Current Advances in Wound Healing and Regenerative Medicine

Treating chronic wounds is a common and costly challenge worldwide. More advanced treatments are needed to improve wound healing and prevent severe complications such as infection and amputation. Like other medical fields, there have been advances in new technologies promoting wound healing potential. Regenerative medicine as a new method has aroused hope in treating chronic wounds. The technology improving wound healing includes using customizable matrices based on synthetic and natural polymers, different types of autologous and allogeneic cells at different differentiation phases, small molecules, peptides, and proteins as a growth factor, RNA interference, and gene therapy. In the last decade, various types of wound dressings have been designed. Emerging dressings include a variety of interactive/ bioactive dressings and tissue-engineering skin options. However, there is still no suitable and effective dressing to treat all chronic wounds. This article reviews different wounds and common treatments, advanced technologies and wound dressings, the advanced wound care market, and some interactive/bioactive wound dressings in the market.

Articular Cartilage Injury; Current Status and Future Direction

Today, treatments of cartilage and osteochondral lesions are routine clinical procedures. The avascular and hard-to-self-repair nature of cartilage tissue has posed a clinical challenge for the replacement and reconstruction of damaged cartilage. Treatment of large articular cartilage defects is technically difficult and complex, often accompanied by failure. Articular cartilage cannot repair itself after injury due to a lack of blood vessels, lymph, and nerves. Various treatments for cartilage regeneration have shown encouraging results, but unfortunately, none have been the perfect solution. New minimally invasive and effective techniques are being developed. The development of tissue engineering technology has created hope for articular cartilage reconstruction. This technology mainly supplies stem cells with various sources of pluripotent and mesenchymal stem cells. This article describes the treatments in detail, including types, grades of cartilage lesions, and immune mechanisms in cartilage injuries.

Trends in organ donation and transplantation over the past eighteen years in Iran

BACKGROUND

This article will review the trends in organ donation over the past 18 years in Iran.

MATERIAL AND METHODS

All donation and transplantation statistics were extracted by reviewing the Organ Procurement and Transplantation database of the Ministry of Health of Iran from 2002 to 2019.

RESULTS

Iran's national deceased donation rate from 2002 to 2019 increased 19.06-fold from .75 to 14.3 per million population (PMP). After the beginning of the COVID-19 pandemic, the rate of organ donation in Iran decreased significantly. Although 1 year after the onset of the pandemic, due to the widespread adoption of COVID19 vaccination, the rate of organ donation began to increase again, this system is still under performing. During the years under examination, the rate of deceased kidney donation increased significantly compared to living kidney donation and reached up to 2001 kidney transplantations in 2021. From 2002 to 2019, the rate of liver transplants increased to 12.8. Likewise, the rate of heart transplants increased 8.4-fold, from 15 to 126 cases during the same time.

CONCLUSSION

Although a personal choice, the process of organ donation involves medical, legal, ethical, organizational, and social aspects. The trend in increasing donation rates over the past years can be attributed to multiple influences, which include rigorous team efforts in the organ donation and transplantation systems, in addition to creating a donation culture and promoting donation through media platforms. Moreover, we can say that the rising rates of deceased donor transplantation also can drive down rates of commercial living donor transplantation.

Induced pluripotent stem cells: Generation methods and a new perspective in COVID-19 research

Induced pluripotent stem cells (iPSCs) exhibit an unlimited ability to self-renew and produce various differentiated cell types, thereby creating high hopes for both scientists and patients as a great tool for basic research as well as for regenerative medicine purposes. The availability and safety of iPSCs for therapeutic purposes require safe and highly efficient methods for production of these cells. Different methods have been used to produce iPSCs, each of which has advantages and disadvantages. Studying these methods would be very helpful in developing an easy, safe, and efficient method for the generation of iPSCs. Since iPSCs can be generated from somatic cells, they can be considered as valuable cellular resources available for important research needs and various therapeutic purposes. Coronavirus disease 2019 (COVID-19) is a disease that has endangered numerous human lives worldwide and currently has no definitive cure. Therefore, researchers have been rigorously studying and examining all aspects of COVID-19 and potential treatment modalities and various drugs in order to enable the treatment, control, and prevention of COVID-19. iPSCs have become one of the most attractive and promising tools in this field by providing the ability to study COVID-19 and the effectiveness of drugs on this disease outside the human body. In this study, we discuss the different methods of generation of iPSCs as well as their respective advantages and disadvantages. We also present recent applications of iPSCs in the study and treatment of COVID-19.

Is there any relationship between red blood cell distribution width and prognosis of brain death?

Background

Accumulating evidence has demonstrated that RDW (red blood cell distribution width) may independently predict clinically important outcomes in many populations. However, the role of RDW has not been elucidated in brain death. We conducted this study with the aim of evaluating the predictive value of RDW in brain death.

