Safety and efficacy of salvage conventional re-irradiation following stereotactic radiosurgery for spine metastases

Purpose@#There has been limited work assessing the use of re-irradiation (re-RT) for local failure following stereotactic spinal radiosurgery (SSRS). We reviewed our institutional experience of conventionally-fractionated external beam radiation (cEBRT) for salvage therapy following SSRS local failure. @*Materials and Methods@#We performed a retrospective review of 54 patients that underwent salvage conventional re-RT at previously SSRS-treated sites. Local control following re-RT was defined as the absence of progression at the treated site as determined by magnetic resonance imaging. @*Results@#Competing risk analysis for local failure was performed using a Fine-Gray model. The median follow-up time was 25 months and median overall survival (OS) was 16 months (95% confidence interval [CI], 10.8–24.9 months) following cEBRT re-RT. Multivariable Cox proportional-hazards analysis revealed Karnofsky performance score prior to re-RT (hazard ratio [HR] = 0.95; 95% CI, 0.93–0.98; p = 0.003) and time to local failure (HR = 0.97; 95% CI, 0.94–1.00; p = 0.04) were associated with longer OS, while male sex (HR = 3.92; 95% CI, 1.64–9.33; p = 0.002) was associated with shorter OS. Local control at 12 months was 81% (95% CI, 69.3–94.0). Competing risk multivariable regression revealed radioresistant tumors (subhazard ratio [subHR] = 0.36; 95% CI, 0.15–0.90; p = 0.028) and epidural disease (subHR = 0.31; 95% CI, 0.12–0.78; p =0.013) were associated with increased risk of local failure. At 12 months, 91% of patients maintained ambulatory function. @*Conclusion@#Our data suggest that cEBRT following SSRS local failure can be used safely and effectively. Further investigation is needed into optimal patient selection for cEBRT in the retreatment setting.

Mechanistic Insight into Age-Related Macular Degeneration (AMD):Anatomy, Epidemiology, Genetics, Pathogenesis, Prevention, Implications, and Treatment Strategies to Pace AMD Management / 전남의대학술지

One of the most complicated eye disorders is age-related macular degeneration (AMD) which is the leading cause of irremediable blindness all over the world in the elderly.AMD is classified as early stage to late stage (advanced AMD), in which this stage is divided into the exudative or neovascular form (wet AMD) and the nonexudative or atrophic form (dry AMD). Clinically, AMD primarily influences the central area of retina known as the macula. Importantly, the wet form is generally associated with more severe vision loss. AMD has a systemic component, where many factors, like aging, genetic, environment, autoimmune and non-autoimmune disorders are associated with this disease. Additionally, healthy lifestyles, regular exercise, maintaining a normal lipid profile and weight are crucial to decreasing the risk of AMD. Furthermore, therapeutic strategies for limiting AMD should encompass a variety of factors to avoid and improve drug interventions, and also need to take into account personalized genetic information. In conclusion, with the development of technology and research progress, visual impairment and legal blindness from AMD have been substantially reduced in incidence. This review article is focused on identifying and developing the knowledge about the association between genetics, and etiology with AMD. We hope that this review will encourage researchers and lecturers, open new discussions, and contribute to a better understanding of AMD that improves patients’ visual acuity, and upgrades the quality of life of AMD patients.

Overexpression of miR-146a and miR-155 are Potentially Biomarkers and Predict Unfavorable Relationship between Gastric Cancer and Helicobacter pylori Infection / 전남의대학술지

Gastric Cancer (GC) is one of the most dangerous malignancies in the world. This study aims to evaluate the relationship between miR-146a and miR-155 in patients with H. pylori infections with GC compared to H. pylori-infected patients and healthy subjects. Forty patients with H. pylori and GC positive diagnoses and 40 patients with H. pylori positive and GC negative diagnoses, and 40 healthy persons were selected.The expression of miR-146a and miR-155 genes in the whole blood was examined using qRT-PCR. Moreover, ROC curves were drawn to represent the sensitivity and specificity of miR-146a and miR-155 expression as biomarkers. The results showed the expression of miR-146a and miR-155 in the whole blood of patients with H. pylori and GC positive diagnoses are significantly higher than in healthy individuals and are non-significantly enhanced compared to H. pylori positive and GC negative. Also, the results stated miR-146a and miR-155 expression in the whole blood of patients who are H. pylori positive and GC negative are significantly increased compared to healthy individuals. Furthermore, the ROC curve analysis of miR-146a and miR-155 RNA level demonstrated the two miRNAs have an appropriate sensitivity and specificity for diagnostic goals. In conclusion, H. pylori infection may increase the expression of miR-146a and miR-155 in patients with H. pylori and GC positive diagnoses, which can be effective in the curbing the progression of GC. For this reason, up-regulation of miR-146a and miR-155 along with H. pylori infection might contribute to the pathogenesis of GC, and also can be suggested as biomarkers for GC diagnosis and treatment.

