Potential application of spent mushroom compost (SMC) biochar as low-cost filtration media in heavy metal removal from abandoned mining water: a review.

Overpopulation and rapid development have put an increasing burden on the environment, leading to various water crisis. Importing water from abandoned mines as an alternative raw water source could be the next answer to alleviate water scarcity problems globally. However, due to its high heavy metals content, there is a need to find an economical and effective method to remove heavy metals before reusing it as potable water source. Biochar, a low-cost and carbon-rich biosorbent, has received increasing attention on its application as a remediating agent to remove heavy metals from water. Previous studies have revealed the potential properties of biochar as a heavy metal removal agent including high cation exchange capacity, high surface area, active surface functional groups, as well as efficient adsorption. Apparently, the most important factor influencing the sorption mechanism is the type of feedstock materials. Spent mushroom compost (SMC), a waste product from mushroom cultivation, has been found as an excellent biosorbent. SMC has received global attention as it is low cost and eco-friendly. It also has been proved as an efficient heavy metals remover from water. Nevertheless, its application as biochar is still scarce. Therefore, this review focuses on the potential of transforming SMC into modified biochar to remove heavy metals, especially from abandoned mining water. The present review emphasizes the current trends in adsorption methods for heavy metal removal from water, assembles data from previous studies on the feedstock of biosorbents to biochars, and discusses the potentials of SMC as a biochar for water treatment.

Prognostic Role of Lymphovascular Invasion in Patients with Early Breast Cancer.

In this study, our aim was to evaluate the role of lymphovascular invasion (LVI) in the prognosis of patients with early stage breast cancer. The medical records of more than 7000 patients who suffered from invasive breast cancer and had undergone surgical treatment since December 1994 till December 2019, retrospectively. Patient's history, physical examination and the clinicopathological features, histopathology characteristics, immunohistochemical findings, adjuvant systemic therapy, recurrence rate, metastasis-free survival (MFS), disease-free survival (DFS), and overall survival (OS) were reviewed. A total of 5425 eligible patients were categorized into two groups based on the presence of LVI; 3031 (55.9%) patients had no LVI (group 1) and LVI was present in 2394 (44.1%) patients (group 2), then divided into LN-positive and -negative groups. Presence of LVI was significantly associated with patient age ≤ 40 years (p = 0.048), high histological grade (grades II and III, p < 0.001), tumor size between 2-5 cm and > 5 cm (p < 0.001), number of involved LN ≥ 4 (p < 0.001), and negative ER (p = 0.042) tumors. Five-year OS, MFS, and DFS were 93%, 88.9%, and 76.1% and 85.2%, 84.7%, and 73.6 in groups 1 and 2, respectively (P < 0.001). On multivariate analysis, LVI was an independent prognostic factor for DFS in all patients. Furthermore, histological grade II, histological grade III, and a higher number of involved LNs (≥ 4) were independent predictors in all patients. Thus, the presence of LVI can be considered as an independent prognostic factor for patients with operable breast cancer, irrespective of the LN status.

Increased B Regulatory Phenotype in Non-Metastatic Lymph Nodes of Node-Positive Breast Cancer Patients.

Tumour-draining lymph nodes (TDLNs) are centre in orchestrating the immune responses against cancer. The cellularity and lymphocyte subpopulations change in the process of cancer progression and lymph node involvement. B lymphocyte subsets and their function in breast cancer-draining lymph nodes have not been well elucidated. Here, we studied the influence of tumour metastasis on the frequencies of different B cell subsets including naïve and memory B cells as well as those which are known to be enriched in the regulatory pool in TDLNs of 30 patients with breast cancer. Lymphocytes were obtained from a fresh piece of each lymph node and stained for CD19 and other B cell-associated markers and subjected to flow cytometry. Our investigation revealed that metastatic TDLN showed a significant decrease in active, memory and class-switched B cells while the frequencies of B cells with regulatory phenotypes were not changed. However, CD27(hi) CD25(+) and CD1d(hi) CD5(+) B regulatory subsets significantly increased in non-metastatic lymph nodes (nMLNs) of node-positive patients compared with node-negative patients. Our data provided evidence that in breast cancer, metastasis of tumour to axillary lymph nodes altered B cell populations in favour of resting, inactive and unswitched phenotypes. We assume that the lymphatic involvement may cause an increase in a subset of regulatory B cells in non-metastatic lymph nodes.

