•Renal cell carcinoma metastases to the gastrointestinal tract (excluding the liver) accounts for about (0.2 − 0.7)% of RCC.•RCC metastases to the gastrointestinal tract may occur years after resection of RCC.•The tyrosine kinase inhibitor Sunitinib has also been shown to have survival benefits for patients with RCC metastasis.•Vascular-endothelial growth factor receptor (VEGFR) as well as the mTOR-signaling pathway have been used as a treatment for RCC metastasis with good results.•Use of VCE and push enteroscopy are of beneficial value in the diagnosis of obscure GI bleeding.
Renal cell carcinoma metastasis to the small intestine is a rare condition. It usually results in gastrointestinal bleeding and it could happen many years after the diagnosis with renal cell cancer. Treatment includes surgery as well as targeted agents such as tyrosine kinases. We report here the case of an 82-year-old man with a past medical history of high-grade renal cell carcinoma and right nephrectomy 6 years earlier, who presented with recurrent episodes of syncope and black stools. He underwent esophagogastroduodenoscopy (EGD) and colonoscopy without evident source of bleeding. Video capsule endoscopy (VCE) showed three bleeding lesions in the jejunum and ileum. Push enteroscopy revealed a proximal jejunum bleeding mass that was suspicious for malignancy. Histopathology demonstrated poorly differentiated carcinoma. Given the patient’s history of high-grade renal cell carcinoma, and similarity of histologic changes to the old renal cell cancer specimen, metastatic renal cell carcinoma was felt to be the responsible etiology.
Renal cell carcinoma; Metastases; Small bowel; Bleeding; Video capsule endoscopy; Push enteroscopy
A new optical trapping design to transport gold nanoparticles using a PANDA ring resonator system is proposed. Intense optical fields in the form of dark solitons controlled by Gaussian pulses are used to trap and transport nanoscopic volumes of matter to the desired destination via an optical waveguide. Theoretically, the gradient and scattering forces are responsible for this trapping phenomenon, where in practice such systems can be fabricated and a thin-film device formed on the specific artificial medical materials, for instance, an artificial bone. The dynamic behavior of the tweezers can be tuned by controlling the optical pulse input power and parameters of the ring resonator system. Different trap sizes can be generated to trap different gold nanoparticles sizes, which is useful for gold nanoparticle therapy. In this paper, we have shown the utility of gold nanoparticle trapping and delivery for therapy, which may be useful for cosmetic therapy and related applications.
gold nanoparticle trapping; particle trapping; therapy; transport
A novel nanomicro syringe system was proposed for drug storage and delivery using a PANDA ring resonator and atomic buffer. A PANDA ring is a modified optical add/drop filter, named after the well known Chinese bear. In principle, the molecule/drug is trapped by the force generated by different combinations of gradient fields and scattering photons within the PANDA ring. A nanomicro needle system can be formed by optical vortices in the liquid core waveguide which can be embedded on a chip, and can be used for long-term treatment. By using intense optical vortices, the required genes/molecules can be trapped and transported dynamically to the intended destinations via the nanomicro syringe, which is available for drug delivery to target tissues, in particular tumors. The advantage of the proposed system is that by confining the treatment area, the effect can be decreased. The use of different optical vortices for therapeutic efficiency is also discussed.
nanomicro syringe; nanomicro needle; molecular therapy; therapeutic efficiency; cancer
De Quervain disease is a mechanical tenosynovitis due to inadequacy volume between abductor pollicis longus, extensor pollicis brevis and their tunnel. Treatment methods include immobilization, steroid injections, and operation. For the first time Fritz De Quervain described surgical treatment of this disease. Since then, various ways of treatment have been reported. The purpose of this study is to compare the clinical outcomes of a longitudinal incision with a transverse incision in De Quervain disease.
This was a randomized controlled clinical trial conducted in three hospitals in Iran, Yazd from March 2003 to September 2008. One hundred-twenty patients with De Quervain disease who did not respond to conservative treatment were operated with two different incisions. The patients were followed for three months to compare the surgical outcomes.