Post-dural puncture headache prevention and treatment with aminophylline or theophylline:a systematic review and meta-analysis

Background@#Post-dural puncture headache (PDPH) is one of the most common complications in patients undergoing spinal anesthesia. The present systematic review and meta-analysis aimed to assess the therapeutic and prophylactic effects of aminophylline and theophylline on PDPH. @*Methods@#Relevant studies were identified by searching the following electronic databases, without language restriction, until June 2020: Scopus, EMBASE, MEDLINE, Google Scholar, Web of Science, Cochrane Library-CENTRAL, and CINAHL Complete. Random effects models were used to calculate the standardized mean difference (SMD) and risk ratios (RRs) with 95% confidence intervals (95% CI) to assess the therapeutic and prophylactic effects of aminophylline and theophylline on PDPH, respectively. The Cochrane tool was used for the quality assessment of the included studies. The certainty of the evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation method. @*Results@#Of the 1,349 initial records, 15 met our eligibility criteria (6 studies on therapeutic and 9 on prophylactic effects). A significant reduction in the pain score was observed following aminophylline/theophylline treatment (SMD = –1.67; 95% CI, –2.28 to –1.05; P < 0.001, I2 = 84.7%; P < 0.001). Subgroup analysis revealed that the therapeutic effect was significantly higher when these agents were compared to placebo than when conventional therapies were used. The risk of PDPH after aminophylline administration was not significantly reduced (RR = 0.74; 95% CI, 0.42 to 1.31; P = 0.290). @*Conclusions@#Theophylline and aminophylline have therapeutic, but not prophylactic, effects on PDPH.

Effect of continuous intra-incisional bupivacaine on postoperative pain in non-traumatic spinal fixation surgeries: a randomized controlled trial

Abstract Background Continuous injection of local anesthetics by using surgical wound catheters for postoperative pain relief has gained acceptance in recent years. However, whether this method can be alternatively used instead of systemic opioids in different surgical procedures has not yet been elucidated. Objectives The aim was to investigate the effect of continuous injection of bupivacaine through a catheter inside the surgical wound on reducing the postoperative pain of lumbar spine fusion surgeries. Methods In this clinical trial, 31 patients undergoing non-traumatic lumbar spine stabilization surgery were randomly assigned to receive (n = 15) or do not receive (n = 16) bupivacaine through a catheter inside the surgical wound, postoperatively. Pain intensity (NRS), dose of required morphine, and drug-related complications within 24 hours of intervention were assessed and compared by the Mann-Whitney and independent t-test. Results Mean pain intensity was significantly lower in the case group over the first postoperative hour in the recovery room (p < 0.001), which continued for the first 2 hours after entering the ward. The mean morphine intake was lower in the bupivacaine group during the first postoperative 24 hours (16 ± 0.88 vs. 7.33 ± 0.93 mg, p < 0.001). The two groups were not significantly different regarding drug-related complications. Conclusion Continuous intra-incisional infusion of bupivacaine helped better pain reduction during the early postoperative hours while sparing morphine consumption in the first postoperative day.

Associação do Genótipo e Fenótipo da Paraoxonase-1 com Angiografia Positiva para Doença Arterial Coronariana / Association of Paraoxonase-1 Genotype and Phenotype with Angiogram Positive Coronary Artery Disease

