A population-based study on incidence trends of kidney and renal pelvis cancers in the United States over 2000-2020.

Cancers of the kidney and renal pelvis are among the most prevalent types of urinary cancers. We aimed to outline the incidence trends of kidney and renal pelvis cancers by age, sex, race/ethnicity, and histology in the United States (US) from 2000 to 2020. The data was obtained from the Surveillance, Epidemiology, and End Results (SEER) 22 database. The identification of patients with kidney and renal pelvis cancers with morphologies of renal cell carcinoma, nephroblastoma, sarcoma, and neuroendocrine tumor was conducted utilizing the International Classification of Diseases for Oncology version 3. The average annual percent change (AAPC) were presented. All estimates were given in the form of counts and delayed age-standardized incidence rates (ASIRs) per 100,000 people. From 2000 to 2019, a total of 490,481 cases of kidney and renal pelvic cancer were recorded across all age groups in the US. The majority of them were among Non-Hispanic Whites (NHWs) (69.75%) and those aged 55-69 years (39.96%). The ASIRs per 100,000 for kidney and pelvis cancers were 22.03 for men and 11.14 for women. Non-Hispanic Black men had the highest ASIR (24.53 [24.24, 24.81]), and increase in ASIR over the 2000-2019 period (AAPC: 2.19% [1.84, 2.84]). There was a noticeable increase in incidence of kidney and renal pelvis cancers. Individuals aged 70-84 years had the highest ASIR for kidney and renal pelvis cancers. The COVID-19 era has resulted in a significant reduction in incidence rates across all demographics.

Adsorption and safe immobilization of Sr ions in modified zeolite matrices.

In the present study, an Iranian natural zeolite (Sabzevar region) was evaluated as a natural adsorbent for the elimination and immobilization of strontium ions from an aqueous solution. For improving the adsorption efficiency of strontium ion, the zeolite surface was modified by the Schiff base ligand of bis (2-hydroxybenzaldehyde)1,2-diaminoethane (H2L). The natural zeolite and zeolite/H2L were characterized using Fourier transform infrared spectroscopy (FT-IR), X-ray diffraction (XRD), X-ray fluorescence (XRF), BET and scanning electron microscope (SEM). Analysis of the natural zeolite showed that the zeolite is from the type of clinoptilolite and has a crystalline structure with the specific surface area 29.74 m2/g. The results showed that strontium adsorption onto modified zeolite increases compared to unmodified zeolite from 64.5% to 97.2% (at pH = 6). The effective parameters pH, adsorbent dosage, initial concentration of strontium ions, contact time, temperature, and interfering ions, were studied and optimized. The maximum adsorption efficiency was confirmed by modified zeolite and found to be 97.5% after 60 min of equilibrium time at pH 6, 0.05g as adsorbent dosage, and at 25 °C. Adsorption of strontium was confirmed by Langmuir model with maximum adsorption capacity of 10.31 mg/g. Kinetic studies showed that the adsorption of strontium ions on the adsorbent follows pseudo-second-order (PSO) model. Also, the thermodynamics of the adsorption process indicated that the adsorption of strontium on zeolite/H2L is an endothermic and spontaneous process, and the adsorption mechanism is a combination of physical and chemical adsorption. Finally, to manage the secondary waste generated from the adsorption process, strontium ions were immobilized in a zeolite structure. The results showed that the stabilization is well done with the thermal preparation process. After thermal treatment at 25-900 °C, modified zeolite satisfactorily retains strontium during back-exchange tests with NaCl solution. According to the results, the amount of strontium released from the adsorbent phase decreases from 52.6 to 1.6% with increasing heat treatment temperature.

A population-based study on incidence trends of myeloma in the United States over 2000-2020.