During a three month follow-up, a significant difference was shown between the two methods (p=0.03). Results of surgical treatment with longitudinal incision were excellent (only 5 hypertrophic scars), but there were 13 postoperative complaints with transverse incision.
According to our findings, longitudinal incision in surgical treatment of De Quervain disease is better than transverse incision.
De Quervian disease; Longitudinal incision; Transverse incision; Surgical treatment
We propose a novel drug delivery system (DDS) by using a PANDA ring resonator to form, transmit and receive the microscopic volume by controlling some suitable ring parameters. The optical vortices (gradient optical field/well) can be generated and used to form the trapping tool in the same way as the optical tweezers. The microscopic volume (drug) can be trapped and moved (transported) dynamically within the wavelength router or network. In principle, the trapping force is formed by the combination between the gradient field and scattering photons, which has been reviewed. The advantage of the proposed system is that a transmitter and receiver can be formed within the same system, which is called transceiver, in which the use of such a system for microscopic volume (drug volume) trapping and transportation (delivery) can be realized.
(140.7010) Laser trapping; (350.4855) Optical tweezers or optical manipulation; (080.4865) Optical vortices; (140.4780) Optical resonators; (190.4360) Nonlinear optics, devices
Klein tunneling refers to the absence of normal backscattering of electrons even under the case of high potential barriers. At the barrier interface, the perfect matching of electron and hole wavefunctions enables a unit transmission probability for normally incident electrons. It is theoretically and experimentally well understood in two-dimensional relativistic materials such as graphene. Here we investigate the Klein tunneling effect in Weyl semimetals under the influence of magnetic field induced by ferromagnetic stripes placed at barrier boundaries. Our results show that the resonance of Fermi wave vector at specific barrier lengths gives rise to perfect transmission rings, i.e., three-dimensional analogue of the so-called magic transmission angles in two-dimensional Dirac semimetals. Besides, the transmission profile can be shifted by application of magnetic field in the central region, a property which may be utilized in electro-optic applications. When the applied potential is close to the Fermi level, a particular incident vector can be selected by tuning the magnetic field, thus enabling highly selective transmission of electrons in the bulk of Weyl semimetals. Our analytical and numerical calculations obtained by considering Dirac electrons in three regions and using experimentally feasible parameters can pave the way for relativistic tunneling applications in Weyl semimetals.
HIV-infected women are at increased risk of HPV infection. We assessed time trends in annual prevalences of cervical high-risk human papillomavirus (HR-HPV) genotypes from 2006-2012 among a non-vaccinated, HIV-infected female cohort in urban Brazil.
Cervical specimens for HPV genotyping were collected yearly between January 2006 and December 2012 in a cross-sectional analysis of participants ≥18 years enrolled in the Women’s HIV Cohort at Fiocruz in Rio de Janeiro, Brazil. Age-adjusted generalized estimating equation models with an exchangeable matrix were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for annual HPV positivity (reference year: 2006).
Among 590 participants: median age 35.5-40.0 from 2006-2012; any HR-HPV prevalence ≥53% every year; HR-HPV 16, 58, 59, and 68 prevalences ≥24% in at least one year. Odds of HPV 16 and 68 decreased in 2012. HPV 58 prevalences followed a U-shape, beginning and ending with >20%. HPV 59 prevalences followed a linear trend, with increased odds in 2012 (OR 16.0, 95% CI [3.8 – 67.3], Bonferroni-adjusted p-value<0.01).
The prevalences of HR-HPV 58, 59 and 68 were high in this cohort. Given current HR-HPV vaccine coverage and availability, further investigation is needed to optimize vaccine recommendations for this population.
HIV; Women; Cervical HPV; High-Risk HPV; HPV Vaccine; Epidemiology
Though insulin has no upper limit in dosage, we do not encounter very high dose requirements too often. The reported case is the first in Bangladesh to require more than 1000 international units (IU) of subcutaneous insulin per day.
