It is clear that cancer is one of the most mortal diseases in the world and the most prevalent among women is breast cancer. As hydroxyurea (HU)—a drug which is used in chemotherapy—has many adverse effects in long-term despite of its therapeutic properties, we made use of nano drug delivery technology in order to reduce adverse effects and increase therapeutic index. Thus, liposomation is a novel way in drug delivery systems. In this study a mixture of phosphatidylcholine and cholesterol was mixed and HU was added to the resultant mixture. The mean diameter of the nanoliposomal HU measured with the Zeta Sizer device (equal to 402.5 nm) and its encapsulation efficiency was 70.8 %. Besides, using dialysis, the pattern of drug release from nanoliposomes has been studied and the results showed that the drug release of nanoliposomal drug within 28 h was equal to 25.85 %. This study showed that the cytotoxicity effect of nanoliposomal drug is more than that of the standard drug.
Breast cancer; Nano drug delivery; Hydroxyurea; Liposomal
Statement of Problem: Systematic reviews of the literature show that the dental erosion is associated with the gastroesophageal reflux disease (GERD).The prevalence of the problem may not be exclusively similar in different countries.
Purpose: The purpose of this study was to investigate the association of gastro-esophageal reflux disease (GERD) with dental erosion in a sample of Iranian population regarding the standing difference in the Iranian oral hygiene and diet.
Materials and Method: 140 patients with the average age of 30 to 50 years old comprised the study group. The participants were already eligible for the endoscopic examination, diagnosed by their gastroenterologist. All patients completed a detailed questionnaire regarding the medical and dental situations. After completing the questionnaire and before endoscopy, dental examination was performed by two blinded dentists.The endoscopy was then performed by a gastroenterologist and the patients were divided into three groups of healthy, suspected to GERD, and positive GERD. Data were collected and analyzed by Chi- Square test. The cross tabulation test was performed to compare the qualitative variants and discover the correlations. The statistical significance was adopted as: p < 0.05.
Results: The prevalence of dental erosion in GERD patients (22.6%) was found to be higher than the suspected (5.3%) and the healthy (7%) individuals.
Conclusion: This study declared the GERD patients are at higher risk of developing dental erosion compared to the healthy individuals in a sample of Iranian population.
Dental erosion; Gastroesophageal reflux disease; Risk factor
Background: The treatment of human brucellosis is controversial. The purpose of this study was to search published clinical trial papers to provide a simple and effective treatment in brucellosis.
Methods: Many studies on brucellosis treatment in a twenty- year span from 1993 to 2012 were searched in PubMed, Web of Science (ISI), Scopus, Google Scholar, Magiran, Iranmedex and SID. The studies that were searched and classified in groups according to combination therapy and monotherapy and their results in treatment outcome were compared. Regimens with lower treatment failure or relapse were considered as more suitable for brucellosis treatment.
Results: The comparison of combined doxycycline and rifampicin (DR) with a doxycycline plus streptomycin (DS) favors the latter regimen. The combined doxycycline/cotrimoxazole (DCTM) showed similar effect with DR. The treatment with the combined regimen including quinolones was similar to DR but with higher relapse rates. Higher relapse rate was searched in monotherapy (13% vs. 4.8%) and in short-term (less than 4 weeks) treatment regimen (22% vs. 4.8%), respectively. Although in children, clinical trials were limited but showed cotrimoxazole plus rifampin for six weeks was the best treatment regimen.
Conclusion: In uncomplicated brucellosis in adult patients, doxycycline-aminoglycoside combination is the first choice with doxycycline- rifampin and doxycycline-cotrimoxazole should be the alternative regimens. The other oral regimens including quinolones may be considered as alternatives. Cotrimoxazole plus rifampin for six weeks may be the regimen of choice for the treatment of patients younger than 8 years old. Gentamicin for 5 days plus cotrimoxazole for six weeks may be a suitable alternative regimen.
Brucellosis; Treatment; Streptomycin; Doxycycline; Relapse
Background: Both influenza A virus (IAV) and respiratory syncytial virus (RSV) cause acute respiratory infection (ARI) in infants and young children. This study was conducted to determine Influenza A virus and its co infection with RSV among the hospitalized children with ARI.