Myeloma is one of the most common types of haematological malignancies. We aimed to investigate the incidence rates of myeloma by sex, race, age, and histological subgroups in the United States (US) over 2000-2020. Data were retrieved from the the Surveillance, Epidemiology, and End Results (SEER) 22 database. The International Classification of Diseases for Oncology version 3 morphological codes 9731, 9732, and 9734 were assigned for solitary plasmacytoma of bone, plasma cell myeloma, and extraosseous plasmacytoma, respectively. Average annual percent change (AAPC) and the pairwise comparison with the parallelism and coincidence were reported. All estimates were reported as counts and age-adjusted incidence rates per 100,000 individuals. Over 2000-2019, most of myeloma cases were among those aged at least 55 years (85.51%), men (54.82%), and non-Hispanic Whites (66.67%). Among different subtypes, plasma cell myeloma with 193,530 cases had the highest frequency over the same period. Also, there was a significant decrease in the age-standardized incidence rate of myeloma across all races/ethnicities in both sexes within all age groups (AAPC: - 8.02; 95% confidence interval (CI): - 10.43 to - 5.61) and those aged < 55 (AAPC: - 8.64; 95% CI - 11.02 to - 6.25) from 2019 to November 2020. The overall trends of myeloma incidence rates were not parallel, nor identical. There was an increase in myeloma incidence in both sexes, with a highly increasing rate, particularly among younger Hispanic and non-Hispanic Black women over 2000-2019. However, a remarkable decline was observed in the incidence rates following the COVID-19 pandemic in 2020.

Adsorption behavior of trace elements of 90Sr on MnO2-ZrO2 loaded with polyacrylonitrile polymer from aqueous solutions.

A MnO2-ZrO2-polyacrylonitrile (MnO2-ZrO2-PAN) composite ion exchanger was produced and its properties were examined by Fourier-transformed infrared spectroscopy, scanning electron microscopy, The BET (Brunauer, Emmett and Teller) surface area, X-Ray diffraction analysis and thermogravimetric analysis. The adsorption of Strontium (Sr) from solutions by MnO2-ZrO2-PAN composite was studied thru batch experiments. The distribution Coefficient of Sr (II) on the composite sorbent was investigated against pH, interaction time, and primary concentration ion. To study the kinetics of adsorption, Pseudo-first-order and Pseudo second-order adsorption kinetics were studied and the results revealed that adsorption kinetics better fit to the pseudo-second-order model. Three iso-temperature models, Langmuir, Freundlich, and Temkin were applied to fit the experimental results. Among those models, Langmuir revealed the most suitable one with minimum deviation. The created composite exhibited strong compatibility to the elimination of Y (III), Ni (II), Pb (II), and Co (II) from radioactive waste streams. On the other, it is evident from the data that the quantifiable extraction of Sr (II) ions from Zr (IV), Mo (VI), and La (III) is feasible. MnO2-ZrO2 Loaded with (PAN) Polymer was figured out to have high ion exchange capacity and thermal stability and selectivity for strontium.

Efficacy of Oral Zinc Sulfate Supplementation on Clearance of Cervical Human Papillomavirus (HPV); A Randomized Controlled Clinical Trial.

AIM: Human Papillomavirus is one of the most crucial infectious disease in gynecology disease. To assess the efficacy of supplemental zinc treatment in clearance of HPV infection. METHODS: Eighty zinc-sufficient women between 21-55 years, with positive HPV DNA testing, and abnormal cervical cytology in Pap test (ASCUS or LISL) were randomly divided to case (n=40) and control group (n=40). Case group received oral tablets of zinc sulfate twice a day for 3 months while control group received no placebo. During follow-up patients underwent repeat HPV DNA test and PAP test and were evaluated for clearance/persistence of HPV infection and regression/progression in the lesion grading. RESULTS: As far as demographics, serum zinc levels and the relevant risk factors for persistence of HPV were concerned, there was no significant difference between two groups, except for the frequency distribution of HR-HPV which was significantly higher in case  group. Zinc treatment for 3 months reduced the risk of persistence of HPV infection and progression from baseline cytology (OR = 0.130) (CI 95% 0.04-0.381; p <0.001) and 0.301 (95% CI 0.777-0.116; p = 0.012), respectively. Age, initial cytology, HPV type, and contraceptive method were not related to persistence of HPV. Serum zinc levels increased in the casr group as a result of oral zinc consumption for 3-month period, though without any statistical significance (p = 0.407). CONCLUSION: The results of the following study suggested that oral intake of zinc sulfate supplement for 3 months increases the rates of HPV clearance and resolution of pre-existing cervical lesion.