Assessment of Internal Validity of Prognostic Models through Bootstrapping and Multiple Imputation of Missing Data.

BACKGROUND: Prognostic models have clinical appeal to aid therapeutic decision making. Two main practical challenges in development of such models are assessment of validity of models and imputation of missing data. In this study, importance of imputation of missing data and application of bootstrap technique in development, simplification, and assessment of internal validity of a prognostic model is highlighted. METHODS: Overall, 310 breast cancer patients were recruited. Missing data were imputed 10 times. Then to deal with sensitivity of the model due to small changes in the data (internal validity), 100 bootstrap samples were drawn from each of 10 imputed data sets leading to 1000 samples. A Cox regression model was fitted to each of 1000 samples. Only variables retained in more than 50% of samples were used in development of final model. RESULTS: Four variables retained significant in more than 50% (i.e. 500 samples) of bootstrap samples; tumour size (91%), tumour grade (64%), history of benign breast disease (77%), and age at diagnosis (59%). Tumour size was the strongest predictor with inclusion frequency exceeding 90%. Number of deliveries was correlated with age at diagnosis (r=0.35, P<0.001). These two variables together retained significant in more than 90% of samples. CONCLUSION: We addressed two important methodological issues using a cohort of breast cancer patients. The algorithm combines multiple imputation of missing data and bootstrapping and has the potential to be applied in all kind of regression modelling exercises so as to address internal validity of models.

The effect of combined decongestive therapy and pneumatic compression pump on lymphedema indicators in patients with breast cancer related lymphedema.

BACKGROUND: Lymphedema treatment is difficult and there is no consensus on the best treatment. This study evaluated the effect of combined decongestive therapy (CDT) and pneumatic compression pump on lymphedema indicators in patients with breast cancer related lymphedema (BCRL). METHODS: Twenty one women with BCRL were enrolled. The volume difference of upper limbs, the circumference at 9 areas and shoulder joint range of motion were measured in all patients. CDT was done by an educated nurse in two phases. In first phase, CDT was accompanied by use of a compression pump for 4 weeks, 3 days per week. In second phase, CDT was performed daily without compression pump for 4 weeks by patients at home. At the end of each phase, the same primary measurements were done for patients. RESULTS: The mean volume difference of the upper limbs and mean difference in circumference in all areas at different phases decreased significantly. Mean flexion, extension, abduction and external rotation (in degrees) at different phases increased significantly. CONCLUSION: CDT significantly reduced mean volume and mean circumference of the affected limb, and significantly increased shoulder joint range of motion. The findings support the optimal effects of CDT in the treatment of secondary lymphedema of upper extremity. CLINICAL TRIAL REGISTRATION NUMBER: 138902212621N8.

Does the missing data imputation method affect the composition and performance of prognostic models?

BACKGROUND: We already showed the superiority of imputation of missing data (via Multivariable Imputation via Chained Equations (MICE) method) over exclusion of them; however, the methodology of MICE is complicated. Furthermore, easier imputation methods are available. The aim of this study was to compare them in terms of model composition and performance. METHODS: Three hundreds and ten breast cancer patients were recruited. Four approaches were applied to impute missing data. First we adopted an ad hoc method in which missing data for each variable was replaced by the median of observed values. Then 3 likelihood-based approaches were used. In the regression imputation, a regression model compared the variable with missing data to the rest of the variables. The regression equation was used to fill the missing data. The Expectation Maximum (E-M) algorithm was implemented in which missing data and regression parameters were estimated iteratively until convergence of regression parameters. Finally, the MICE method was applied. Models developed were compared in terms of variables significantly contributed to the multifactorial analysis, sensitivity and specificity. RESULTS: All candidate variables significantly contributed to the MICE model. However, grade of disease lost its effect in other three models. The MICE model showed the best performance followed by E-M model. CONCLUSION: Among imputation methods, final models were not the same, in terms of composition and perform-ance. Therefore, modern imputation methods are recommended to recover the information.

