Altered miR-223 Expression in Sputum for Diagnosis of Non-Small Cell Lung Cancer.

BACKGROUND: Diagnosis of Non-small Cell Lung Cancer (NSCLC) at an early stage is a daunting challenge due to the deficiency of specific noninvasive markers. MicroRNAs (miRNAs) play important roles in the initiation and progression of NSCLC. Measuring miRNA expression levels could provide a potential approach for the diagnosis of NSCLC. Our goals were to examine miR-223, miR-212, miR-192, miR-3074, SNORD33 and SNORD37 expression levels in tissue and sputum of NSCLC patients and cancer free subjects for molecular diagnosis of NSCLC. METHODS: Relative expressions of miR-223, miR-212, miR-192, miR-3074, SNORD33 and SNORD37 were examined with quantitative real-time RT-PCR assay in tissue and sputum obtained from 17 NSCLC patients and 17 controls. RESULTS: miR-3074 was upregulated in tissue samples of NSCLC patients compared with control group. miR-223 was upregulated, miR-212 and SNORD37 were downergulated in sputum samples of patients compared with controls. miR-223 quantification produced 82% sensitivity and 95% specificity with areas under the ROC curve at 0.90 in detection of NSCLC. CONCLUSION: miR-223 clearly discriminated cancer patients from cancer-free subjects and our results suggest that miR-223 could be a diagnostic useful biomarker. The measurement of altered miRNA expression in sputum samples manifested the potential noninvasive approach for detection of lung cancer.

Obstructed Defecation Syndrome After Delivery Trauma.

BACKGROUND: Obstructed defecation syndrome (ODS) occurs in about 7% of adults; it seems that the etiology of pelvic floor disorders is multifactorial. Pregnancy and childbirth damage to the pelvic nerve and muscles are proposed causes for this condition. The precise role of vaginal delivery (VD) is not clearly defined, although in recent studies association of pelvic floor disorder with Operative vaginal delivery and episiotomy has been proposed. OBJECTIVES: In this prospective study, we assessed the outcome of stapled transanal rectal resection (STARR) in females with one of the two modes of delivery (VD or caesarean section (C/S). PATIENTS AND METHODS: We used Longo's ODS score for the assessment of the severity of pelvic floor malfunction. Stapled Trans Anal Rectal Resection (STARR) procedure was performed using two circular staplers. Follow-up was done 12 months after the discharge. To assess the role of episiotomy in patient with VD, we divided them into two subgroups; females who had VD with episiotomy (Vd + epi) and females who had VD alone. Data were analyzed using SPSS version 20 software. P values less than 0.05 were considered statistically significant. RESULTS: In 30 consecutive females undergoing STARR for the treatment of ODS, who enrolled in this prospective study, 19 (63.3%) had Vaginal Delivery VD and 11 (36.7%) had Cesarean Section (C/S). The ODS score before the surgery was higher in females who had C/S, although there was no significant difference between VD and C/S groups in terms of the percentage of the ODS score improvement after the STARR surgery. CONCLUSIONS: Higher ODS score in females who had C/S showed that C/S could not protect the pelvic organ from pregnancy and delivery trauma. It seems that episiotomy has a protective effect during VD; it can reduce the severity of trauma in pelvic organs during childbearing.

Parathyroid hormone measurement in prediction of hypocalcaemia following thyroidectomy.

OBJECTIVE: To determine the risk of postthyroidectomy hypocalcaemia by measuring parathyroid hormone (PTH) level after thyroidectomy. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Baqiyatallah Hospital, Tehran, Iran, from March 2008 to July 2010. METHODOLOGY: All included patients were referred for total or near bilateral thyroidectomy. Serum Calcium (Ca) and PTH levels were measured before and 24 hours after surgery. In low Ca cases or development of hypocalcaemia symptoms, daily monitoring of Ca levels were continued. Data were analyzed using SPSS 20 software (SPSS, Chicago, IL, USA). A p-value less than 0.05 were considered statistically significant. To assess the standard value of useful predictive factors, we used receiver operating characteristic (ROC) curves. RESULTS: Of total 99 patients who underwent bilateral thyroidectomy, 47 patients (47.5%) developed hypocalcaemia, out of them, 12 (25.5%) became symptomatic while 2 patients developed permanent hypoparathyroidism. After surgery, mean rank of PTH level within the normocalcaemic and hypocalcaemic patients was 55.34 and 44.1 respectively, p=0.052. Twenty four hours after surgery, 62% drop in PTH was associated with 83.3% of symptomatic hypocalcaemic. For diagnosis of symptomatic hypocalcaemia, 62% PTH drop had sensitivity and specificity were 83.3% and 90.80%. The area under the ROC curve for the PTH postoperative and PTH drop for diagnostic symptomatic hypocalcaemia were 0.835 and 0.873 respectively. CONCLUSION: Measuring PTH levels after 24 hours postthyroidectomy is not reliable factor for predicting hypocalcaemia itself. For predicting the risk of hypocalcaemia after thyroidectomy it is more reliable to measure the serum PTH level before and after operation and compare the reduction level of percentage of PTH drop for predicting the risk of hypocalcaemia.

