

MATERIALS AND METHODS

This cross sectional study was performed on 337 patients with chronic stable angina hospitalized in Sari heart center, Mazandaran University of Medical Sciences from February 2010 to July 2012. Coronary angiography was performed and the angiograms were evaluated by two cardiologists. Moreover, blood samples were collected after a 14-hour fast immediately before the coronary angiography in order to measure the total cholesterol, HDL- cholesterol, and glucose. The patients were divided into four groups to evaluate the severity of Coronary Artery Disease (CAD) according to Syntax scoring system.

RESULTS

The study results revealed a significant difference among the four study groups regarding the iron serum level. It was significantly higher in the sever atherosclerosis group compared to the normal (P=0.0122), mild (P=0.023), and moderate CAD groups (P<0.001).

CONCLUSIONS

The findings indicated that the serum level of iron was higher in the atherosclerotic patients and increased with the severity of CAD. Therefore, a basic relationship probably exists between the serum iron level and CAD. Further prospective and experimental studies are needed to confirm the association between the iron status and atherosclerosis.

Exposure to outdoor air pollution and chronic bronchitis in adults: a case-control study

BACKGROUND

Although Lebanon is a highly polluted country, so far no study has specifically been designed to assess the association between outdoor air pollution and chronic bronchitis in this country.

OBJECTIVE

To assess the association between exposure to outdoor air pollution and chronic bronchitis in Lebanon.

METHODS

A pilot case-control study was conducted in two tertiary care hospitals. Cases consisted of patients diagnosed with chronic bronchitis by a pulmonologist and those epidemiologically confirmed. Controls included individuals free of any respiratory signs or symptoms. After obtaining informed consent, a standardized questionnaire was administered.

RESULTS

Bivariate, stratified (over smoking status and gender) and multivariate analyses revealed that passive smoking at home (ORa: 2.56, 95% CI: 1.73-3.80) and at work (ORa: 1.89, 95% CI: 1.13-3.17); older age (ORa: 1.75, 95% CI: 1.55-2.39); lower education (ORa: 1.44, 95% CI: 1.21-1.72); living close to a busy road (ORa: 1.95, 95% CI: 1.31-2.89) and to a local power plant (ORa: 1.62, 95% CI: 1.07-2.45); and heating home by hot air conditioning (ORa: 1.85, 95% CI: 1.00-3.43) were moderately associated with chronic bronchitis; an inverse association was found with heating home electrically (ORa: 0.58, 95% CI: 0.39-0.85). A positive dose-effect relationship was observed in those living close to a busy road and to a local diesel exhaust source.

CONCLUSION

Chronic bronchitis is associated with outdoor air pollution.