Peak bone mass of Iranian population: the Iranian Multicenter Osteoporosis Study.

Osteoporosis is a major public health problem in the Western countries and is projected to have a similar impact in the Middle East. It has been suggested that peak bone mineral density (BMD), a major determinant of osteoporotic fractures later in life, may be lower in this part of the world compared with the Western world. The purpose of the Iranian Multicenter Osteoporosis Study was to determine peak bone mass in a randomly chosen sample of healthy Iranian subjects. A total of 5201 participants (2340 males, mean age 42.7+/-13.8) were recruited based on randomized clustered sampling from all regions of five major cities across the country. In women, peak lumbar BMD (1.182+/-0.127 g/cm2) occurred in the 29- to 33-yr age group, whereas peak total femur BMD (1.006+/-0.126 g/cm2) occurred in the 32- to 36-yr age group. In men, peak lumbar BMD (1.181+/-0.153 g/cm2) and femoral BMD (1.096+/-0.159 g/cm2) both occurred in the 20- to 24-yr age group. When standardized to mg/cm2 units using established formulas, Iranian peak bone mass values are comparable with that of Western countries and are generally higher than that of Eastern Asian and Middle Eastern countries.     

Percutaneous Excisional Biopsy of Palpable Breast Masses under Ultrasound Visualization

Abstract:   A palpable breast mass is a common reason for surgical consultation. Our goal was to determine whether ultrasound-guided vacuum-assisted core biopsy (US-VACB) is safe and effective in completely removing presumed benign palpable breast masses. We conducted a cohort study of 201 consecutive patients with presumed benign palpable masses who underwent removal with US-VACB. The main outcome measured was the successful removal of palpable masses. Palpable masses were successfully removed with US-VACB in 99% of cases; 2% were cancer and 7.5% were atypical ductal hyperplasia or phyllodes tumor. Two clinical recurrences representing a seroma were seen on follow-up. US-VACB is safe and effective in the initial diagnosis and management of presumed benign palpable breast masses. It provides the benefits of percutaneous biopsy and the palpable abnormality no longer remains.      

Excisional biopsy of borderline lesions after large bore vacuum-assisted core needle biopsy- is it necessary?

The current recommendation for borderline breast lesions after core needle biopsy is for surgical excision due to a high rate of pathologic underestimation. With the use of vacuum-assisted core needle (VACN) biopsy devices, upgrade rates have improved, but still average 20 per cent. We routinely use larger bore VACNs (7- and 8-gauge) than previously reported (9 to 11-gauge). The aim of this study is to evaluate the upgrade rate to malignancy in patients undergoing VACN using larger bore needles. VACN biopsies were performed in 902 patients. Of those, 87 were recommended excisional biopsy for borderline or noncorrelating lesions and 66 underwent the procedure. Two patients were upgraded to cancer, for an overall upstage rate of 3 per cent. Both of these underestimations were in patients that initially had atypical ductal hyperplasia. In the patients not excised, no patient developed further cancer. A 7- or 8-gauge needle was used in 57 per cent of patients, greater than 90 per cent removal of the initial lesion was accomplished in 53 per cent of cases, and there were no bleeding complications. This study suggests that upgrade rates decline with larger bore biopsy needles with near complete excision of the initial lesion, and that some borderline lesions may potentially be managed nonoperatively.     

Persistent infections with Sendai virus and Newcastle disease viruses

Summary Persistent infections (Pi) were established in two host-cell systems [Madin-Darby bovine kidney (MDBK) and Madin-Darby canine kidney (MDCK)] with Sendai virus and three strains of NDV, to test the influence of different viruses and host-cell systems.Virus was recovered from the persistently infected cells. An RNA- ts mutant was recovered from a Pi of MDBK cells, but no Pi could be established in MDCK cells with the three strains of NDV. Additionally, the Pi was established exclusively by a virulent strain, NDV-Milano.On the other hand, Sendai virus could establish Pi in MDBK and MDCK cell-systems. Several ts mutants were recovered from late passages of Pi, and from an accidental infection, a ts mutant with an altered P polypeptide. Ten other ts mutants were tested, however, the specific ts lesion could not be identified. From three Pi in MDCK cells, host range mutants (ts-f1, ts-f2, and ts-f3) were recovered. One of the mutants (ts-f1) has an altered M (matrix) protein. The host range mutants undergo a productive infection in MDBK and MDCK cells, which are nonpermissive for wild type Sendai virus. The possible significance of the results are discussed.With 5 Figures     

Anticancer properties of green-synthesised zinc oxide nanoparticles using Hyssopus officinalis extract on prostate carcinoma cells and its effects on testicular damage and spermatogenesis in Balb/C mice

