Primary carcinoma of gallbladder in Yazd, Iran: A 14-year study (1992–2006)

Aim: To investigate the clinico‐pathological profile and stage of disease at presentation of patients with carcinoma of the gallbladder diagnosed during 1992–2006 in Iran. Methods: During this study period 34 consecutive patients with gallbladder carcinoma were identified using a pathology‐based tumor database. The data extracted for each study patient included their gender, age at diagnosis, signs and symptoms, presence of gallstones and histopathological pattern of the gallbladder carcinoma and the UICC/AJCC TNM staging system was used for labeling the stages of the disease. Results: The median age of the 34 patients studied was 69.50 with most between 61 and 70 years of age. The age range of the men was between 53 and 80 years with a median age of 71.50 years and that of the women was between 33 and 79 years with a median age of 68.50 years. The most common symptom was pain in the right hypochondrium. More women had gallstones (15/34) than men (3/10). Adenocarcinoma was the most common histopathological type (91.18%) with the commonest subtype being papillary (47.06%). Eighteen patients had stage IB and stage IIA (52.94%) carcinomas whereas stages IIB and III were observed in six (17.6%) and seven cases (20.6%), respectively. Only three cases (8.82%) were seen in stage IV. The follow up of gall bladder carcinoma (GBC) patients in this study ranged from 6 to 60 months. However, there was a progressive reduction of patients attending follow‐up oncology clinic, particularly by those who had stages III and IV of the disease. Conclusion: Most patients (52.94%) presented with early disease (stage IB and IIA) which carries a good prognosis. Early detection of GBC and a national consensus for the evidence‐based management of GBC in Iran should be the major components of a strategy aimed at improving therapeutic outcome.     

IL28B: Implications for Therapy

Within the last 2 years, a number of Genome-Wide Association Studies (GWAS) have shown that single nucleotide polymorphisms (SNPs) in the interleukin 28B (IL28B) gene region, encoding interferon-λ3, are predictive of hepatitis C clearance in patients receiving interferon-α and ribavirin-based treatment regimens. In addition, the same SNPs are strongly linked with spontaneous clearance of hepatitis C virus in treatment-na?ve patients. The causal variant responsible for these findings has not been identified. Nevertheless, the discovery of a correlation between the IL28B genotype status and treatment outcome has impacted all aspects of clinical decision making in patients with hepatitis C, and has opened up the very real possibility of individualized treatment regimens based on variations at the IL28B gene locus.     

Liver disease in pregnancy

Changes in the liver biochemical profile are normal in pregnancy. However, up to 3% to 5% of all pregnancies are complicated by liver dysfunction. It is important that liver disease during pregnancy is recognized because early diagnosis may improve maternal and fetal outcomes, with resultant decreased morbidity and mortality. Liver diseases that occur in pregnancy can be divided into 3 different groups: liver diseases that are unique to pregnancy, liver diseases that are not unique to pregnancy but can be revealed or exacerbated by pregnancy, and liver diseases that are unrelated to but occur coincidentally during pregnancy.     

Comparison of Health Status and Quality of Life of Related Versus Paid Unrelated Living Kidney Donors

The aim of this cross‐sectional study was to assess the health status and quality of life (QOL) of paid unrelated versus related living kidney donors postdonation at Shiraz Transplant Center in Iran. We invited all donors (n = 580, 347 paid unrelated, 233 related) who underwent donor nephrectomy at our center from 2004 to 2010 to participate in a health survey and physical examination. Of 580 donors, 144 consented to participate; participation of paid unrelated donors was significantly lower than related (52/347 vs. 92/233; p < 0.001). Participants underwent a complete physical examination, QOL assessment (using a 36‐item short form health survey [SF‐36] questionnaire) and laboratory work‐up. The paid unrelated donors compared with related donors were younger (34.2 ± 7.2 vs. 40.7 ± 9.7 years, p < 0.001), had shorter time since donation (2.9 ± 1.6 vs. 3.8 ± 2 years, p = 0.004), had higher estimated GFR (72.6 ± 22 vs. 63.8 ± 15.3 mL/min/1.73 m², p = 0.006) and had a higher percentage of patients with microalbuminuria (35% vs. 0%, p < 0.001). Additionally, general health and social functioning scores among paid unrelated donors were significantly lower (p < 0.001 and p = 0.02, respectively) than related donors. Other SF‐36 scores, although lower in paid unrelated donors, did not reach statistical significance. Iranian paid unrelated donors have lower QOL and higher incidence of microalbuminuria compared with related donors.     

