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1.  Antibiotics Use Patterns for Surgical Prophylaxis Site Infection in Different Surgical Wards of a Teaching Hospital in Ahvaz, Iran 
Background:
Despite the effectiveness of prophylactic antimicrobials to prevent surgical site infection the use of antibiotic prophylaxis is often inappropriate.
Objectives:
The current study aimed to determine the pattern of prophylactic antibiotic use in a teaching hospital affiliated to Jundishapur University of Medical Sciences, Ahvaz, Iran.
Patients and Methods:
The current descriptive study included 8586 patients who received prophylactic antibiotics before surgery from April 2011 to March 2012, in Razi Hospital affiliated to Jundishapur University of Medical Sciences. Indications for antibiotic use, proper or inappropriate antibiotics, an antibiotic or combination of antibiotics, dosage and length of treatment for each patient based on the infectious disease textbook (Mandel's Principle and practice of infectious diseases) definitions were administrated.
Results:
Of the total 8586 patients who took antibiotics for preventive purposes, 4815 (56%) required antimicrobial prophylaxis, and 3771 (44%) patients did not. Of the 4815 patients who received prophylaxis, 86.9% received it appropriately, 13.1% received it inappropriately; 8.2% received inappropriate dosage, and 9.5% received antibiotic longer than 24 hours.
Conclusions:
The current study revealed that 44% of those who received prophylaxis did not need it. In the patients who received antibiotics, the most common mistakes were antibiotic selection followed by prolonged prophylaxis (> 24 hours) and excess dose.
doi:10.5812/jjm.12251
PMCID: PMC4332232  PMID: 25774270
Prophylaxis; Infection; Nosocomial Infection
2.  Cytotoxicity of Liposomal Paclitaxel in Breast Cancer Cell Line MCF-7 
Regarding that the breast cancer is the most prevalent disease among women, paclitaxel, an anti-cancer drug, could be used in treatment of this disease. As paclitaxel has adverse effects, it was used of nanoliposome drug delivery technology in order to reduce adverse effects and improve drug efficacy. Certain ratios of phosphatidylcholine, cholesterol and paclitaxel were synthesized to prepare nanoliposomal paclitaxel. Using Zeta sizer device, the mean diameter of nanoliposomal paclitaxel was obtained 421.4 nm and its encapsulation efficiency was 91.3 %. By dialysis, drug release in nanoliposome paclitaxel formulation within 28 h was studied which was 5.53 %. This study showed that cytotoxicity effect of nanoliposomal paclitaxel is more than that of the standard form.
doi:10.1007/s12291-013-0296-1
PMCID: PMC3783912  PMID: 24426237
Breast cancer; Nano drug delivery; Paclitaxel; Nanoliposome
3.  Drug Delivery of Hydroxyurea to Breast Cancer Using Liposomes 
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.
doi:10.1007/s12291-012-0291-y
PMCID: PMC3689336  PMID: 24426227
Breast cancer; Nano drug delivery; Hydroxyurea; Liposomal
4.  Dental Erosion in Patients with Gastroesophageal Reflux Disease (GERD) in a Sample of Patients Referred to the Motahari Clinic, Shiraz, Iran 
Journal of Dentistry  2014;15(1):33-38.
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.
PMCID: PMC3986576  PMID: 24738088
Dental erosion; Gastroesophageal reflux disease; Risk factor
5.  Treatment of brucellosis: a systematic review of studies in recent twenty years 
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.
PMCID: PMC3755828  PMID: 24009951
Brucellosis; Treatment; Streptomycin; Doxycycline; Relapse
6.  Influenza A virus among the hospitalized young children with acute respiratory infection. Is influenza A co infected with respiratory syncytial virus?  
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.
PMCID: PMC3755862  PMID: 24009929
Respiratory syncytial virus; Influenza A virus; swine H1N1; Acute respiratory infection; Co-infection.
7.  Melioidosis: It is not Far from here 
Tanaffos  2011;10(4):64-68.
In the modern world, with developed traveling facilities, tourism is an important factor in emerging new infectious diseases in non-endemic areas.
Therefore, the epidemiology of infections is a considerable issue for physicians and should be taken into account.
We report a case of melioidosis in a 69-year-old Iranian man during his trip to Southeast Asia.
On admission, he was febrile with tachycardia and tachypnea and had diabetes mellitus and hypertension since eleven years ago.
Bronchoscopy and bronchoalveolar lavage (BAL) were performed. Blood and BAL cultures revealed heavy growth of Burkholderia pseudomallei.
