Demographic characteristics and prognostic factors in pediatric-type sarcomas; A 7 year single institutional experience and comprehensive review of the current literature

Background: due to limited clinical data in pediatric-type sarcomas [rhabdomyosarcoma, Ewing's sarcoma, PNET, and desmoplastic small round-cell tumor], the aim of this study was to evaluate the demographic characteristics and identifying prognostic factors for survival

Materials and Methods: we retrospectively reviewed 110 patients with pediatric-type sarcomas. Overall and disease free survival was analyzed with the Kaplan-Meier method and log rank test. To identify prognostic factors for overall and disease free survival, multivariate survival analyses using a Cox's proportional-hazard regression model was performed

Results: in this study mean age of patients were 20.30 years [SD=13.61; range, 1-83 years]. The survival data of 54 patients [49.1%] were obtained with median survival of 27 months. 3 and 5-year survival rate of these patients were 41.5% and 28.3% respectively. Recurrence of disease [P=0.006] and Ewing sarcoma subtype [P=0.018] were significantly associated with poor overall survival and location of the lesion in the upper extremities [P=0.007] and trunk [P=0.005] were significantly associated with a lower disease free survival

Conclusion: with multivariate analysis, the authors determined that recurrence of disease and Ewing's sarcoma subtype are poor prognostic factors for overall survival and site of origin for disease free survival among patients with pediatric-type sarcoma. In addition, gender, patient's age, and size of tumor had no significant impact on overall and disease free survival

Radiotherapy for Ewing sarcoma: a 5 year experience from Iran cancer institute

Background: Ewing Sarcoma Family of Tumors [ESFTs] is the second most common primary tumors of bone in childhood. The decision regarding the optimal modality for achieving local tumor control remains uncertain. The aim of this study was to report the clinical features and outcome as well as reviewing risk factors in patients. Materials and Methods: This retrospective study included 75 ESFTs patients who were treated at cancer institute between 2004 and 2009. Files of all patients with ESFTs were reviewed retrospectively and we called them for follow up. Specific data were collected with regard to the age at diagnosis, gender, tumor site and size, clinical stage, surgical procedure, plan of radiotherapy and treatment outcome [5-year and median survival]. Results: The mean age at diagnosis was 21 that ranged from 1 to 52 years [SD = 9.6]. The mean tumor size at diagnosis was 4.8+/-4.48 cm. The percent of biopsy only, partial and complete resection was 54.7% [41 patients], 6.7% [5 patients] and 37.3% [28 patients] respectively. Radiotherapy was done as definitive treatment or postoperatively [adjuvant] in 46 [61.3%] and 16 [21.4%] patients respectively. Overall 5 year survival was 24% and median survival for patients with and without metastases was 21+/-17 and 75+/-10 months. Conclusion: Presence of metastases, age at diagnosis, positive surgical margin and tumor size were the prognostic factors that influenced outcome of patients. This study suggests that radiation therapy is an acceptable local treatment modality in patients with Ewing sarcoma family

Evaluation the role of ferula gummosa essential oil against the hepatoxicity induced by acetaminophen in animal model

Background: Acetaminophen as a common antipyretic drug, in overdoses, is poisonous for the liver

Objective: The current study aimed to assess the protective effects of Ferula [F.] gummosa essential oils against the liver toxicity of acetaminophen in rats

Methods: 80 male Wistar rats were randomly divided into 16 groups [n=5]. Negative control group received only DMSO and the positive control group received acetaminophen 500 mg/kg b.w i.p. The treatment groups received F. gummosa essential oils [100 and 200 mg/kg b.w] i.p immediately after acetaminophen administration. The blood were collected for estimating the values of total antioxidant of plasma [FRAP] and liver enzymes; alanin teransferase [ALT], aspartate teransferase [AST], and alkaline phosphatase [ALP]. Also, a piece of liver was used for determining of glutathione [GSH], lipid peroxidation [LP] concentrations, the activity of glutathione s-transferase [GST] and histopathological studies

Results: The data showed that F. gummosa essential oil modulate significantly the changes in the levels of GSH, GST and FRAP as well as the liver enzymes and lipid peroxidation compared to negative control group. Furthermore, the histopathological findings of the liver tissue was confirmed the biochemical results

Conclusion: The essential oil extracted from F. gummosa possessed antioxidant activity which protects the liver against the toxic effects of acetaminophen

[Effectiveness of solution- focused brief therapy [SFBT] on couple burnout and divorce tendency in married women]