Methods: A total of 153 throat samples of the hospitalized young children aged between below one year and 5 years with the clinical signs of ARI were collected from the different hospitals in Khuzestan from June 2009 to April 2010. The samples were tested for Influenza A viruses by real time PCR. Positive IAV samples were tested for influenza A sub type H1N1 and for RSV by the nested PCR.
Results: In this study, from the total 153 samples, 35 samples (22.9%) including 15 (42.8%) females and 20 (57.2%) males were positive for influenza A viruses. From the 35 positive samples for IAV, 14 were positive for swine H1N1 subtype. All the positive samples for influenza showed negative for RSV infection which revealed no coinfection with RSV. The prevalence of influenza A among age/sex groups was not significant.
Conclusion: Influenza A is a prevalent viral agent isolated from young children with ARI. Influenza A subtype H1N1 was accounted for the 40 percent all laboratory-proven diagnoses of influenza in 2009. No evidence of coinfection of influenza A and RSV has been observed in the present study.
Respiratory syncytial virus; Influenza A virus; swine H1N1; Acute respiratory infection; Co-infection.
Background and aims
Temporomandibular disorders (TMD) account for the most common orofacial pains rising from musculoskeletal origin. The aim of this study was to investigate the level of knowledge, attitudes and practice of dental practitioners regarding TMD in Tehran, Iran.
Materials and methods
A questionnaire, containing 29 questions on etiology, signs and symptoms, diagnosis and treatment of TMD, was given to 200 randomly selected general dental practitioners and specialists as well as 11 TMD ex-perts.
An overall response rate of 97% was achieved among participants (mean age: 39 ± 8.2 years old; mean years in practice: 11.5 ± 7.4). The mean score of knowledge of TMD was found to be 10.85± 2.54 (of a total of 23). TMD specialists were significantly more knowledgeable than general dental practitioners (p<0.05). With respect to attitude, there was a significant difference among various age groups, and by increasing age and years in practice, the attitude towards TMD had weakened. However, no significant difference was recorded between general dental practitioners’ attitude and that of TMD experts towards TMD. There was a positive correlation between subjects’ knowledge and attitude (P= 0.007, r=0.138).
According to the results, the level of knowledge and attitude of general dental practitioners of Tehran regarding TMD is not desirable. The majority are not willing to admit and treat TMD patients.
Attitude, dentist; knowledge; practice; temporomandibular disorders
Cardiac and pulmonary veins de-airing are of the most important steps during open heart surgery. This study evaluates the effect of continuous positive airway pressure (CPAP) on air trapping in pulmonary veins and on quality of de-airing procedure.
Materials and Methods:
This randomized prospective double blind clinical trial conducted on 40 patients. In the control group: During cardiopulmonary bypass (CPB), the ventilator was turned off and adjustable pressure limit (APL) valve was placed in SPONT position. In CPAP group: During CPB, after turning the ventilator off, the flow of oxygen flow was maintained at the rate of 0.5 L/min and the APL valve was placed in MAN position on 20 mbar. During cardiopulmonary bypass (CPB) weaning, the patients were observed for air bubbles in left atrium by using transesophageal echocardiography.
The mean de-airing time after the start of mechanical ventilation in CPAP group (n = 20) was significantly lower than the control group (n = 20) (P = 0.0001).
The mean time of the left atrium air bubbles occupation as mild (P = 0.004), moderate (P = 0.0001) and severe (P = 0.015) grading was significantly lower in CPAP group.
By CPAP at 20 mbar during CPB in open heart surgery, de-airing process can be down in better quality and in significantly shorter time.
Cardiopulmonary bypass; continuous positive airway pressure; de-airing; heart surgery
Rectal cancer management has evolved into a complex multimodality approach with survival, local recurrence, and quality of life parameters being the relevant endpoints. Surgical treatment for low rectal cancer has changed dramatically over the past 100 years.
Abdominoperineal resection, once the standard of care for all rectal cancers, has become much less frequently utilized as surgeons devise and test new techniques for preserving the sphincters, maintaining continuity, and performing oncologically sound ultra-low anterior or local resections. Progress in rectal cancer surgery has been driven by improved understanding of the anatomy and pathophysiology of the disease, innovative surgical technique, improved technology, multimodality approaches, and increased appreciation of the patient’s quality of life. The patient with a low rectal cancer, once almost universally destined for impotence and a colostomy, now has the real potential for improved survival, avoidance of a permanent stoma, and preservation of the normal route of defecation.