A 44-year old male diabetic patient from Bangladesh presented with unusually uncontrolled diabetes mellitus due to extreme insulin resistance. Despite dramatic increase in insulin step by step up to 1110 IU of concomitant short and intermediate acting insulin per day by subcutaneous route, his blood glucose remained over 12 mmol/L persistently, in all the fasting, pre-prandial, postprandial and random samples. He was also treated with several oral hypoglycemic agents including metformin, vildagliptin, glimepiride, pioglitazone and miglitol along with insulin but blood glucose levels remained almost unchanged. However, intravenous infusion of insulin over 4 hours caused a plummet in the glucose level. His blood test for insulin autoantibody was negative.
This paper provides a scope to review literatures on extreme subcutaneous insulin resistance and its management. It also reveals the limitations of management due to lack of facilities in an underdeveloped country, which hinders proper exploration to many medical issues.
Diabetes Mellitus; Insulin Resistance; Subcutaneous Injection
As a significant type of cerebral cortical convolution pattern, the gyrus is widely preserved across species. Although many hypotheses have been proposed to study the underlying mechanisms of gyrus formation, it is currently still far from clear which factors contribute to the regulation of consistent gyrus formation. In this paper, we employ a joint analysis scheme of experimental data and computational modeling to investigate the fundamental mechanism of gyrus formation. Experimental data on mature human brains and fetal brains show that thicker cortices are consistently found in gyral regions and gyral cortices have higher growth rates. We hypothesize that gyral convolution patterns might stem from heterogeneous regional growth in the cortex. Our computational simulations show that gyral convex patterns may occur in locations where the cortical plate grows faster than the cortex of the brain. Global differential growth can only produce a random gyrification pattern, but it cannot guarantee gyrus formation at certain locations. Based on extensive computational modeling and simulations, it is suggested that a special area in the cerebral cortex with a relatively faster growth speed could consistently engender gyri.
In this work we study the effects of in-plane magnetic fields on thin films of the Dirac Semimetal (DSM) Na3Bi where one of the in-plane directions is perpendicular to the k-separation between the two Weyl nodes that exist for each spin orientation. We show numerically that the states localized near the surfaces of these thin films are related to the Fermi arc states in semi-infinite slabs. Due to the anisotropy between the two in-plane directions, the application of a magnetic field along these directions have differing effects. A field parallel to the k space separation between the Weyl nodes leads to a broadening of the surface state band and the formation of an energy plateau, while a perpendicular field shifts the energy where the hole and particle bands meet upwards, and sharpens the tips of the bands. We illustrate the effects of these changes to the dispersion relation by studying the transmission from a source segment without a magnetic field to a drain segment with a field, with the field and interface at various in-plane directions.
Background. Monitoring changes in obesity prevalence by risk factors is relevant to public health programs that focus on reducing or preventing obesity. The purpose of this paper was to study trends in obesity odds ratios (ORs) for individuals aged 20 years and older in Iran by using a new statistical methodology. Methods. Data collected by the National Surveys in Iran, from 2000 through 2011. Since responses of the member of each cluster are correlated, the quadratic inference functions (QIF) method was used to model the relationship between the odds of obesity and risk factors. Results. During the study period, the prevalence rate of obesity increased from 12% to 22%. By using QIF method and a model selection criterion for performing stepwise regression analysis, we found that while obesity prevalence generally increased in both sexes, all ages, all employment, residence, and smoking levels, it seems to have changes in obesity ORs since 2000. Conclusions. Because obesity is one of the main risk factors for many diseases, awareness of the differences by factors allows development of targets for prevention and early intervention.
In nature, jumping out of water is a behaviour commonly observed in aquatic species to either escape from predators or hunt prey. However, not all aquatic species are capable of jumping out, especially small organisms whose length scales are comparable to the capillary length (approx. 2.7 mm for water). Some aquatic animals smaller than the capillary length are able to jump out while others are not, as observed in some marine copepods. To understand the dynamics of jumping out of the water–air interface, we perform physical experiments by shooting a spherical particle towards the liquid–air interface from below. Experimental results show that the particle either penetrates or bounces back from the interface, depending on the particle and fluid properties, and the impact velocity. The transition from bouncing to penetration regimes, which is theoretically predicted based on a particle force balance, is in good agreement with both physical experiments and plankton behavioural data.
copepod; jumping out of water; surface tension
Years after the development of antituberculosis (TB) drugs, many people continue to suffer from this disease. To control the spread of TB, strains of the Mycobacterium tuberculosis complex need to be determined, and sources of infection must be identified. Such steps should help to prevent transmission of the infection.
