Preparation and characterization of pH-sensitive chitosan/starch/MoS2 nanocomposite for control release of curcumin macromolecules drug delivery; application in the breast cancer treatment.

In this work, chitosan (CS), Starch (S), and Molybdenum Disulfide (MoS2) were combined to create a nanocarrier that was utilized to treat breast cancer using the MCF-7 cell line. To analyze the features of the nanocarrier, Fourier-transform infrared spectroscopy (FTIR) and X-Ray diffraction (XRD) tests were performed, respectively, to discover physical interactions and chemical bonding. Field emission scanning electron microscopy (FE-SEM), Dynamic light scattering (DLS), and zeta potential analyses were performed and reported to determine the structural characteristics and morphology of nanoparticles, size distribution, and surface charge of nanocarriers, respectively. The average size of the nanocomposite was measured at around 279 nm, and the surface charge of the nanocarrier was determined to be +86.31 mV. The entrapment and drug loading efficiency of nanocarriers were 87.25 % and 46.5 %, respectively, which is an acceptable value. The kinetics and release mode of the drug were investigated, and it was found that the synthesized nanocarrier was sensitive to pH and that its release was stable. The amount of the nanocarriers' toxicity and cell death were evaluated using MTT tests and flow cytometry, respectively. In the present study, the nanocarrier was wholly nontoxic and had anticancer properties against the MCF-7 cell line. This nanocarrier is very important due to its non-toxicity and sensitivity to pH and can be used in drug delivery and medical applications.

Surgical Treatment Options for Buerger's Disease (Experience with 315 Cases in Iran).

Background: Buerger's disease (thromboangiitis obliterans) may be a rare peripheral vascular disease that sometimes affects young male smokers. This study presents surgical treatment options for 315 Buerger's patients during a period of 18 years from 2002 to 2020. Methods: In this cross-sectional study, 315 newly diagnosed Buerger patients in a period of 18 years (by Census sampling) were evaluated. Data included age, sex, cigarette smoking status, clinical presentation, the affected limb (right or left, upper or lower extremities), and the performed therapeutic procedures such as angiography of limb arteries, amputation, sympathectomy, and vascular bypass surgery, which were collected in a data sheet. Vascular reconstruction was done if there were suitable inflow and outflow arteries. Sympathectomy was performed for the patients who were unsuitable for revascularization. All analyzes were performed using SPSSV.18 software package (SPSS Inc., Chicago, IL). Data are presented as frequency, mean ± variance (SD). Results: The mean age of patients was 42.6±9 years old, ranging from (26-75). There were 309 (98.1%) males and 6 (1.9%) females. The most common symptom was ulcer 252 (80%), and the most commonly involved arteries were the dorsal pedis (N=231; 73.4%) and posterior tibialis (N=225; 71.5%). Vascular bypass surgery, sympathectomy, and amputation were performed for patients who met surgical indications. Aortofemoral (N=9) and femoropopliteal (N=24) bypass procedures were done in 2.8% and 7.6% of patients respectively. Of nine patients who underwent aorto-femoral bypass procedure, 6 cases presented with leg claudication, 3 with an ulcer, and 3 with the Raynaud phenomenon. The digital loss rate was 9.6% (N=9) in toes and 1% (N=3) in fingers. Conclusion: As most of the Buerger patients have multi arterial involvement, bypass surgery or sympathectomy can't help treat these patients more than cigarette smoking or pharmaceutical therapy.

Surgical Repair Outcomes of Inflammatory and Degenerative Abdominal Aortic Aneurysms.

Inflammatory abdominal aortic aneurysm (IAAA) is characterised by thick aortic wall, with perianeurysmal fibrosis extending to adjacent organs. This study aimed to determine the early surgical outcomes of 10 IAAAs and compare the risk factors, perioperative complications, and 30-day mortality of these patients to 50 degenerative AAAs (dAAA), who underwent open repair in Sina Hospital, Tehran, Iran. The study was conducted from 2011 to 2019. IAAA patients were followed for 22.7 ± 3.8 months. The frequency of IAAA was 4.9%. All IAAA patients were males and smokers. There was no statistical difference in preoperative risk factors (age, smoking, hypertension, chronic kidney disease, ischemic heart disease, chronic obstructive pulmonary disease), operation time, blood loss, postoperative complications between dAAA and IAAA patients. The thirty-day mortality rate of open surgeries in degenerative and inflammatory cases was 8% (N=4) and 10% (N=1), respectively. Open repair with proximal/and/or distal clamping, avoids severe adhesiolysis, procedure-related morbidity, and 30-day perioperative mortality. Key Words: Inflammatory abdominal aortic aneurysm, Open surgery, Mortality, Outcome, Degenerative aortic aneurysm.