Rectal cancer; Sphincter preservation; Total mesorectal excision; Anterior resection; Intersphincteric resection; Local excision rectal cancer
The present study was carried out in order to compare national and personal identity and their subscales in internet addicts and nonaddicts.
Materials and Methods:
This study was a descriptive-analytical research, and was carried out on 384 student internet users in different universities in the city of Isfahan who were selected using quota sampling. Subjects completed the questionnaires, then, subscales of personal and national identity questionnaires in internet addict and nonaddict were analyzed via SPSS16 software.
Results indicated a significant difference between the scores of national identity and personal identity as well as all subscales in internet addicts and nonaddicts, except for national heritage and homeland defence factors. In addition, there was a negative and significant relationship between addiction to internet and personal and national identity, except for the fourth and fifth factors of national identity (viewpoints of others considering the national group and homeland defence). Moreover, after controlling for the sex variable, internet addiction had an effect on personal and national identity.
The findings of this research indicate that an excess of internet use and overinvolvement in cyberspace and the addiction to them, could be associated with defects in some aspects of national and personal identity.
Internet addiction; internet user; national identity; personal identity
Studies on the World Health Organization Frame-work Convention on Tobacco Control (FCTC) are scarce in Iran and the Eastern Mediterranean region (EMR).
This study was conducted in 2007-2008 in Iran to design a practical evaluation model of the implementation of FCTC with the potential to be adopted in the EMR. Given that, the findings of this evaluation can be useful in increasing political and public support for enforcing the implementation of legislations, testing their feasibility, and maintaining sustainability. The viewpoints of tobacco growers as part of stakeholders in this regardwould have an influential role.
Settings and Design:
This study was a qualitative one to investigate the tobacco growers viewpoints about thestrengths/weaknesses of FCTC implementation in Iran.
Materials and Methods:
In this study, we conducted semi-structured in-depth individual interviews with 5 tobacco growers. All interviews were carried out with their permissionwere recorded and were assured that their interviews will be kept confidential. All questions were related to different FCTC articles, then written transcripts were prepared and the basic concepts were extrapolated.
After transcribing the recorded interviews, we extracted first level codes and main concepts from them.
The findings suggested that although tobacco growers agreed with FCTC implementation, however, subjects like the necessity to support tobacco growers and obtaining insurance from the government, the necessity of the enforcement of national tobacco control law and planning to decrease access to tobacco by policy makers were the most key points that tobacco growers pointed to them.
Our results showed that tobacco growers agreed with the implementation of FCTC but they worried about their job and the expenses of their daily life. Therefore, it seems that policy makers have to design a plan to support tobacco growers for changing tobacco with a safe cultivate.
Frame-work convention on tobacco control; policy makers; tobacco growers
Image segmentation methods may be classified into two categories: purely image based and model based. Each of these two classes has its own advantages and disadvantages. In this paper, we propose a novel synergistic combination of the image based graph-cut (GC) method with the model based ASM method to arrive at the GC-ASM method for medical image segmentation. A multi-object GC cost function is proposed which effectively integrates the ASM shape information into the GC framework. The proposed method consists of two phases: model building and segmentation. In the model building phase, the ASM model is built and the parameters of the GC are estimated. The segmentation phase consists of two main steps: initialization (recognition) and delineation. For initialization, an automatic method is proposed which estimates the pose (translation, orientation, and scale) of the model, and obtains a rough segmentation result which also provides the shape information for the GC method. For delineation, an iterative GC-ASM algorithm is proposed which performs finer delineation based on the initialization results. The proposed methods are implemented to operate on 2D images and evaluated on clinical chest CT, abdominal CT, and foot MRI data sets. The results show the following: (a) An overall delineation accuracy of TPVF > 96%, FPVF < 0.6% can be achieved via GC-ASM for different objects, modalities, and body regions. (b) GC-ASM improves over ASM in its accuracy and precision to search region. (c) GC-ASM requires far fewer landmarks (about 1/3 of ASM) than ASM. (d) GC-ASM achieves full automation in the segmentation step compared to GC which requires seed specification and improves on the accuracy of GC. (e) One disadvantage of GC-ASM is its increased computational expense owing to the iterative nature of the algorithm.