Resumo Fundamento Tem sido demonstrado que um aumento dos níveis séricos de PON1 é protetor contra vários distúrbios. Foi relatado que vários polimorfismos de nucleotídeo único (SNPs, single nucleotide polymorphisms ) do gene PON1 estão associados a níveis e atividade de proteínas enzimáticas séricas. Objetivos Investigar a associação de SNPs do PON1 e atividade da paraoxonase sérica com a doença arterial coronariana (DAC). Métodos Foram estudados 601 pacientes não relacionados submetidos à angiografia coronária, incluindo aqueles com estenose >50% (N=266) e aqueles com estenose <30% (N=335). Os SNPs rs662 e rs840560 do gene da paraoxonase foram determinados utilizando o método ARMS-PCR e o SNP rs705379 foi genotipado utilizando análise de PCR-RFLP. A atividade da paraoxonase sérica foi medida utilizando paraoxon como substrato. O valor de p<0,05 foi considerado significante. Resultados A atividade da paraoxonase sérica não foi significativamente diferente entre os grupos de estudo. Após ajuste para idade, sexo, hipertensão, diabetes mellitus e dislipidemia, o genótipo GG e o modelo codominante de rs662 foram positivamente associados a uma angiografia positiva (respectivamente, OR = 2,424, IC 95% [1,123-5,233], p <0,05, OR = 1,663, IC 95% [1,086-2,547]). A atividade da paraoxonase sérica foi significativamente maior no alelo G e variante GG do polimorfismo rs662, alelo A e variante AA de rs854560 e alelo C e variante CC de rs705379. A análise de haplótipos mostrou que o haplótipo ATC foi significativamente mais prevalente no grupo com angiografia negativa. A análise entre os grupos indicou que o alelo A de rs662 foi significativamente associado à menor atividade da paraoxonase no grupo com angiografia positiva (p=0,019). Conclusões A presença do alelo G do polimorfismo de nucleotídeo único rs662 está independentemente associada ao aumento do risco de DAC.

Abstract Background It has been shown that increased serum PON1 levels are protective against several disorders. Several single nucleotide polymorphisms (SNPs) of the PON1 gene have been reported to be associated with serum enzyme protein levels and activity. Objective To investigate the association of SNPs of PON1 and serum paraoxonase activity with coronary artery disease (CAD). Methods A total of 601 unrelated patients who underwent coronary angiography including those who had >50% stenosis (N=266) and those with <30% stenosis (N=335) were studied. The Paraoxonase gene rs662 and rs840560 SNPs were determined using the ARMS-PCR method and the rs705379 SNP was genotyped using PCR-RFLP analysis. Serum paraoxonase activity was measured using paraoxon as a substrate. A p value of p<0.05 was considered as significant. Results Serum paraoxonase activity was not significantly different between the study groups. After adjustment for age, sex, hypertension, diabetes mellitus and dyslipidemia, the GG genotype and co-dominant model of rs662 was positively associated with a positive angiogram (respectively, OR=2.424, 95%CI [1.123-5.233], p<0.05, OR=1.663, 95%CI [1.086-2.547]). Serum paraoxonase activity was significantly higher in the G allele and GG variant of rs662, A allele and AA variant of rs854560 and C allele and CC variant of rs705379. The haplotype analysis has shown that the ATC haplotype was significantly more prevalent among the angiogram negative group. The analysis between groups indicated that the A allele of rs662 was significantly associated with lower paraoxonase activity in the positive angiogram group (p=0.019). Conclusions The presence of the G allele of the rs662 single nucleotide polymorphism is independently associated to increased risk of CAD.

A new combination of naringin and trimetazidine protect kidney Mitochondria dysfunction induced by renal Ischemia / Reperfusion injury in rat

Abstract Ischemia/reperfusion (IR) injury leads to overproduction of Reactive Oxygen Species (ROS), and disrupts membrane potential that contributes to cell death. The aim of this study was to determine if naringin (NAR), trimetazidine (TMZ) or their combination, protect the kidney mitochondrial from IR injury. Forty rats were randomly allocated into five groups, harboring eight rats each: Sham, IR, NAR (100 mg/kg), TMZ (5 mg/kg) and NAR plus TMZ. Ischemia was induced by obstructing both renal pedicles for 45 min, followed by reperfusion for 4 hours. The mitochondria were isolated to examine the ROS, Malondialdehyde (MDA), Glutathione (GSH), mitochondrial membrane potential (MMP) and mitochondrial viability (MTT). Our findings indicated that IR injury resulted in excessive ROS production, increased MDA levels and decreased GSH, MMP and MMT levels. However, NAR, TMZ or their combination reversed these changes. Interestingly, a higher protection was noted with the combination of both, compared to each drug alone. We speculate that this combination demonstrates a promising process for controlling renal failure, especially with the poor clinical outcome, acquired with NAR alone. This study revealed that pretreatment their combination serves as a promising compound against oxidative stress, leading to suppression of mitochondrial stress pathway and elevation of GSH level.