Survival of male breast cancer in fars, South of iran.

BACKGROUND: Although breast cancer in men is uncommon, its incidence rate has an increasing trend. Due to its low incidence, there are few studies in this subject and limited information is available. The purpose of this study was to investigate clinicopathological characteristics and survival of male breast cancer (MBC) in Fars Province, south of Iran. METHODS: The data for this study were obtained from the population based cancer registry of Vice-Chancellor for Health Affairs of Shiraz University of Medical Sciences and Shiraz hospitals between January 1, 1989 and January 1, 2008, including 64 patients with MBC. Demographic, clinical and pathological aspects were investigated. The Kaplan-Meier method was used for the determination of survival rate and Log Rank test for the comparison. The Cox proportional hazards model was used for the multiple analysis. RESULTS: The patients' mean age at the time of diagnosis was 60.3 years (SD=12.7). The most frequent age group (26.6%) was 51-60 years. The most common symptom (96.8%) was a palpable mass. The majority of patients (44.4%) had a symptom duration of less than or equal to 6 months. 56.3% of the patients had a tumor size of 2-4.9 cm. Forty six percent of the cases had axillary lymph node involvement. The median survival time was 10.0 years [95% confidence interval (CI): 6.0-14.0]. The 5 year overall survival rate was 66.0% (95% CI=51.0-81.0%). The median survival time of patients with axillary lymph node involvement was 8.2 years (95% CI=6.7-9.6) and for the cases without involvement was 12.0 years (95% CI=8.4-15.2). In addition to axillary lymph node involvement, positive family history in contrast to negative family history and left tumors in compari-son with right tumors were poorer prognostic factors in univariate analysis respectively (p=0.006, p=0.031). In multiple analysis, axillary lymph node involvement was an independent predictor of poorer survival (Hazard ratio=1.6, 95% CI=1.1-6.4, p=0.030) and the other variables did not have a significant effect. CONCLUSION: The mean age of MBC in this series is lower than that in western countries. It is compatible to the mean age of female breast cancer which is approximately one decade less than that in developed countries. The survival rate of MBC is relatively lower than that in western countries. Axillary lymph node involvement is an important prognostic factor in the survival of MBC. Multicenter population based studies with greater number of patients are required for better estimation of different aspects of MBC in Iran.

Multiple imputation in survival models: applied on breast cancer data.

BACKGROUND: Missing data is a common problem in cancer research. While simple methods such as completecase (C-C) analysis are commonly employed for handling this problem, several studies have shown that these methods led to biased estimates. We aim to address the methodological issues in development of a prognostic model with missing data. METHODS: Three hundred and ten breast cancer patients were enrolled. At first, patients with missing data on any of four candidate variables were omitted. Secondly, missing data were imputed 10 times. Cox regression model was fitted to the C-C and imputed data. Results were compared in terms of variables retained in the model, discrimination ability, and goodness of fit. RESULTS: Some variables lost their effect in complete-case analysis, due to loss in power, but reached significance level after imputation of missing data. Discrimination ability and goodness of fit of imputed data sets model was higher than that of complete-case model (C-index 76% versus 72%; Likelihood Ratio Test 51.19 versus 32.44). CONCLUSION: Our findings showed inappropriateness of ad hoc complete-case analysis. This approach led to loss in power and imprecise estimates. Application of multiple imputation techniques to avid such problems is recommended.

Detection of B cell lymphoma 2, tumor protein 53, and FAS gene transcripts in blood cells of patients with breast cancer.