Object Recognition; Image Segmentation; Statistical Shape Models; Graph Cut
When implanted inside the body, bioprosthetic heart valve leaflets experience a variety of cyclic mechanical stresses such as shear stress due to blood flow when the valve is open, flexural stress due to cyclic opening and closure of the valve, and tensile stress when the valve is closed. These types of stress lead to a variety of failure modes. In either a natural valve leaflet or a processed pericardial tissue leaflet, collagen fibers reinforce the tissue and provide structural integrity such that the very thin leaflet can stand enormous loads related to cyclic pressure changes. The mechanical response of the leaflet tissue greatly depends on collagen fiber concentration, characteristics, and orientation. Thus, understating the microstructure of pericardial tissue and its response to dynamic loading is crucial for the development of more durable heart valve, and computational models to predict heart valves’ behavior. In this work, we have characterized the 3D collagen fiber arrangement of bovine pericardial tissue leaflets in response to a variety of different loading conditions under Second-Harmonic Generation Microscopy. This real-time visualization method assists in better understanding of the effect of cyclic load on collagen fiber orientation in time and space.
Bioprosthetic heart valve; Collagen fiber orientation; Second harmonic generation microscopy; Biaxial loading
Carboxyamido-triazole (CAI) is a synthetic inhibitor of non-voltage-gated calcium channels that reversibly inhibits angiogenesis, tumor cell proliferation, and metastatic potential. This study examined the efficacy, safety and pharmacokinetics of oral CAI in the treatment of patients with newly diagnosed glioblastoma multiforme (GBM) in an open-label, single arm non-randomized phase 2 trial.
Eligible patients with histologically confirmed GBM started CAI therapy on the first day of radiation (6000 cGy in 30 fractions) and continued until progression, unless side effects became intolerable. The primary outcome was survival compared to historical controls within the NABTT CNS Consortium database. Secondary outcomes included toxicity and pharmacokinetic parameters.
Fifty-five patients were enrolled with a median Karnofsky performance status of 90 and age of 56 years. Forty-six (84%) of these patients had debulking surgeries and 52 have died. The median survival was 10.3 months (95% confidence interval (CI), 8.5–12.8) compared to 12.1 months (95% CI, 10.3–13.3) in the NABTT reference group (p=0.97). Significant toxicities included 2 incidents of reversible vision loss. The mean CAI plasma concentration for patients taking enzyme inducing antiepileptic drugs (EIAED) was 1.35 ±1.22 compared to 4.06 ± 1.50 (p<0.001) for subjects not taking these agents. Overall survival and grade ≥ 3 toxicities were comparable by EIAED status.
This study demonstrated that 1) CAI can be administered safely with concomitant cranial irradiation, 2) the pharmacokinetics of CAI are significantly affected by co-administration of EIAED, and 3) the survival of patients with newly diagnosed GBM was not improved with this novel agent, despite achieving adequate drug levels.
CAI; Phase II; angiogenesis; GBM
Crimean-Congo hemorrhagic fever (CCHF), an acute viral infection, is a zoonotic disease which is transmitted to humans by infected ticks, direct contact with fresh meat or blood of infected animals (usually domestic livestock), or direct contact with the blood or secretions of an infected person. Livestock handlers, skin processors, veterinary staff, livestock market workers, and other personnel engaged in jobs requiring some contact with animals and/or animal products are at high risk for CCHF. Most reported cases of this disease in Iran belong to butchers and slaughterhouse workers.
We aimed to study the prevalence of CCHF in slaughterhouse workers and livestock handlers who were admitted to Boo-ali Hospital for treatment of CCHF.
Materials and Methods:
We evaluated all patients’ files with confirmed CCHF admitted to Boo-ali Hospital in Zahedan, in southeastern part of Iran, during 1999-2011. Then, we examined the prevalence of disease among the high risk groups.
Out of 362 patients with CCHF (86% male, 14% female; with age range 12-78 years), 123 (34%) were slaughterhouse workers, 103 (28.5%) livestock handlers and farmers, 32 (9%) housewives, 7 (2%) students, 6 (1.9%) teachers, 4 (1.2%) military personnel, and other groups were workers with different employments.
The present study showed that CCHF is highly prevalent in high risk occupational groups in Zahedan, Iran. Further surveillance, teaching and prevention programs are recommended.