The aim of this study was to perform molecular genotyping of isolates of the M. tuberculosis complex obtained from patients in northwestern Iran.
One hundred ninety-four culture-positive M. tuberculosis isolates obtained from patients in northwestern Iran were analyzed using the mycobacterial interspersed repetitive unit-exact tandem repeats (MIRU-ETR) method.
The MIRU-ETR method distinguished 162 different patterns in the 194 isolates, comprising 23 clusters and 139 unique patterns. Its discriminatory power according to the Hunter-Gaston discriminatory index (HGDI) was 0.9978. The largest cluster contained six isolates.
This research indicated that various strains of M. tuberculosis were responsible for TB and that the majority of cases were due to reactivation.
Tuberculosis; Molecular Diversity; Iran; ETR
Advanced, metastatic, castration resistant and chemo-resistant prostate cancer has triggered change in the drug development landscape against prostate cancer. Bovine lactoferrin (bLf) is currently attracting attention in clinics for its anti-cancer properties and proven safety profile. bLf internalises into cancer cells via receptor mediated endocytosis, boosts immunity and complements chemotherapy. We employed bLf as an excellent functional carrier protein for delivering doxorubicin (Dox) into DU145 cells, CD44+/EpCAM+ double positive enriched DU145 3D prostaspheres and drug resistant ADR1000-DU145 cells, thus circumventing Dox efflux, to overcome chemo-resistance. Successful bLf-Dox conjugation with iron free or iron saturated bLf forms did not affect the integrity and functionality of bLf and Dox. bLf-Dox internalised into DU145 cells within 6 h, enhanced nuclear Dox retention up to 24 h, and proved significantly effective (p < 0.001) in reducing LC50 value of Dox from 5.3 μM to 1.3 μM (4 fold). Orally fed iron saturated bLf-Dox inhibited tumour development, prolonged survival, reduced Dox induced general toxicity, cardiotoxicity, neurotoxicity in TRAMP mice and upregulated serum levels of anti-cancer molecules TNF-α, IFN-γ, CCL4 and CCL17. The study identifies promising potential of a novel and safer bLf-Dox conjugate containing a conventional cytotoxic drug along with bLf protein to target drug resistance.
Production of carbapenemase, especially Klebsiella pneumoniae carbapenemases (KPC), is one of the antibiotic resistance mechanisms of Enterobacteriaceae such as Klebsiella oxytoca. This study aimed to investigate and identify KPC-producing K. oxytoca isolates using molecular and phenotypic methods.
A total of 75 isolates of K. oxytoca were isolated from various clinical samples, and were verified as K. oxytoca after performing standard microbiological tests and using a polymerase chain reaction (PCR) method. An antibiotic susceptibility test was performed using a disc diffusion method according to the Clinical and Laboratory Standards Institute guidelines. CHROMagar KPC chromogenic culture media was used to examine and confirm the production of the carbapenemase enzyme in K. oxytoca isolates; in addition, PCR was used to evaluate the presence of blaKPC gene in K. oxytoca strains.
Of a total of 75 K. oxytoca isolates, one multidrug resistant strain was isolated from the urine of a hospitalized woman. This strain was examined to assess its ability to produce carbapenemase enzyme; it produced a colony with a blue metallic color on the CHROMagar KPC chromogenic culture media. In addition, the blaKPC gene was confirmed by PCR. After sequencing, it was confirmed and deposited in GenBank.