According to the aforementioned culture results, the patient was treated with meropenem and TMP-SMX, while other antibiotics were discontinued.
After 3 weeks, the patient was discharged with stable status and normal pulmonary function; and eradication therapy with TMP-SMX continued for about 3 months. The control lung CT scan after one month demonstrated significant improvement
PMCID: PMC4153165  PMID: 25191391
Meloiodosis; Infection; Burkholderia pseudomallei
8.  Temporomandibular Disorders: Knowledge, Attitude and Practice among Dentists in Tehran, Iran 
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.
Results
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).
Conclusion
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.
doi:10.5681/joddd.2010.023
PMCID: PMC3429978  PMID: 22991606
Attitude, dentist; knowledge; practice; temporomandibular disorders
9.  Combined MTOR and autophagy inhibition 
Autophagy  2014;10(8):1391-1402.
The combination of temsirolimus (TEM), an MTOR inhibitor, and hydroxychloroquine (HCQ), an autophagy inhibitor, augments cell death in preclinical models. This phase 1 dose-escalation study evaluated the maximum tolerated dose (MTD), safety, preliminary activity, pharmacokinetics, and pharmacodynamics of HCQ in combination with TEM in cancer patients. In the dose escalation portion, 27 patients with advanced solid malignancies were enrolled, followed by a cohort expansion at the top dose level in 12 patients with metastatic melanoma. The combination of HCQ and TEM was well tolerated, and grade 3 or 4 toxicity was limited to anorexia (7%), fatigue (7%), and nausea (7%). An MTD was not reached for HCQ, and the recommended phase II dose was HCQ 600 mg twice daily in combination with TEM 25 mg weekly. Other common grade 1 or 2 toxicities included fatigue, anorexia, nausea, stomatitis, rash, and weight loss. No responses were observed; however, 14/21 (67%) patients in the dose escalation and 14/19 (74%) patients with melanoma achieved stable disease. The median progression-free survival in 13 melanoma patients treated with HCQ 1200mg/d in combination with TEM was 3.5 mo. Novel 18-fluorodeoxyglucose positron emission tomography (FDG-PET) measurements predicted clinical outcome and provided further evidence that the addition of HCQ to TEM produced metabolic stress on tumors in patients that experienced clinical benefit. Pharmacodynamic evidence of autophagy inhibition was evident in serial PBMC and tumor biopsies only in patients treated with 1200 mg daily HCQ. This study indicates that TEM and HCQ is safe and tolerable, modulates autophagy in patients, and has significant antitumor activity. Further studies combining MTOR and autophagy inhibitors in cancer patients are warranted.
doi:10.4161/auto.29119
PMCID: PMC4203516  PMID: 24991838
MTOR; autophagy; clinical trial; hydroxychloroquine; melanoma
10.  Allosteric inhibition of the IRE1α RNase preserves cell viability and function during endoplasmic reticulum stress 
Cell  2014;158(3):534-548.
SUMMARY
Depending on endoplasmic reticulum (ER) stress levels, the ER transmembrane multi-domain protein IRE1α promotes either adaptation or apoptosis. Unfolded ER proteins cause IRE1α lumenal domain homo-oligomerization, inducing trans auto-phosphorylation that further drives homo-oligomerization of its cytosolic kinase/ endoribonuclease (RNase) domains to activate mRNA splicing of adaptive XBP1 transcription factor. However, under high/chronic ER stress, IRE1α surpasses an oligomerization threshold that expands RNase substrate repertoire to many ER-localized mRNAs, leading to apoptosis. To modulate these effects, we developed ATP-competitive IRE1α Kinase Inhibiting RNase Attenuators—KIRAs—that allosterically inhibit IRE1α’s RNase by breaking oligomers. One optimized KIRA, KIRA6, inhibits IRE1α in vivo and promotes cell survival under ER stress. Intravitreally, KIRA6 preserves photoreceptor functional viability in rat models of ER stress-induced retinal degeneration. Systemically, KIRA6 preserves pancreatic β-cells, increases insulin, and reduces hyperglycemia in Akita diabetic mice. Thus, IRE1α powerfully controls cell fate, but can itself be controlled with small molecules to reduce cell degeneration.
doi:10.1016/j.cell.2014.07.002
PMCID: PMC4244221  PMID: 25018104
11.  NRASQ61R, BRAFV600E immunohistochemistry: a concomitant tool for mutation screening in melanomas 
Diagnostic Pathology  2015;10:121.