The unclear bio-safety issue and potential risk of nanoparticles (NPs) on various organelles can be considered as a major challenge. In the present study, we have assessed the green synthesis of ZnO nanoparticles using Hyssop (Hyssopus officinalis) extract and their effects on PC3 cell line and BALB/c mice model. The cytotoxicity of the ZnO-NPs was assessed on PC3 cell line by MTT test after characterisation. Apoptotic effect of ZnO-NPs was determined by in vitro AO/PI staining. The histopathological assessments and determination of LH and FSH levels carried out as in vivo analysis in BALB/c adult male mice. The expression of major genes involved in spermatogenesis and sperm maturation (Adam3, Prm1, Spata19, Tnp2, Gpx5) were also analysed. The obtained result demonstrated that the IC₅₀ for PC3 cell line treated with green-synthesised ZnO-NPs during 24 and 48 hr was reported 8.07 and 5 µg/ml respectively. Meanwhile, the induced apoptosis was recorded 26.6% ± 0.05, 44% ± 0.12 and 80% ± 0.07 of PC3 cells. The results of gene expression analysis revealed that the increase in the concentration of ZnO-NPs significantly (p < .05) down-regulated the Adam3, Prm1, Spata-19, Tnp2 and Gpx5 genes. The overall results of this research elucidated that ZnO-NPs impaired spermatogenesis, sperm maturation process and sperm motility.     

Mitral valve‐in‐valve replacement supported by a transapically snared guidewire via septostomy

We describe a 72‐year‐old woman, a known case of rheumatic heart disease with a history of mitral and aortic valve replacement 8 years previously, who underwent mitral valve‐in‐valve replacement supported by a transapically snared guidewire through septostomy.     

The use of CMVIg rescue therapy in cardiothoracic transplantation: A single‐center experience over 6 years (2011‐2017)

Cytomegalovirus (CMV) is the most important infectious agent in solid organ transplant recipients and has a major impact on morbidity and mortality. Most cases are well managed with antiviral agents, but CMV hyperimmune globulin (CMVIg) can be used alongside antiviral therapy for prophylaxis in high‐risk thoracic organ recipients and to treat life‐threatening CMV infection or disease. CMVIg may also improve antiviral host defences when genetic resistance to antivirals or unwanted side effects occur. In this single‐center, retrospective study, we reviewed the CMVIg use to supplement antiviral therapy as a “rescue therapy” in cardiothoracic transplant recipients. These comprised 12 single lung, 11 double lung, and 12 heart transplant recipients. Patients received a median of 2 doses of CMVIg, most often in combination with ganciclovir or valganciclovir, and reduced immunosuppression. One week after rescue therapy was initiated, CMV DNA levels were significantly reduced, and after four weeks, CMV DNA was undetectable in 73% patients. Only one patient died as a result of CMV‐related disease. No significant adverse effects were observed. We conclude that CMVIg rescue therapy is safe, well tolerated, and effective at controlling viral replication in cardiothoracic transplant recipients.     

Brain structure and function in patients with ovarian cancer treated with first-line chemotherapy: a pilot study

Women with ovarian cancer often undergo chemotherapy involving multiple agents. However, little is known about treatment-related central neurotoxicity in this population. The goal of this cross-sectional study was to assess brain structure and function and neurocognitive abilities in patients with ovarian cancer following first-line chemotherapy. Eighteen patients with ovarian, peritoneal and fallopian tube cancer and eighteen healthy controls matched for gender, age and education participated in the study. The patients were evaluated 1–4 months following completion of first-line taxane/platinum chemotherapy. All participants underwent structural and functional magnetic resonance imaging (MRI), and completed neuropsychological tests of attention, memory and executive functions. Neuroimaging assessments included voxel-based morphometry (VBM) for measuring gray matter (GM) volume, and functional MRI (fMRI) during the N-back working memory task. The results of VBM showed that patients had significantly reduced GM volume compared to healthy controls in the right middle/superior frontal gyrus, and in the left supramarginal gyrus and left inferior parietal lobule. fMRI results indicated significantly decreased activation in patients relative to healthy controls in the left middle frontal gyrus and left inferior parietal lobule during the N-back task (1/2/3-back >0-back). There were no statistically significant differences between the two groups on the neuropsychological tests. This is the first study showing structural and functional alterations involving frontal and parietal regions in patients with ovarian cancer treated with first-line chemotherapy. These findings are congruent with studies involving women with breast cancer, and provide additional supporting evidence for central neurotoxicity associated with taxane/platinum chemotherapy.     

Comparison of carpal tunnel release with three different techniques

Background

Carpal tunnel syndrome is one of the most common compression neuropathies in the upper limbs and requires surgery if conservative treatment fails. This article compares the result of regular open incision, mid-palmar mini incision and endoscopic technique in carpal tunnel release.

Methods

This is a clinical trial study on 105 patients (10 males, 95 females) within one year, who were surgical candidates. The surgery was done with regular open incision or with mid-palmar small incision. The clinical outcomes were evaluated one week, 4 weeks and 4 months post-surgery.

Results

Relief and satisfaction were better in the first month in the endoscopic and mid-palmar mini incision group. All 3 techniques had similar outcomes after 4 months. In the 4-month follow-up, night pain relief, followed by parasthesia relief had the best improvement. Weakness was the symptom with the least improvement. Longer incision cases were associated with more delay to return to work.

Conclusion

Carpal tunnel release with endoscopic and mini incision techniques have better early satisfaction rates compared to regular open incision, but no difference is seen between the two groups after four months.