Effectiveness and safety of combined direct oral anticoagulant and antiplatelet among high-risk peripheral arterial disease: a meta-analysis

Funding Acknowledgements

Type of funding sources: None.

Background

Peripheral arterial disease (PAD) is a common manifestation of systemic atherosclerosis which strongly correlates to cardiovascular morbidity and mortality and increased risk of limb loss, and despite the wide use of guideline-based antiplatelet therapy, patients remain at high risk for cardiovascular and limb events. There has been increasing interest in novel anticoagulants to improve prevention of complications secondary to PAD.

Purpose

This study aims to determine the effectiveness and safety of combined direct oral anticoagulant plus antiplatelet in reducing MACE, MALE and all-cause mortality among patients with PAD.

Method

Randomized controlled trials with outcomes on major adverse cardiac events (MACE), major adverse limb events (MALE), all-cause mortality and bleeding were searched through PubMed, Cochrane and EBSCOHost.

Result

Pooled analysis of studies on patients peripheral arterial disease showed that anticoagulant combined with antiplatelet have significant benefits compared with antiplatelet alone in reducing major adverse limb events (RR 0.72, 95% CI 0.62 to 0.83) and stroke (RR 0.74, 95% CI 0.57 to 0.97) but had inconclusive results in reducing myocardial infarction (RR 0.85, 95% CI 0.70 to 1.03).There was no significant benefit in reducing cardiovascular death (RR 1.04, 95% CI 0.88 to 1.23) and all-cause mortality (RR 1.02, 95% CI 0.90 to 1.16). Likewise, there was increased risk of bleeding (RR 1.46, 95% CI of 1.18 to 1.80) compared with antiplatelet alone.

Conclusion

Anticoagulant (Rivaroxaban) combined with antiplatelet (aspirin) as alternative to traditional antiplatelet (aspirin) therapy significantly reduced major adverse limb events and stroke. However, there was a higher incidence of bleeding for the combined cohort. Therefore, it is deemed necessary to identify high-risk PAD patients with low risk of bleeding who can benefit the most with the combined intervention.

Discussion on Optimality Conditions of Fuzzy Optimal Control Problems

In this study, a novel methodology for detecting fuzzy optimal solutions of fuzzy optimal control problems governed by fuzzy differential equations is presented. For this purpose, first the concept of optimal solution is proposed by considering a partial ordering on fuzzy numbers space which is based on a new parametric representation for α-level set of fuzzy numbers. Using this partial ordering and parametric representation, the discussed fuzzy optimal control problems are reduced to general optimal control problems in parametric form. Then by Pontryagin’s principle, a candidate for the solution of the original problem is derived. The procedure of extracting candidate solution is illustrated for two experimental problems, which improve the recent results of Refs. 10 and 17.

Density-functional-theory approach to the Hamiltonian adaptive resolution simulation method

In the Hamiltonian adaptive resolution simulation method (H-AdResS) it is possible to simulate coexisting atomistic (AT) and ideal gas representations of a physical system that belong to different subdomains within the simulation box. The Hamiltonian includes a field that bridges both models by smoothly switching on (off) the intermolecular potential as particles enter (leave) the AT region. In practice, external one-body forces are calculated and applied to enforce a reference density throughout the simulation box, and the resulting external potential adds up to the Hamiltonian. This procedure suggests an apparent dependence of the final Hamiltonian on the system's thermodynamic state that challenges the method's statistical mechanics consistency. In this paper, we explicitly include an external potential that depends on the switching function. Hence, we build a grand canonical potential for this inhomogeneous system to find the equivalence between H-AdResS and density functional theory (DFT). We thus verify that the external potential inducing a constant density profile is equal to the system's excess chemical potential. Given DFT's one-to-one correspondence between external potential and equilibrium density, we find that a Hamiltonian description of the system is compatible with the numerical implementation based on enforcing the reference density across the simulation box. In the second part of the manuscript, we focus on assessing our approach's convergence and computing efficiency concerning various model parameters, including sample size and solute concentrations. To this aim, we compute the excess chemical potential of water, aqueous urea solutions and Lennard-Jones (LJ) mixtures. The results' convergence and accuracy are convincing in all cases, thus emphasising the method's robustness and capabilities.

Role of Natural Flocculation in Eliminating Toxic Metals

Metals as the most common environmental pollutants derive from different sources and have far-reaching harmful impacts on flora, fauna and human health. Moreover, metals cause irreversible damages to marine ecosystems. Estuaries are most productive ecosystems for living creatures and act as a transporting corridor for exchanging materials from river to water bodies including oceans, seas and lakes. One of the most important processes in this region is flocculation. Not only does flocculation process convert a huge percentage of metals from dissolved phase to particulate phase in providing micronutrients to aquatic organisms, more importantly, but it also eliminates metals from aquatic ecosystems and gives aid to the pollution of water bodies to be on the decrease. Moreover, the chemical mass balance between river and sea is substantially influenced by flocculation process. Salinity, pH, dissolved oxygen, dissolved organic carbon and sodium hypochlorite as important factors affect the flocculation of metals during estuarine mixing of river water with seawater. It is vital to make use of natural processes in eliminating pollutants. Thus, natural processes need to be recognized and promoted by various means.