Comparison of Colonic J-pouch and Straight Coloanal anastomosis after Low Anterior Resection.

BACKGROUND: The tendency towards sphincter preserving for low rectal cancers with low anterior resection, has led to the technique of straight coloanal anastomosis (SCAA) or colonic J-pouch anal anastomosis (CPAA). OBJECTIVES: The aim of our study was to compare functional outcomes, complication rates and quality of life (QoL) after LAR with either a straight or colonic J pouch anastomosis. PATIENTS AND METHODS: In 88 patients with rectal tumors located in lower third, who were candidate for LAR with coloanal anastomosis. They were divided for reconstruction using either SCAA (n= 47) or CPAA (n= 41) from January 2007 to May 2009. Functional results were assessed after closure of temporary loop ileostomy, 6 months postoperatively. Quality of life (QoL) was measured using European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30. RESULTS: The two groups were matched for gender, age, and preoperative chemotherapy and radiotherapy. There were no significant differences between the SCAA and CPAA groups relative to anastomotic leakage. Among patients with CPAA, the mean of 24 hours bowel movements, daytime bowel movements, incontinence scores, and incidence of urgency were significantly lower than those in the SCAA group. Also, patients with a CPAA had a significantly better quality of life. CONCLUSIONS: CPAA provided not only better functional results than SCAA, but also improved quality of life, thus may be the better choice.

Thoracoscopic Sympathicotomy vs Sympathectomy in Primary Hyperhidrosis.

BACKGROUND: Primary hyperhidrosis (P.H.H.) is characterized by excessive sweating in certain parts of body. It's estimated prevalence is 0%-6.1% in different populations. In Asian population its prevalence is around 3%. In 57% of cases, there is a positive family history. OBJECTIVES: To evaluate and compare the early and late satisfaction, outcomes and complications of thoracoscopic sympathectomy and sympathicotomy in the treatment of primary hyperhidrosis. MATERIALS AND METHODS: From April 2007 to January 2011, we prospectively treated 60 primary hyperhidrosis patients via thoracoscopic surgery. The first 30 patients underwent sympathectomy and the next 30 patients underwent sympathicotomy. We evaluated early and late satisfactions, outcomes and complications on the first visit (5-8days) following surgery and 12 months after surgery, for all patients. RESULTS: The mean operative time was 66.3 minutes in sympathicotomy group and 110.8 minutes in sympathectomy group (P < 0.001). There were no significant differences between the two groups in overall early and late satisfaction, gustatory sweating, pompholyx and post-operative pain. There was comparatively less early and late compensatory sweating (C.S.), and other adverse influences of C.S. in the sympathicotomy group. CONCLUSIONS: Because of shorter operative time, less C.S. and less adverse influence of C.S., sympathicotomy seems a better treatment for primary hyperhidrosis, compared with sympathectomy.

The role of performing life support courses in rural areas in improving pre-hospital physiologic conditions of patients with penetrating injuries.

OBJECTIVE: To evaluate the impact of animal model based medical training courses for village healthcare workers on prehospital physiologic condition and prognosis of patients with penetrating injuries. STUDY DESIGN: Experimental study. PLACE AND DURATION OF STUDY: This study was carried out in Mehran city and its neighbouring rural districts in western part of Iran from 2002 to 2004. METHODOLOGY: Seventy-six village healthcare workers were trained and equipped to deliver in-field medical first cares. First group (226 patients) consisted of those who received this cares by the trained group and second group (245 patients) were those who received no in-field cares and were transported directly to the trauma center in provincial capital, Ilam. Physiologic Severity Score (PSS) was calculated to determine the physiologic condition of patients in both groups. RESULTS: The most prevalent cause of trauma in both groups was car accidents (61.6%). Controlling of hemorrhage was the most frequent provided initial medical care (40.6%). A significant improvement regarding the PSS score was observed in the first group of patients compared to the second group (7.505 vs. 6.799, 95% CI for difference: 0.3 to 0.9). The mortality rates of the first and second group of patients were 3% and 7.3%, respectively (p=0.051). CONCLUSION: Performing life support courses in rural areas of low-income countries where there is no pre-hospital triage and emergency medical system and provision of classic resuscitative measures are limited, has a significant impact on improvement of pre-hospital physiologic condition and prognosis of patients with penetrating injuries.