Knowledge about Autism Spectrum Disorder (ASD) Predicts Motivation to Volunteer: A Cross-Sectional Survey among Psychology Students (Pengetahuan mengenai ASD merupakan peramal untuk kesukarelawanan: Kajian keratan rentas dalam kalangan pelajar Psikologi) / Jurnal Sains Kesihatan Malaysia

@#Children with Autism Spectrum Disorder (ASD) and their parents require support from the community, and could profit from volunteer work involving the family. At the same time, university students demonstrate a high willingness to volunteer in community initiatives such as work involving children with ASD. This study aims to examine the relationship between ASD knowledge and the motivation to volunteer among university students. Students (N=150) from a private university in the Klang Valley, Malaysia, participated in this study. Instruments utilized in this study were the Stone Autism Survey and Volunteer Functions Inventory. The results indicated that a higher level of ASD knowledge was the strongest predictor of higher motivation to volunteer after adjusting for relevant demographic factors and exposure to ASD children. Meanwhile, female and Hindu participants reported a significantly higher motivation to volunteer. This study emphasizes the need to increase factual knowledge about ASD among university students, and any effort to encourage students to volunteer in helping individuals with ASD should include knowledge sharing about this population.

Microorganism-derived biological macromolecules for tissue engineering / 医学前沿

According to literature, certain microorganism productions mediate biological effects. However, their beneficial characteristics remain unclear. Nowadays, scientists concentrate on obtaining natural materials from live creatures as new sources to produce innovative smart biomaterials for increasing tissue reconstruction in tissue engineering and regenerative medicine. The present review aims to introduce microorganism-derived biological macromolecules, such as pullulan, alginate, dextran, curdlan, and hyaluronic acid, and their available sources for tissue engineering. Growing evidence indicates that these materials can be used as biological material in scaffolds to enhance regeneration in damaged tissues and contribute to cosmetic and dermatological applications. These natural-based materials are attractive in pharmaceutical, regenerative medicine, and biomedical applications. This study provides a detailed overview of natural-based biomaterials, their chemical and physical properties, and new directions for future research and therapeutic applications.

The Association of COVID-19 and Reactive Oxygen Species Modulator 1 (ROMO1) with Oxidative Stress / 전남의대학술지

There is no denying that the massive spread of COVID-19 around the world has worried everyone. The virus can cause mild to severe symptoms in various organs, especially the lungs. The virus affects oxidative stress in the cells. Reactive Oxygen Species modulator 1 (ROMO1) is one of the most important mitochondrial proteins that plays a critical regulatory role in the production of Reactive Oxygen Species (ROS). According to the studies, COVID-19 can promote oxidative stress through some important pathways, for instance, TNF-α and NF-κB routes. Furthermore, ROMO1 is closely related to these pathways and its dysfunction may affect these routes, then promote oxidative stress, and ultimately cause tissue damage, especially in the lungs. Another factor to consider is that the TNF-α and NF-κB pathways are associated with ROMO1, COVID-19, and oxidative stress. To summarize, it is hypothesized that COVID-19 may increase oxidative stress by affecting ROMO1. Understanding the exact molecular mechanisms of ROMO1 in the pathogenesis of COVID-19 can pave the way to find better therapeutic strategies.

Naringin and trimetazidine improve baroreflex sensitivity and nucleus tractus solitarius electrical activity in renal ischemia-reperfusion injury / Naringin and trimetazidine improve baroreflex sensitivity and nucleus tractus solitarius electrical activity in renal ischemia-reperfusion injury

Resumo Fundamento: O núcleo do trato solitário (NTS) é uma área do cérebro que desempenha um papel fundamental na regulação renal e cardiovascular através dos impulsos dos barorreceptores. Objetivos: O objetivo deste estudo foi avaliar o efeito da Naringina (NAR) e trimetazidina (TMZ), isoladamente e combinadas, na atividade elétrica do NTS e na sensibilidade barorreflexa (SBR) na lesão de isquemia e reperfusão (I/R) renal. Métodos: Foram utilizados quarenta ratos machos Sprague-Dawley (200-250 g), alocados em 5 grupos com 8 ratos cada. Grupos: 1) Sham; 2) I/R; 3) TMZ 5 mg/kg; 4) NAR 100 mg/kg; e 5) TMZ5 + NAR100. A veia femoral esquerda foi canulada para infundir a solução salina ou droga e avaliar a SBR. A I/R foi induzida por oclusão dos pedículos renais por 45 min, seguida de reperfusão de 4 horas. O eletroencefalograma local do NTS foi registrado antes, durante a isquemia e durante a reperfusão. A fenilefrina foi injetada por via intravenosa para avaliar a SBR ao final do tempo de reperfusão. Os dados foram analisados por ANOVA de duas vias com medidas repetidas seguida pelo teste post hoc de Tukey. Um valor de p<0,05 foi considerado como significativo. Resultados: As ondas elétricas do NTS não se alteraram durante o tempo de isquemia, mas diminuíram significativamente durante todos os tempos de reperfusão. A atividade elétrica do NTS e a SBR foram reduzidas drasticamente em ratos com lesão I/R; no entanto, a administração de NAR e TMZ, isoladamente e combinadas, melhorou significativamente essas alterações em ratos com lesão I/R. Conclusões: Os resultados mostraram que a lesão de I/R leva à redução da atividade elétrica da SBR e do NTS, e pode haver uma ligação entre a I/R e a diminuição da SBR. Além disso, a NAR e a TMZ são agentes promissores para tratar complicações de I/R.