BACKGROUND: Proteins encoded by FAS, BCL-2 and TP53 genes are major regulators of cellular survival and apoptosis. Results of recent investigations show remarkable biological features of these factors, which propose their role in the course of cancer. Therefore, it is plausible to test whether transcripts of these genes could be detected in the peripheral blood cells of patients with breast cancer. MATERIALS AND METHODS: Real-time polymerase chain reaction assay was performed to detect FAS, BCL-2, and TP53 gene transcripts in the peripheral blood samples of 50 women with histologically confirmed infiltrative ductal carcinoma of the breast. Gene expression of patients was compared with 40 healthy women without history of malignancies or autoimmune disorders. RESULTS: The relative overexpression of BCL-2 in the blood cells from patients of early stages (I and II), nonmetastatic and low-grade tumors compared with healthy individuals, was shown by measuring the gene transcript. Similarly, 3-4-fold higher expression of FAS was found in those patients. The measurement of TP53 transcripts also showed higher levels of gene expression in patients compared with healthy controls. BCL-2 gene expression showed a significant correlation with FAS, while such a correlation was not observed between BCL-2 and TP53 . CONCLUSION: It seems tumor cells overexpress BCL-2 to inhibit apoptosis and guarantee their cell survival. As a physiologic response, FAS and TP53 could be upregulated to suppress tumors. However, these pathways at early stages of disease may be inadequate and cause progressive malignancy.

Association of interleukin-18 gene promoter polymorphisms with breast cancer.

Interleukin-18 [IL-18] gene promoter polymorphism is reported to be a genetic risk factor for several types of cancer. The aims of this investigation were to evaluate and compare the frequencies of IL-18 gene promoter polymorphisms at positions -137 [G/C] and -607 [C/A] in breast cancer patients and healthy controls as well as to study the contribution of these data with clinicopathological parameters at diagnosis. The studied populations comprised 250 cases with breast carcinoma and 206 healthy subjects. IL-18 gene promoter polymorphisms at positions -137 and -607 were amplified in patient and control groups using allele specific polymerase chain reaction [AS-PCR]. The frequencies of GG, GC and CC genotypes of -137 SNP were 141 [56.4%], 96 [38.4%] and 13 [5.2%] in patients vs. 110 [53.4%], 72 [34.9%] and 24 [11.7%] in controls, respectively. A significant decrease of the CC genotype was observed in patients [p = 0.04]. The frequency of the CC genotype at position -137 was also significantly higher in patients with metastasis than non-metastatic patients [21.4% vs. 4.3%] [p = 0.02]. There was no significant association between genotype frequencies at position -607 with breast cancer or its clinicopathological parameters at diagnosis. Moreover, allelic frequencies at these positions did not contribute to breast cancer incidence. The distribution of IL-18 gene haplotypes and genotype combinations were not significantly different between patients and normal control individuals. This is the first report investigating the contribution of IL-18 gene promoter polymorphisms to breast cancer. These results suggest contrast effects of IL-18 gene in cancer induction and progression. Key words: Breast cancer, IL-18, polymorphism.

Splenic lesions: FNA findings in 48 cases.

OBJECTIVE: To study fine needle aspiration (FNA) cytological findings of splenic lesions and assess the role of FNA in the diagnosis of splenomegaly or splenic tumours. METHODS: This study consisted of 48 cases, 25 males and 23 females. The ages ranged between 3 and 71 years. Most of these cases were aspirated under ultrasonographic guidance and a small number were also aspirated directly by using a 22- to 23-gauge needles. The smears were stained with Wright-Giemsa and Papanicolaou methods. Special stains were used whenever necessary. RESULTS: In this study 14 cases were diagnosed as lymphoma-leukaemia, 7 cases as tuberculosis, 12 cases as kala-azar, 2 cases as hydatid cyst, 3 cases as storage diseases, 3 cases as simple cyst, 2 cases as myeloproliferative disorders, 2 cases as malignant tumours and 3 cases as hamartomas (these were wrongly diagnosed as malignant tumours). CONCLUSION: Splenic aspiration is a safe procedure and is very useful in the diagnosis of parasitic and infectious diseases, especially in endemic countries like Iran.

Cytotoxic T lymphocyte antigen-4 promoter variants in breast cancer.