Predicting negative appendectomy by using demographic, clinical, and laboratory parameters: a cross-sectional study.

INTRODUCTION: Acute appendicitis (AA) is still the most common acute surgical disease. While negative appendectomy (NA) is inevitable, one of the greatest challenges a surgeon faces when treating patients with a primary diagnosis of AA is to decrease NA without increasing the morbidity and mortality rates. This study was conducted to evaluate the frequency of symptoms, signs, laboratory data and the diagnostic values of these findings as regards avoiding NA in patients with a primary diagnosis of AA. METHODS: In a cross-sectional study, 1197 patients with a primary diagnosis of AA who underwent open appendectomy in two general military hospitals with a primary diagnosis of AA were evaluated over a two-year period. Data were compared between the two groups; namely those with AA and the ones with NA. Statistical analysis was performed using one-way ANOVA, Kappa and odds ratio correlation coefficients and the logistic regression model. RESULTS: The mean age was 24.1+/-0.25 years. There were 911 (76.1%) males. Rate of NA was 18.2%. The regression model revealed that being younger (<21 years old) (P=0.049), being female (P=0.001), having a lower percentage of polymorph nuclear (PMN) cells (P=0.024) and a lower heart rate (P=0.021) could be regarded as independent predictors of NA (P<0.001). CONCLUSION: Obtained results indicate that female gender, low PMN percentage and pulse rate, and age below 21 years can provide important diagnostic information in addition to other diagnostic workups to prevent unnecessary laparotomies.

Preconditioning with oxygen attenuates rat renal ischemia-reperfusion injury.

BACKGROUND: Short time pretreatment with oxygen is reported to be protective against subsequent ischemia-reperfusion (IR) injury of heart and spinal cord in some animal models. The purpose of this study was to investigate the effects of pre-exposure to hyperoxic environment on rat renal IR injury for the first time. MATERIALS AND METHODS: The effects of 1 h/d pretreatment with oxygen (>or=95%) for 5 days on a right nephrectomized rat model of renal IR injury was investigated by comparing creatinine clearance, fractional excretion of sodium, plasma creatinine, blood urea nitrogen, and histological injury scores among three groups: IR (40 min ischemia-24 h reperfusion), sham (no IR), and hyperoxia (5 days intermittent pretreatment with oxygen + IR). RESULTS: Intermittent pretreatment with oxygen resulted in significant improvement of creatine clearance and fractional excretion of sodium (P

Earthquake related injuries: assessment of 854 victims of the 2003 Bam disaster transported to tertiary referral hospitals.

BACKGROUND: In December 2003, the residents of Bam, Iran experienced an earthquake that measured 6.6 on the Richter scale and destroyed >90% of the city. After the assessment and initial treatment of injuries at national and international field hospitals, a considerable number of victims (approximately 12,000) were transferred to tertiary referral hospitals around the country. OBJECTIVE: This report evaluated the injuries of 854 victims transferred to 12 referral hospitals in Tehran. METHODS: The demographic data, injury patterns, injury severity score (ISS), diagnosis, treatment, and outcome data of 854 Bam earthquake victims were assessed. RESULTS: There were 467 (54.7%) males and 387 (45.3%) females. The mean age of the patients was 29.0 years. Transportation by aircraft was the most common method used for evacuation, which was used to evacuate 555 patients (65%). Fifty-four percent of the victims required initial medical aid at field hospitals before transportation to Tehran. There were 1,322 patients with injuries, of which, fractures of the lower extremities were the most common (331; 25%). Limb fixation was the most commonly performed primary procedure in emergency wards (389 cases, 39.9%). The mean value +/- SD for ISS was 6.7 +/- 5.2. Orthopedic operations were the most frequent surgical procedures performed (195/260 operations, 75%) and the overall mortality rate was 1.6% (n = 14). CONCLUSIONS: Along with the crucial importance of aid provided by national and international field hospitals in disasters, suitable triage of casualties and preparedness of tertiary referral centers in unaffected regions also play an important role in providing medical care to disaster victims. During these situations, the number of victims cannot be predicted accurately, and sufficient medical care, particularly for orthopedic problems, can be provided by referral centers.