Abstract Background: Nucleus tractus solitarius (NTS) is a brain area that plays a key role in kidney and cardiovascular regulation via baroreceptors impulses. Objectives: The aim of this study was to evaluate the effect of naringin (NAR) and trimetazidine (TMZ) alone and their combination on NTS electrical activity and baroreceptor sensitivity (BRS) in renal ischemia- reperfusion (I/R) injury. Methods: Forty male Sprague-Dawley rats (200- 250 g) were allocated into 5 groups with 8 in each. 1) Sham; 2) I/R; 3) TMZ 5 mg/kg; 4) NAR 100 mg/kg; and 5) TMZ5+ NAR100. The left femoral vein was cannulated to infuse saline solution or drug and the BRS was evaluated. I/R was induced by occlusion of renal pedicles for 45 min, followed by 4 hours of reperfusion. The NTS local electroencephalogram (EEG) was recorded before, during ischemia and throughout the reperfusion. Phenylephrine was injected intravenously to evaluate BRS at the end of reperfusion time. The data were analyzed by two-way repeated measurement ANOVA followed by Tukey's post hoc test. A p-value <0.05 was considered significant. Results: NTS electrical waves did not change during ischemia time, while they significantly decreased during the entire reperfusion time. NTS electrical activity and BRS dramatically reduced in rats with I/R injury; however, administration of NAR, TMZ alone or their combination significantly improved these changes in rats with I/R injury. Conclusions: The results showed that I/R injury leads to reduced BRS and NTS electrical activity and there may be an association between I/R and decreased BRS. In addition, NAR and TMZ are promising agents to treat I/R complications.

Methylene blue for treatment of hospitalized Covid-19 patients: a randomized, controlled, open-label clinical trial, phase 2

ABSTRACT Background: There is no pharmacological intervention on the treatment of hypoxemia and respiratory distress in COVID-19 patients. Objective: The objective of the study was to study the effect of the reduced form of methylene blue (MB) on the improvement of oxygen saturation (SpO2) and respiratory rate (RR). Methods: In an academic medical center, 80 hospitalized patients with severe COVID-19 were randomly assigned to receive either oral MB along with standard of care (SOC) (MB group, n = 40) or SOC only (SOC group, n=40). The primary outcomes were SpO2 and RR on the 3rd and 5th days. The secondary outcomes were hospital stay and mortality within 28 days. Results: In the MB group, a significant improvement in SpO2 and RR was observed on the 3rd day (for both, p < 0.0001) and also the 5th day (for both, p < 0.0001). In the SOC group, there was no significant improvement in SpO2 (p = 0.24) and RR (p = 0.20) on the 3rd day, although there was a significant improvement of SpO2 (p = 0.002) and RR (p = 0.01) on the 5th day. In the MB group in comparison to the SOC group, the rate ratio of increased SpO2 was 13.5 and 2.1 times on the 3rd and 5th days, respectively. In the MB group compared with the SOC group, the rate ratio of RR improvement was 10.1 and 3.7 times on the 3rd and 5th days, respectively. The hospital stay was significantly shortened in the MB group (p = 0.004), and the mortality was 12.5% and 22.5% in the MB and SOC groups, respectively. Conclusions: The addition of MB to the treatment protocols significantly improved SpO2 and respiratory distress in COVID-19 patients, which resulted in decreased hospital stay and mortality. ClinicalTrials.gov: NCT04370288

Anatomical characteristics of mandibular bone in skeletal class I, II and III patients by using cone beam computed tomography images in an iranian population / Características anatômicas do osso mandibular em pacientes Classe I, II e III esquelética usando imagens de Tomografia Computadorizada de Feixe Cônico: em uma População Iraniana