Hemorrhagic Fever; Crimean; Prevalence; Dangerous Behavior
Outcomes research has established itself as an integral part of surgical research as physicians and hospitals are increasingly required to demonstrate attainment of performance markers and surgical safety indicators. Large-volume and clinical and administrative databases are used to study regional practice pattern variations, health care disparities, and resource utilization. Understanding the unique strengths and limitations of these large databases is critical to performing quality surgical outcomes research. In the current work, we review the currently available large-volume databases including selection processes, modes of analyses, data application, and limitations.
outcomes; databases; administrative; research
Congenital granular cell tumor (GCT) is a relatively rare intraoral benign tumor, approximately 200 cases of which have been reported in the neonatal period worldwide. The newborn infant may have feeding problems and respiratory difficulties due to airway obstruction. This lesion may be diagnosed by prenatal ultrasonography and simple resection is mostly required. We report a case of an adult type of GCT in a newly born infant, who presented with an intraoral protruding mass with a prenatal diagnosis. This article describes the prenatal course, clinical, and pathological characteristics, and management of the GCT.
Gingiva; Granular cell tumor; Newborn; Prenatal diagnosis
This article describes an esthetic rehabilitation of a case of severe fluorosis associated with tooth mobility and gingival recession. Direct composite technique was applied to improve the color, shape and alignment of the teeth using direct composite veneering and replacement of the missing tooth by fiber-reinforced composite bridge. One year follow up have displayed acceptable outcomes and esthetic appearance.
Fluorosis; Esthetic; Direct composite veneer; Fiber- reinforced composite; bridge
This study aimed to develop indicators for evaluating the implementation of The Framework Convention on Tobacco Control (FCTC) in Iran. We used the “grounded theory” framework. Totally, 265 policy-makers, stakeholders, and community members were recruited by purposeful sampling in 2008. After analyzing the gathered data, 251 indicators, including 82 indicators as “applied indicators”, were derived from second-level codes for three groups. A suitable evaluation questionnaire can be designed based on the extracted indicators for policy makers, stakeholders, and the community to follow the implementation of the FCTC in Iran.
Program evaluation; Tobacco; Iran
Premature birth is one of the most important unresolved reproductive health problems. Premature birth is often traumatic and a source of distress for parents. Increased parental stress during the first year of their infant's life is a risk factor for later behavioral problems in infants.
This study was designed to compare anxiety, post-traumatic stress, and social supports in parents of premature and mature infants.
Patients and Methods:
This was a comparative descriptive study conducted at healthcare centers of Qom city, in 2012. In this study, 82 couples (164 parents) divided into two groups including parents who have preterm and term infants. Questionnaires including items such as demographic characteristics, obstetric and post-traumatic stress disorders, Spielberger anxiety and Multidimensional Scale of Perceived Social Support were completed two months after childbirth. Data were analyzed using χ2 test, Fisher’s exact test, Mann-Whitney test, independent t-test, and regression logistic using SPSS18 software.
The levels of anxiety was not significantly different in mothers and fathers in the two groups, but the trait anxiety level of mothers (P < 0.001) and fathers who had preterm infants (P = 0.01) was significantly greater than the parents of full-term infants. Post-traumatic stress disorder was significantly greater in mothers of preterm infants than those of term infants (P = 0.03), but this amount was not significantly different between the two groups of fathers. Mothers' social support did not differ significantly (P = 0.08), however, it was significantly different in fathers (P = 0.01).
Premature infants' parents are more at risk of mental disorders than term infants' parents. This result shows the need of interventions, so these parents can better deal with the problems of premature infants.
Infant, Premature; Anxiety; Stress Disorders, Post-Traumatic; Social Support
Vascular access complications are a major cause of excessive morbidity and mortality in the dialysis population. Moreover, there is not sufficient research regarding the factors correlated with vascular access complications among hemodialysis patients. This study aimed to evaluate the vascular access complications and their related factors such as nursing techniques and self-care in hemodialysis patients.
Materials and Methods:
A cross-sectional study was performed on 110 patients undergoing hemodialysis in Isfahan Aliasghar hospital during 9 months from July 2010 to March 2011. The data collection tools were a demographic questionnaire and three checklists designed to assess the complications of vascular access and care techniques. Data were collected by observations and interviews with the patients. Fisher's exact test, chi-square test, Pearson correlation coefficient, and descriptive statistics were used to analyze the data through SPSS 16.