Sexual Life During Pregnancy: Effect of an Educational Intervention on the Sexuality of Iranian Couples: A Quasiexperimental Study

The sexual life of couples and their needs during pregnancy receive little attention in practice. The aim of this study was to evaluate an educational intervention delivered to pregnant couples to improve their sexual function and satisfaction. This quasiexperimental study was conducted on 128 couples, allocated into two groups of intervention (group A: couples, group B: pregnant women) and one control group (C). Postintervention, the mean of the total score of sexual function and satisfaction of the couples was significantly higher in the intervention groups compared with the control group (p < 0.05). It seems sexuality education specific for prenatal care would be effective.

Effect of Sexual Education on Sexual Function of Iranian Couples During Pregnancy: A Quasi Experimental Study

BACKGROUND

The aim of this study was to evaluate the impact of husbands' participation in sexual education on sexual function during pregnancy.

METHODS

This quasi experimental study was conducted on 123 couples who were divided in two intervention (A: couples, B: pregnant women) and one control (C) groups. Group A couples received sex education, Group B women received sex education without their spouses, and Group C women received routine prenatal care without sex education. Sexual functions of couples were assessed by Female Sexual Function Index (FSFI) and International Index Erectile Function (IIEF) questionnaires, before sex education, four weeks after the intervention, at the end of the second trimester and at the end of the third trimester.

RESULTS

Mean total scores of FSFI and IIEF were not different at baseline in three groups. Repeated measure analysis showed significant differences between groups (A and B with C) in the mean total scores of FSFI and IIEF during the third trimester. The mean total scores of the two intervention groups of A and B were not significant.

CONCLUSION

According to the results of the present study, promoting the sexual function of pregnant women needs to include the sex education on prenatal care. Whereas spouses' participation was suggested to have a great role in the effectiveness and strengthening of the education in various studies, this study showed that the lack of spouses' participation for whatever reasons may lead to the same results of previous studies which emphasized the necessity of spouses' participation.

The melatonin immunomodulatory actions in radiotherapy

Radiotherapy has a key role in cancer treatment in more than half of patients with cancer. The management of severe side effects of this treatment modality is a limiting factor to appropriate treatment. Immune system responses play a pivotal role in many of the early and late side effects of radiation. Moreover, immune cells have a significant role in tumor response to radiotherapy, such as angiogenesis and tumor growth. Melatonin as a potent antioxidant has shown appropriate immune regulatory properties that may ameliorate toxicity induced by radiation in various organs. These effects are mediated through various modulatory effects of melatonin in different levels of tissue reaction to ionizing radiation. The effects on the DNA repair system, antioxidant enzymes, immune cells, cytokines secretion, transcription factors, and protein kinases are most important. Moreover, anti-cancer properties of melatonin may increase the therapeutic ratio of radiotherapy. Clinical applications of this agent for the management of malignancies such as breast cancer have shown promising results. It seems anti-proliferative, anti-angiogenesis, and stimulation or suppression of some immune cell responses are the main anti-tumor effects of melatonin that may help to improve response of the tumor to radiotherapy. In this review, the effects of melatonin on the modulation of immune responses in both normal and tumor tissues will be discussed.

Brain iron accumulation affects myelin-related molecular systems implicated in a rare neurogenetic disease family with neuropsychiatric features

The 'neurodegeneration with brain iron accumulation' (NBIA) disease family entails movement or cognitive impairment, often with psychiatric features. To understand how iron loading affects the brain, we studied mice with disruption of two iron regulatory genes, hemochromatosis (Hfe) and transferrin receptor 2 (Tfr2). Inductively coupled plasma atomic emission spectroscopy demonstrated increased iron in the Hfe^-/- × Tfr2^mut brain (P=0.002, n ≥5/group), primarily localized by Perls' staining to myelinated structures. Western immunoblotting showed increases of the iron storage protein ferritin light polypeptide and microarray and real-time reverse transcription-PCR revealed decreased transcript levels (P<0.04, n ≥5/group) for five other NBIA genes, phospholipase A2 group VI, fatty acid 2-hydroxylase, ceruloplasmin, chromosome 19 open reading frame 12 and ATPase type 13A2. Apart from the ferroxidase ceruloplasmin, all are involved in myelin homeostasis; 16 other myelin-related genes also showed reduced expression (P<0.05), although gross myelin structure and integrity appear unaffected (P>0.05). Overlap (P<0.0001) of differentially expressed genes in Hfe^-/- × Tfr2^mut brain with human gene co-expression networks suggests iron loading influences expression of NBIA-related and myelin-related genes co-expressed in normal human basal ganglia. There was overlap (P<0.0001) of genes differentially expressed in Hfe^-/- × Tfr2^mut brain and post-mortem NBIA basal ganglia. Hfe^-/- × Tfr2^mut mice were hyperactive (P<0.0112) without apparent cognitive impairment by IntelliCage testing (P>0.05). These results implicate myelin-related systems involved in NBIA neuropathogenesis in early responses to iron loading. This may contribute to behavioral symptoms in NBIA and hemochromatosis and is relevant to patients with abnormal iron status and psychiatric disorders involving myelin abnormalities or resistant to conventional treatments.