To date, many cases of KPC-producing Enterobacteriaceae, in particular K. pneumoniae, have been reported in different countries; there are also some reports on the identification of KPC-producing K. oxytoca. Therefore, to prevent the outbreak of nosocomial infections, the early detection, control, and prevention of the spread of these strains are of great importance.
blaKPC; CHROMagar KPC; Klebsiella oxytoca; polymerase chain reaction
In this study, maximum entropy models were developed in four seasons to evaluate habitat suitability and factors affecting Asian Houbara in Iran. Environmental variables used in modeling consisted of 42 environmental and climate variables for Nayband wildlife refuge and 36 environmental and climate variables for Petregan protected area. Also, seasonal overlap area were obtained using the ENM TOOLS software. The results showed that the most important factors affecting habitat suitability of the Asian Houbara in all seasons included the ratio of distance to hill, the type of Artemisia−Gymnocarpus, distance to the slope (8–12%) in the Nayband wildlife refuge, distance to the type of Artemisia aucheri, distance to the Land Passion, and distance to the dry land farming in the Petregan region. In summer, the most suitable habitat is Nayband but is Petergan during fall-winter. there is maximum overlap in summer, and the least overlap in the spring these areas. The results of this study can be used as a valuable tool in implementing conservation and management strategies, in order to increase desirable habitats in the eastern part of Iran.
Interventional procedures, cine acquisitions and operation of fluoroscopic equipment in high-dose fluoroscopic modes, involve long fluoroscopic times which can lead to high staff doses. Also, Coronary angiography (CA) procedures require the cardiologist and assisting personnel to remain close to the patient, which is the main source of scattered radiation. Thus, radiation exposure is a significant concern for radiation workers and it is important to measure the radiation doses received by personnel and evaluate the parameters concerning total radiation burden. In this research, we investigated radiation doses to 10 cardiologists performing 120 CA procedures. Using thermo luminescent dosimeters doses to the wrists, thyroid and eyes per procedure were measured. Based on the measured dose values, maximum doses to the Left wrist, Right wrist, thyroid and eyes of cardiologist were measured 241.45 µSv, 203.17 µSv, 78.21 µSv and 44.58 µSv, respectively. The results of this study indicate that distance from the source, use of protective equipment’s, procedure complexity, equipment performance, and cardiologist experience are the principal exposure-determining variables. It can be conclude that if adequate radiation protection approaches have been implemented, occupational dose levels to cardiologists would be within the regulated acceptable dose limits.
coronary angiography; radiation dose; radiation worker; thermo luminescent dosimeter
Although the effectiveness of ginger as an antioxidant agent has been exploited, little human research has been conducted on its activity on male reproductive functions.
This study was designed to investigate the effects of ginger (Zingiber officinale) on sperm DNA fragmentation (SDF) in infertile men.
Materials and Methods:
This randomized double-blind, placebo-controlled trial with a 1:1 allocation was performed on 100 infertility treatment candidates who were admitted to Royan Institute for Reproductive Biomedicine, Tehran, Iran. Patients were randomly assigned to receive one of two treatments: ginger and placebo. Patients were given a 3-month oral treatment (members received capsules containing 250 mg of ginger powder twice a day in ginger and a placebo in other group). Before and after treatment, standardized semen samples were obtained to determine sperm concentration, motility, and SDF according to World Health Organization.
There was no significant difference between two groups regarding SDF at baseline (53.48. 95%CI: 37.95-69.02) in cases and (56.75, 95%CI: 40.01-73.5) in controls. The average positive percentage of SDF in patients receiving ginger (17.77, 95%CI: 6.16-29.39) was lower compared with placebo (40.54, 95%CI: 23.94-57.13) after three month of treatment (p=0.02). In multivariate analysis, SDF was significantly lower in patients receiving ginger compared with placebo (mean difference: 3.21, 95%CI: 0.78-5.63, p=0.009). There were no significant differences between two groups regarding to semen parameters.
The present study has demonstrated that ginger in a controlled study of efficacy was effective in decreasing SDF in infertile men.
DNA fragmentation; Ginger; Semen analysis; Infertility; Male
Conventional hepatitis B virus (HBV) vaccination fails to achieve efficient protection in about 5–10% of the world population. Hence, different strategies have been adopted to ameliorate HBV antibody titers. This study aimed to evaluate the concurrent application of tetanus-diphtheria (Td) and HBV vaccination on hepatitis B surface (HBs) antibody titer in low-responder healthy individuals.