Among 110 subjects, there were 63 male and 47 female subjects. Subjects’ mean age was 55.88 (15.51) years. There were 72 patients undergoing hemodialysis through arteriovenous fistula and 38 through permanent intra-jugular catheters. Insufficient blood flow in the catheter was the most common complication in patients with jugular catheters. Also, aneurysm was the most prevalent complication in patients with arteriovenous fistula. Low self-care of patients and needling into the aneurysm were correlated with aneurysm size. Presence of underlying diseases was related to ischemia.
Nursing techniques and self-care of patients were correlated with the occurrence of complications. Therefore, it draws the attention of the nurses toward continuing professional education and patients’ education, which can increase the longevity of vascular access.
Complication; correlation agents; hemodialysis; nursing techniques; self-care; vascular access
The aim of this study was to evaluate the response of common sized fiber-reinforced composites (FRCs) to different deflections due to bending forces and comparing it with stainless steel (SS) wires.
Materials and Methods:
In this experimental study, two FRC groups with 0.75 mm and 1.2 mm diameters (Everstick Ortho, Stick Tech, Finland) and three SS groups with 0.016 × 0.022 inch, 0.0215 × 0.028 inch and 0.7 mm diameters (3M Uniteck, Monrovia, California, USA) were tested. Each group contained 10 samples that were tested according to a three point bending test. Each group was tested at deflections of 0.5, 1 and 1.5 mm and the data was analyzed using the repeated measure ANOVA by SPSS software (Statistical Package for the Social Sciences, IBM SPSS, Inc. in Chicago, Illinois, USA). P < 0.05 was considered as significant.
The highest recorded load belonged to the 1.2 mm FRC and after that 0.7 mm SS wire, 0.75 mm FRC, 0.0215 × 0.028 inch SS wire and finally 0.016 × 0.022 inch SS wire. The 0.7 mm SS wire and 0.75 mm FRC were compared as retainers and the results showed the 0.7 mm SS wire showed significantly higher load compared with 0.75 mm FRC (P < 0.05). The 1.2 mm FRC had significantly higher load compared to 0.0215 × 0.028 inch and 0.016 × 0.022 inch SS wires (P < 0.05).
The results showed that the 1.2 mm FRC group had significantly higher load compared to SS wires and other FRC groups under the 0.5, 1 and 1.5 mm deflections. Therefore, it can be suggested that FRC can be used as an esthetic replacement for SS wires for active and passive purposes in orthodontics.
Fiber-reinforced composite; load-deflection; stainless steel wire
Glass and quartz fiber posts are used in restoration of structurally compromised roots. Accessory fiber posts are recently introduced to enhance the fiber post adaptation. This study evaluated the effectiveness of glass versus quartz accessory fiber posts.
Materials and Methods:
In this experimental study, 40 mandibular premolar roots with similar dimension (radius of 3.5 ± 0.2 mm and length of 13 ± 0.5 mm) were selected and their root canals were flared until 1.5 mm of dentin wall remained. They were randomly assigned to four groups (n = 10) and restored as follows: Exacto glass fiber post (EX), Exacto glass fiber post + 2 Reforpin accessories (EXR), D. T. Light quartz fiber post (DT), and D. T. Light quartz fiber post + 2 Fibercone accessories (DTF). All posts were cemented with Duo-Link resin cement and the cores were built with the particulate filler composite. Following 1-week water storage, specimens were subjected to fracture loads in a universal testing machine. The maximum loads and failure modes were recorded and analyzed with the two-way analysis of variance (ANOVA) and Fisher's exact tests (α = 0.05).
The mean fracture resistance values (N) were 402.8 (EX), 378.4 (EXR), 400.1 (DT), and 348.5 (DTF). Two-way ANOVA test showed neither reinforcing method (P = 0.094), nor post composition (P = 0.462) had statistically significant differences on fracture resistance of the structurally compromised premolar teeth. Fisher's exact test also demonstrated no statistically significant difference regarding two variables (P = 0.695). Core fracture was the most common failure mode (62.5%).
Glass and quartz fiber posts with or without accessories restored the weakened premolar roots equally.
Accessory fiber post; compromised roots; fracture resistance; glass; quartz
Conventional non-invasive imaging modalities of atherosclerosis such as coronary artery calcium (CAC)1 and carotid intimal medial thickness (C-IMT)2 provide information about the burden of disease. However, despite multiple validation studies of CAC3–5, and C-IMT2,6, these modalities do not accurately assess plaque characteristics7,8, and the composition and inflammatory state of the plaque determine its stability and, therefore, the risk of clinical events9–13.