Association between the C34T polymorphism of the AMPD1 gene and essential hypertension in Malaysian patients

The aim of this study was to determine whether C34T, a common polymorphism of the adenosine monophosphate deaminase 1 gene (AMPD1), is associated with essential hypertension (EH). We hypothesize that C34T is associated with the development of EH. A case-control design was used for this study. The DNA was extracted using a commercial kit from the whole blood of 200 patients with hypertension and 200 subjects without hypertension from selected Malaysian ethnicities (Malays, Chinese, and Indians). Polymerase chain reaction followed by restriction fragment length polymorphism (PCR-RFLP) and agarose gel electrophoresis were used for genotyping. The C34T gene polymorphism of AMPD1 was significantly associated with EH in the Malaysian subjects (P < 0.0001). The genotype frequencies of CC, CT, and TT were 6%, 79%, and 15%, respectively, among hypertensive subjects, while no TT genotypes were observed in the normotensive subjects. Further, the frequency of hypertension was higher among T allele carriers than C carriers (OD = 9.94; 95%CI = 6.851-14.434). There were significant differences in the systolic blood pressure, diastolic blood pressure, and pulse pressure (P ˂ 0.05) between the normotensive and hypertensive Malaysian subjects; we believe those difference were caused by the C34T polymorphism. For the first time in Malaysia, the current study provides evidence that a common polymorphism of the AMPD1 gene (C34T) is strongly associated with EH.

The Association Between Blood Pressure and Normal Range Thyroid Function Tests in a Population Based Tehran Thyroid Study

Several studies have shown an association between overt hypothyroidism and diastolic hypertension. Association between subclinical hypothyroidism and hypertension is a matter of debate. The aim of this study was to examine the association of systolic and diastolic blood pressure, pulse pressure and mean arterial blood pressure with serum thyroid hormones levels in euthyroid subjects.Data from 4 756 individuals of the Tehran Thyroid study (TTS) without any previously known thyroid disease were analyzed. We divided participants based on TSH tertiles. Serum TSH and free T4 (FT4) concentration, systolic blood pressure (SBP), diastolic blood pressure (BPD) body mass index (BMI) were measured in all subjects.Among 5 786 individuals participated, 4 985 were euthyroid. After implementing exclusion criteria, 4 756 individuals remained of whom 2 122 (44.6%) were male and 2 634 (55.4%) were female. Multiple linear regression analysis revealed no association between TSH levels within reference ranges and blood pressure profile. No significant relationship was observed between TSH levels and systolic or diastolic blood pressure or the mean arterial pressure or pulse pressure in each tertile of TSH. There was a negative association between pulse pressure and TSH in the second tertile (r=- 0.066, p=0.009). Regression analysis showed that FT4 was significantly associated with systolic blood pressure, diastolic blood pressure, pulse pressure and mean arterial pressure.No association was found between serum TSH and blood pressure profile in euthyroid subjects. Serum FT4 levels showed a positive association with blood pressure profiles.

The effects of intra-dorsal hippocampus infusion of pregnenolone sulfate on memory function and hippocampal BDNF mRNA expression of biliary cirrhosis-induced memory impairment in rats

Learning and memory impairment is one of the most challenging complications of cirrhosis and present treatments are unsatisfactory. The exact mechanism of cirrhosis cognitive dysfunction is unknown. Pregnenolone sulfate (PREGS) is an excitatory neurosteroid that acts as a N-methyl-D-aspartate (NMDA) receptor agonist and GABAA receptor antagonist. In this study we evaluated the effect of intra CA1 infusion of PREGS on cirrhotic rats' memory function using the Y-maze test. Hippocampal brain-derived neurotrophic factor (BDNF) mRNA expression was also evaluated. Three weeks after bile duct ligation (BDL) surgery, rats were under stereotaxic surgery for insertion of two guide cannulas in the CA1 region of the hippocampus. After 1-week of recovery, PREGS was administered through CA1 cannulas in cirrhotic rats, while control or sham groups received vehicle. For evaluation of NMDA receptor role in memory-enhancing effects of PREGS, DL-2-Amino-5-phosphonopentanoic acid (AP5) which is a potent and competitive antagonist of NMDA receptor, co-administered with PREGS and for assessment of hippocampal BDNF mRNA expression, quantitative Real-time reverse transcriptase-PCR (RT-PCR) was used. Results showed that 28 days after BDL, cirrhotic animals' memory significantly decreased in comparison with control and sham groups, while PREGS infusion could restore memory impairment (P<0.05). PREGS effects on memory of cirrhotic rats were antagonized by DAP5. RT-PCR findings have shown that hippocampal relative BDNF mRNA expression was up-regulated in PREGS-treated groups in comparison with the BDL group (P<0.001). Our findings suggest that PREGS has a memory-enhancing effect in cirrhosis memory deficit in acute therapy and this effect may be through NMDA (glutamate) receptor involvement and BDNF mRNA expression.

Continuous neural network with windowed Hebbian learning

We introduce an extension of the classical neural field equation where the dynamics of the synaptic kernel satisfies the standard Hebbian type of learning (synaptic plasticity). Here, a continuous network in which changes in the weight kernel occurs in a specified time window is considered. A novelty of this model is that it admits synaptic weight decrease as well as the usual weight increase resulting from correlated activity. The resulting equation leads to a delay-type rate model for which the existence and stability of solutions such as the rest state, bumps, and traveling fronts are investigated. Some relations between the length of the time window and the bump width is derived. In addition, the effect of the delay parameter on the stability of solutions is shown. Also numerical simulations for solutions and their stability are presented.