Introduction: Couple burnout is one of the problems that is a main reason for emotional divorce because of its adverse and destructive effects on marital system and creating psycho-emotional distance in a couple, and this problem, if untreated, will prepare the grounds for formal divorce. The solution-focused brief therapy is a postmodern approach in couple therapy and family therapy which focuses on finding solutions by the client in cooperation with the therapist. In this study we investigated the effectiveness of solution-focused brief therapy in couple burnout and divorce tendency among married women

Methods: This research is a quasi-experimental study and pretest-posttest with control group design is used. The population consists of all married women with marital conflicts and problems who have visited Golha House of health, located in the 6[th] district of Tehran city in the second half of 2013. In this study, the sampling method was available sampling. Thus, 30 women who were qualified to participate in meetings and had earned the highest scores in the survey questionnaire were selected, and they were placed in experimental and control groups through random assignment [each n=15]. The data gathering tools in this study were pains couple burnout measure [CBM] and the Divorce Tendency Scale of Roswelt, Jonson and, Moro [DTS] 1986, which were completed by the subjects in the pretest. The intervention group was exposed to solution-focused brief therapy for seven two-hour sessions in groups, in a step-by-step manner with the sequence of one session per week. But no intervention was performed in the control group. The data were analyzed by using descriptive statistics methods and through multivariate analysis of covariance [MANCOVA] in software SPSS20

Results: The results of multivariate analysis of covariance showed a significant reduction in couple burnout and divorce tendency [P= 0.000] of married women after performing solution-focused brief therapy. The mean and standard devietion of couple burnout and divorce tendency of interference group in pretest respectively was 113/6 +/- 20/04 and 126/53 +/- 31/12 and in post test stage was 94/6 +/- 21/69 and 102/26 +/- 22/15. In control group also mean and standard devietion of couple burnout and divorce tendency before interference respectively was108/53 +/- 16/68 and 106/46 +/- 27/21 and after interference was 106/93 +/- 28/16

Conclusion: According to the findings of this research, it can be concluded that solution-focused brief therapy has been able to be effective in reducing couple burnout and divorce tendency among married women. Counselors and family therapists can use this short-term, efficient and effective therapy approach to solve marital conflicts and help people to improve their marital relationships

New drug in neoadjuvant chemoradiation for rectal cancer

In recent years, neoadjuvant chemoradiation and subsequent surgical resection with total mesorectal excision has been shown to increase local control with decreased toxicity. Neoadjuvant chemoradiotherapy is the standard treatment for locally advanced rectal cancer. In this study we evaluated the efficacy a cox-2 inhibitor on pathologic response, sphincter preservation and acute toxicity during neoadjuvant chemoradiation. Thirty-six patients with Adenocarcinoma of rectum [up to 15 cm of anal verge] was enrolled in this phase 2 study. Patients were undergone endorectal ultrasound, abdomino-pelvic and chest CT scan for staging. Then received neoadjuvant concurrent chemo radiation [capecitabine 825 mg/m2 bid in combination with celecoxib 100 mg qid and Radiotherapy "50-50.4Gy/25-28fraction"].Surgery was done 6-8 weeks after Chemoradiation. Acute complications were scored by common toxicity criteria 3.0 and tumor response was graded by tumor regression grade. Of 36 patients, total mesorectal excision was done in 30 patients. Tumor regression grade was reported as: 8 patients[26.7%] had grade 0 or complete response, 10 patients [33.3%] had grade 1 or moderate response,9 patients[30%] had grade 2 or minimal response and 3 patients [10%] had grade 3 or poor response. Tumor down staging was 43.3% and Node down staging was 30.8%.No patient had skin reaction or cardio-vascular toxicity. Results indicate celecoxib in combination with neoadjuvant chemoradiation is safe and associated with low toxicity. This combination can promote pathologic complete response, tumor regression grade and T and N down staging in rectal adenocarcinoma

Association between immunohistochemical profile and clinicopathological appearance in breast cancer: a 7-year review from Hamadan, Iran

Introduction: Invasive breast cancer is the most common carcinoma in women. Immunohistochemistry classification now plays a key role in prognostic identification and prediction of outcome in this disease. Based on recent gene expression studies, immunohistochemical subtypes are as follows: Luminal A [ER+ and /or PR+, HER2-], luminal B [ER+ and /or PR+, HER2+], HER2+/ ER-, PR-, and basal-like [ER-, PR-, HER2-]. These molecular differences have been shown to correlate with clinical features, such as survival, and sensitivity to treatment. In this study we evaluated the association between different subtypes with histological type, grade, tumor stage, lymph node positive ratio, lymph node status, recurrence, and survival