Endovascular treatment of penetrating vascular injuries.

Endovascular treatment of vascular injuries has resulted in reduced operating time, blood loss, hospital mortality and sepsis. The purpose of this study was to evaluate the success and complication rate of the endovascular management of penetrating peripheral vascular injuries during 5 years. In this observational study, the clinical records and imaging features of 22 penetrating trauma injuries of 276 penetrating vascular trauma patients (8%), which were repaired using endovascular stent-grafts or coil embolization, between April 2013 and August 2018, included in the study. The median age of patients was 43 years (Range, 20-78 years). There were 17 stab wounds (77.3%), 2 shotgun war remnants (9.1%) and 2 iatrogenic post-surgical lesions. Eleven stent-grafts (50%) and nine coil embolizations (40.9%) were deployed. Endovascular interventions in the management of peripheral vascular injuries can be efficient in definitive repair, damage control and hemorrhage control in severely ill trauma patients.

Behcet's disease and multiple arterial aneurysms: 4 case reports.

Behcet's disease (BD) is a vasculitis of unknown origin. BD is rare in Western countries and the southern hemisphere and is mainly seen in countries along the Silk Road such as the Middle East and Mediterranean regions including Iran. We report four interesting cases of BD with multiple aneurysms three of which had subclavian aneurysms. We chose different surgical approaches for each of these patients due to the different presentations and unique circumstances of each case. Endovascular stent graft used for patients and we discussed open vs. endovascular treatment for BD aneurysms in the discussion.

Totally implanted chemotherapy port catheters: literature review and report of four cases.

Totally implantable catheters tend to be the most popular choice because once installed they allow permanent access to a deep vein, which is gained by puncturing the port rather than a vein. In this article, we explain four cases of chemotherapy port complications: superior vena cava (SVC) syndrome in a metastatic colorectal cancer patient who presented with bilateral mastitis, snare technique for removal of migrated catheter line, carotid artery placement of a port in a 5-year-old child that was referred to our hospital from a pediatric center and adhesive port tip in the heart that finally we left the port in situ. In SVC syndrome, treatment should be guided by the severity of symptoms, etiology of the obstruction, prognosis of the patient and treatment goals. We propose timely removal of port-a-cath following completion of intended chemotherapeutic regimen.

Splenic artery aneurysm, case series of seven patients.

Splenic artery aneurysms (SAA) account for 46-60% of all visceral artery aneurysms. Small SAAs are usually asymptomatic, but giant aneurysms are more likely to cause symptoms and can result in life-threatening complications. Treatment of a splenic artery aneurysms includes laparotomy, laparoscopy or endovascular techniques. Case presentation: In this article, seven interesting cases of splenic artery aneurysms in different size and parts of artery and various interventions (open, endovascular and hybrid surgery) are discussed. Six of the patients were male. Five of them had giant SAAs (≥5 cm). Two patients underwent hybrid surgery. Coil embolization was carried out for one patient. All seven patients discharged with no procedure-related complications. Endovascular procedures considered as a first choice of treatment for splenic artery aneurysm. Open surgery is reserved mostly for the treatment of complications or if the endovascular techniques fail, lack of availability of endovascular procedures or allergy to contrast medium.

ESR, CRP, and failure of Arterio-Venous Fistula (AVF).

Background: The survival of arteriovenous fistula (AVF) remains an important problem for hemodialysis patients, accounting for 20% of all hospitalizations related to AV access problems in western countries. We designed an observational prospective cohort study on 265 AVFs and evaluated their results after 4 months of fistula creation and its relation to laboratory tests as ESR and CRP levels. Methods: Wrist or antecubital AVFs were created for patients with End-Stage renal disease. All laboratory tests (ESR and CRP) were checked quantitatively. The patients were followed-upfor at least 4 months and failure or maturation of AVFs were recorded in a checklist. Results: 177 (66.8%) males and 88 (33.2%) females were included. The surgeon created 161(60.8%) wrist and 98 (37%) antecubital AVFs. The mean age of patients was 53.18±17.1, ranged from 8 to 91 years old. CRP and total protein had significant differences between the two groups of failure and mature accesses (0.029 and 0.045 respectively). Conclusion: High CRP level is recognized as a reliable predictor for the survival of AVF.