Reproductive responses of dairy cows with ovarian cysts to simultaneous human chorionic gonadotropin or gonadotropin-releasing hormone and cloprostenol compared to gonadotropin-releasing hormone alone treatment

Aim:

Bovine ovarian cysts are a common cause of economic loss in modern dairy herds. The objective of the present study was to evaluate the reproductive responses to three protocols using hCG, GnRH and cloprostenol when the definite diagnosis of the type of ovarian cyst is/is not possible in dairy cows.

Materials and Methods:

A total of 144 lactating dairy cows with ovarian cysts were divided into three groups. At diagnosis (Day 0), cows in Group 1 (the conventional method, n=47) were injected with 0.02 mg of a GnRH analogue i.m. (Buserelin); cows in Group 2 (n=47) were intramuscularly treated with 0.02 mg Buserelin plus 500 µg cloprostenol; and cows in Group 3 (n=50) were intramuscularly treated with 1500 IU hCG plus 500 µg cloprostenol. All cows received 500 µg cloprostenol intramuscularly on Day 10.

Results:

No statistically significant differences were found in the recovery time, interval to conception, conception rate at first AI, and pregnancy rates by Days 70 and 100 after treatment among the three groups.

Conclusions:

Simultaneous treatment of ovarian cysts with hCG or GnRH and cloprostenol appeared to have no advantage over the conventional method, GnRH alone, in dairy cows. Furthermore, hCG and GnRH have an equal therapeutic effect in cows with ovarian cysts.

Dextrin-coated zinc substituted cobalt-ferrite nanoparticles as an MRI contrast agent: In vitro and in vivo imaging studies

Application of superparamagnetic iron oxide nanoparticles (NPs) as a negative contrast agent in magnetic resonance imaging (MRI) has been of widespread interest. These particles can enhance contrast of images by altering the relaxation times of the water protons. In this study, dextrin-coated zinc substituted cobalt-ferrite (Zn0.5Co0.5Fe2O4) NPs were synthesized by a co-precipitation method, and the morphology, size, structure and magnetic properties of the NPs were investigated. These NPs had superparamagnetic behavior with an average size of 3.9 (±0.9, n=200)nm measured by transmission electron microscopy. Measurements on the relaxivities (r2 and r2(*)) of the NPs were performed in vitro by agarose phantom. In addition, after subcutaneous injection of the NPs into C540 cell line in C-57 inbred mice, the relaxivities were measured in vivo by a 1.5T MRI system. These NPs could effectively increase the image contrast in both T2-and T2(*)-weighted samples.

Endocarditis associated with Erysipelothrix rhusiopathiae in a fat-tailed ram

Endocarditis is rarely reported in sheep and information presented for ovine endocarditis is based mostly on comparative findings in the cattle. Infective vegetative endocarditis of the right heart was diagnosed in a 3-year-old fat-tailed ram. Clinical findings included tachycardia, marked brisket edema, jugular veins distention and pulsation and pale mucous membranes. Hematologic abnormality included neutrophilic leukocytosis. Necropsy confirmed severe right atrioventricular and pulmonary valves vegetative endocarditis with evidence of right heart failure. Erysipelothrix rhusiopathiae was isolated from those vegetative lisions.

Trends of skin cancer incidence in 6 geographical regions of the Islamic Republic of Iran, 2000-2005

Data about the incidence of skin cancer in the Islamic Republic of Iran are lacking. This study investigated trends in the incidence of skin cancer (lCD-10 category C44, other malignant neoplasms of skin) in 6 regions using data from the Iranian cancer registry from 2000 to 2005. The standardized incidence rates in each year were calculated by the direct method using the standard World Health Organization population and a Poisson regression model was applied to analyse trends. Over the study period, 30 701 cases of cancer were identified, rising from 2353 in 2000 to 8484 in 2005. The male-to-female ratio was 1.6. The age-standardized incidence rose significantly from 3.8 cases per 100 000 in 2000 to 13.0 in 2005 (slope = 0.26), and the same trend was seen in all regions except the region to the east of the Caspian Sea. This increasing incidence of skin cancer in the Islamic Republic of Iran is similar to that reported in other countries.

Rapid Detection of Escherichia coli O157: H7 by Fluorescent Amplification-Based Specific Hybridization (FLASH) PCR

BACKGROUND

Escherichia coli O157:H7 is an enteric pathogen which can be frequently found asymptomatically in ruminant mammals, but can cause diseases from mild diarrhea to hemolytic uremic syndrome in humans.

METHODS

We developed fluorescent amplification-based specific hybridization (FLASH-PCR) assay to detect the Stx-encoding gene Stx-1 of E. coli O157:H7.

RESULT

PCR product of 336 bp was successfully amplified in a FLASH-PCR.

CONCLUSION

As rapid detection and confirmation of the presence of E. coli O157:H7 are of importance for the medical, food, and water industries, FLASH-PCR is one of selective methods for detection of E. coli O157:H7.