Patients and methods: We retrieved the clinical records of 580 patients with breast cancer who were treated at Mahdieh Institute of oncology in Hamadan, Iran, between Oct 2004 and Oct 2011, and we evaluated clinicopathological data of these patients

Results: Mean age of patients was 47.22 +/- 11.1 years. Of 573 patients, 116 [20.2%] were ER /PR+, HER2+, 257 [44.9%] were ER /PR+, HER2-, 72 [12.6%] were ER /PR-, HER2+, 124 [21.6%] were ER /PR-, HER2- and 4 were undefined. The estimated median follow up period for all subjects was 4.9 years [range 3 months to 6.9 years]. The overall survival for all patients was 88.21% and the disease free survival was 83.7%. The interesting result of this study was the lower incidence of positive axillary lymph nodes in triple negative subtypes. Five-year relative survival rates were higher for patients with ER/PR+ and negative lymph nodes [p< 0.05]

Conclusion: This study highlighted the importance of immunohistochemical subtypes. As our patients were good representatives of breast cancer in western Iran and this study showed some differences with literature, further research should be directed at standardization of molecular and immunohistochemical methods in our country

[ features of esophageal cancer in Ardabil province: report of a population-based cancer registry in Northwest Iran]

Evidence shows that the mortality rate of esophageal cancer [EC] in Ardabil Province is among the highest worldwide. Studies on the epidemiological profile of EC in Ardabil are scarce. We aim to study the characteristics of EC in Ardabil using data from the recently established Ardabil Cancer Registry [ACR]. This study has been accomplished based on data collected in ACR between 2004 and 2006. Cases reported to ACR were coded based on the third edition of the International Classification of Diseases for Oncology [ICD-O III]. The age-standardized incidence rates [ASR] and the standard rate ratio [SRR] have been calculated for each district in Ardabil Province. A total of 549 new cases of EC were registered within ACR during the study period. The ASR was 19.5 for men and 19.7 for women per 100,000 person-years. The majority of cases [79.1%] were diagnosed based on pathology. The most common morphology of EC was squamous cell carcinoma [SCC, 73%] followed by adenocarcinoma [17.8%]. The ASR was significantly higher in northern districts of the province [p < 0.001]; highest in Meshkinshahr [27.2/100,000] and lowest in Nir [7.6/100,000]. The male:female ratio approximated one in the northern and above 2.5 in the southern districts. Our results demonstrate that the increased incidence of EC in Ardabil is mainly due to an increase in the incidence of esophageal adenocarcinoma [ACE] during recent years. The almost equal incidence of EC among men and women, and its geographical pattern across the province indicate the possible role of environmental risk factors, which need further investigations

Cancer incidence and mortality in Ardabil: report of an ongoing population-based cancer registry in Iran, 2004-2006

Ardabil cancer registry is the first population-based cancer registry in Iran that was established in 2000. The first report from this registry revealed that Ardabil has one of the highest rate of gastric cardia cancer and the lowest rate of cervical cancer in the world. We aim to update the cancer incidence in this area by the second follow up report from this registry. Method: Data on all newly diagnosed cancer cases between 2004 and 2006 were actively collected. CanReg4 software was used for data entry and the data of cancer-related death were obtained from the comprehensive death registry system. More than 4300 new cases were registered during 3 years. Diagnosis of cancer was based on histopathology in 69%, clinical investigation 8%, clinical only 5%, and Death Certificate Only [DCO] in 18% of cases. In terms of age-standardized rate [/100,000], the five leading cancers in men [excluding skin cancer] were stomach [51.8], esophagus [19.5], bladder [13.1], lung and bronchus [10.8], and colorectal [9.6]; in women, they were stomach [24.9], esophagus [19.7], breast [11.9], colon and rectum [7.4], and brain tumors [6.9]. According to death registration data, upper gastrointestinal cancers constituted more than 43% of cancer-related death in Ardabil. The ASR for gastric cancer is among the highest rate for this cancer in male and female in the world. Most of the cancers, especially in female, have a significant increase compared to previous report from Ardabil. This is most likely due to the change in the registration practice