Methods

A retrospective study of seventy-seven of brain death cases during 36 months were evaluated at university hospitals, affiliated in Tehran, Iran. Demographical data include age, sex, BMI and cause of brain death, also laboratory results (red blood cell distribution, mean corpuscular volume, hemoglobin) collected by checklists from patient records. Having the three RDW measurements (days of hospital admission, day of brain death, and day of cardiac arrest) required.

Results

Time interval from hospital admission until brain death was 5.27±4.07. The mean age of brain death cases was 32.65±16.53. The mean RDW values on days of hospital admission, the day of brain death, and the day of cardiac arrest were 14.53±1.98, 15.12±1.93 and 15.18±2.07, respectively. Results of the repeated-measures ANOVA test reveal that RDW level was constantly higher in the traumatic patient group compared to the non-traumatic ones (P=0.008).

Conclusion

The frequency of brain death was high in patients with high RDW values. RDW might be a prognostic biomarker for brain death. More prospective studies with large sample size and long follow-up period should be carried out to determine the prognostic significance of RDW and brain death in future.

Adipose-derived stem cells: potentials, availability and market size in regenerative medicine

Adipose-derived stem cells (ADSCs) have been described as one of the most potent and accessible human adult stem cells which can be utilized in various therapeutic approaches. Due to the vast variety of cytokines and GFs secreted by them, ADSCs can be used for controlled drug release. These cells can be used for proliferation and differentiation of tissues regardless of survival conditions and immunologic problems. Because of their ability to differentiate into various lineages, ADSCs can be used in musculoskeletal problems, diabetes, heart diseases, obesity, neurologic and nephrogenic diseases, and wound healing, as well as applications in regenerative medicine such as osteogenic, cartilage, tendon, muscle, skin, CNS, cardiac and vascularization, as well as liver and even periodontal regeneration. To maintain the highest viability and efficiency, companies that provide ADSCs should offer the best product quality to gain market share and scientists need to acquire an understanding of sources where they can find the best products available. Therefore, in this article, we have reviewed the available products, companies and the market size currently available for ADSCs. Enormous effort has been made to list the most important trials, products and companies, currently existent in the field. To achieve better outcomes in scientific research, there is the need to compare the products available and choose the best option according to desired goals. Thus, this paper provides a valuable reference for those interested in the field of ADSCs and their applications.

Bacterial contamination of bone allografts in the tissue banks: a systematic review and meta-analysis

BACKGROUND

Bone allografts are harvested and transplanted under sterile conditions. However, the risk of bacterial contamination of grafts during these processes is a health concern. Bioburden testing and bacterial contamination detection are conducted to ensure allograft sterility.

AIM

The present study aimed to determine the incidence of bacterial contamination in bone allografts based on different classifications.

METHODS

PROSPERO registration number was received for the study. Systematic searches were conducted in PubMed and EMBASE databases with relevant keywords from January 2000 to March 2021. After choosing related studies according to the PRISMA flow diagram, Stata software was used for data analysis. We considered I² ˃ 50% as heterogeneity between studies.

FINDINGS

The overall incidence of bacterial contamination was 12.6% (95% CI 0.100, 0.152) among 19,805 bone allografts of 17 studies. The bacterial contamination rate among bone allografts was 10.8% before 2010 and 14.7% in 2010-March 2021. The contamination frequency in Asia, Europe, and Australia was 11.5%, 14.3%, and 5.2%, respectively. Bone contamination rates were higher in cadaver donors (19.9%), retrieval time sampling (13.5%), and swab samples (13.2%) compared to those in living donors (7.5%), implantation time sampling (6.9%), and bone fragments cultures (6.3%). Bacterial contamination was recovered 24.4%, 19.7%, 13.2%, and 21% from tibia, fibula, femoral, and other bones, respectively. Staphylococcus spp. was the predominant isolated bacteria from bones (63.2% of all isolated genera), followed by Propionibacterium spp. (10.6%).

CONCLUSION

The high contamination of bone allografts is a health concern, indicating the need for more health monitoring and improvement of standards.