Effect of polymorphic variants of GH, Pit-1, and beta-LG genes on milk production of Holstein cows

Effect of polymorphic variants of growth hormone (GH), beta-lactoglobulin (beta-LG), and Pit-1 genes on milk yield was analyzed in a Holstein herd. Genotypes of the cows for these genes were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Allele frequencies were 0.884 and 0.116 for L and V variants of GH, 0.170 and 0.830 for A and B variants of Pit-1, and 0.529 and 0.471 for A and B variants of beta-LG, respectively. GLM procedure of SAS software was used to test the effects of these genes on milk yield. Results indicated significant effects of these genes on milk yield (P < 0.05). Cows with LL genotype of GH produced more milk than cows with LVgenotype (P < 0.05). Also, for Pit-1 gene, animals with AB genotype produced more milk than BB genotype (P < 0.05). In the case of beta-LG gene, milk yield of animals with AA genotype was more than BB genotype (P < 0.01). Therefore, it might be concluded that homozygote genotypes of GH (LL) and beta-LG (AA) were superior compared to heterozygote genotypes, whereas, the heterozygote genotype of Pit-1 gene (AB) was desirable.

Neural fields with fast learning dynamic kernel

We introduce a modified-firing-rate model based on Hebbian-type changing synaptic connections. The existence and stability of solutions such as rest state, bumps, and traveling waves are shown for this type of model. Three types of kernels, namely exponential, Mexican hat, and periodic synaptic connections, are considered. In the former two cases, the existence of a rest state solution is proved and the conditions for their stability are found. Bump solutions are shown for two kinds of synaptic kernels, and their stability is investigated by constructing a corresponding Evans function that holds for a specific range of values of the kernel coefficient strength (KCS). Applying a similar method, we consider exponential synaptic connections, where traveling wave solutions are shown to exist. Simulation and numerical analysis are presented for all these cases to illustrate the resulting solutions and their stability.

The influence of low-intensity laser therapy on bone healing

OBJECTIVE

Low-intensity laser therapy (LILT) is defined to supply direct biostimulative light energy to the cells. While several studies have demonstrated that LILT has stimulating effects on bone cells and can accelerate the repair process of the bone, others reported delayed fracture healing or no effects after LILT. The aim of this article was to review the studies evaluating the biomodulation effects of LILT on bone-derived stem cells.

MATERIALS AND METHODS

To access relevant articles, searching in three electronic databases including PubMed, Google Scholar and Science Direct was conducted until April 2012. The key words used were low-level laser, low-intensity laser, low-power laser therapy, stem cell, bone marrow stem cell, bone and osteoblast. The articles that met the eligibility criteria were included in this review of literature.

RESULTS

Twenty-five relevant articles (13 in vitro and 12 animal studies) were included. Eleven in vitro studies showed positive results with regard to acceleration of cell proliferation and differentiation. All animal studies showed improved bone healing in sites irradiated with low-intensity laser.

CONCLUSION

Based on the results of the reviewed articles, low intensity laser therapy can accelerate bone healing in extraction sites, bone fracture defects and distraction osteogenesis, provided proper parameters were applied.

Survey of microbial quality of drinking water in rural areas of Kashan-Iran in second half of 2008

The objective of the study is surveying microbial quality of drinking water in Kashan rural areas and determining the rural population that using safe water in terms of microbial quality in second-half of 2008. In this cross-sectional study, microbial quality of water in all rural areas was determined in 3 stages based on 3 parameters as Total Coliforms, Fecal Coliforms and Heterotrophic Plate Count (HPC). The results of this study illustrates that 100.0, 47.71 and 92.99% population in under coverage and non under coverage areas of Kashan Rural Water and Wastewater Company (KRWWC) and all Kashan rural areas, respectively using safe water in terms of Fecal Coliforms and 98.4, 21.2 and 88.00% population in under coverage and non under coverage areas of KRWWC rural areas and all Kashan rural areas, respectively using safe water in terms of Total Coliforms. There is also a meaningful difference in microbial quality between under coverage and non-under coverage rural areas. The results of this study express that the fecal contamination in under coverage rural areas is excellent, but there is a bad condition in non-under coverage areas. Generally, the microbial quality in all Kashan rural areas is approximately equal to national microbial criteria. Its been also illustrated that the role of KRWWC in supplying safe drinking water in terms of microbial quality for rural population is very important.

Evaluation of apoptosis-related genes: Fas (CD94), FasL (CD178) and TRAIL polymorphisms in Iranian multiple sclerosis patients

Multiple sclerosis (MS) is a central nervous system (CNS) demyelinating disease characterized by a relapsing-remitting course leading to progressive disability. Given the critical role of apoptosis-related genes in the maintenance of homeostasis in the immune privilege sites, mutations in these genes have a profound effect on occurring autoimmune diseases such as multiple sclerosis. In the current study, polymorphisms in the apoptosis-related genes: Fas _-670 A>G, FasL _-844C>T, FasLIVS2nt _124 A>G and TRAIL_1595C>T were analyzed in 107 Iranian patients suffering from MS and 112 unrelated healthy controls using PCR-RFLP method. Our results demonstrated that among Iranian patients with MS and controls being homozygous in Fas_670A/A, G/G and FasL_-844C/C, TT in the promoter region and homozygocity in the minor allele for FasLIVS2nt_124G/G and TRAIL_1595C/C, polymorphisms were not associated with the MS risk in Iranian patients when compared with normal controls. However, the Fas _-670G/G genotype had a borderline significantly increased frequency with secondary progressive MS type (X(2)=5.8, P=0.05). In conclusion, no statistical association was found between the Fas, FasL and TRAIL polymorphisms and the risk of MS in Iranian patients.