Comparison between Single Versus Twice Application of Topical 85% Trichloroacetic Acid in the Treatment of Cervical Intraepithelial Neoplasia; A Randomized Clinical Trial on Efficacy and Tolerability.

PURPOSE: To compare the efficacy and safety of up to two-time administration of 85% TCA, as a promising alternative therapy to conservative and surgical management of grade one to three CINs. METHODS: In this two-armed randomized clinical trial, a total of 53 patients with biopsy-proven CIN lesions were allocated to two groups of TCA treatment. The first group (n=26) received a single dose of local therapy with 85% TCA while the second group (n=27) was treated on two separate occasions with a two-week interval. Two participants (one in each group) were lost to follow-up. At the two-month follow-up after TCA application, a colposcopy-guided biopsy was performed for all patients and the pathological specimens were studied by a single experienced pathologist to determine the post-intervention grading of CIN. RESULTS: Two groups were comparable in terms of age and base-line lesion grading, as CIN 1 lesions comprised the majority of cases (54%), followed by CIN 2(37%). While our sample was a poor representative of CIN3 lesions (7%), no significant difference was noticed between the single and twice TCA treated groups with a response rate of 52% and 54% respectively (either complete remission to normal histology or regression to any low-grade lesion). Either separate analysis (with respect to the base-line grading within each treatment group) or combined analysis (regardless of CIN sub-group) could not generate any statistical significance. The second dose of TCA did not increase the frequency of reported adverse events. CONCLUSION: The second dose of topical 85% TCA does not seem to increase the CIN response rate more so than its single dose. However, further controlled clinical trials with larger samples are warranted to verify current findings. The use of TCA was not limited by any major side effect, therefore, the potential to achieve an increased efficacy with more frequent TCA applications is appealing.

Diagnostic value of a power Doppler ultrasound-based malignancy index for differentiating malignant and benign solid breast lesions.

BACKGROUND: Power Doppler ultrasound (PDUS) can provide useful information regarding the vascularity of breast lesions. The aim of this study was to investigate the diagnostic performance of a new PDUS-driven malignancy index in differentiating between malignant and benign causes of solid breast lesions. MATERIALS AND METHODS: Patients with solid breast lesions were enrolled consecutively and evaluated first by PDUS and subsequently by histopathologic assessment after undergoing surgical biopsy. A custom-made software was used to extract data from images for calculating malignancy index formula. RESULTS: A total of 87 patients with solid breast lesions were enrolled. Histopathologic evaluation identified 49 patients as benign and 38 patients as malignant. Malignancy index was significantly higher in the malignant group as compared to benign tumors (6.31 vs 0.30,P < 0.001). Area under the receiver operating characteristics (ROC) curve (AUC) was 0.98 (95% confidence interval (CI) 0.95-1.00). According to the ROC curve analysis, the cut-off point of 1.23 for malignancy index had a sensitivity and specificity of 94.7% (95% CI 82.2-99.3) and 94.0% (95% CI 83.1-98.7), respectively. CONCLUSION: Comparing with the histopathologic evaluation as the gold standard for diagnosing breast lesions, PDUS-driven malignancy index was shown to have a high discriminative performance in identifying malignant lesions with high sensitivity, specificity, and diagnostic accuracy. The noninvasive nature of PDUS is an important advantage that could prevent unnecessary biopsies.

Health promoting hospitals in Iran: Persian translation, cultural adaptation, content and face validation of selfassessment form of the standards of health promoting hospitals affiliated to the World Health Organization.

