Prospects for improving outcomes in systemic sclerosis‐related pulmonary hypertension

Pulmonary arterial hypertension (PAH) is a leading cause of morbidity and mortality in patients with systemic sclerosis (SSc). Approximately one in 10 will develop PAH during their lifetime. These patients have a worse prognosis than those with PAH due to other causes. The most common clinical feature of SSc‐PAH in the early stages is non‐specific exercise intolerance that can be erroneously attributed to other manifestations of SSc. Screening provides an opportunity for early identification of SSc‐PAH and prompt initiation of therapies with the potential to improve quality of life and survival. International guidelines recommend annual transthoracic Doppler echocardiography (TTE), but TTE has limitations. The tricuspid regurgitant jet required for estimating the systolic pulmonary artery pressure is absent in up to 39% of patients, including a proportion with PAH. This has prompted a move to new screening algorithms that are less dependent on TTE. Not all pulmonary hypertension (PH) in patients with SSc is PAH. Other causes include PH secondary to left heart disease, interstitial lung disease‐related PH, chronic thromboembolic PH and pulmonary veno‐occlusive disease. With the advent of evidence‐based therapies, including newer agents such as macitentan, riociguat and selexipag, the establishment of centres with expertise in PAH and the focus on early detection, there has been considerable improvement in survival. The role of anti‐coagulation for SSc‐PAH has been the subject of a recent meta‐analysis of nine observational studies that suggests it may confer a survival benefit, but to date, there have been no randomised controlled trials to confirm this.     

Fibroblast Growth Factor Type 1 (FGF1)-Overexpressed Adipose-Derived Mesenchaymal Stem Cells (AD-MSC<Superscript>FGF1</Superscript>) Induce Neuroprotection and Functional Recovery in a Rat Stroke Model

Stroke, as the second most common cause of death, imposes a great financial burden on both the individual and society. Mesenchymal stem cells from rodents have demonstrated efficacy in experimental animal models of stroke due to enhanced neurological recovery. Since FGF1 (fibroblast growth factor 1) displays neuroprotective properties, for the first time, we investigated the effect of acute intravenous administration of FGF1 gene transfected adipose-derived mesenchymal stem cell (AD-MSC^FGF1) on transient experimental ischemic stroke in rats. Stroke induction was made by transient middle cerebral artery occlusion (tMCAO). 2?×?10⁶ AD-MSC^FGF1 was administrated intravenously 30 min after carotid reperfusion. The ability of technetium^99m-hexamethyl propylene amine oxime (^99mTc-HMPAO)-labeled AD-MSC^FGF1 to enter into ischemic brain was evaluated 2 h post injection. 24 h post operation, the neurological recovery (rotarod and Roger’s tests), the infarct volume (2, 3, 5-triphenyltetrazolium chloride, TTC assay), apoptosis rate (TUNEL assay), and the expression of FGF1 protein (western blotting) in the ischemic hemisphere were assessed. The ^99mTc-HMPAO-labeled AD-MSC^FGF1 could enter into the ischemic brain. Ischemic hemisphere activity was significantly higher than that observed in the contralateral hemisphere (p?=?0.002). The administration of AD-MSC^FGF1 resulted in significant improvement of neurological function tests and increased density of FGF1 protein in the peri-infarct area, while the infarct volume and the apoptotic index were significantly decreased, in comparison to the other treated groups. In conclusion, acute intravenous administration of AD-MSC^FGF1 can be a novel and promising candidate approach for the treatment of ischemic stroke.     

MSI1 overexpression in diffuse type of gastric cancer

Being the third most frequent cause of cancer mortality in the world, gastric cancer is the major cause of cancer-related mortality in Iran. Musashi1 recognizes a motif in the 3′UTR of target mRNAs – involved in cell cycle regulation, proliferation and apoptosis – and represses the translation of the mRNAs. As tissue stem cells exist in many adult tissues other than the CNS, Musashi is considered to be associated with many malignancies. In the current study, we aimed to assess Musashi1 gene expression in human stomach cancer. In total, 30 paired gastric tumoral and adjacent non-tumoral tissue specimens were examined for gene expression by qReal-Time RT-PCR. Our results demonstrated that the expression of the gene did not significantly change between tumor/non-tumor tissues (p value: 16 × 10⁻²) and different grades (p value: 36 × 10⁻²). However, there was a statistical difference between the MSI1 gene expression in different tumor types, i.e., intestinal versus diffuse type (p value: 3 × 10⁻²). All together, further investigations should be done to elucidate the precise molecular mechanisms by which MSI1 contribute to the pathogenesis of gastric cancer.     