Comparison of local anesthetic effects of tramadol and lidocaine used subcutaneously in minor surgeries with local anesthesia

OBJECTIVES

In this study, the local anesthetic and post-operative analgesic effects of tramadol were compared to those of lidocaine in minor surgeries under local anesthesia.

METHODS

This double-blind clinical trial study included 70 patients in ASA physical status I and II, aging between 20 and 50 years, undergoing minor surgery (lipoma excision and revision of scars less than 4 cm within 30 minutes or less) under local anesthesia. The patients were randomly assigned to receive either 2 mg/kg tramadol (group T, n = 35) or 1 mg/kg lidocaine 2% (group L, n = 35) subcutaneously. Scores of the pain sensation were recorded as VAS (visual analogue scale 0-10) during injection, incision and 15, 30 and 45 minutes after incision, and then 2, 4 and 6 hours post-operatively at the ward.

RESULTS

There was no significant difference between pain scores of the two groups during injection, incision and surgery or in the post-operative period at the ward (p = 0.181). Incidence of nausea was 0% and 22.8% in group L and group T, respectively. The difference was statistically significant (p = 0.002). Furthermore, 82.9% of subjects in group L and 60% of subjects in group T needed acetaminophen to control their pain and the difference was significant (p = 0.004).

CONCLUSION

Tramadol 2 mg/kg has local anesthetic and post-operative analgesic effect equal to lidocaine 1 mg/kg in minor surgeries performed subcutaneously. Therefore, we concluded that tramadol can be used as an alternative drug to lidocaine in local anesthesia and has the ability to decrease the demand for post operative analgesics.

Genetics and vaccine efficacy: host genetic variation affecting Marek's disease vaccine efficacy in White Leghorn chickens

Marek's disease (MD) is a T-cell lymphoma disease of domestic chickens induced by MD virus (MDV), a naturally oncogenic and highly contagious cell-associated α-herpesvirus. Earlier reports have shown that the MHC haplotype as well as non-MHC genes are responsible for genetic resistance to MD. The MHC was also shown to affect efficiency of vaccine response. Using specific-pathogen-free chickens from a series of 19 recombinant congenic strains and their 2 progenitor lines (lines 6(3) and 7(2)), vaccine challenge experiments were conducted to examine the effect of host genetic variation on vaccine efficacy. The 21 inbred lines of White Leghorns share the same B*2 MHC haplotype and the genome of each recombinant congenic strain differs by a random 1/8 sample of the susceptible donor line (7(2)) genome. Chickens from each of the lines were divided into 2 groups. One was vaccinated with turkey herpesvirus strain FC126 at the day of hatch and the other was treated as a nonvaccinated control. Chickens of both groups were inoculated with a very virulent plus strain of MDV on the fifth day posthatch. Analyses of the MD data showed that the genetic line significantly influenced MD incidence and days of survival post-MDV infection after vaccination of chickens (P<0.01). The protective indices against MD varied greatly among the lines with a range of 0 up to 84%. This is the first evidence that non-MHC host genetic variation significantly affects MD vaccine efficacy in chickens in a designed prospective study.

Upregulation of the ERG11 gene in Candida krusei by azoles

BACKGROUND AND THE PURPOSE OF THE STUDY

Candida species are the agents of local and systemic opportunistic infections and have become a major cause of morbidity and mortality in the last few decades. Azole resistance in Candida krusei (C. krusei) species appears to be the result of gene alterations in relation to the ergosterol biosynthesis pathway, as well as efflux pumps. The main objective of this study was to examine the RNA expression of ERG11 in C. krusei which had been identified to be resistance to azoles.

METHODS

The ERG11 mRNA expression was investigated in four Iranian clinical isolates of C. krusei, which were resistant to fluconazole and itraconazole by a semiquantitative RT-PCR.

RESULTS

The mRNA expression levels were observed in all four isolates by this technique. Furthermore, it was found that ERG11 expression levels vary among four representative isolates of C. krusei. Although DNA sequencing revealed no significant genetic alteration in the ERG11 gene, one heterozygous polymorphism was observed in two isolates, but not in others. This polymorphism was found in the third base of codon 313 for Thr (ACT>ACC).

MAJOR CONCLUSION

Even though such a polymorphism creates a new Ear1 restriction site, no significant effect was found on the resistance of C. krusei to azoles. RESULTS of this investigation are consistent with previous studies and may provide further evidence for the genetic heterogeneity and complexity of the ergosterol biosynthetic pathway or efflux pumps.

Association of TGIFLX/Y mRNA expression with azoospermia in infertile men

HOX genes are well-known to encode transcriptional regulatory proteins that play essential roles in directing embryonic development. TGIFLX/Y contains two genes, TGIFLX (X-linked) and TGIFLY (Y-linked), which are specifically expressed in human adult testes. The function(s) of these genes in normal and abnormal development are unknown. To investigate the potential role(s) of the TGIFLX/Y gene in infertile males, a nested reverse transcriptase polymerase chain reaction (RT-PCR) was performed on testicular samples from 110 patients with nonobstructive azoospermia. Although the only 51 (46.4%) of the 110 patients had detectable levels of TGIFLY expression, none of the patients with various spermatogenesis defects showed any of the TGIFLX gene expression found in normal testes. These results suggest that the function of TGIFLX may be required for the regulation of spermatogonial stem cell specification and proliferation. While functional similarity has been demonstrated among some homeobox genes, these results may refute the suggestion of redundancy between TGIFLX and TGIFLY. Furthermore, TGIFLX might be a potential biomarker candidate for male infertility assessment.