Background
The determination of NRAS and BRAF mutation status is a major requirement in the treatment of patients with metastatic melanoma. Mutation specific antibodies against NRASQ61R and BRAFV600E proteins could offer additional data on tumor heterogeneity. The specificity and sensitivity of NRASQ61R immunohistochemistry have recently been reported excellent. We aimed to determine the utility of immunohistochemistry using SP174 anti-NRASQ61R and VE1 anti-BRAFV600E antibodies in the theranostic mutation screening of melanomas.
Methods
142 formalin-fixed paraffin-embedded melanoma samples from 79 patients were analyzed using pyrosequencing and immunohistochemistry.
Results
23 and 26 patients were concluded to have a NRAS-mutated or a BRAF-mutated melanoma respectively. The 23 NRASQ61R and 23 BRAFV600E-mutant samples with pyrosequencing were all positive in immunohistochemistry with SP174 antibody and VE1 antibody respectively, without any false negative. Proportions and intensities of staining were varied. Other NRASQ61L, NRASQ61K, BRAFV600K and BRAFV600R mutants were negative in immunohistochemistry. 6 single cases were immunostained but identified as wild-type using pyrosequencing (1 with SP174 and 5 with VE1). 4/38 patients with multiple samples presented molecular discordant data. Technical limitations are discussed to explain those discrepancies. Anyway we could not rule out real tumor heterogeneity.
Conclusions
In our study, we showed that combining immunohistochemistry analysis targeting NRASQ61R and BRAFV600E proteins with molecular analysis was a reliable theranostic tool to face challenging samples of melanoma.
Electronic supplementary material
The online version of this article (doi:10.1186/s13000-015-0359-0) contains supplementary material, which is available to authorized users.
doi:10.1186/s13000-015-0359-0
PMCID: PMC4513673  PMID: 26204954
Melanoma; BRAF; NRAS; Molecular analysis; Immunohistochemistry
12.  Effect of Gold Nanoparticles on Properties of Nanoliposomal Hydroxyurea: An In Vitro Study 
New hopes in cancer treatment have been emerged using functional nanoparticles. In this work, we tried to synthesize gold nanoparticles and gold nanoparticles conjugated with DNA extracted from human breast cancer cells. After synthesizing, gold nanoparticles were mixed with nanoliposomal hydroxyurea and corresponding compounds were formed. They were described by UV–Visible spectrophotometry and Zeta sizer. Amount of drug loading into liposomes was determined by spectrophotometry and cytotoxicity effect on MCF-7 cells was measure by MTT assay. Drug loading was determined to be 70 %. Size, size distribution and Zeta potential of particles were 473 nm, 0.46 and −21 mV for control nanoliposomal ones and 351 nm, 0.38 and −25 mV for nanoliposomal particles containing hydroxyurea. This was 29 nm, 0.23 and −30 mV for gold nanoparticles and 502 nm, 0.41 and −38 mV for nanoliposomes containing drug loaded by gold nanoparticles conjugated with DNA. It was found that nano conjugated complex in concentrations less than 20 μM of hydroxyurea can improve efficiency compared with liposomal drug. In maximum concentration of drug (2,500 μM), cytotoxicity was equal to 95 %. In minimum concentration of drug (5 μM), cytotoxicity of liposomal drug and conjugated complex were 70 and 81 %, respectively which probably comes from increased drug entry into cells due to the presence of gold nanoparticles. Free drug resulted in toxicity of 32 % in 5 μM and 88 % in 2,500 μM. Results demonstrated higher drug efficiency in nanoparticle form compared with free form which can be used in in vivo studies.
doi:10.1007/s12291-013-0355-7
PMCID: PMC4062658  PMID: 24966479
Gold nanoparticle; Liposome; Hydroxyurea; Drug delivery
13.  An Investigation into the Parameters Affecting Preparation of Polybutyl Cyanoacrylate Nanoparticles by Emulsion Polymerization 
Emulsion polymerization was used to synthesize poly butyl cyanoacrylate nanoparticles in presence of steric stabilizer dextran 70. Nanoparticles were characterized by particle size analysis, scanning electron microscopy and light microscopy. Polymerization factors affecting particle size and distribution such as dextran 70, polysorbate 80 (PS 80) and H+ concentration, polymerization time and temperature, and sonication were studied. Distinct concentrations of stabilizer were needed to produce proper nanoparticles. In this case, the appropriate value was 2 % of total volume. At pH 4 significant decrease in production efficiency demonstrated the substantial effect of H+ concentration on nanoparticles. Furthermore significant increases in particle size and distribution was observed at 50 °C compared to room temperature. 0.001 % (v/v) PS 80 represented notable influence on size and distribution. In addition, shaped nanoparticles were obtained by altering polymerization time from 5.5 h to 18 h. Finally, nanoparticle features were influenced by different factors. Appropriate manipulating of such factors can lead to obtaining desirable nanoparticles.