Objetive: This study aimed to compare the anatomical characteristics of the mandible in patients with skeletal class I, II and class III disorders using cone beam computed tomography (CBCT). Material and Methods: CBCT scans of patients between 17 to 40 years taken with NewTom 3G CBCT system with 12-inch field of view (FOV) were selected from the archive. Lateral cephalograms were obtained from CBCT scans of patients, and type of skeletal malocclusion was determined (Class I, II or III). All CBCT scans were evaluated in the sagittal, coronal and axial planes using the N.N.T viewer software. Results: The ramus height and distance from the mandibular foramen to the sigmoid notch in class II patients were significantly different from those in skeletal class I (P < 0.005). Distance from the mandibular canal to the anterior border of ramus in class III individuals was significantly different from that in skeletal class I individuals (P < .005). Conclusion: Length of the body of mandible in skeletal class I was significantly different from that in skeletal class II and III patients. Also, ramus height in skeletal class I was significantly different from that in skeletal class II patients. CBCT had high efficacy for accurate identification of anatomical landmarks. (AU)

Objetivo: Este estudo teve como objetivo comparar as características anatômicas da mandíbula em pacientes com desordem esquelética Classe I, II e III usando imagens de tomografia computadorizada de feixe cônico (TCFC). Material e Métodos: Foram selecionadas de arquivo, imagens de TCFC (Sistema NewTon 3G) com FOV (campo de visão) 12 polegadas e incluindo pacientes entre 17 a 40 anos. Cefalometrias laterais foram obtidas a partir das imagens de TCFC e o tipo de maloclusão esquelética foi determinada (Classe I, II ou III). Todas as imagens de TCFC foram avaliadas nos planos sagital, coronal e axial usando o software de visualização N.N.T. Resultados: A altura do ramo e distância do forame mandibular para a incisura da mandíbula em pacientes Classe II foi significativamente diferente daqueles Classe I esquelética (p< 0.005). A distância do canal mandibular até a borda anterior do ramo em indivíduos Classe III foi significativamente diferente daqueles indivíduos Classe I esquelética (p<0.005). Conclusão: O comprimento do corpo da mandíbula na Classe I esquelética foi diferente significativamente daqueles pacientes em Classe II e III esquelética. Além disso, a altura do ramo na Classe I esquelética foi significativamente diferente daqueles pacientes Classe II esquelética. A TCFC apresentou alta eficácia para a identificação precisa de marcos anatômicos. (AU)

Development and psychometric evaluation of performance-based upper extremity motor control test (PB-UE-MCT) for people with cerebral palsy / Desenvolvimento e avaliação psicométrica do Teste de Controle Motor das Extremidades Superiores com Base no Desempenho (PB-UE-MCT) para pessoas com paralisia cerebral

Abstract Introduction Upper extremity disorders limits the performance in the activities of daily living, especially, in bilateral (two-handed) activities. Objective This study was designed to develop a performance-based upper extremity motor control test (PB-UE-MCT) and to measure its psychometric properties (including, convergent validity, intrarater reliability, and interrater reliability) for people with cerebral palsy (CP). Method The PB-UE-MCT was developed in three phases, including planning, construction, and psychometric evaluation. The participants included 50 people with CP with an age range of 6 to 18 years. To measure internal consistency, Cronbach's alpha was run (n=50). Intrarater and interrater reliability was measured for 25 participants. To assess convergent validity, the correlations of the PB-UE-MCT with the Manual Ability Classification System (MACS) and with the Selective Control Upper Extremity Scale (SCUES) were calculated. Results The values obtained for Cronbach's alpha (.90 to .96) indicated the excellent internal consistency of the PB-UE-MCT. The ICC values for intrarater reliability and interrater reliability were between .84 and .99 and between .89 and .99, respectively. The correlation coefficients obtained for the items of the PB-UE-MCT and those of the MACS were between .51 and .73. The correlation coefficients of the items of the PB-UE-MCT with those of the SCUES were in the range of .67 to .98, which proves the PB-UE-MCT's good to excellent levels of convergent validity. Conclusion The results confirm that the PB-UE-MCT is a valid and reliable tool for evaluating the upper extremity performance of people with CP through task analysis.