The Predominant microRNAs in β-cell Clusters for Insulin Regulation and Diabetic Control

micro (mi)-RNAs are vital regulators of multiple processes including insulin signaling pathways and glucose metabolism. Pancreatic β-cells function is dependent on some miRNAs and their target mRNA, which together form a complex regulative network. Several miRNAs are known to be directly involved in β-cells functions such as insulin expression and secretion. These small RNAs may also play significant roles in the fate of β-cells such as proliferation, differentiation, survival and apoptosis. Among the miRNAs, miR-7, miR-9, miR-375, miR-130 and miR-124 are of particular interest due to being highly expressed in these cells. Under diabetic conditions, although no specific miRNA profile has been noticed, the expression of some miRNAs and their target mRNAs are altered by posttranscriptional mechanisms, exerting diverse signs in the pathobiology of various diabetic complications. The aim of this review article is to discuss miRNAs involved in the process of stem cells differentiation into β-cells, resulting in enhanced β-cell functions with respect to diabetic disorders. This paper will also look into the impact of miRNA expression patterns on in vitro proliferation and differentiation of β-cells. The efficacy of the computational genomics and biochemical analysis to link the changes in miRNA expression profiles of stem cell-derived β-cells to therapeutically relevant outputs will be discussed as well.

Hemodynamic Changes and Early Recovery of Liver Graft Function after Liver Transplantation

BACKGROUND

Patients with liver cirrhosis experience a hyperdynamic circulation.

OBJECTIVE

To investigate the association between early hemodynamic changes and graft function after liver transplant.

METHODS

Those patients who underwent liver transplantation in 2016 were enrolled in the study. Liver function indices measured in postoperative days (POD) 1, 3, 5, 7, 9, and 11 along with hemodynamic indices including pulse rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and central venous pressure (CVP) measured q6h in the first 3 days after transplantation were recorded.

RESULTS

57 deceased-donor liver recipients with a mean±SD age of 41.4±11.8 years including 33 (58%) males were enrolled in the study. The mean±SD aspartate and alanine aminotransferases, alkaline phosphatase, and lactate dehydrogenase were significantly decreased from 1879±670.5, 369.2±40.5, 174.9±18.8, and 1907.6±323.1 U/L in POD 1 to 37.2±10.7, 243.4±37.3, 207.5±19.5, and 382.4±59.8 U/L in POD 3, respectively (p=0.028, <0.001, 0.002, and 0.001, respectively). During this period, the pulse rate of the patients was significantly (p<0.001) decreased by a median (IQR) of 28.7 (8.5-39.7) beats/min; it was significantly correlated with a decrease in serum hepatic enzymes activities during this period. SBP, DBP, and CVP were significantly increased (p<0.001 for all) during this period. Liver graft function improved significantly earlier in those patients with a mean pulse rate of 87 beats/min compared with others (p=0.03).

CONCLUSIONS

There may be an association between changes of hemodynamic indices, especially reduction of pulse rate, and improved graft function early after liver transplantation.

Safety and Efficacy of Early Oral Feeding after Liver Transplantation with Roux-en-Y Choledochojejunostomy: A Single-Center Experience

BACKGROUND

Early oral feeding, as one of the most important components of multimodal strategies referred to as Enhanced Recovery After Surgery (ERAS), is now widely adopted for optimization of post-operative recovery of surgical patients.

OBJECTIVE

To assess ERAS outcome in patients who underwent liver transplantation in our center.

METHODS

In a prospective study, patients who underwent liver transplantation from April 2015 to June 2018 at Imam Khomeini Hospital Complex, affiliated to Tehran University of Medical Sciences, Tehran, Iran, were enrolled in this study. Serum albumin, total iron-binding capacity (TIBC), and course of hospital stay were assessed.

RESULTS

39 (23 male) patients who underwent choledochojejunostomy with Roux-en-Y anastomosis for liver transplantation were enrolled. The mean±SD pre-operative serum albumin and TIBC levels of patients were 3.0±0.6 (range: 1.9-4.1) g/dL and 304±75 (range: 154.0-437.0) µg/dL, respectively. The mean±SD time between the end of operation and starting oral feeding was 11.6±1.8 (range: 9.0-15.0) hours. All patients tolerated early oral feeding with liquids followed by solid foods; no vomiting reported in patients. Overall, patient survival rates at one month and three months were 89.7% and 89.7%, respectively. In our study, no leak of anastomosis was reported.

CONCLUSION

There was no major harm for ERAS after liver transplantation and it might be even helpful as in colorectal surgeries. As seen in our study, oral feeding was started as soon as possible after the end of operation in almost all patients and all of them tolerated early oral feeding. No one had vomiting or nausea.