doi:10.1007/s12291-013-0325-0
PMCID: PMC4062665  PMID: 24966486
Polybutyl cyanoacrylate; Nanoparticles; Drug delivery; Affecting factors
14.  Polybutylcyanoacrylate Nanoparticles and Drugs of the Platinum Family: Last Status 
Cisplatinum and carboplatinum drugs from platinum-containing family are anti-cancer drugs. Using these drugs causes side effects. Targeted and selective prescription decreases side effects of the drugs. This can be achieved using nanotechnology. In this study, cisplatinum and carboplatinum drugs were loaded on polybutylcyanoacrylate nanoparticles using emulsion polymerization method. To determine amount of loaded drug onto nanoparticle, spectrophotometry method was used. Evaluation of cytotoxicity of such nanoparticles was performed on MCF-7 cell line using MTT assay. Loading percentage of cisplatinum and carboplatinum drugs on nanoparticles were estimated 4 and 6 %, respectively. Cytotoxicity survival rate for cisplatinum and nanoparticle containing cisplatinum at the lowest concentration (p < 0.01) (20 μM) were estimated 64 ± 1 and 67 ± 0.5 %, respectively. These values at the highest concentration (p < 0.01) (160 μM) were measured 28 ± 0.7 and 31 ± 0.4 %. Additionally for carboplatinum and nanoparticles containing carboplatinum at the concentration (p < 0.01) (20 μM) amounts were estimated to be 80 ± 0.6 and 84 ± 0.6 %, while at the concentration (p < 0.01) (160 μM) were identified to be 44 ± 0.5 and 51 ± 0.2 %, respectively. Probably, due to low level of loading, cytotoxicity of both drugs at nano particle status was decreased in comparison with their standard form.
doi:10.1007/s12291-013-0364-6
PMCID: PMC4062671  PMID: 24966482
Polybutylcyanoacrylate; Drug delivery; Emulsion polymerization; Cisplatinum; Carboplatinum
15.  The effect of metal artefact reduction on CT-based attenuation correction for PET imaging in the vicinity of metallic hip implants: A phantom study 
Annals of nuclear medicine  2014;28(6):540-550.
Background
To determine if metal artefact reduction (MAR) combined with a priori knowledge of prosthesis material composition can be applied to obtain CT-based attenuation maps with sufficient accuracy for quantitative assessment of 18F-fluorodeoxyglucose uptake in lesions near metallic prostheses.
Methods
A custom hip prosthesis phantom with a lesion-sized cavity filled with 0.2 ml 18F-FDG solution having an activity of 3.367 MBq adjacent to a prosthesis bore was imaged twice with a chrome-cobalt steel hip prosthesis and a plastic replica, respectively. Scanning was performed on a clinical hybrid PET/CT system equipped with an additional external 137Cs transmission source. PET emission images were reconstructed from both phantom configurations with CT-based attenuation correction (CTAC) and with CT-based attenuation correction using MAR (MARCTAC). To compare results with the attenuation-correction method extant prior to the advent of PET/CT, we also carried out attenuation correction with 137Cs transmission-based attenuation correction (TXAC). CTAC and MARCTAC images were scaled to attenuation coefficients at 511 keV using a tri-linear function that mapped the highest CT values to the prosthesis alloy attenuation coefficient. Accuracy and spatial distribution of the lesion activity was compared between the three reconstruction schemes.
Results
Compared to the reference activity of 3.37 MBq, the estimated activity quantified from the PET image corrected by TXAC was 3.41 MBq. The activity estimated from PET images corrected by MARCTAC was similar in accuracy at 3.32 MBq. CTAC corrected PET images resulted in nearly 40% overestimation of lesion activity at 4.70 MBq. Comparison of PET images obtained with the plastic and metal prostheses in place showed that CTAC resulted in a marked distortion of the 18F-FDG distribution within the lesion, whereas application of MARCTAC and TXAC resulted in lesion distributions similar to those observed with the plastic replica.