CTLA4 is a coinhibitory molecule expressed mainly on activated T lymphocytes. To test the putative involvement of CTLA-4 in inhibitory state of immunity to breast cancer, we genotyped 283 patients and 245 healthy control subjects for -1722 T/C, -1661 A/G, and -318 C/T single nucleotide polymorphisms in the promoter region of the CTLA4 gene. There were no significant differences in genotype, allele, or haplotype frequencies in all three loci between patients and healthy controls. Moreover, the incidence of the most frequent haplotype combination (TAC/TAC, T -1722, A -1661, C -318) was only slightly higher among healthy controls than patients (68.4 vs. 64.8%, P = 0.2). This haplotype combination was associated with lower stages of the disease (P = 0.0007), however, and higher estrogen receptor (ER) expression in patients (P = 0.006). Association with tumor prognostic or predictive factors was also observed with certain genotypes: the -1661 AA genotype was associated with lesser lymph node (LN) involvement (P = 0.017) and higher ER expression (P = 0.004), and the -318 CC genotype with lesser LN involvement (P = 0.007). These results suggest that CTLA4 promoter variants participate in the progression of breast cancer rather than in its initial development.

Insulin adsorbance to polyvinylchloride (PVC) surfaces of fluid container and infusion-set.

INTRODUCTION: In total parenteral nutrition (TPN) solution, adsorbance of insulin to polyvinylchloride (PVC) surfaces of fluid containers and infusion-sets, decrease the amount of insulin that reaches the patients. OBJECTIVE: To clarify the biding sites of insulin and to propose a solution to overcome this problem. METHODS AND MATERIALS: To each of four 1000ml. PVC bottles of 5 percent dextrose solution, 300 microunit of insulin per each milliliter of dextrose solution were added. Each bottle was then connected to an infusion-set and the system made to run at an infusion rate of 100ml. per hour. One milliliter samples were then collected from both the PVC bottles and infusion-sets-terminal, separately, immediately at the starting point (time zero) and 15, 30, 45 and 60 minutes thereafter. The concentrations of insulin were checked using insulin kits. RESULTS: At the starting point (time zero) the mean of insulin concentrations among four PVC bottles was 213.79 microunit per each milliliter of 5 percent dextrose solution. No significant fluctuation was noted in the concentration of insulin in the PVC bottles through 60th minute period. However the concentration of insulin at infusion-set- terminal decreased significantly at the end of the same hour (p. value = 0.004). CONCLUSION: Our results demonstrate that the adsorbance of insulin takes place at the surfaces of infusion sets. It follows therefore that increase in the primary dosage of insulin added to PVC infusion solutions and the selection of a suitable infusion set (polyethylene) seem to be beneficial for overcoming this problem.

Assessment of a breast cancer screening programme in Shiraz, Islamic Republic of Iran.

A breast cancer screening programme was evaluated for approximately 10,000 women aged 35 years and older. There were 67 cases of breast cancer. Highest rates of attendance were seen among younger women (35-44 years) and middle socioeconomic groups. Lowest rates were among those aged over 65 years and low socioeconomic groups. The rate of detection by self-examination was similar to that by health personnel examination. At all stages of screening, positive findings were most common among the high socioeconomic class. Attendance decreased steadily from first to last stages of serial screening. Although mammography is the most sensitive method of detection, because of its high cost we suggest establishing breast self-examination education programmes and encouraging women to self-examine.

Assessment of a breast cancer screening programme in Shiraz, Islamic Republic of Iran

A breast cancer screening programme was evaluated for approximately 10,000 women aged 35 years and older. There were 67 cases of breast cancer. Highest rates of attendance were seen among younger women [35-44 years] and middle socioeconomic groups. Lowest rates were among those aged over 65 years and low socioeconomic groups. The rate of detection by self-examination was similar to that by health personnel examination. At all stages of screening, positive findings were most common among the high socioeconomic class. Attendance decreased steadily from first to last stages of serial screening. Although mammography is the most sensitive method of detection, because of its high cost we suggest establishing breast self-examination education programmes and encouraging women to self-examine

p53 gene alteration and protein expression in Iranian women with infiltrative ductal breast carcinoma.