Recent Advances in Gene Therapy and Modeling of Chronic Granulomatous Disease

The Chronic granulomatous disease (CGD) is a primary immunodeficiency that characterized by mutations in phagocyte nicotinamide adenine dinucleotide phosphate (NADPH) oxidase, resulting in deficient antimicrobial activity of phagocytic cells and recurrent childhood infections. Hematopoietic stem cell transplantation (HSCT) is a curative option for patients with human leukocyte antigen (HLA) matched donor, when conventional cares and therapies fail. However, in many cases when the patients have not an HLA-matched donor, they need to a method to recapitulate the function of the affected gene within the patient's own cells. Gene therapy is a promising approach for CGD. While, the success of retroviral or lentiviral vectors in gene therapy for CGD has been hampered by random integration and insertional activation of proto-oncogenes. These serious adverse events led to improvement and generations of viral vectors with increased safety characteristics. Gene therapy continues to progress and the advent of new technologies, such as engineered endonucleases that have shown a great promise for the treatment of genetic disease. This review focuses on the application of gene therapy for the CGD, the limitations encountered in current clinical trials, advantages and disadvantages of endonucleases in gene correction and modeling with CRISPR/Cas9 approach.

Transplantation of Spermatogonial Stem Cells Suspension into Rete Testis of Azoospermia Mouse Model

PURPOSE

The loss of spermatogonia following chemo-or radiotherapy leading to temporary or permanent infertility of the patient is a well known and unwanted side effect of many oncological therapies.

MATERIALS AND METHODS

In this study, germ cells were isolated from 4 days old mouse testis cells. Busulfan treatment was used to the eliminate proliferating cells in the testis of recipient mice. The donor cells suspended in DMEM, were introduced into the rete testis of recipient mice via microinjection method. To distinguish the progeny of the transplanted donor stem cells from endogenous germ cells, BrdU-labeled cells were used. In addition, real time PCR was performed to determine expression levels of ngn3 and LIN28 (spermatogonia stem cells markers)before and after transplantation. Western blot analysis was further performed to detect an increase in - ngn3 expression after transplantation.

RESULTS

Transplantations of stem cells into rete testis of the recipients was done. Our results clearly showed a significant increase in spermatozoa number in epididymal luman Spermatogonial stem cells (SSCs) did not show alkaline phosphatase activities while ngn3 and LIN28 were clearly expressed. Ngn3 and LIN28 expression were reduced after busulfan treatment compared to untreatmented mice. However, the expression of ngn3 and LIN28 increased after transplantation . BrdU-labeled testis cells were successfully transplanted into rete testis of recipient mice. These cells remained in rete testis of all recipient mice up to two months after transplantation.

CONCLUSION

The present study clearly confirme that a regeneration after cytotoxic treatment was based on morphological criteria. We demonstrated the increase in stem cell numbers during regeneration and after transplantation. Transplantation of spermatogonial stem cells suspension by the injection of cells via the rete testis of recipient azoospermia model considerably enhances the efficiency of this procedure.

Differentiation of Human Mesenchymal Stem Cells into Insulin Producing Cells by Using A Lentiviral Vector Carrying PDX1

Objective

Type I diabetes is an immunologically-mediated devastation of insulin producing cells (IPCs) in the pancreatic islet. Stem cells that produce β-cells are a new promising tool. Adult stem cells such as mesenchymal stem cells (MSCs) are self renewing multi potent cells showing capabilities to differentiate into ectodermal, mesodermal and endodermal tissues. Pancreatic and duodenal homeobox factor 1 (PDX1) is a master regulator gene required for embryonic development of the pancreas and is crucial for normal pancreatic islets activities in adults.

Materials and Methods

We induced the over-expression of the PDX1 gene in human bone marrow MSCs (BM-MSCs) by Lenti-PDX1 in order to generate IPCs. Next, we examine the ability of the cells by measuring insulin/c-peptide production and INSULIN and PDX1 gene expressions.

Results

After transduction, MSCs changed their morphology at day 5 and gradually differentiated into IPCs. INSULIN and PDX1 expressions were confirmed by real time polymerase chain reaction (RT-PCR) and immunostaining. IPC secreted insulin and C-peptide in the media that contained different glucose concentrations.

Conclusion

MSCs differentiated into IPCs by genetic manipulation. Our result showed that lentiviral vectors could deliver PDX1 gene to MSCs and induce pancreatic differentiation.

The Generation of Insulin Producing Cells from Human Mesenchymal Stem Cells by MiR-375 and Anti-MiR-9

Background

MicroRNAs (miRNAs) are a group of endogenous small non-coding RNAs that regulate gene expression at the post-transcriptional level. A number of studies have led to the notion that some miRNAs have key roles in control of pancreatic islet development and insulin secretion. Based on some studies on miRNAs pattern, the researchers in this paper investigated the pancreatic differentiation of human bone marrow mesenchymal stem cells (hBM-MSCs) by up-regulation of miR-375 and down-regulation of miR-9 by lentiviruses containing miR-375 and anti-miR-9.