Early-Onset Multiple Sclerosis: Reports of 300 Patients from Iran.

BACKGROUND: The epidemiologic data on demographic features of early-onset multiple sclerosis (EOMS) are rare in the Middle East, and no previous study has explored it. We aim to perform a neuroepidemiologic analysis to emphasize on the demographic features of EOMS in Tehran, Iran, during 2005-2015. MATERIALS AND METHODS: Our study was performed in Tehran, Iran; the research included patients with EOMS who had experienced their first symptoms before the age of 18 years and those who were referred to Iranian Multiple Sclerosis Society in Tehran during 2005-2015. A total of 300 patients were contacted and filled the checklists by themselves or the physician. The checklist contained data about gender, age at the onset, the first symptom, time interval between the first presentation and the diagnosis, clinical course, family history of MS, and history of smoking in parents. RESULTS: Among the patients with EOMS, 78% were female and 22% were male. Average age of disease onset was 15.6 years (standard deviation, 2.6 years), mean time interval between the first symptoms and disease diagnosis was 16.8 months, the shortest time interval measured was 0.1 month, and the longest time interval was 144 months. The first symptom at the onset of the disease was ocular in 140 patients and sensory in 82 patients. Approximately 16.7% of the patients had a positive family history for MS. The most common clinical course of disease was relapsing-remitting MS (RRMS). Parental smoking history was negative in 63.3% of the patients. CONCLUSION: In our study, the EOMS was higher in females. Despite the earlier studies, it was found that the polysymptomatic onset was not very common. Optic neuritis was the most initial presentation and RRMS was the most frequent course.

Transcranial sonography in carriers of Gaucher disease.

Background: Glucocerebrosidase (GBA) mutation is the most common genetic risk factor in Parkinson's disease (PD). Transcranial sonography (TCS) shows increased substantia nigra (SN) echogenicity in both idiopathic and genetic forms of PD. The goal of this study was to compare maximal area of SN hyperechogenicity (aSNmax) and diameter of third ventricle (DTV) between GBA mutation carriers and healthy controls. Methods: Twenty-six carriers of GBA mutation and twenty-six healthy controls underwent TCS. The aSNmax and the DTV were measured. Mini-mental status examination (MMSE) and demographic data of the subjects were recorded, too. Results: Mean aSNmax in GBA mutation carriers was significantly higher (0.31 ± 0.06 cm2) than controls (0.16 ± 0.04 cm2). Moreover, DTV was significantly higher in GBA mutation carriers group (3.98 ± 0.90 vs 3.29 ± 0.56 cm). Conclusion: Increased SN echogenicity and increased third ventricle diameter in GBA mutation carriers may be caused by alterations in iron metabolism with reference to their genetic status.

Correlation between CRP and early failure of arteriovenous fistula (AVF).

BACKGROUND: Arteriovenous Fistula (AVF) is the ideal method of vascular access for patients on maintenance hemodialysis (HD). Therefore it is an important part of treatment in HD. There are several observations that indicate the role of inflammation in failure of AVF. The aim of this study was to evaluate the hematologic and inflammatory biomarkers in early AVF failure. METHODS: This case-control study included 110 ESRD patients, whom were undergone AVF creation, divided in two groups. About 700 radius-cephalic AVF were created during these two years. We found 55 cases with AVF failure. In this study, we compared those 55 failures with 55 functional AVF which were selected using randomized sampling from the rest of patients according to age, gender, and AVF location. Levels of serum C-reactive protein (CRP) were checked in both groups to evaluate the relation between AVF failure and CRP level before surgery. RESULTS: The mean±SD age of the patients was 49.7±17.28 years. CRP was positive in 34 patients (61.8%) with unsuccessful fistula function, while only 4 (7.3%) of those with successful AVF had positive CRP and the rest had negative CRP. The difference between the two groups of patients was strongly significant (p<0.001). Statistically, there was not any significant difference between the average of age (p: 0.580) of patients in the control and experimental groups. However, the gender (p: 0.832) discrepancies was not meaningful between the groups. CONCLUSION: AVF thrombosis is one of the main complications after AVF creation. Therefore, it is recommended to check CRP before AVF surgery to prevent possible failure of the fistula function.