Conclusions
MAR combined with a tri-linear CT number mapping for PET attenuation correction resulted in estimates of lesion activity comparable in accuracy to that obtained with 137Cs transmission-based attenuation correction, and far superior to estimates made without attenuation correction or with a standard CT attenuation map. The ability to use CT images for attenuation correction is a potentially important development because it obviates the need for a 137Cs transmission source, which entails extra scan time, logistical complexity and expense.
doi:10.1007/s12149-014-0844-7
PMCID: PMC4101148  PMID: 24710757
PET/CT; attenuation correction; metal artefacts; metal artefact reduction; phantoms
16.  FDG-PET for diagnosing infection in hip and knee prostheses: prospective study in 221 prostheses and subgroup comparison with combined 111In-labeled leukocyte/99mTc- sulfur colloid bone marrow imaging in 88 prostheses 
Clinical nuclear medicine  2014;39(7):609-615.
Purpose
To assess and compare the value of FDG-PET to combined 111In-labeled leukocyte/99mTc-sulfur colloid bone marrow (WBC/BM) imaging for diagnosing infection in hip and knee prostheses.
Methods
In this prospective study, patients with painful hip or knee arthroplasty, who were scheduled to undergo clinical and diagnostic evaluation for prosthesis revision were included. They have been studied by using FDG-PET and 111In-labeled leukocyte/99mTc-sulfur colloid bone marrow scan. This study was IRB approved and HIPAA compliant. All patients provided written informed consent.
Results
A total of 134 hip and 87 knee prostheses, suspected of being either infected or non-infectious loosening were evaluated. All 221 prostheses underwent FDG-PET, whereas both WBC/BM imaging and FDG-PET was performed in 88 prostheses. The initial analysis of data from the WBC/BM images demonstrated somewhat results compared to those of FDG-PET scans on 88 patients. Also, some patients were not willing to undergo both procedures and therefore participate in this study. Therefore, a decision was made to eliminate WBC/BM imaging from the procedures for the remainder of this research study. This decision was reached partly due to the significant radiation dose delivered from labeled WBC as well as safety issues related to preparing these labeled cells. Final diagnosis was based on microbiological examinations of the surgical specimens in 125 prostheses and joint aspirations combined with the clinical follow-up of 6 months or more in 86 prostheses. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FDG-PET in hip prostheses were 81.8%, 93.1%, 79.4%, and 94.0%, respectively and in knee prostheses were 94.7%, 88.2%, 69.2%, and 98.4% respectively. The sensitivity, specificity, PPV, and NPV of WBC/BM imaging in hip prostheses were 38.5%, 95.7%, 71.4%, and 84.6%, respectively and in knee prostheses were 33.3%, 88.5%, 25.0%, and 92.0%, respectively. In those cases that underwent both FDG-PET and WBC/BM imaging, there was a trend (P=0.0625) towards a higher sensitivity for FDG-PET in hip prostheses, whereas other comparisons did not show any significant differences between the two imaging modalities.
Conclusion
Based on this study, the diagnostic performance of FDG-PET scan in detecting infection in painful hip and knee prostheses is optimal for routine clinical application. Considering the complexity and costs of WBC/BM imaging and related safety issues associated with this preparation, FDG-PET appears to be an appropriate alternative for assessing these patients.
doi:10.1097/RLU.0000000000000464
PMCID: PMC4113396  PMID: 24873788
Arthroplasty; FDG-PET; Infection; Prosthesis; WBC/BM imaging
17.  Pyoderma Vegetans: A Case Report in a Child Suspected to Primary Immunodeficiency and Review of the Literature 
Pyoderma vegetans (PV) is a rare inflammatory disorder characterized by vegetating pustules and plaques affecting the skin and mucosal membranes. It is believed that this entity is mostly associated with inflammatory bowel disease (IBD), chronic malnutrition, human immunodeficiency virus (HIV), malignancies, and other immunocompromised states. Pyoderma vegetans occurs more commonly in young and middle-aged adults. There is no sex predilection for this entity. The lesions could heal spontaneously, but usually recur and become chronic.
Our patient was an 11-year-old girl suspected to have primary combined immunodeficiency complicated by chronic recurrent vegetating pustular lesions on the face and postauricular area since one year of age. The histological features of the lesions were consistent with pyoderma vegetans. This is the first case of PV beginning from early infancy in the setting of primary immunodeficiency and in an unusual location.
PMCID: PMC4487467  PMID: 26170528
Skin disease; Pyoderma; Diagnosis; Child; Immunologic deficiency syndrome
18.  The Effects of Topical Sesame (Sesamum indicum) Oil on Pain Severity and Amount of Received Non-Steroid Anti-Inflammatory Drugs in Patients With Upper or Lower Extremities Trauma 
Background:
Most patients with trauma experience different levels of pain. Due to side effects as well as economic burden of drugs used for pain relief after trauma commonly, it is important to use low-cost methods independently or combined with drugs to alleviate pain.