[18F]-2-fluoro-2-deoxy-D-glucose (FDG) imaging using positron-emission tomography (PET)/computed tomography (CT) has been extensively studied in oncologic metabolism14,15. Studies using animal models and immunohistochemistry in humans show that FDG-PET/CT is exquisitely sensitive for detecting macrophage activity16, an important source of cellular inflammation in vessel walls. More recently, we17,18 and others have shown that FDG-PET/CT enables highly precise, novel measurements of inflammatory activity of activity of atherosclerotic plaques in large and medium-sized arteries9,16,19,20. FDG-PET/CT studies have many advantages over other imaging modalities: 1) high contrast resolution; 2) quantification of plaque volume and metabolic activity allowing for multi-modal atherosclerotic plaque quantification; 3) dynamic, real-time, in vivo imaging; 4) minimal operator dependence. Finally, vascular inflammation detected by FDG-PET/CT has been shown to predict cardiovascular (CV) events independent of traditional risk factors21,22 and is also highly associated with overall burden of atherosclerosis23. Plaque activity by FDG-PET/CT is modulated by known beneficial CV interventions such as short term (12 week) statin therapy24 as well as longer term therapeutic lifestyle changes (16 months)25.
The current methodology for quantification of FDG uptake in atherosclerotic plaque involves measurement of the standardized uptake value (SUV) of an artery of interest and of the venous blood pool in order to calculate a target to background ratio (TBR), which is calculated by dividing the arterial SUV by the venous blood pool SUV. This method has shown to represent a stable, reproducible phenotype over time, has a high sensitivity for detection of vascular inflammation, and also has high inter-and intra-reader reliability26. Here we present our methodology for patient preparation, image acquisition, and quantification of atherosclerotic plaque activity and vascular inflammation using SUV, TBR, and a global parameter called the metabolic volumetric product (MVP). These approaches may be applied to assess vascular inflammation in various study samples of interest in a consistent fashion as we have shown in several prior publications9,20,27,28
FDG-PET/CT; atherosclerosis; vascular inflammation; quantitative radiology
This is descriptive analytical study.
The present study aims at comparing treatment results found between the two groups comprising of patients who underwent posterior spinal fusion using thoracic pedicle screws and the ones who underwent combined anterior-posterior method, respectively.
Overview of Literature
There was controversy about surgical techniques including anterior, posterior, or a combined anterior-posterior approaches are applied to treat non-congenital scoliosis with surgical indications.
Medical records of 50 patients suffering from thoracic non-congenital scoliosis with curves exceeding 70° were reviewed. In this study, 25 patients who underwent posterior spinal fusion using thoracic pedicle screws were compared with 25 patients who underwent combined anterior-posterior method.
Patients treated through posterior-only and combined approaches were respectively hospitalized for 11.84±5.18 and 26.5±5.2 days (p=0.001). There was a significant difference between these two groups considering intensive care unit admission duration (p=0.001), correction in sagittal view of X-ray (p=0.01), and number of days the patients underwent traction (0.001). Finally, coronal view was corrected without any significant difference (p=0.2).
According to our findings, it is hypothesized that posterior-only method is associated with some significant advantages and is an advisable method in patients with severe scoliosis over than 70°.
Scoliosis; Curved spine; Spinal deformity
Medical students spend most of their time in hospital wards and it is necessary to study clinical educational opportunities. This study was aimed to explore faculty members’ experience on Ward Round Teaching content.
Methods and Materials:
This qualitative study was conducted by purposive sampling with the maximum variation of major clinical departments faculty members in Isfahan University of Medical Sciences (n = 9). Data gathering was based on deep and semi-structured interviews. Data gathering continued till data saturation. Data was analyzed through the Collaizzi method and validated. Strategies to ensure trustworthiness of data (credibility, dependability, conformability, transferability) were employed (Guba and Lincoln).
Basic codes extracted from the analyzed data were categorized into two main themes and related subthemes, including (1) tangible teachings (analytic intelligence, technical intelligence, legal duties) and (2) implied teachings (professionalism, professional discipline, professional difficulties).
Ward round teaching is a valuable opportunity for learners to learn not only patient care aspects but also ethical values. By appropriate planning, opportunities can be used to teach capabilities that are expected of general practitioners.
Clinical academia; content; qualitative study; ward round teaching