Methodology

After 21 days of induction, islet-like clusters containing insulin producing cells (IPCs) were confirmed by dithizone (DTZ) staining. The IPCs and β cell specific related genes and proteins were detected using qRT-PCR and immunofluorescence on days 7, 14 and 21 of differentiation. Glucose challenge test was performed at different concentrations of glucose so extracellular and intracellular insulin and C-peptide were assayed using ELISA kit. Although derived IPCs by miR-375 alone were capable to express insulin and other endocrine specific transcription factors, the cells lacked the machinery to respond to glucose.

Conclusion

It was found that over-expression of miR-375 led to a reduction in levels of Mtpn protein in derived IPCs, while treatment with anti-miR-9 following miR-375 over-expression had synergistic effects on MSCs differentiation and insulin secretion in a glucose-regulated manner. The researchers reported that silencing of miR-9 increased OC-2 protein in IPCs that may contribute to the observed glucose-regulated insulin secretion. Although the roles of miR-375 and miR-9 are well known in pancreatic development and insulin secretion, the use of these miRNAs in transdifferentiation was never demonstrated. These findings highlight miRNAs functions in stem cells differentiation and suggest that they could be used as therapeutic tools for gene-based therapy in diabetes mellitus.

Hydatid cyst of fallopian tube

Echinococcosis is a common disease in the Middle East region and is in the differential diagnosis of cystic lesions in patients of this area. Liver and lung are commonly involved. Infection of unusual sites can cause difficulties in diagnosis. Here, we present a patient with echinococcal cyst of the fallopian tube. She had abdominal pain and a cystic lesion in adnexa was found by imaging. She underwent surgery and diagnosis of echinococcosis was established.

Generation of high-yield insulin producing cells from human bone marrow mesenchymal stem cells

Allogenic islet transplantation is a most efficient approach for treatment of diabetes mellitus. However, the scarcity of islets and long term need for an immunosuppressant limits its application. Recently, cell replacement therapies that generate of unlimited sources of β cells have been developed to overcome these limitations. In this study we have described a stage specific differentiation protocol for the generation of insulin producing islet-like clusters from human bone marrow mesenchymal stem cells (hBM-MSCs). This specific stepwise protocol induced differentiation of hMSCs into definitive endoderm, pancreatic endoderm and pancreatic endocrine cells that expressed of sox17, foxa2, pdx1, ngn3, nkx2.2, insulin, glucagon, somatostatin, pancreatic polypeptide, and glut2 transcripts respectively. In addition, immunocytochemical analysis confirmed protein expression of the above mentioned genes. Western blot analysis discriminated insulin from proinsulin in the final differentiated cells. In derived insulin producing cells (IPCs), secreted insulin and C-peptide was in a glucose dependent manner. We have developed a protocol that generates effective high-yield human IPCs from hBM-MSCs in vitro. These finding suggest that functional IPCs generated by this procedure can be used as a cell-based approach for insulin dependent diabetes mellitus.

Cytotoxic effects of chloroform and hydroalcoholic extracts of aerial parts of Cuscuta chinensis and Cuscuta epithymum on Hela, HT29 and MDA-MB-468 tumor cells

Previous studies have indicated that some species of Cuscuta possess anticancer activity on various cell lines. Due to the lack of detailed researches on the cytotoxic effects of Cuscuta chinensis and Cuscuta epithymum, the aim of the present study was to evaluate cytotoxic effects of chloroform and hydroalcoholic extracts of these plants on the human breast carcinoma cell line (MDA-MB-468), human colorectal adenocarcinoma cell line (HT29) and human uterine cervical carcinoma (Hela). Using maceration method, different extracts of aerial parts of C. chinensis and C. epithymum were prepared. Extraction was performed using chloroform and ethanol/water (70/30). Total phenolic contents of the extracts were determined according to the Folin-Ciocalteu method. Using MTT assay, the cytotoxic activity of the extracts against HT29, Hela and MDA-MB-468 tumor cells was evaluated. Extracts were considered cytotoxic when more than 50% reduction on cell survival was observed. The poly-phenolic content of the hydroalcoholic and chloroform extracts of C. chinensis and C. epithymum were 56.08 ± 4.11, 21.49 ± 2.00, 10.64 ± 0.86 and 4.81 ± 0.38, respectively. Our findings showed that the chloroform extracts of C. chinensis and C. epithyum significantly reduced the viability of Hela, HT-29 and MDA-MB-468 cells. Also, hydroalcoholic extracts of C. chinensis significantly decreased the viability of HT29, Hela and MDA-MB-468 cells. However, in the case of hydroalcoholic extracts of C. epithymum only significant decrease in the viability of MDA-MB-468 cells was observed (IC50 = 340 μg/ml). From these findings it can be concluded that C. chinensis and C. epithymum are good candidates for further study to find new possible cytotoxic agents.