Objectives:
Therefore, this study aimed to investigate the effects of topical sesame oil on pain severity and frequency of received NSAIDs of patients with trauma.
Patients and Methods:
This randomized clinical trial study was conducted on 150 patients with upper or lower extremities trauma in Dezful Ganjavian Hospital, Ahvaz, Iran, in 2014. Data was collected by a researcher-made questionnaire and Visual Analogue Scale (VAS). Patients were divided into two groups of control (n = 75) and intervention (n = 75) randomly. In the intervention group, patients applied topical sesame oil beside the routine cares, while in the control group patients just received routine cares. Severity of pain and frequency of received NSAIDs was assessed in the first, third, seventh and tenth days after the intervention in the both groups. Data was analyzed by SPSS19 software using descriptive and analytic (Chi-square and independent sample t-test) statistical methods.
Results:
Based on student sample t-test, there was a significant difference between intervention and control groups regarding the pain severity in the first (P = 0.06), third (P = 0.001), seventh (P = 0.001) and tenth (P = 0.001) days after the intervention. Besides, the frequency of received NSAIDs in the intervention group and the control group showed significant difference in four days after the intervention (for four days P = 0.001).
Conclusions:
Topical application of sesame oil could reduce pain severity and frequency of received NSAIDs in patients with upper or lower extremities trauma. Therefore, it is recommended to use this oil in complementary medicine for pain relief due to low cost, easy usage and lack of adverse effects.
doi:10.5812/aapm.25085v2
PMCID: PMC4493737  PMID: 26161326
Sesame Oil; Pain Severity; Non-Steroid; Anti-Inflammatory Drugs; Trauma
19.  Surgeon Volume and Elective Resection for Colon Cancer: An Analysis of Outcomes and Use of Laparoscopy 
BACKGROUND
Surgeon volume may be an important predictor of quality and cost outcomes. We evaluated the association between surgeon volume and quality and cost of surgical care in patients with colon cancer.
STUDY DESIGN
We performed a retrospective study of patients who underwent resection for colon cancer, using data from the University HealthSystem Consortium from 2008 to 2011. Outcomes evaluated included use of laparoscopy, ICU admission, postoperative complications, length of stay, and total direct hospital costs by surgeon volume. Surgeon volume was categorized according to high (HVS), medium (MVS), and low (LVS) average annual volumes.
RESULTS
A total of 17,749 patients were included in this study. The average age of the cohort was 65 years and 51% of patients were female. After adjustment for potential confounders, compared with LVS, HVS and MVS were more likely to use laparoscopy (HVS, odds ratio [OR] 1.27, 95% CI 1.15, 1.39; MVS, OR 1.16 95% CI 1.65, 1.26). Postoperative complications were significantly lower in patients operated on by HVS than LVS (OR 0.77 95% CI 0.76, 0.91). The HVS patients were less likely to require reoperation than those in the LVS group (OR 0.70, 95% CI 0.53, 0.92) Total direct costs were $927 (95% CI −$1,567 to −$287) lower in the HVS group compared with the LVS group.
CONCLUSIONS
Higher quality, lower cost care was achieved by HVS in patients undergoing surgery for colon cancer. An assessment of differences in processes of care by surgeon volume may help further define the mechanism for this observed association.
doi:10.1016/j.jamcollsurg.2014.01.057
PMCID: PMC4467094  PMID: 24768291
20.  Unicentric Castleman's disease: an uncommon cause of posterior mediastinal mass 
BMJ Case Reports  2013;2013:bcr2012008522.
Castleman's disease is a rare lymphoproliferative disease that may be unicentric or multicentric in presentation. It may develop anywhere along with the lymphatic system such as the abdomen, neck and thoracic cavity. However, mediastinum is the most common location for unicentric disease. Here, we discuss a unicentric Castleman's disease in a 28-year-old woman who presented with cough, mild dysphagia and a large posterior mediastinal mass.
doi:10.1136/bcr-2012-008522
PMCID: PMC3702804  PMID: 23761562
21.  Adenoid cystic carcinoma of buccal mucosa 
BMJ Case Reports  2013;2013:bcr2013009770.