Resumo Introdução Distúrbios dos membros superiores limitam o desempenho nas atividades da vida diária, especialmente em atividades bilaterais (com as duas mãos). Objetivo Desenvolver um teste de controle motor de membros superiores baseado em desempenho (PB-UE-MCT) para avaliar pessoas com paralisia cerebral espástica. Método O PB-UE-MCT inclui planejamento, construção e avaliação psicométrica. Os participantes incluíram 50 pessoas com paralisia cerebral entre 6 e 18 anos. Para medir a consistência interna, o alfa de Cronbach foi executado (n = 50). A confiabilidade intra-examinador foi medida para 25 participantes que realizaram o teste duas vezes com um intervalo de duas semanas. Para confiabilidade entre avaliadores, dois examinadores administraram separadamente o teste a 25 participantes. Para avaliar a validade convergente, foram calculadas as correlações do PB-UE-MCT com o Manual Ability Classification System (MACS) e com a Selective Control Upper Extremity Scale (SCUES). Resultados Os valores obtidos para o alfa de Cronbach (0,90 a 0,96) indicaram a excelente consistência interna do PB-UE-MCT. Os valores de ICC para confiabilidade intraexaminador e confiabilidade interexaminador estavam entre 0,84 e 0,99 e entre 0,89 e 0,99, respectivamente. Os coeficientes de correlação obtidos para os itens do PB-UE-MCT e do MACS ficaram entre 0,51 e 0,73. Os coeficientes de correlação dos itens do PB-UE-MCT com os das SCUES situaram-se na faixa de 0,67 a 0,98, o que comprova os níveis de validade convergente bons a excelentes do PB-UE-MCT. Conclusão O PB-UE-MCT é uma ferramenta válida e confiável para avaliar o desempenho dos membros superiores de pessoas com paralisia cerebral durante a realização de tarefas.

Combination of yttrium-90 radioembolization with stereotactic body radiation therapy in the treatment of portal vein tumor thrombosis

Purpose@#Portal vein tumor thrombosis (PVTT) from cancer involving the liver carries a dismal prognosis, with median overall survival (OS) ranging from 2 to 5 months. While treatment with yttrium-90 (90Y) radioembolization alone may improve outcomes, overall prognosis remains poor. We hypothesize that the combination of 90Y radioembolization to the parenchymal component of the tumor and stereotactic body radiation therapy (SBRT) to the vascular component is a safe and effective means of improving outcomes. @*Materials and Methods@#A single center retrospective review identified 12 patients with cancers involving the liver who received both 90Y radioembolization and SBRT to the PVTT between May 2015 to August 2020. Primary endpoint was the 90-day toxicity rate by the Common Terminology Criteria for Adverse Events version 5.0. Secondary endpoints were the best response rate based on the Response Evaluation Criteria in Solid Tumors v1.1, local control rate, portal vein (PV) patency rate, and median OS. @*Results@#Patients received a median 90Y dose of 104.3 Gy (range, 83.3 to 131.7 Gy) and a median 5-fraction SBRT dose of 32.5 Gy (range, 27.5 to 50 Gy). There were no late toxicities reported, and only 7 acute grade 1 toxicities reported: elevation of liver function tests (17%), nausea (17%), fatigue (17%), and esophagitis (8%). Local control was 83%. 58% of patients had a patent PV after treatment. With a median follow-up time of 28 months, 1-year OS was 55% with a median OS of 14 months. @*Conclusion@#Combination 90Y radioembolization and SBRT appears to be safe and effective in the treatment of PVTT. Larger prospective studies are warranted to better evaluate this combination treatment approach.

Ivermectin as an adjunct treatment for hospitalized adult COVID-19 patients: A randomized multi-center clinical trial

Objective: To evaluate different doses of ivermectin in adult patients with mild COVID-19 and to evaluate the effect of ivermectin on mortality and clinical consequences. Methods: A randomized, double-blind, placebo-controlled, multicenter clinical trial was performed at five hospitals. A total of 180 mild hospitalized patients with COVID-19 confirmed by PCR or chest image tests were enrolled and allocated to six arms including hydroxychloroquine 200 mg twice per day, placebo plus hydroxychloroquine 200 mg twice per day, single dose ivermectin (200 μg/kg), three low interval doses of ivermectin (200, 200, 200 μg/kg), single dose ivermectin (400 μg/kg), and three high interval doses of ivermectin (400, 200, 200 μg/kg). The primary endpoint of this trial was all-cause of mortality or clinical recovery. The radiographic findings, hospitalization and low O

Combination of yttrium-90 radioembolization with stereotactic body radiation therapy in the treatment of portal vein tumor thrombosis