Cortical reorganization in children with unilateral sensorineural hearing loss

Previous studies have shown evidence of cortical reorganization following unilateral sensorineural hearing loss (USNHL). In addition, study participants with right USNHL have shown greater deficits in academic and language performance compared with those with left USNHL. A preliminary functional magnetic resonance imaging investigation was performed on a small cohort of participants, four with left USNHL and four with right USNHL, using the paradigm of listening to random tones. While the participants with left USNHL displayed greater activation in the right superior temporal gyrus, those with right USNHL displayed greater activation in the left inferior frontal area immediately anterior to the superior temporal gyrus. The results provide preliminary evidence of disparate neural circuitry supporting auditory processing in participants with left and right USNHL.     

Synthesis, antibacterial, antifungal activity and interaction of CT-DNA with a new benzimidazole derived Cu(II) complex

The ligand [C(16)H(10)O(2)N(4)S(2)] L has been synthesized by the condensation reaction of 2-mercaptobenzimidazole and diethyloxalate. The ligand L was allowed to react with bis(ethylenediamine)Cu(II)/Ni(II) complexes to yield [C(20)H(22)N(8)S(2)Cu]Cl(2)1 and [C(20)H(22)N(8)S(2)Ni]Cl(2)2 complexes. The Ni(II) complex was synthesized only to elucidate the structure of the complex. The complexes 1 and 2 were characterized by elemental analyses, IR, NMR, EPR, UV-vis spectroscopy and molar conductance measurements. Both the complexes are ionic in nature and possess square-planar geometry. The binding of the complex 1 to calf thymus DNA was investigated spectrophotometrically. The absorption spectra of complex 1 exhibits a slight red shift with "hyperchromic effect" in presence of CTDNA. Electrochemical analysis and viscosity measurements were also carried out to ascertain the mode of binding. The complex 1 in the absence and in presence of CT DNA in aqueous solution exhibits one quasi-reversible redox wave corresponding to Cu(II)/Cu(I) redox couple at a scan rate of 0.2 V s(-1). The shift in DeltaE(p), E(1/2) and I(pa)/I(pc) values ascertain the interaction of calf thymus DNA with copper(II) complex. There is decrease in viscosity of CTDNA which indicates that the complex 1 binds to CTDNA through a partial intercalative mode. The antibacterial and antifungal studies of the [C(7)H(6)N(2)S], [C(4)H(16)N(4)Cu]Cl(2,) [C(16)H(10)N(4)S(2)O(2)] and [C(20)H(22)N(8)S(2)Cu]Cl(2) were carried out against S. aureus, E. coli and A. niger. All the results reveal that the complex 1 is highly active against the bacterial strains and also inhibits fungal growth.     

Percutaneous osteoid osteoma treatment with combination of radiofrequency and alcohol ablation

AIM: To assess the efficacy of percutaneous osteoid osteoma treatment using a combination of radiofrequency ablation (RFA) and alcohol ablation with regard to technical and long-term clinical success. MATERIALS AND METHODS: From December 2001 to November 2004, RFA and subsequent alcohol ablation was performed on 54 patients with osteoid osteoma, diagnosed clinically using radiography, computed tomography (CT) and symptoms. Under general anaesthesia, treatment was performed via percutaneous access under thin section (2mm) spiral CT guidance in all cases with an 11 G radiofrequency-compatible coaxial needle and 2mm coaxial drill system and 1.0 cm active tip 17 G non-cooled radiofrequency needle. RFA was performed at 90 degrees C for a period of 6 min. After needle removal, 0.5-1.0 ml absolute alcohol (99.8% concentration) was injected directly into the nidus using a 20 G needle. Patients were discharged within 24h and followed up clinically (at 1 week, 1 month and every 3 months thereafter). RESULTS: The technical success rate was 100%. Complications occurred in two patients consisting of local mild cellulitis in entry site and peripheral small zone paresthesia on the anterior part of leg. The follow-up period range was 13-48 months (mean+/-SD, 28.2+/-7.4 months). Prompt pain relief and return to normal activities were observed in 52 of 54 patients. Recurrent pain occurred in two patients after a 1 and 3 months period of being pain free, respectively; a second RFA and alcohol ablation was performed achieving successful results. Primary and secondary clinical success rates were 96.3% (52/54 patients) and 100% (2/2 patients), respectively. CONCLUSION: Percutaneous osteoid osteoma treatment with combination of radiofrequency and alcohol ablation is safe, effective and minimally invasive with high primary and secondary success rates. Persistent or recurrent lesions can be effectively re-treated.     