Background: According to the World Health Organization, hospitals should assess their internal wards to improve health promotion services using self-assessment tools. To achieve this goal, standards of health promoting hospitals have been developed by the World Health Organization, and measurable elements and indicators have been defined to facilitate the practical application of these standards in planning, implementation, and evaluation of health promotion in hospitals. Moreover, a form has been developed for this self-assessment. Considering linguistic and cultural differences in various countries, standards must be written in equivalent texts and, then, their content and face validity should be examined. Performing this process in a systemic and scientific way can guarantee that the same tools have been used, and thus the results obtained from different hospitals are comparable. Methods: After the preparation phase (considering research aim, obtaining permission from the original designers, and determining the time), the following activities were done: translating the form from its original language to the target language, combining and compiling initial translations to a single translation, reversing the final version of the translation from the target language to the original language, obtaining cognitive information, revising and concluding, and determining the content and face validity of the translated form and final report. After filling in the form, face validity was calculated using impact score formula. Content validity was measured using content validity ratio (CVR) and content validity index (CVI). Results: After calculating the impact score, all 40 items showed a high impact score greater than 1.5, representing the fact that all items are important. The minimum value of CVR for each of the 40 items was estimated to be 0.64; CVI of all items was greater than 0.79. Conclusion: Given the input of the standards of health promoting hospitals affiliated to the World Health Organization in National Accreditation of Iranian hospitals, the form was translated and found to be valid according to content and face validity and is available in Persian to be used in Iranian hospitals (Appendix 1).

The association of serum vitamin D concentration and ventricular dysfunction among patients with acute coronary syndrome.

OBJECTIVE: To determine if vitamin D deficiency was associated with higher odds of left ventricular dysfunction among patients with acute coronary syndrome (ACS) and, if so, to determine whether this association was mediated by increased inflammation as measured by C-reactive protein (CRP) and white blood cell count (WBC). METHODS: This was a cross-sectional study of 170 participants with ACS. Multiple logistic regression was used to examine the association between the outcome of ventricular performance and serum vitamin D concentrations. We also determined whether CRP and WBC meet standard criteria as the mediators between left ventricular ejection fraction and vitamin D deficiency. RESULTS: Participants with vitamin D deficiency were more likely to have ventricular dysfunction (OR: 2.12, 95% CI: 1.2-5.23). WBC counts did not meet one of the criteria for mediation. However, the WBC was an effect modifier such that the association of vitamin D deficiency and ventricular dysfunction was only present among participants with WBC more than 11,000. CONCLUSION: This study found that vitamin D deficiency was associated with higher odds of ventricular dysfunction. Further longitudinal and experimental studies are necessary to confirm this finding and to determine if there is a role for vitamin D supplementation therapy in preventing ventricular dysfunction in select patient populations.

A pilot randomized controlled clinical trial of second uterine curettage versus usual care to determine the effect of re-curettage on patients' need for chemotherapy among women with low risk, nonmetastatic gestational trophoblastic neoplasm in Urmia, Iran.

OBJECTIVE: The objective of this study was to determine if second curettage was associated with a decreased need for the number of chemotherapy treatments compared to usual care. METHODS: A pilot randomized controlled clinical trial was designed at Motahhari Referral Hospital in 2014. Fifty-two patients with low risk, nonmetastatic gestational trophoblastic neoplasm were assigned randomly to two arms. The interventional arm included a repeat uterine curettage, and the control group received standard care (chemotherapy). All participants were followed periodically over 6 months. Primary outcome was defined as the number of chemotherapy courses in each arm. Student's t-test and receiver operator characteristics (ROC) curve were applied for statistical analysis as appropriate. RESULTS: Fifty percent of participants who underwent re-curettage did respond to intervention with no further chemotherapy after 6 months of follow-up. The intervention arm had higher number of remissions without chemotherapy compared to those who received usual care. In the subgroup analysis, the ROC curve could predict the re-curettage treatment response by beta human chorionic gonadotropin (BhCG) level significantly. No complications were reported in the intervention arm. CONCLUSION: Second curettage is an alternative effective procedure to decrease the need for chemotherapy among patients with low risk, nonmetastatic gestational trophoblastic neoplasm. Further clinical trials with larger sample size may be needed to determine the effective role of second curettage among patients.

EXPRESION OF P53 IN OVARAN EPITHELIAL TUMOURS AND ITS CORRELATION WITH HISTOPATHOLOGICAL PARAMETERS.