Dispersive Micro-Solid Phase Extraction for Sensitive Determination of Methotrexate from Human Saliva Followed by Spectrophotometric Method

For biological assessing of hospital personnel occupationally exposed to antineoplastic drugs, highly sensitive and accurate methods are required. Methotrexate (MTX) is an anticancer agent that is widely used in a variety of human cancers. For the first time, dispersive-micro solid phase extraction (D-µ-SPE) has been applied for determination of low levels of MTX in saliva samples. The method is based on rapid extraction of MTX using graphene oxide adsorbent. The sample preparation time is decreased by the fact that the adsorbent dispersed in the sample solution and extraction equilibrium can be reached very fast. This significant feature which obtained with this method is of key interest for routine trace laboratory analysis. The influence of different variables on D-µ-SPE was investigated. Under optimum conditions, the calibration graph was linear over the range of 10–1000 ng/ml. The relative standard deviations are better than 9.0%. The proposed method was successfully applied for the determination of MTX in patient samples.     

Cost savings with a novel algorithm for early detection of systemic sclerosis‐related pulmonary arterial hypertension: alternative scenario analyses

Pulmonary arterial hypertension is an important cause of death and disability in patients with systemic sclerosis (SSc). Yearly screening of all SSc patients with transthoracic echocardiography (TTE) is recommended in international guidelines and currently utilised by the Australian Scleroderma Interest Group (ASIG_STANDARD). Owing to the limitations of TTE, the ASIG developed a new screening algorithm (ASIG_PROPOSED) utilising a serum biomarker, NT‐proBNP, in place of TTE, which has been shown to be equally accurate as the current algorithm. The aim of this study was to compare the cost of these two algorithms using different scenarios. The new algorithm resulted in significant yearly cost savings of between AU$42 913.35 and AU$84 570 in screening and diagnosis of an Australian cohort which, if extrapolated to the Australian population, would result in a yearly cost saving of between AU$367 066 and AU$725 564. There was no scenario in which the proposed algorithm did not result in a cost saving.     

Mercury in the Oriental Sole <Emphasis Type="Italic">(Brachirus orientalis</Emphasis>) Near a Chlor-Alkali Plant in the Persian Gulf,Iran

Total mercury in muscle and liver of Oriental sole from the largest inlet in the Persian Gulf was evaluated. Fish were collected from three channels of Moses Inlet near a chlor-alkali plant. Ahamdi and Jafari channels were closest to this plant and Ghanam was farther away. We sampled in August 2007 and February 2008. The overall estimated marginal mean for total mercury in sole tissue was 2.4 ± 0.1 mg/kg wet weight. Mercury in fish was similar in August and February; but muscle from Ahmadi contained higher mercury in August (1 ± 0.2) than in February (0.5 ± 0.01). This trend was reversed in the liver (1.3 ± 0.2 and 3.7 ± 0.3).     

Cancer patient education in Iran: a descriptive study

Abstract. This study was carried out to examine the status of cancer patient education in Iran. Using the Multinational Association of Supportive Care in Cancer's (MASCC) patient education questionnaire, 310 individuals - a sample of heterogeneous cancer patients ( n=167) and their relatives ( n=143) - were enrolled in the study. The pooled results indicated that only 15% of respondents believed more than 80% of cancer patients were told of their diagnosis. In contrast, 30% of respondents thought less than 20% of patients knew their cancer diagnosis. When asked, "Were you given written materials about (i) cancer, (ii) treatment, and (iii) symptom management", the vast majority of respondents said "No" (91%, 87%, and 87%, respectively). When respondents were asked, "Would you like to learn more about cancer and treatments", 97% said "Yes". Most respondents indicated the need for information on the treatments available (27%) and general information about cancer (20%); most had sought information from health professionals (31%), other cancer patients and friends (29%), and television (22%). Finally, it was found that concern about patients' depression (17%), lack of printed materials (13%), the idea that it was better for patients not to know (12%), and families' requests not to tell the patient (11%) were the most frequently stated barriers to or reasons for restricted cancer patient education. The findings of the study suggest that cancer patient education in Iran is very poor and there is an urgent need to develop policy guidelines on disclosure of cancer diagnoses and patient education.