Regeneration of spermatogenesis in a mouse model of azoospermia by follicle-stimulating hormone and oestradiol

Busulfan is a chemotherapeutic drug that induces sterility, azoospermia and testicular atrophy. To induce degeneration of spermatogenesis, we used different amounts of busulfan. Adult male C57Bl/6 mice were treated with 15, 30 and 45 mg kg(-1) of busulfan. After 5 weeks, animals had daily injections of 7.5 IU human follicle-stimulating hormone (hFSH) and 12.5 μg kg(-1) oestradiol benzoate (EB), separately or simultaneously. After this time, the animals were killed and blood samples were taken through cardiac puncture. Testes were used for histopathology experiments, DNA flow cytometry and RNA extraction for expression of c-kit and cyclin B1 genes. EB unlike FSH has induced stimulatory effects on spermatogenesis, increased the level of serum testosterone 2-fold and caused a 2-fold increase in the number of haploid cells. The result showed that hFSH with EB multiplied EB stimulatory effects on spermatogenesis up to four times. Expression of c-kit and cyclin B1 genes increased in EB and hFSH+EB groups. These findings suggest that EB regulates spermatogonial stem cells via hFSH. hFSH with EB had synergistic effect on regeneration of spermatogenesis.

QuantiFERON-TB Gold In-Tube test for diagnosis of latent tuberculosis (TB) infection in solid organ transplant candidates: a single-center study in an area endemic for TB

BACKGROUND

The prevalence of Mycobacterium tuberculosis in transplant recipients is estimated to be 50 times higher than in the general population, with a mortality rate of around 40%. Diagnosis and treatment of latent tuberculosis (TB) infection (LTBI) is an essential strategy for TB control. In this study we compared the QuantiFERON-TB Gold In-Tube test (QFT) with the tuberculin skin test (TST) for detection of LTBI in solid organ transplant (SOT) candidates.

PATIENTS AND METHODS

Between March 2008 and September 2011, 187 transplant candidates, who were referred to the transplant clinic of Imam-Khomeini Hospital, were enrolled in the study. Patients were screened for LTBI with both QFT and TST. Twenty-three patients (12.3%) were excluded for failure to follow up. Concordance between the 2 tests, and variables associated with test discordance were assessed.

RESULTS

The mean age of patients was 40 years (range: 11-65) and male-to-female ratio was 1.2 (88/76). TST and QFT were positive in 26 (15.9%) and 33 (20.1%) patients, respectively. Five cases (3.1%) had indeterminate QFT. Overall agreement between QFT and TST was about 80% (k = 0.32, P-value = 0.0001).

CONCLUSION

Considering the fair overall agreement between the 2 tests, and greater ease of the QFT from the patient's point of view, QFT is recommended for detection of LTBI in SOT candidates.

Diagnostic Accuracy of Sixty Four Multi-Slice CT Angiography in Assessment of Arterial Cut-Off and Run-Off in Comparison with Surgical Findings

BACKGROUND/OBJECTIVE

The accurate anatomic mapping and determination of the severity of arterial disease, an important health problem of the elderly, is of great significance. We aimed to determine the diagnostic value of 64-multislice CT angiography (MSCTA) in run-off and cut-off sites of arterial disease.

PATIENTS AND METHODS

Throughout the study, MSCTA followed by an operative intervention was carried out on a total of 38 patients with clinical signs and symptoms suggestive of arterial disease (AD) all of whom had the indication for vascular surgery. The mean age of patients was 34±15.86 (range, 23 to 93) years. MSCTA was executed using a 64-slice CT scanner, during the arterial phase of injecting the nonionic, contrast medium with a power injector at the rate of 5 ml/sec into the antecubital vein and exploration and revascularization of peripheral arterial disease was performed intraoperatively.

RESULTS

Atherosclerosis and arterial disease, the most common causes of vascular occlusion, were more common in the lower extremities. According to MSCTA findings, the most frequent site of stenosis was the superficial femoral artery. Spearman's correlation coefficient showed a high degree of agreement amongst the raters. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the accuracy of MSCTA compared to surgery were 83.8%, 96%, 96.8%, 81.3% and 89%, respectively. MSCTA findings were compared with surgery as a standard of reference, which showed concordance in the majority of cases (81.6%). Cut-off sites were correctly identified by MSCTA in 97.3% of the patients and the most common sites of discordance were the run-off sites (18.2%).

CONCLUSION

MSCTA angiography as a novel diagnostic modality may be a suitable alternative and a viable choice for routine clinical diagnosis.

Doctors' views of attitudes towards peer medical error

BACKGROUND

This study aims at evaluating doctors' attitudes towards handling medical errors made by their peers.