BACKGROUND: Ovarian cancers are the leading cause of death among gynaecologic neoplasms. The most common form of ovarian tumours is surface epithelial tumours divided as benign, borderline and malignant. Of particular interest are borderline tumours, because the pathologist may rely on some what vague morphologic criteria. The aim of this study was to evaluate the correlation of tumour suppressor protein P53 with macroscopic and microscopic criteria of ovarian surface epithelial tumours and distinction of borderline from malignant tumours. METHODS: We studied 109 ovarian neoplasms including 74 benign, 8 borderline and 27 malignant ovarian epithelial tumours during March 2006-March 2011 in Urmia University of Medical Sciences. Immuno-histochemical staining for P53 performed on paraffin blocks and quantified with 12- point weighted score proposed by W.Y chan. RESULTS: Mean P53 weighted scores in benign, borderline and malignant tumours were 0.20 ± 0.63, 0.76 ± 0.89 and 3.79 ± 4.20, respectively. There was significant difference between malignant and borderline tumours (p = 0.002) and between malignant and benign ones (p = 0.000). None of 11 immuno-reactive benign and 4 borderline tumours showed P53 expression in > 50% of tumour cells, but 11 out of 15 immuno-reactive malignant tumours (73.3%) expressed p53 in > 50% of tumour cells. P53 score significantly increases with mitotic count (p = 0.000) and solidification of the tumour (p = 0.001). There was no significant correlation with size (p = 0.277), papillary structures (p = 0.062) and grade (p = 0.578). CONCLUSION: According to our results, P53 staining can be used as a helpful method in distinction of borderline from malignant ovarian epithelial tumours, especially in the manner that expression in > 50% of cells favouring malignancy.

A Pilot Randomized Trial of Financial Incentives or Coaching to Lower Serum Phosphorus in Dialysis Patients.

OBJECTIVE: Among chronic hemodialysis patients, hyperphosphatemia is common and associated with mortality. Behavioral economics and complementary behavior-change theories may offer valuable approaches to achieving phosphorus (PO4) control. The aim was to determine feasibility of implementing financial incentives and structured coaching to improve PO4 in the hemodialysis setting. DESIGN AND METHODS: This pilot randomized controlled trial was conducted in 3 urban dialysis units for 10 weeks among 36 adults with elevated serum PO4 (median >5.5 mg/dL over 3 months). INTERVENTIONS: Twelve participants each were randomized to: (1) financial incentives for lowering PO4, (2) coaching about dietary and medication adherence, or (3) usual care. PO4 was measured during routine clinic operations. Each incentives arm participant received the equivalent of $1.50/day if the PO4 was ≤5.5 mg/dL or >5.5 mg/dL but decreased ≥0.5 mg/dL since the prior measurement. The coach was instructed to contact coaching arm participants at least 3 times per week. MAIN OUTCOME MEASURES: The outcome measures included: (1) enrollment rate, (2) dropout rate, and (3) change in PO4 from beginning to end of 10-week intervention period. RESULTS: Of 66 eligible patients, 36 (55%) enrolled. Median age was 53 years, 83% were black race, and 78% were male. Median baseline PO4 was 6.0 (interquartile range 5.6, 7.5). Using stratified generalized estimation equation analyses, the monthly decline in PO4 was -0.32 mg/dL (95% CI -0.60, -0.04) in the incentives arm, -0.40 mg/dL (-0.60, -0.20) in the coaching arm, and -0.24 mg/dL (-0.60, 0.08) in the usual care arm. No patients dropped out. All intervention arm participants expressed interest in receiving similar support in the future. CONCLUSIONS: This pilot trial demonstrated good feasibility in enrollment and implementation of novel behavioral health strategies to reduce PO4 in dialysis patients.

The association of antidepressant medications and diabetic retinopathy among people with diabetes.