Host responses in the bursa of Fabricius of chickens infected with virulent Marek's disease virus

The bursa of Fabricius serves as an important tissue in the process of Marek's disease virus (MDV) pathogenesis, since B cells of the bursa harbor the cytolytic phase of MDV replication cycle. In the present study, host responses associated with MDV infection in the bursa of Fabricius of chickens were investigated. The expression of MDV phosphoprotein (pp)38 antigen, MDV glycoprotein (gB) and MDV viral interleukin (vIL)-8 transcripts was at the highest at 4 days post-infection (d.p.i.) and then showed a declining trend. On the contrary, the expression of meq (MDV EcoRI Q) gene as well as the viral genome load increased gradually until day 14 post-infection. The changes in viral parameters were associated with significantly higher infiltration of macrophages and T cell subsets, particularly CD4+ T cells into the bursa of Fabricius. Of the genes examined, the expression of interferon (IFN)-alpha, IFN-gamma genes and inducible nitric oxide synthase (iNOS) was significantly up-regulated in response to MDV infection in the bursa of Fabricius. The results suggest a role for these cells and cytokines in MDV-induced responses in the bursa of Fabricius.

Marek's disease virus-induced skin leukosis in scaleless chickens: tumor development in the absence of feather follicles

Marek's disease virus (MDV) is an oncogenic cell-associated herpesvirus that causes T-cell lymphoma in chickens. Lymphoproliferative neoplasms in Marek's disease (MD) occur in various organs and tissues, including the viscera, peripheral nerves, skin, gonads, and musculatures. MDV is restrictively produced in the feather follicle epithelial (FFE) cells, and it gains access to the external environment via infected cells or as infectious enveloped cell-free virus particles. The goals of the present study were to 1) determine whether the MDV-induced skin lesions are neoplastic in nature or inflammatory reactions to viral infection, 2) determine whether physical presence of feather follicles (FF) is necessary for skin tumor development, and 3) study the role of skin epithelial cells not associated with feathers or FF in the replication and dissemination of infectious virus particles. Scaleless chickens that produce only a few scattered feathers and no sculate scales along the anterior metatarsi were used as a unique model to study the pathogenesis of dermal lesions. Histologic and immunohistochemical analysis revealed that the cutaneous lesions were tumorous as was manifested by massive accumulation of lymphoblasts and extensive activation of meq oncoprotein, the hallmark of MDV oncogenesis, within the skin lesions. Neoplastic cutaneous lesions in the scaleless chickens indicate that feather follicles are not necessary for skin tumor development. Finally, our preliminary data indicate that inoculation with supernatant fluid from homogenized and sonicated skin samples of MDV-infected scaleless chickens induces MD in susceptible birds, suggesting that skin epithelial cells not associated with FF also harbor infectious viral particles.

Genetic variation at the tumour virus B locus in commercial and laboratory chicken populations assessed by a medium-throughput or a high-throughput assay

The tumour virus B (TVB) locus encodes cellular receptors mediating infection by three subgroups of avian leukosis virus (B, D, and E). Three major alleles, TVB*S1, TVB*S3, and TVB*R, have been described. TVB*S1 encodes a cellular receptor mediating infection of subgroups B, D, and E. TVB*S3 encodes the receptor for two subgroups, B and D, and TVB*R encodes a dysfunctional receptor that does not permit infection by any of the subgroups, B, D, or E. Genetic diversity at the TVB locus of chickens was investigated in both layer and broiler commercial pure lines and laboratory lines. Genotyping assays were developed for both medium-throughput and high-throughput analysis. Of the 36 broiler lines sampled, 14 were fixed for the susceptible allele TVB*S1. Across all broiler lines, 83% of chickens were typed as TVB*S1/*S1, 3% as TVB*R/*R, and 14% as TVB*S1/*R. In the egg-layer lines, five of the 16 tested were fixed for TVB*S1/*S1. About 44% of egg-layers were typed as TVB*S1/*S1, 15% as TVB*R/*R, with the rest segregating for two or three of the alleles. In the laboratory chickens, 60% were fixed for TVB*S1/*S1, 6% for TVB*S3/*S3, 14% for TVB*R/*R, and the rest were heterozygotes (TVB*S1/*S3 or TVB*S1/*R). All commercial pure lines examined in this study carry the TVB*S1 allele that sustains the susceptibility to avian leukosis viruses B, D, and E. More importantly, the TVB*R allele was identified in multiple populations, thus upholding the opportunities for genetic improvement through selection.

Bacteriological findings in patients with ocular infection and antibiotic susceptibility patterns of isolated pathogens

INTRODUCTION

Isolation of common pathogens involved in ocular infection, and their in-vitro susceptibility to commonly-used ocular antibiotics, as well as the trends in antibiotic resistance developed by these pathogens, were investigated.

METHODS

Corneal scrapings were obtained from 318 hospitalised patients and inoculated directly onto enriched and differential culture media. Subcultures were performed on selective media. The necessary biochemical tests were conducted and the organisms identified using standard procedures. Susceptibility of isolated pathogens to commonly-used ocular antibiotics was examined using standard susceptibility testing.