Genetic alterations in the p53 tumor suppressor gene with or without protein overexpression have been reported to be associated with sporadic breast cancer. To assess the role of p53 in infiltrative ductal breast carcinoma among Iranian patients, p53 protein expression and p53 gene mutations were studied by immunohistochemical analysis and single-strand conformation polymorphism, respectively. The p53 protein was expressed in 25 out of 51 (49%) tumors and p53 gene mutations were detected in 17 out of 37 (46%) tested tumors. No significant correlation was observed between p53 gene mutations and p53 protein expression. There was no significant correlation between p53 abnormalities (mutation and expression) and tumor size, histological grade, nodal status, and progesterone receptor expression. However, a non-statistically significant trend of association (P=0.07) was observed between p53 gene mutations and lack of estrogen receptor. The high percentage of alterations both in p53 gene and protein among southern Iranian breast cancer patients suggests that p53 is probably one of the genes involved in sporadic breast cancer in this area.

HLA-DBR 1 alleles and the susceptibility of Iranian patients with breast cancer.

Breast cancer is considered a major malignancy among women worldwide. The contribution of genetic elements to the onset of familial breast cancer has already been established. The current study investigate the alfele frequency of HLA-DRB 1 in 36 primary operable female breast cancer patients from southern Iran by polymerase chain reaction using sequence specific primers (PCR-SSP). Results were compared with those of 36 female control subjects. Statistical analysis was performed and P values were determined for each character. Our results indicated that the frequency of HLA-DRB 1*12 allele is significantly higher in the patient group (p<0.03) compared to the control group. In addition, HLA-DRB1*11 appeared to be as the most frequent allele in the control group (29.2%) and had approximately the same distribution among the patient group (22.5%).

Epidemiology and mortality of burns in the South West of Iran.

Burn injuries still produce a significant morbidity and mortality in Iran. This study was carried out to analyze the epidemiology, mortality, and current etiological factors of 2043 burn patients who were admitted to the burn centers in the Fars province during 4 years (1994-1998). There were two burn centers in the Fars province serving 3817036 people over an area of 124,000 km(2). The overall incidence rates of hospitalization and death were 13.4 and 4.6 per 100000 person-years. The mean age was 21.9 years, and 51% of patients were children under 19-years-old. The highest rates of hospitalization and death were observed in the elderly (80 years). Also young females (20-29 years) had a high rate of hospitalization. Thus, 55% of the patients had BBS less than 40%. Burn injuries were more frequent and larger with higher mortality in females than in males (P<0.0001). There was also statistically significant correlation between age groups, gender, and BBS with mortality rate (P<0.0001). Flame was the most common etiology of burns. There was also significant correlation between age groups and type of burns (P<0.0001). Suicide attempts for all the patients > or = 11 years were the cause of 41.3% (256/620) of the burns involving women and of 10.3% (40/388) of the burns involving men. The overall case fatality rate was 34.4%. The mortality rate was significantly higher for self-inflicted burns (78%) than for accidental burns (26.7%). Most of the lesions requiring hospital admission occurred during the winter months. Factors associated with an increase in mortality were suicidal burns, burn size, age, and flame burns. Most of the burn injuries were caused by domestic accidents and were, therefore, preventable.

Fine needle aspiration cytology of foreign bodies presenting as cystic abdominal masses. A report of three cases.

BACKGROUND: Foreign body material (gauze sponges) presented as cystic abdominal masses and were confused with malignant tumors. CASES: Two females and one male presented with abdominal masses. They had undergone laparotomy 5-12 years earlier. Clinically the masses were diagnosed as benign or malignant cystic lesions. Fine needle aspiration revealed necrotic material, hemosiderin-laden macrophages, foreign body giant cells, cholesterol crystals and many fragments of birefringent material. The possibility of malignancy was ruled out. Cut sections of the excised cystic lesions revealed gauze sponges surrounded by a thick, fibrotic wall. CONCLUSION: This report underscores the usefulness of fine needle aspiration in ruling out malignancy.