Antispasmodic effect of hydroalcoholic extract of thymus vulgaris on the guinea-pig ileum

The widespread use of medicinal herbs among the general population gives rise to the possibility of therapeutic or toxic effects in patients that use these plants. The effects of Thymus vulgaris [TV] hydroalcoholic extract on the contractile responses of the isolated guinea-pig ileum were investigated. Male guinea pigs that were starved for 24 hours were decapitated after cervical dislocation, and terminal ileum were removed. Segments were fixed at a resting tension of 0.5 g in an organ bath containing in Tyrode solution at 37°C, which was bubbled with 95% oxygen and 5% carbon dioxide. The effects of the Thymus vulgaris extracts at six concentrations ranging from 0.02 to 6 mg/ml. Each segment served as its own control. Paired Student's t-test was used for statistical analysis. p < 0.05 was considered to be significant. Thymus vulgaris inhibited the contractile response in a dose-dependent manner in 0.6mg/mI concentration decreased the amplitude of the muscles up to 60% [t = -5.67, P<0.02]. This inhibitory activity was blocked by Granisetron and inhibited the contractions induced by acetylcholine, the activities of this plant may be due to the anticolinergic effect and block of serotoninergic pathways. Regression analysis had shown that with increasing in extract concentration the effect of extract was increased [r = 0.96, p<0.001]. The coefficient of extract dose was 0.089 mg. Our results demonstrate that extract prepared from the plant of Thymus vulgaris inhibited electrical induced contractions of the guinea-pig ileum when tested in vitro. This effect is dose dependent and reversible

[Evaluation of change in etiology and epidemiology of upper GI bleeding in a population study]

Acute upper GI bleeding [UGIB] is a common medical emergency situation. In the past years, important changes have taken place that might have influenced the incidence, etiology, and outcome for patients with acute UGIB. The aim of this study was to determine current time trends in the incidence, management, and prognosis of patients with UGIB in 14 years period in a region in center of Iran. All of the patients with UGIB who hospitalized in all hospitals from 1991 to 2004 in Semnan city were evaluated in a retrospective study. The patients with permanent residency in this area and age more than 15 years enrolled in the study. The patients were divided in two subgroups based on endoscpic diagnosis; peptic ulcer [PU] and non-peptic ulcer [Non-PU]. Again, analysis was performed by dividing the patients to acid-pepsin disorders [APDs] and non-acid pepsin disorders [Non-APDs]. 873 patients [617 male [70.7%], Mean +/- SD [46.9+/-21.2]] enrolled in the study. The incidence rate of UGIB has decreased from 98.4 to 40.1 in 100.000 person in year in this period [p<0.001]. The incidence rates of bleeding due to PU and Non-PU have decreased. However, in the second analysis the rate of APDs has decreased, but the rate of non-APDs has remained unchanged, during the study period. In regard to prognosis, the rates of endoscopic therapy, surgery and mortality were not changed significantly in this period. The overall incidence of UGIB, and bleeding due to APDs was declined in recent years that may be due to better approach to peptic ulcers and eradication of helicobacter pylori and wide spread use of PPIs and H2 blockers in APDs

Evaluation of Dot-ELISA method using excretory-secretary antigens of fasciola hepatica in laboratory diagnosis of human fasciolosis

Fasciolosis diagnosis, due to low sensitivity of coprological diagnostic method has been challenging for a long period. In this study, Dot-ELISA, one of the simplest and the most sensitive tests in this regard, was evaluated using excretory-secretory antigens of Fasciola hepatica to diagnose human fasciolosis Three groups consisting of patients infected with fasciolosis [n= 95], patients with other parasitic diseases [n= 37] and healthy individuals [n= 40], were implicated in the test. All collected sera were tested by Dot-ELISA using excretory-secretory antigens. Optimal criteria were detected as 1.5 micro g of antigen per dot, serum dilution of 1:320, and anti human IgG conjugate dilution of 1:500. The sensitivity, specificity, positive and negative predictive values were 96.8%, 96.1%, 96.8% and 96.1%, respectively. In conclusion, Dot-ELISA using excretory-secretory antigens could be regarded as a cheap, rapid, antigen and serum conservative diagnostic method in diagnosing fasciolosis

Preparation of an artificial matrix to replace human standards of prostate specific antigen IRMA assay kit