Purpose@#Portal vein tumor thrombosis (PVTT) from cancer involving the liver carries a dismal prognosis, with median overall survival (OS) ranging from 2 to 5 months. While treatment with yttrium-90 (90Y) radioembolization alone may improve outcomes, overall prognosis remains poor. We hypothesize that the combination of 90Y radioembolization to the parenchymal component of the tumor and stereotactic body radiation therapy (SBRT) to the vascular component is a safe and effective means of improving outcomes. @*Materials and Methods@#A single center retrospective review identified 12 patients with cancers involving the liver who received both 90Y radioembolization and SBRT to the PVTT between May 2015 to August 2020. Primary endpoint was the 90-day toxicity rate by the Common Terminology Criteria for Adverse Events version 5.0. Secondary endpoints were the best response rate based on the Response Evaluation Criteria in Solid Tumors v1.1, local control rate, portal vein (PV) patency rate, and median OS. @*Results@#Patients received a median 90Y dose of 104.3 Gy (range, 83.3 to 131.7 Gy) and a median 5-fraction SBRT dose of 32.5 Gy (range, 27.5 to 50 Gy). There were no late toxicities reported, and only 7 acute grade 1 toxicities reported: elevation of liver function tests (17%), nausea (17%), fatigue (17%), and esophagitis (8%). Local control was 83%. 58% of patients had a patent PV after treatment. With a median follow-up time of 28 months, 1-year OS was 55% with a median OS of 14 months. @*Conclusion@#Combination 90Y radioembolization and SBRT appears to be safe and effective in the treatment of PVTT. Larger prospective studies are warranted to better evaluate this combination treatment approach.

A possible protective role for Bacillus Calmette-Guérin therapy in urinary bladder cancer in the era of COVID-19: a brief report

Given the systemic immunogenic effects of Bacillus Calmette-Guérin (BCG) therapy in patients with bladder cancer and its non-specific immunogenic effects in viral respiratory diseases, we aimed to study severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in bladder cancer patients with a history of BCG therapy. In the present study, all bladder cancer survivors with a history of BCG therapy were identified and included in the study according to the data recovered from the UORC (Uro-Oncology Research Center) registry database. These patients were followed up in terms of acquiring coronavirus disease 2019 (COVID-19). Among the studied patients, 102 eligible bladder cancer patients with a history of BCG therapy entered the study. The males constituted the majority of the patients (86.3%), and more than half of the study population (55.9%) were above 65 years old. Among the understudy patients, 12.7% were confirmed for COVID-19. The study results did not show a statistically significant association between the time and number of BCG therapy courses and SARS-CoV-2 infection. Although no statistically significant association was observed between receiving BCG therapy and developing COVID-19, the infection rate in patients who had recently received BCG therapy was lower than those who had received therapy more than a year ago.

Effects and treatment applications of polymeric nanoparticles on improving plateletsÊ storage time: a review of the literature from 2010 to 2020

Maintaining the quality of platelet products and increasing their storage time are priorities for treatment applications. The formation of platelet storage lesions that limit the storage period and preservation temperature, which can prepare a decent environment for bacterial growth, are the most important challenges that researchers are dealing with in platelet preservation. Nanotechnology is an emerging field of science that has introduced novel solutions to resolve these problems. Here, we reviewed the reported effects of polymeric nanoparticles—including chitosan, dendrimers, polyethylene glycol (PEG), and liposome—on platelets in articles from 2010 to 2020. As a result, we concluded that the presence of dendrimer nanoparticles with a smaller size, negative charge, low molecular weight, and low concentration along with PEGylation can increase the stability and survival of platelets during storage. In addition, PEGylation of platelets can also be a promising approach to improve the quality of platelet bags during storage.

Identify Prognostic Risk Factor of Breast Cancer in North West of Iran

@#Introduction: Breast cancer is the most common cancer and it is the second leading cause of cancer mortality for women after lung cancer in Iran. Given the high prevalence of breast cancer, it is of crucial importance to determine reproductive risk factors of breast cancer. Methods: A total of 139 female patients suffering from breast cancer (the case group) and 279 healthy females (the control group) who were age-matched participated in the study over the period from March 2018 to March 2019. Demographic and reproductive variables, including the number of pregnancies, breastfeeding, history of oral contraceptive use, abortion history, age at first menstruation and age at first childbirth, were all recorded via survey. Conditional Logistic regression was employed to calculate OR (CI: 95%). Results: The mean age of breast cancer patients was 50.8 ± 8.31. First degree family history of breast cancer, History of oral contraceptive use and delaying first pregnancy drastically increased the chance of breast cancer whereas breastfeeding and menstruation after the age of 14 reduced the chance of breast cancer. Conclusion: The findings of this study reveal that the age at first birth, use of oral contraceptives, first degree family history of breast cancer and lack of breastfeeding have a significant relationship with breast cancer. Thus, women who have experienced such factors are susceptible to breast cancer and need to be prioritized for preventive treatments and screening.