OBJECTIVE: To determine if the use of antidepressants was associated with lower odds of diabetic retinopathy and if so, to determine if this association was mediated by decreased inflammation as measured by C-reactive protein (CRP). DESIGN: This was a cross sectional study of 1,041 participants with type 2 diabetes 40-85years old from the 2005-2008 National Health and Nutrition Examination Survey (NHANES). Multiple logistic regression was used to examine the association between the outcome of diabetic retinopathy and the primary exposure of antidepressant medication usage. We also determined whether CRP meets standard criteria as a mediator between antidepressant use and diabetic retinopathy. RESULTS: Participants using antidepressants were less likely to have diabetic retinopathy (OR 0.50, 95% CI: 0.31-0.82). CRP did not meet one of the criteria for mediation. However, CRP was an effect modifier such that the association of antidepressant use and diabetic retinopathy was only present among participants with CRP ≥0.3mg/dl. Among the antidepressant drug classes, selective serotonin reuptake inhibitor (SSRI) users had significantly lower odds of developing diabetic retinopathy compared to non-users of antidepressants. CONCLUSIONS: Using representative survey data of US adults with type-2 diabetes, this study found that antidepressant use was associated with lower odds of diabetic retinopathy. Further longitudinal and experimental studies are necessary to confirm this finding and to determine if there is a role for antidepressants in preventing diabetic retinopathy in select patient populations.

Self-perception in Iranian adolescents with diabetes: a qualitative study.

BACKGROUND: It is obvious that self-perception can play an important role in the development of self-management behaviours among adolescents with diabetes to promote their health and quality of life. This study seeks to explain self-perception in adolescents with diabetes. METHOD: This qualitative study, which is of "grounded theory" type, was performed in 2013 in Ahvaz, Iran, through semi-structured interviews with ten adolescents with type 1 diabetes, two parents and a nurse, who were chosen objectively. Data analysis was performed using Strauss and Corbin 1998 method. RESULTS: Four main theme was obtained from the analysis of data, and the consequence theme was inferred as follows: getting insight (knowledge acquisition and belief management), perceiving similarities with others (not hiding the disease, showing the illness is normal, and accepting an active role in the family), and self-care management (independent control of food and treatment regimen and understanding of capabilities to manage the future of life and manage the daily activities of life), and life satisfaction (perception of being healthy and having a normal life). CONCLUSION: Getting insight into the disease is the most important part of perceiving similarities with others and offering self-care, which can provide a person's positive perception of himself/herself and the illness, as well as life satisfaction for their adolescent over time. These results are an operational guide for personnel providing health care services, especially diabetes specialist nurses.

Preliminary dosimetry of (166)Ho-propylene di-amino tetra (methy1enephosphonicacid) for human based on biodistribution data in rats.

CONTEXT: Nowadays, radionuclides with high ß- particle energies such as (166)Ho are recommended for bone marrow ablation in patients with multiple myeloma. The addition of skeletal targeted radiotherapy to the patients can improve the response rate in phase I and II trials, with promising long-term survival data. AIMS: In this work, the absorbed dose to each organ of human for (166)Ho-propylene di-amino tetra methy1enephosphonicacid (PDTMP) was evaluated based on biodistribution studies in rats and was compared with (166)Ho-tetraazacyclododecane tetramethylene-phosphonate (DOTMP) as the only clinically used Ho-166 bone marrow ablative agent. SETTINGS AND DESIGN: In this work, the accumulated activity in animals was extrapolated to the accumulated activity in humans by mass extrapolation method. The absorbed dose to each organ of human for (166)Ho-PDTMP was evaluated by medical internal radiation dose method. MATERIALS AND METHODS: In this study, 166 Ho-PDTMP complex was prepared successfully using an in-house synthesized PDTMP ligand and (166)HoCl 3. Radiochemical purity of (166)Ho-PDTMP was checked by instant thin layer chromatography (>99%). The biodistribution of (166)Ho-PDTMP in wild-type rats was checked in animal tissues up to 48 h. STATISTICAL ANALYSIS USED: All values were expressed as mean ± standard deviation, and the data were compared using Student's t-test. Statistical significance was defined as P < 0.05. RESULTS: The highest absorbed dose for this complex is observed in red marrow with 0.691 mSv/MBq. (166)Ho-PDTMP demonstrated a higher red marrow: Non target organ uptake ratio compared to (166)Ho-DOTMP. CONCLUSIONS: The results showed that 166 Ho-PDTMP has considerable characteristics compared to (166)Ho-DOTMP and therefore can be a good candidate for bone marrow ablation.