Adenoid cystic carcinoma is a malignant neoplasm most commonly originating in the salivary glands of head and neck region. The clinical and pathological findings typical of this tumour include slow growth, perineural invasion and potential local recurrence. Up to 50% of these tumours occur in the intraoral minor salivary glands usually in the hard palate. We present a case report of a 26-year-old woman who was diagnosed with adenoid cystic carcinoma of the right buccal mucosa. The peculiarity of the lesion and the approach we made is the key factor in the presentation.
doi:10.1136/bcr-2013-009770
PMCID: PMC3702945  PMID: 23761566
22.  Metabolic Activity of the Tongue in Obstructive Sleep Apnea. A Novel Application of FDG Positron Emission Tomography Imaging 
Rationale: The metabolic activity of the tongue is unknown in patients with obstructive sleep apnea (OSA). Tongue electromyographic (EMG) activity is increased in patients with OSA. This increase in tongue EMG activity is thought to be related to either increased neuromuscular compensation or denervation with subsequent reinnervation of the muscle fibers. Increased glucose uptake in the tongue would support increased neuromuscular compensation, whereas decreased glucose uptake in the tongue would support denervation with subsequent reinnervation of the muscle fibers.
Objectives: To investigate the metabolic activity of the genioglossus and control upper airway muscles in obese patients with sleep apnea compared with obese control subjects.
Methods: Obese subjects with and without OSA underwent a standard overnight sleep study to determine an apnea–hypopnea index. Each subject had a positron emission tomography with [18F]-2-fluoro-2-deoxy-d-glucose scan in addition to noncontrast computed tomography or magnetic resonance imaging. Glucose uptake was quantified within upper airway tissues with the standardized uptake value.
Measurements and Main Results: We recruited 30 obese control subjects (apnea–hypopnea index, 4.7 ± 3.1 events per hour) and 72 obese patients with sleep apnea (apnea–hypopnea index, 43.5 ± 28.0 events per hour). Independent of age, body mass index, sex, and race, patients with OSA had significantly reduced glucose uptake in the genioglossus (P = 0.03) in comparison with obese normal subjects. No differences in standardized uptake value were found in the control muscles (masseter [P = 0.38] and pterygoid [P = 0.70]) and subcutaneous fat deposits (neck [P = 0.44] and submental [P = 0.95]) between patients with OSA and control subjects.
Conclusions: There was significantly reduced glucose uptake in the genioglossus of patients with sleep apnea in comparison with obese normal subjects with [18F]-2-fluoro-2-deoxy-d-glucose positron emission tomography imaging. The reduction in glucose uptake was likely secondary to alterations in tongue muscle fiber-type or secondary to chronic denervation. The reduced glucose uptake argues against the neuromuscular compensation hypothesis explaining the increase in tongue EMG activity in obese patients with OSA.
doi:10.1164/rccm.201310-1753OC
PMCID: PMC4098082  PMID: 24779734
FDG-PET; genioglossus; masseter; obstructive sleep apnea; MRI
23.  Assessment of global cardiac uptake of Radiolabeled Iron Oxide Nanoparticles in Apolipoprotein E-Deficient Mice: implications for imaging cardiovascular inflammation 
Purpose
Atherosclerosis is a leading cause of death in industrialized countries and is characterized by the accumulation of lipids and inflammatory cells, including macrophages, in blood vessel walls. Therefore, the ability to image macrophages could help identify plaques that are precursors of acute thrombotic events. Previous research has shown that long-circulating, nanoparticles could be used to detect macrophages within atherosclerotic plaques of the aorta. By conducting this study, we investigated whether global cardiac uptake of radiolabeled nanoparticles could allow assessment of total macrophage burden in the coronary arteries.
Procedures
Dextran-coated Iron Oxide Nanoparticles (IONPs) were labeled with iodine-125 via Bolton-Hunter (SHPP) method. IONPs were characterized by means of dynamic light scattering and transmission electronic microscopy. Biodistribution studies were performed in healthy and atherosclerotic mice. Additionally, digital autoradiography of hearts from both healthy and atherosclerotic mice was performed to assess regional and global atherosclerotic burden.
Results
The [125I]IONPs exhibited high radiolabel stability and long blood circulation, which eventually led to high heart uptake in apoE −/− mice when compared with healthy controls. Furthermore, digital autoradiography showed substantially enhanced emission of signals from the hearts of atherosclerotic mice, while no or minimal cardiac signals were detected in healthy mice.