MATERIALS

This cross-sectional questionnaire survey was conducted between April and July 2006 and targeted general practitioners attending continuing medical education programmes in Tehran. A total of 474 doctors were approached, 400 of whom completed the questionnaire. The questionnaire contained a clinical vignette with three hypothetical patient outcomes: near-miss, leading to harm, and leading to death. The participants were asked how they would deal with each case. They were also asked how they would prefer their peers to react when they themselves made a medical error.

RESULTS

The most common attitude toward peers' medical errors was reporting it to the original doctor and asking them to disclose it to the patient (near-miss: 63.0%; 95% CI 58% to 68%; leading to harm: 70.0%; 95% CI 65.4% to 74.6%; and leading to death: 62.5%; 95% CI 57.5% to 67.5%). In most cases, doctors expected their peers to report their medical errors to them (92.7%; 95% CI 89.7% to 93.0). About 67% of the participating doctors had encountered a peer's medical error in the past 6 months, although 90% of them had received no or very little training in dealing with this issue.

DISCUSSION

The most acceptable approach to dealing with a peer's medical error is to report it to the responsible doctor and encourage them to disclose it to the patient.

Knowledge and attitude of donor cardholders toward organ and tissue donation and transplantation in an Iranian tissue bank: a case-control study

BACKGROUND

Cadaveric organ shortage is the most important obstacle to more widespread provision of transplants. Many factors influence the donation rate: social factors, religion, familial relations, and especially knowledge and attitudes toward organ and tissue donation and transplantation. Increasing public awareness can reform the incorrect beliefs and myths about donation and transplantation. This study investigated knowledge and attitudes of donor cardholders toward organ and tissue donation as well as transplantation.

METHODS

This case-control study was performed in 2006 among 178 donor cardholders and the same number of a control group who completed a questionnaire including 23 questions and demographic information.

FINDINGS

Knowledge and attitude among the cardholder was significantly greater than the control group (P < .05). We observed a inverse correlation between age and a positive attitude toward donation and transplantation among cardholders.

CONCLUSION

This study suggested that the main reasons for refusal to donate organ and tissue were insufficient knowledge and negative attitudes due to misinformation regarding donation and transplantation. We believe that educating and motivating the public via the mass media can increase the rate of consent for organ and tissue donation and transplantation.

Mutation of the histidin residue of the DRH motif in vasopressin V2 receptor expression and function

BACKGROUND AND THE PURPOSE OF THE STUDY

Vasopressin type 2 receptor (V2R), a G protein coupled receptor (GPCR), plays an important role in the regulation of renal antidiuretic function. The highly conserved DRH motif is essential for G protein signaling of V2R; however its role especially regarding the histidin residue is not fully understood..

METHODS

Site directed mutagenesis was performed with replacements of the histidin to isoleucine by using nested polymerase chain reaction. ELISA was performed for receptor expression assay and the adenylyl cyclase activity assay was performed for functional characterization of DRI mutation on V2R signaling.

RESULTS AND MAJOR CONCLUSION

The adenylyl cyclase activity assay in COS-7 cells showed no difference in the amount of cAMP production between the wild type and the mutant V2 receptors. The V2 receptor expression was not changed in the presence of this mutation using ELISA assay. These results suggest that the role of histidin residue is not critical in the V2 receptor function, however further mutagenesis studies are required to define the role of this motif in V2R function.

The role of strain variation in BAX and BCL-2 expression in murine bleomycin-induced pulmonary fibrosis

This study hypothesized that the expression of apoptosis-regulatory genes, such as BCL-2 and BAX may be affected by genetic variation in bleomycin-induced pulmonary fibrosis in C57BL/6 and NMRI mice. Pulmonary fibrosis induced by single intratracheal dose of bleomycin (3 U kg(-1)). After 2 weeks, lung samples were analyzed for collagen deposition, pathological changes and expression of BCL-2 and BAX. The fibrotic lung changes were similar in both strains. The immunohistochemical assay using a biotin-streptavidin technique showed no significant difference in immunoreactivity for BCL-2 protein between the controls and bleomycin-treated C57BL/6 mice. However, in NMRI mice, the expression of BCL-2 was significantly (p<0.05) upregulated in myofibroblasts and neutrophils. The expression of BAX protein was significantly (p<0.05) upregulated in alveolar epithelial cells of both strains and downregulated in myofibroblasts and lymphocytes of the lung tissues of C57BL/6 mice and also in lymphocytes of NMRI mice at 2 weeks after bleomycin instillation. These results confirm the role of BCL-2 and BAX proteins in the pathogenesis of pulmonary fibrosis and suggest that the expression of apoptotic regulatory genes may be specific in different cell types in various strains.

Propofol–alfentanil vs propofol–remifentanil for posterior spinal fusion including wake-up test

BACKGROUND

Wake-up test can be used during posterior spinal fusion (PSF) to ensure that spinal function remains intact. This study aims at assessing the characteristics of the wake-up test during propofol-alfentanil (PA) vs propofol-remifentanil (PR) infusions for PSF surgery.