Comparison of elective lumbar discectomy outcomes between civilians and military personnel.

OBJECTIVE: To determine the results of discectomy surgery for lumbar disc herniation in military personnel and compare it with civilians. DESIGN: A cross-sectional study. PLACE AND DURATION: This study was conducted in Neurosurgery Department and Trauma Research Center, Baqiyatallah Medical Sciences University, Tehran, Iran, from February to October 2006. PATIENTS AND METHODS: One-hundred and seventeen military patients (54 subjects as combat forces and 63 as office personnel) and 115 civilians, who underwent discectomy surgery were included. In a mean duration of 50.8 months, the ability to return to full duty and resolution of complaints were assessed and satisfaction was measured using a Visual Analog Scale. RESULTS: Inability to return to previous duty was significantly higher in military personnel compared to civilians (p = 0.002); and in combat forces compared to office personnel (p < 0.001). The mean (SD) satisfaction was 80.09 (17.8) and 79.32 (9.8) percent in civilian and military personnel, respectively; p = 0.02. However, this difference was not seen in military subgroup forces. Military personnel had less complaints after surgery, 32.1% comparing to 42.7% in civilians; but the difference was not statistically significant. Likewise, fewer complaints were observed in combat forces comparing with office forces; 37% vs. 47.6% (p>0.05). CONCLUSION: Surgical intervention had relatively poor outcomes in military personnel, specifically in combat forces. Prevention of injury to back region should be considered in military training programs and in case of presence of disc herniation related symptoms, efforts should be made to save patients' effective function by conservation and medical therapies.

The 2003 Bam earthquake: overview of first aid and transport of victims.

INTRODUCTION: In December 2003, the residents of Bam, Iran experienced an earthquake that measured 6.6 on the Richter scale and destroyed more than 90% of the city. PROBLEM: The purpose of this study was to assess the status of the rescue, evacuation, and transportation of the casualties during the early stages following the earthquake. METHODS: A cross-sectional study of 185 casualties who were transferred to and hospitalized in the university hospital during the first week period following the earthquake was conducted. Information regarding different places of settlement after being removed from the rubble, initial medical care, and the means of transportation was obtained by reviewing medical records and interviewing the victims. RESULTS: The mean value of the duration of times taken for the first rescuers to reach the scene and remove the casualties from the rubble was 1.7 +/- 2.7 and 0.9 +/- 1.1 hours, respectively. Sixty-nine (37.7%) of the patients stayed within the area immediately surrounding their home for average times of 8 +/- 10 hours. The majority of casualties (57.6%) were transferred manually to a first place of settlement; 45.8% were taken to a second place of settlement using blankets. Of the patients studied, 159 (85.9%) did not receive any basic medical care at the first place and intravenous fluid therapy was the most common treatment provided for 24 (13%) patients at the second place of settlement. Patients received medical care at the first place of settlement for a mean time of 16.8 +/- 13.5 hours after escaping the rubble. CONCLUSIONS: These findings indicate that the emergency medical service system in Bam was destroyed and not able to respond adequately. In order to reduce the negative effects of such disasters in the future, there is an essential need for a comprehensive disaster management plan and improvement of hospital structures, healthcare facilities, and communication between the different governmental departments for better coordination and planning.

Comparing presentation and diagnostic accuracy for conscripts and nonconscripts who have already been selected for appendectomy.

BACKGROUND: The evaluation of acute appendicitis (AA), the most common cause of acute abdomen, in conscripts is important, specifically when it seems that the probability of malingering for secondary gains (such as exemption) is high, and surgeons may lose some cases of AA through this assumption. METHODS: In this analytic cross-sectional study, 455 male conscripts with suspected AA were compared with 142 male individuals between 14 and 26 years of age who had already been selected for appendectomy. RESULTS: The mean age (+/-SE) was 20.4+/-0.08 years. There were no statistically significant differences between the case and control groups in terms of age, rates of different symptoms and signs, quality and duration of pain, vital signs, and laboratory findings. CONCLUSIONS: There was no significant difference between conscripts and others in terms of the presentation of AA and its accurate diagnosis. Therefore, it is recommended that military physicians approach conscripts with suspected AA like other patients.