Trunk biomechanics during maximum isometric axial torque exertions in upright standing

BACKGROUND: Activities involving axial trunk rotations/moments are common and are considered as risk factors for low back disorders. Previous biomechanical models have failed to accurately estimate the trunk maximal axial torque exertion. Moreover, the trunk stability under maximal torque exertions has not been investigated. METHODS: A nonlinear thoracolumbar finite element model along with the Kinematics-driven approach is used to study biomechanics of maximal axial torque generation during upright standing posture. Detailed anatomy of trunk muscles with six distinct fascicles for each abdominal oblique muscle on each side is considered. While simulating an in vivo study of maximal axial torque exertion, effects of antagonistic coactivities, coupled moments and maximum muscle stress on results are investigated. FINDINGS: Predictions for trunk axial torque strength and relative muscle activities compared well with reported measurements. Trunk strength in axial torque was only slightly influenced by variations in coupled moments. Presence of abdominal antagonistic coactivities and alterations in maximum strength of muscles had, however, greater effect on maximal torque exertion. Abdominal oblique muscles play crucial role in generating moments in all three planes while back muscles are mainly effective in balancing moments in sagittal/coronal planes. Trunk stability is not of a concern in maximum axial torque exertions nor is it improved by antagonistic abdominal coactivities. INTERPRETATION: In contrast to previous biomechanical model studies, the Kinematics-driven approach accurately predicts the trunk response in maximal isometric axial torque exertions by taking into account detailed anatomy of abdominal oblique muscles while satisfying equilibrium requirements in all planes/directions. In maximal torque exertions, the spine is at much higher risk of tissue injury due to large segmental loads than of instability.     

The age of diagnosis of sensorineural hearing impairment in children

Objective: To identify factors responsible for delays in diagnosis and treatment of pediatric sensorineural hearing impairment (SNHI), and to assess the thoroughness of medical evaluation in these children. Design: Retrospective analysis. Setting: State-supported school for the deaf. Patients and other participants: 291 children with SNHI, the vast majority of whom are profoundly hearing impaired. Data were collected from the school's database, individual student records, and a parental questionnaire. Main outcome measures: (1) The age of diagnosis and treatment of SNHI; (2) factors leading to a delay in diagnosis; (3) current medical evaluations used to determine the etiology of SNHI; and (4) the level of parental satisfaction with the evaluation process. Results: Many children with SNHI experience delays in diagnosis from the time of first suspicion of hearing loss. Children with a risk factor for SNHI are diagnosed no earlier than children without a risk factor. Caucasian children are diagnosed significantly earlier than either Black or Hispanic children, regardless of socioeconomic status. Inconsistent medical evaluation ensues following the diagnosis of SNHI, and parental satisfaction with this process is low. Conclusions: The average age of diagnosis of SNHI remains unacceptably high. There exists a need to enhance physician awareness of childhood deafness and to develop guidelines for the medical evaluation in cases of pediatric SNHI. Lastly, the importance of parental concern regarding a child's hearing or language development must be re-emphasized.     

Obesity and Obesity Shape Markedly Influence Spine Biomechanics: A Subject-Specific Risk Assessment Model

Underlying mechanisms of obesity-related back pain remain unexplored. Thus, we aim to determine the effect of obesity and its shapes on the spinal loads and the associated risks of injury. Obesity shapes were initially constructed by principal component analysis based on datasets on 5852 obese individuals. Spinal loads, cycles to vertebral failure and trunk stability margin were estimated in a subject-specific trunk model taking account of personalized musculature, passive ligamentous spine, obesity shapes, segmental weights, spine kinematics and bone mineral density. Three obesity shapes (mean and extreme abdominal circumferences) at three body weights (BWs) of 86, 98 and 109 kg were analyzed. Additional BW (12 kg) increased spinal loads by ~11.8%. Higher waist circumferences at identical BW increased spinal forces to the tune of ~20 kg additional BW and the risk of vertebral fatigue compression fracture by 3–7 times when compared with smaller waist circumferences. Forward flexion, greater BW and load in hands increased the trunk stability margin. Spinal loads markedly increased with BW, especially at greater waist circumferences. The risk of vertebral fatigue fracture also substantially increased at greater waist circumferences though not at smaller ones. Obesity and its shape should be considered in spine biomechanics.