Expression of CD44 and P53 in renal cell carcinoma: association with tumor subtypes.

Renal cell carcinoma (RCC) is a common malignancy of the kidney and accurate prediction of prognosis is valuable for the design of adjuvant therapy and counseling and effective scheduling of follow-up visits. Molecular genetic investigations of CD44 and P53 in RCC may be helpful in this regard. We studied the CD44 and P53 expressions semi-quantitatively on paraffin-embedded specimens of 64 RCC patients (37 male/27 female) who underwent surgery from 2003 to 2008 by immunohistochemistry and analyzed the correlation of P53 and CD44 expression in RCC and outcome. Thirteen of 64 (20.3%) specimens were P53 positive, 30/64 (46.9%) were CD44 positive and five tumors with positive P53 expressed CD44 protein (P = 0.5). A statistically significant correlation was not found between CD44 and P53 expression (P = 0.5) and age (P = 0.07), sex (P= 0.3), tumor size (P = 0.7), grade (P = 0.23), vascular invasion (P = 1.00) and ureteral invasion (P = 1.00). Furthermore, a significant correlation was not found between P53 expression with age (P = 0.3), sex (P = 0.7), tumor size (P = 0.7), grade (P = 0.1), vascular invasion (P = 1.00) and ureteral invasion (P = 1.00). According to our findings, only P53 expression is generally accompanied by non-conventional subtype tumor.

Outcome of immediate use of the permanent peritoneal dialysis catheter in children with acute and chronic renal failure.

OBJECTIVE: Peritoneal dialysis remains the only available option for patients which need immediate dialysis and it could be a bridge between end-stage renal failure (ESRD) and transplantation. There is a paucity of published experience of children with immediate use of permanent Tenckhoff Catheter for peritoneal dialysis from developing countries. In this study we report our experience on immediate use of permanent peritoneal access and continued peritoneal dialysis for a prolonged time. METHODS: Fifty six patients were studied including 30 males and 26 females within the age range of 1 month to 14 years with mean age of 6.5 years in Urmia, Northwest Iran. FINDINGS: No operative morbidity was seen. During a total of 499.5 continuous ambulatory peritoneal dialysis months, 16 patients had 28 episodes of peritonitis, which means a overall result of one episode per 17.8 months. There were 3 patients (5.35%) with catheter site leakage, 12 (21.4%) catheter obstructions (which led to omentectomy), 4 (7.2%) exit site infections (2 patients in the early postoperative period and 2 patients in during follow up). Death due to catheter related complications occurred in 1 per 56 patients and due to non-catheter related causes in 10 per 56 patients. CONCLUSION: Present results indicate that catheter-related complications were not higher than those previously reported and peritoneal dialysis could be initiated immediately after catheter implantation and could be a safe bridge between end-stage renal failure (ESRD) and transplantation.

Correlation between ankle-brachial index and microalbuminuria in type 2 diabetes mellitus.

INTRODUCTION: Microalbuminuria is a reliable marker of diabetic nephropathy. Establishment of peripheral vascular complications leads to early diagnosis, prevention, and treatment of renal and cardiovascular complications. This study investigated the value of ankle-brachial index (ABI) for prediction of microalbuminuria in type 2 diabetic patients. MATERIALS AND METHODS: Measurement of ABI with color Doppler ultrasonography was carried out for 206 patients with type 2 diabetes mellitus. An ABI Index less than 0.9 was defined as a predictive marker for atherosclerosis. Microalbuminuria and risk factors of atherosclerosis were compared between the patients categorized based on the ABI values. RESULTS: The mean ABI was 1.1 ± 0.2 (range, 0.052 to 1.6), and 41 (20%) had an abnormal ABI (< 0.9). The correlations were significant between abnormal ABI and duration of disease (P = .04), cardiovascular event and cardiac care unit admission (P = .001), hypertension (P = .01), and dyslipidemia (P = .01). There was a significant correlation between ABI and microalbuminuria (odds ratio, 0.05; 95% confidence interval, 0.038 to 0.630; P < .001). A cutoff point of an ABI less than or equal to 1.04 had a sensitivity of 71.6% and a specificity of 64.2% for prediction of microalbuminuria. CONCLUSIONS: The ABI is a noninvasive and reliable assay for detection of peripheral and cardiovascular complications, and also early stage of nephropathy in diabetic patients. In patients with an abnormal ABI, long-term follow-up for earlier detection and prevention of complications is helpful.