Prostate specific antigen [PSA] is one of the most sensitive markers for diagnosis of prostate cancer. Immunoradiometric kit [IRMA] is a common and sensitive method for determination of PSA in clinical laboratories. This kit has four major components: solid phase coated with monocolonal antibody, pair antibody labelled with I-125, series of standards in different ranges of concentration and lyophilized control samples. In IRMA method, PSA is determined in human serum. Therefore, matrix of standards have to be similar to human serum. Using human serum as standard has many shortcomings namely biohazard contamination, instability, serum protein precipitation and unavailability. Artificial matrix however, is an ideal substitute for human serum. In this study, we used an artificial matrix as standard sample and evaluated its effects including reproducibility, sensitivity, precision and stability for determination of PSA in comparision to human serum. The specificity, sensitivity, storage condition and the stability of these standards prepared with artificial matrix were studied. Similar results in comparison to human serum was observed. The prepared standards with this matrix had suitable and ideal properties and it can be used as standard in PSA assay kit

Diffuse Lamellar Keratitis after LASIK: prevalence, natural course, and final visual outcomes in stage III or IV

To evaluate the prevalence, natural course, and final visual acuity in patients with stages III or IV of diffuse lamellar keratitis [DLK] following Laser in situ keratomileusis [LASIK]. In this descriptive study, records of all the patients who underwent LASIK surgery in two private excimer laser clinics were reviewed. According to Linebarger- Lindstrom-Hardten classification, ocular findings of patients with DLK were classified. There was no preoperative systemic or corneal contraindication for LASIK. Age, preoperative refraction and best corrected visual acuity [BCVA], type and duration of treatment, postoperative refraction, topography, final BCVA, possible side effects of medications and complications were reviewed. Out of 4097 eyes of 2131 patients, DLK above stage II developed in 28 eyes [0.68%] of 14 patients [0.66%]. DLK was in stage II-III in 78.6%, stage III in 10.7%, and stage IV in 1.7%. None of these patients had history of allergies. Treatment consisted of frequent betamethasone drops alone or with ointment and oral systemic prednisolone. Interface irrigation was not performed in any patients during the course of treatment. Average interval from LASIK to diagnosis was 3 +/- 1.5 days. Patients were treated for an average duration of 20 +/- 13.2 days and were followed for an average duration of 11 +/- 10 months. Average preoperative BCVA was 0 LogMAR [20,20] and final post LASIK and DLK vision remained the same. Prevalence of DLK stages III and IV is considered insignificant as compared to the enormous number of candidates for LASIK surgery [0.68%]. All patients with DLK stages III and IV responded well to immediate topical and systemic corticosteroid therapy and on follow up there was no adverse effect on final BCVA

[Prophylactic topical steroids prior to Lasik for prevention of diffuse lamellar keratitis [DLK]]

Purpose: to evaluate the role of prophylactic topical steroids in the prevention of DLK after LASIK

Methods: in a randomized double blind clinical trial, 101 LASIK candidates aged 18 to 55 years were enrolled. Myopia ranged from -2 to -12 diopters and was stable for at least one year. No patient had any ocular or systemic contraindication for LASIK. From one day before surgery, topical betamethasone 0.1% was randomly applied for one eye every 4 hours while the other eye received placebo. One hour before surgery the dosage was increased to every 5 minutes for at least six times. All operations were performed by one surgeon [F.K]. Both eyes were operated in one setting. Six hours after surgery, all the eyes were put on topical betamethasone every 2 hours and dosage was tapered depending on the response and according to the grade of DLK if present. Severity of DLK was graded according to the Linebarger-Lindstorm classification. Patients were regularly examined in the first week and if the postoperative course was uneventful they were re-examined one and three months after surgery. Vision [BCVA], refraction [cyclorefraction], and severity of DLK were documented by a third examiner at each visit

Results: one hundred eyes were in the treatment and 98 eyes were in the control group. In both groups, pre and post LASIK refraction and VA were comparable [P> 0.05]. There were no significant complications in both groups during or after LASIK except for DLK. DLK was seen in 55 eyes [55%] of the treatment group including 44 eyes [44%] with grade I and 11 eyes [11%] with grade II. In the control group DLK was seen in 36 eyes [36.7%] of which 29 eyes [29.5%] were grade I, and 7 eyes [7.2%] were grade II. There was no statistically significant difference between the incidence of DLK in the two groups [P= 0.81]. More severe grades of DLK [III and IV] were not seen in any group

Conclusion: although steroids [topical and systemic] play a key role in the treatment of DLK, they seem to have no inhibitory role on DLK