This was a randomized clinical trial, which was implemented among 140 of medical staff working as health-care workers assumed as low-responders. The subjects were randomly allocated to either control or interventional groups. The control and interventional groups received HBV recombinant vaccine while the latter group was also vaccinated through Td. Enzyme-linked immunosorbent assay was applied to measure HBs antibody (HBsAb) titers just before and 6 months after the last vaccination. All data were entered into SPSS software. Independent t-test, paired t-test, and Chi-square or Fisher's exact test were applied for data comparison.
Antibody titers of the subjects in the intervention and control groups soared from 49.08 ± 20.08 IU/L to 917.78 ± 204.80 IU/L and from 46.95 ± 18.55 to 586.81 ± 351.77 IU/L, respectively (both P < 0.001); nevertheless, by comparison with control group, variation of antibody titer in the interventional group was significantly higher (P < 0.001).
Concurrent application of Td and HBV vaccine could effectively enhance protective levels of HBsAb titers in low-responder individuals.
Hepatitis B vaccine; low responders; tetanus-diphtheria vaccine
Uropathogenic Escherichia coli (UPEC) are major bacterial agent of Urinary Tract Infection (UTI). This infection is more prevalent among women because approximately half of all women will experience a UTI in their life-time and near a quarter of them will have a recurrent infection within 6–12 months. IutA protein has a major role during UPEC pathogenesis and consequently infection. Therefore, the aim of current study was assessment of IutA protein roles as a potential candidate antigen based for vaccine designing.
This survey was conducted during 2014–2015 at the University of Tehran, Iran. Chromosomal DNA extracted from E. coli 35218 and iutA gene amplified by PCR. The amplicon cloned to pVax.1 eukaryotic expression vector and recombinant vector confirmed by sequencing. The iutA gene expression in genetic cassette of pVax/iutA was evaluated in COS7 cell line by RT-PCR. Then, injected to mouse model, which divided to three groups: injected with pVax vector, PBS and pVax/iutA cassette respectively in two stages (d 1 and 14). One week after the second injection, bleeding from immunized mouse was performed and IFN-gamma was measured.
The mice immunized with pVax/iutA showed increased interferon-γ responses significantly higher than two non-immunized groups (P<0.05).
Cellular immune response has a main protective role against UTI. Raising this kind of immune response is important to preventing of recurrent infection. Moreover, the current DNA cassette will be valuable for more trying to prepare a new vaccine against UTI.
Genetic vaccination; Uropathogenic Escherichia coli; IutA
This study reviewed prostate volumetric-modulated arc therapy (VMAT) plans with intensity-modulated radiotherapy (IMRT) plans after prostate IMRT technique was replaced by VMAT in an institution. Characterizations of dosimetry and radiobiological variation in prostate were determined based on treatment plans of 40 prostate IMRT patients (planning target volume = 77.8–335 cm3) and 50 VMAT patients (planning target volume = 120–351 cm3) treated before and after 2013, respectively. Both IMRT and VMAT plans used the same dose-volume criteria in the inverse planning optimization. Dose-volume histogram, mean doses of target and normal tissues (rectum, bladder and femoral heads), dose-volume points (D99% of planning target volume; D30%, D50%, V30 Gy and V35 Gy of rectum and bladder; D5%, V14 Gy, V22 Gy of femoral heads), conformity index (CI), homogeneity index (HI), gradient index (GI), prostate tumor control probability (TCP), and rectal normal tissue complication probability (NTCP) based on the Lyman-Burman-Kutcher algorithm were calculated for each IMRT and VMAT plan. From our results, VMAT plan was found better due to its higher (1.05%) CI, lower (0.83%) HI and (0.75%) GI than IMRT. Comparing doses in normal tissues between IMRT and VMAT, it was found that IMRT mostly delivered higher doses of about 1.05% to the normal tissues than VMAT. Prostate TCP and rectal NTCP were found increased (1%) for VMAT than IMRT. It is seen that VMAT technique can decrease the dose-volume evaluation criteria for the normal tissues. Based on our dosimetric and radiobiological results in treatment plans, it is concluded that our VMAT implementation could produce comparable or slightly better target coverage and normal tissue sparing with a faster treatment time in prostate radiotherapy.
Dose-volume histogram; intensity-modulated radiotherapy; normal tissue complication probability; prostate; tumor control probability; volumetric-modulated arc therapy