A report of the injuries sustained in Iran Air Flight 277 that crashed near Urmia, Iran.

BACKGROUND: On January 9, 2011 Iran Air Flight 277 crashed during approach to Urmia, Iran. Out of 105 passengers, 27 survived. This brief report presents a perspective of the passengers' sustained injuries. METHODS: We reviewed the recorded injuries of all passengers as provided by the Legal Medicine Organization authorities. The Injury Severity Score (ISS), an anatomical scoring system, was used to provide an overall code for those who survived with multiple anatomical injuries. RESULTS: There were a total of 96 ISS body region injuries among those who survived. Facial injuries (83%) were the most frequent injuries noted among fatalities, which was statistically significant (P = 0.000). In those who survived, injuries to the head and neck (37%) and facial (33%) regions were relatively less frequent than other anatomical regions. The most serious injuries among survivors belonged to the extremity (85%) region, particularly lower limb fractures (62%). Differences in extremity injuries between the survivors and fatalities were not statistically significant. CONCLUSION: The findings of this study were similar to other studies where the most frequent serious injuries were fractures of the extremities, particularly the lower limbs.

Co- transplantation of Bone Marrow Stromal Cells with Schwann Cells Evokes Mechanical Allodynia in the Contusion Model of Spinal Cord Injury in Rats.

OBJECTIVE: Several studies have shown that, although transplantation of neural stem cells into the contusion model of spinal cord injury (SCI) promotes locomotor function and improves functional recovery, it induces a painful response, Allodynia. Different studies indicate that bone marrow stromal cells (BMSCs) and Schwann cells (SCs) can improve locomotor recovery when transplanted into the injured rat spinal cord. Since these cells are commonly used in cell therapy, we investigated whether co-transplantation of these cells leads to the development of Allodynia. MATERIALS AND METHODS: In this experimental research, the contusion model of SCI was induced by laminectomy at the T8-T9 level of the spinal cord in adult female wistar rats (n=40) weighting (250-300g) using the New York University Device. BMSCs and SCs were cultured and prelabeled with 5-bromo-2-deoxyuridine (BrdU) and 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate (DiI) respectively. The rats were divided into five groups of 8 including: a control group (laminectomy only), three experimental groups (BMSC, SC and Co-transplant) and a sham group. The experimental groups received BMSCs, SCs, and BMSCs and SCs respectively by intraspinal injection 7 days after injury and the sham group received serum only. Locomotion was assessed using Basso, Beattie and Bresnahan (BBB) test and Allodynia by the withdrawal threshold test using Von Frey Filaments at 1, 7, 14, 21, 28, 35, 42, 49 and 56 days after SCI. The statistical comparisons between groups were carried out by using repeated measures analysis of variances (ANOVA). RESULTS: Significant differences were observed in BBB scores in the Co- transplant group compared to the BMSC and SC groups (p< 0.05). There were also significant differences in the withdrawal threshold means between animals in the sham group and the BMSC, SC and the Co-transplant groups (p<0.05).BBB scores and withdrawal threshold means showed that co-transplation improved functioning but greater Allodynia compared to the other experimental groups. CONCLUSION: The present study has shown that, although transplantation of BMSCs, SCs and a combination of these cells into the injured rat spinal cord can improve functional recovery, it leads to the development of mechanical Allodynia. This finding indicates that strategies to reduce Allodynia in cell transplantation studies are required.