METHODS

Sixty patients with scoliosis and candidates for PSF surgery were randomly allocated in either alfentanil (PA) or remifentanil (PR) group. After an i.v. bolus of alfentanil 30 microg kg(-1) in the PA group or remifentanil 1 microg kg(-1) in the PR group, anaesthesia was induced with thiopental and atracurium. During maintenance, opioid infusion consisted of alfentanil 1 microg kg(-1) min(-1) or remifentanil 0.2 microg kg(-1) min(-1), in the PA group and the PR group, respectively. All patients received propofol 50 microg kg(-1) min(-1). Atracurium was given to maintain the required surgical relaxation. At the surgeon's request, all infusions were discontinued. Patients were asked to move their hands and feet. Time from anaesthetic discontinuation to spontaneous ventilation (T(1)), and from then until movement of the hands and feet (T(2)), and its quality were recorded.

RESULTS

The average T(1) and T(2) were significantly shorter in the PR group [3.6 (2.5) and 4.1 (2) min] than the PA group [6.1 (4) and 7.5 (4.5) min]. Quality of wake-up test, however, did not show significant difference between the two groups studied.

CONCLUSION

Wake-up test can be conducted faster with remifentanil compared with alfentanil infusion during PSF surgery.

Anxiolytic effects of Salvia reuterana Boiss. on the elevated plus-maze model of anxiety in mice

The anxiolytic and sedative effects of hydroalcoholic extract (HE) of Salvia reuterana Boiss. was evaluated in mice. The HE of Salvia reuterana (100 mg/kg), increased the percentage of time-spent and the percentage of arm entries in the open arms of the elevated plus-maze. Spontaneous locomotor activity count measured in 15 min of the test was significantly decreased in animals pretreated with diazepam and 100 mg/kg of Salvia reuterana extract. Results of the present study provide support for the traditional usage of Salvia reuterana as a sedative and anxiolytic medicinal plant.

Anxiolytic effects of Echium amoenum on the elevated plus-maze model of anxiety in mice

The ethanolic extract of Echium amoenum flowers at the dose of 50 mg/kg increased the percentage of time-spent and the percentage of arm entries in the open arms of the elevated plus-maze (EPM) and decreased the percentage of time-spent in the closed arms of EPM. Moreover, it prolonged the ketamine-induced latency to sleep but had no significant effects on total sleeping time induced by ketamine. Also, the locomotor activity was affected but not to the same extent as observed for diazepam. These results suggested that the extract of E. amoenum seems to possess anxiolytic effect with lower sedative activity than that of diazepam.

Passive immunization with an anti-substance P antibody prevents substance P- and neurokinin A-induced bronchospasm in anesthetized guinea-pigs

In a guinea-pig model of asthma, active immunization against substance P (SP) prevented the development of airways' hyperresponsiveness and reduced bronchospastic responses to SP (i.v.). The rat-mouse heterohybridoma NC1/34 secretes a specific, rat IgG1, anti-substance P antibody (alpha-SP Ab) which was isolated and purified by passing supernatant from cultures through thiophilic gel. Purity of antibody was about 50% (SDS-PAGE). The relative affinities of the alpha-SP Ab for SP, neurokinin A (NKA) and calcitonin gene-related peptide (CGRP) were estimated by ELISA using a constant amount of SP coupled (glutaraldehyde) to bovine serum albumin (BSA) to capture the antibody, alone and in the presence of increasing concentrations of the neuropeptides. At alpha-SP Ab dilutions of 1 in 5,000 to 1 in 32,000, CGRP did not prevent antibody binding to SP-BSA conjugate bound to the plates, but both SP and NKA prevented binding. In this system, the relative affinity of the alpha-SP Ab, at dilutions of 1 in 5,000 and 1 in 10,000, was about 50 times greater for SP than NKA. Whether passive immunization with alpha-SP Ab prevented bronchospastic responses to SP and NKA (i.v.), in vivo, was determined in groups of anesthetized guinea-pigs by recording pulmonary flow resistance (RL) and dynamic pulmonary elastance (EL). Injection of alpha-SP Ab (i.v., 5:1 molar ratio: alpha-SP Ab:SP total dose) did not alter baseline values of RL and EL, but markedly inhibited increases in RL and EL induced by SP and NKA (i.v.) without affecting responses to methacholine (i.v.). A control, "irrelevant" rat IgG-type antibody at a similar concentration had no effect on responses to SP or NKA. These findings indicate that passive immunization with a monoclonal alpha-SP Ab can prevent the bronchospastic effects of exogenous SP and NKA in guinea-pigs.