RESULTS

70 different organisms were isolated. Gram-positive cocci accounted for 47 (67.2 percent) and gram-negative bacilli for 23 (32.8 percent) bacterial isolates. Coagulase-negative Staphylococci (33 percent) and Pseudomonas species (24 percent) were the most commonly-isolated organisms. In susceptibility testing, Gentamycin had coverage against 35 (74.5 percent) of 47 gram-positive cocci and 19 (82.6 percent) of 23 gram-negative bacilli tested. The coverage of Tetracycline, Cephalotin and Ceftriaxon against gram-positive cocci were 61.7, 55 and 53 percent, respectively. All the tested gram-positive cocci showed resistance to Cefotaxime and Penicillin. Ceftriaxon and Tobramycin had coverage against 17 (73.9 percent) and 14 (60.8 percent) of 23 gram-negative bacilli isolates, respectively. The coverage of Vancomycin against coagulase-negative Staphylococci was 100%, but all the isolates of Staphylococcus aureus were resistant to Vancomycin.

CONCLUSION

Susceptibility analysis revealed that antibiotic with the greatest coverage was Gentamycin (77.1 percent of 54 isolates). Gentamycin also had good coverage against gram-positive cocci, which constituted the majority (67.1 percent) of ocular isolates.

The nuclear oncoprotein TLX1/HOX11 associates with pericentromeric satellite 2 DNA in leukemic T-cells

TLX1/HOX11, a DNA-binding homeodomain protein, was originally identified by virtue of its aberrant expression in T-cell leukemia and subsequently found to be crucial for normal spleen development. The precise mechanism of TLX1 function remains poorly understood, although it is known that it can act as both a transcriptional activator and repressor and can downregulate the Aldh1a1 gene in embryonic mouse spleen. Using a whole-genome PCR approach, we show here that TLX1 protein directly interacts with pericentromeric human satellite 2 DNA sequences. Such DNA is known to localize to heterochromatin, which among other roles has been implicated in gene silencing. The interaction was confirmed in vitro and in vivo by gel retardation and chromatin immunoprecipitation assays involving satellite 2 DNA, which contained sequences resembling TLX1 binding sites. Using immunofluorescence microscopy, TLX1 demonstrated a punctate pattern of staining in the nuclei of leukemic T-cells (ALL-SIL). Double labelling indicated that TLX1 colocalized with the centromeric protein CENP-B, demonstrating that the TLX1 foci corresponded to clusters of centromeric DNA. The novel interaction of TLX1 with constitutive heterochromatin adds an additional level of complexity to the intracellular functions of this transcriptional regulator and may have relevance to its roles in transcriptional repression and T-cell immortalization.

The efficacy and safety of intravesical Bacillus-Calmette-Guerin in the treatment of female patients with interstitial cystitis: a double-blinded prospective placebo controlled study

PURPOSE

To evaluate the efficacy and safety of intravesical Bacillus Calmette-Gurein injection in the treatment of female patients with interstitial cystitis.

MATERIALS AND METHODS

Thirty women meeting the National Institute of Arthritis, Diabetes, digestive and kidney diseases criteria for interstitial cystitis, were randomized in a double-blinded fashion in two groups each consisted of 15 patients to receive six, weekly instillation of 120 mg BCG vaccine of Iranian Institute of pastor or placebo. Periodic questionnaires on symptoms of interstitial cystitis, voiding diaries, bladder capacity at first desire to void, and maximum bladder capacity were obtained. Adverse events were closely monitored during the treatment and follow-up phases of the study. Subjective and objective baseline values were compared with the follow-up data.

RESULTS

With a mean follow-up of 24 (range 6 to 33) months 11 out of 15 (73%) in BCG group, and 3 out of 15 (20%) in placebo group responded to the treatment (p<0.002). Responders were defined the patients with more than 40% improvement in the symptoms of interstitial cystitis. The global improvement in symptoms and signs of interstitial cystitis was 62%. Adverse events were similar in both groups, mostly irritative in nature and no significant systemic event was noted. BCG did not worsen interstitial cystitis symptoms.

CONCLUSION

We concluded that intravesical BCG is safe, effective, available, and inexpensive with relatively durable results in the treatment of interstitial cystitis.

Results of modified Gil-Vernet antireflux surgery in the treatment of vesicoureteral reflux

PURPOSE

To evaluate the efficacy of modified Gil-Vernet anti-reflux surgery in the treatment of patients with primary vesicoureteral reflux in a prospective historical controlled trial.

MATERIALS AND METHODS

A total of 30 patients with 46 refluxing units underwent this surgery since February 1998 until September 2002, with the mean follow-up period of 18 (range 6 to 43) months.

RESULTS

Vesicoureteral reflux was resolved completely in 44 ureteral units (95.6%, p<0001). In 2 refluxing units (4.3%) in spite of reflux improvement, hydroureter remained unchanged after the surgery. In respect to response rate, there was no significant difference between different grades, genders, age groups, and laterality of primary vesicoureteral reflux.

CONCLUSION

Our findings indicate that modified Gil-Vernet anti-reflux surgery which separately transfers each ureteral orifice to the tip of trigone with two fine absorbable suture on each side, is a completely successful procedure in the treatment of primary vesicoureteral reflux and produces a longer submucosal tunnel with a more suitable angel than classic Gil-Vernet procedure dose.