Conclusions
This preparation showed adequate physical-chemical properties for in vivo studies, such as small size (~30 nm), good radiolabel stability, and long circulation time. There was also significant accumulation in the heart of apoE−/− mice compared with that of healthy control animals. These findings suggest that radiolabeled dextran-coated iron oxide nanoparticles may have potential to become a useful tool to detect macrophages in the atherosclerosis plaques of coronary arteries; however, these preliminary findings should be confirmed by further studies in a larger scale in various atherosclerosis models.
doi:10.1007/s11307-013-0709-9
PMCID: PMC4016162  PMID: 24297372
Atherosclerosis; Radiolabeled nanoparticles; Diagnosis; Iron oxide nanoparticles; Global heart uptake
24.  A Comparative Study on the Life-Saving Radioprotective Effects of Vitamins A, E, C and Over-the-Counter Multivitamins 
Introduction
Oral intake of vitamins which present antioxidant characteristics can protect living organisms against oxidative damage caused by exposure to ionizing radiation. It was previously reported that administration of high levels of vitamin C can lead to increased DNA damage through production of hydroxyl radicals from hydrogen peroxide by the Fenton reaction. However, our early experiments did not confirm this hypothesis. The main goal of this study was to determine if high doses of Vit C can show life-saving radioprotective effects.
Materials and Methods
Phase I: Seventy two male Balb/c mice weighing 20-25g were randomly divided into six groups of 12 animals each. Group I; Vit E for five days, Groups II and III; Vit C and Vit A. Group 4; all three vitamins. Group V; an over-the-counter multivitamin. Group VI; none of the above. Phase II: 120 male BALB/c mice weighing 20-25g were randomly divided into 12 groups of 10 each. Group I; Vit A for five days. Groups II-IV; Vit C 200 mg/kg, 400 mg/kg, 800 mg/kg, respectively. Group V-VII; Vit E at daily doses of 200 iu/kg, 400 iu/kg, 800 iu/kg, respectively. Group VIII and IX; all three vitamins at low and high doses, respectively. Group X; an over-the-counter multivitamin. Group XI; controls group and Group XII; received pure olive oil. All animals (Phases I and II) were exposed to a lethal dose of gamma rays and the survival rates of the animals were monitored and recorded continuously for 16 days after exposure.
Results
Phase I: 14 days after irradiation the survival rate for control group was 33.33%, while the survival rates for the 1st to 5th groups were 45.45%, 81.81%, 50%, 57.14%, and 9.09% , respectively. Phase II: The survival rates in the control group and the group that only received pure olive oil, were 50% and 60%, respectively. Survival rate in the animals received Vit C at daily doses of 200 mg/kg, 400 mg/kg, 800 mg/kg, were 90%, 90% and 90%, respectively. Log rank (Mantel-Cox) test showed statistically significant differences between the survival rates in control irradiated mice (no vitamins) and mice received Vit C at daily doses of 200 mg/kg (P=0.042), 400 mg/kg (P=0.042) and 800 mg/kg (P=0.042).
Conclusion
Altogether, findings of this study showed that even high doses of Vit C can show life-saving radioprotective effects. The significant radioprotective effect of Vit C at doses used in this study, opens new horizons in developing non-toxic, cost effective, easily available radioprotectors in life-threatening situations such as exposure to lethal doses of ionizing radiation.  The radioprotective effect of Vit A and Vit E seem to be less efficient compared to that of Vit C.
PMCID: PMC4479387  PMID: 26157731
Radioprotective Effects; Vitamin C; Ascorbic Acid; Radiation; Survival
25.  Design and Implementation Content Validity Study: Development of an instrument for measuring Patient-Centered Communication 
Journal of Caring Sciences  2015;4(2):165-178.
Introduction: The importance of content validity in the instrument psychometric and its relevance with reliability, have made it an essential step in the instrument development. This article attempts to give an overview of the content validity process and to explain the complexity of this process by introducing an example.
Methods: We carried out a methodological study conducted to examine the content validity of the patient-centered communication instrument through a two-step process (development and judgment). At the first step, domain determination, sampling (item generation) and instrument formation and at the second step, content validity ratio, content validity index and modified kappa statistic was performed. Suggestions of expert panel and item impact scores are used to examine the instrument face validity.
Results: From a set of 188 items, content validity process identified seven dimensions includes trust building (eight items), informational support (seven items), emotional support (five items), problem solving (seven items), patient activation (10 items), intimacy/friendship (six items) and spirituality strengthening (14 items). Content validity study revealed that this instrument enjoys an appropriate level of content validity. The overall content validity index of the instrument using universal agreement approach was low; however, it can be advocated with respect to the high number of content experts that makes consensus difficult and high value of the S-CVI with the average approach, which was equal to 0.93.
Conclusion: This article illustrates acceptable quantities indices for content validity a new instrument and outlines them during design and psychometrics of patient-centered communication measuring instrument.
doi:10.15171/jcs.2015.017
PMCID: PMC4484991  PMID: 26161370
Cancer; Communication; Content validity; Data collection

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