Cosmetic Breast Implants and the Risk of Suicide: A Systematic Review and Meta-Analysis.

Objective: Having cosmetic breast implants increases a woman's chance of suicide, which is now a global challenge. This systematic review evaluated the possible risk of suicide among women who undergo cosmetic breast implants. Method : This meta-analysis was done based on Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). In the current systematic review and meta-analysis, we systematically searched for all articles written in both English or Persian that estimated the prevalence of suicidal ideation in women who had cosmetic breast implants. We systematically searched different databases, including MEDLINE (PubMed), Web of Science, Embase, Cochrane, Library ProQuest, Scopus, and Google Scholar, from inception to March 2021. There was also a search for references. Suicidal ideation, a suicide plan, or suicide attempts were the outcomes. In order to determine the total pooled prevalence of suicidal ideation, we utilized a random-effects model. To examine the risks of bias in each study, we applied the Joanna Briggs Institute Critical Appraisal method. Results: We identified 218 citations in our initial search. After omitting duplicated citations and excluding irrelevant studies according to the title and abstract selection, 42 studies were chosen for the full text analysis. Finally, 11 research, examining a total of 324,332 women were incorporated into the systematic review and critical appraisal assessment. Eight of these studies were found to be eligible for meta-analysis. The frequency of suicide in women with cosmetic breast implant was 0.2% (95% CI: 0.1% to 0.4%; P < 0.001) (Q-value: 168.143, I2:95.83). Most of the included studies had moderate quality. Conclusion: There might be a correlation between cosmetic breast implants and suicide risk, which could be stronger in the presence of a history of mental illnesses. The evidence about the possible effects of breast implants on the risk of suicide is still inconclusive, and there is a need for future well-designed studies on this topic.

A systematic synthesis of expert opinion on effective policies to tackle bacterial resistance worldwide.

Actions that are taken to preserve effective antibacterial agents and eliminate transmission of resistant organisms are crucial to prevent a catastrophic postantibiotic era. In this systematic review, we searched and appraised relevant texts and expert opinions to determine effective strategies to tackle bacterial resistance worldwide. We considered expert opinions, consensus, current discourses, comments, assumptions or assertions and discussion papers published in English. We searched following databases for expert opinion-based literature: MEDLINE, CINAHL, ISI Web of Knowledge, SCOPUS, Cochrane Central Register of Controlled Trials and World Health Organization (WHO). We extracted the textual data from texts using a standardised data extraction tool. Textual pooling was not possible, so the conclusions were presented in a narrative form. Eighteen texts were included in this review. The findings show that, the most repeated policies and strategies include implementing and strengthening bacterial resistance surveillance, developing national guidelines, improving public awareness; enhancing home and everyday life hygiene; improving prescribing patterns, improving laboratories capacity, promoting innovation and research in new drugs and technology and strengthening coordination. This review systematically gathered strategies that were recommended by textual publications. To our knowledge, this was the first systematic review of text and opinion in the field of bacterial resistance. These results can be used by policymakers, hospital managers, and governments, alongside the results of quantitative and qualitative systematic reviews.

Management of urolithiasis in pregnancy: A systematic review and meta-analysis.

PURPOSE: Management of nephrolithiasis is unique in pregnancy and requires multidisciplinary care. To identify the effectiveness or safety of temporary drainage or definitive treatment methods to manage urolithiasis in pregnancy. METHODS: The search strategy aimed to find both published and unpublished studies was conducted in August 2021. Studies published in any language on any date were considered for inclusion. RESULTS: Of a total of 3349 publications, 36 studies were included in our qualitative evaluation and 32 studies in the quantitative synthesis. The commonly reported method was stent insertion (n = 29 studies), pneumatic (n = 12), laser (n = 9) lithotripsy, and stone removal using any devices (basket, grasper, or forceps) (n = 11). In seven studies, the authors reported the outcomes of conservative management, and the results showed that the stone-free rate is 54%, and symptom relief occurred in 62% of women. Seven eligible studies reported that 79.9% of urolithiasis were expulsed through stent insertion, while this rate was 94.6% among percutaneous nephrostomy use in two included studies, 88.5% for pneumatic lithotripsy (n = 7 studies), and 76.4% for laser lithotripsy (n = 4 studies), or 95.4% for stone removal method. In addition, adverse events were reported in less than 10% of pregnant women. CONCLUSIONS: The results showed that stent, pneumatic or laser lithotripsy, and ureteroscopic stone removal were the commonest used methods in the included studies. They can be effective and safe treatment approaches without major maternal or neonatal complications, and could be introduced as an effective and safe therapeutic method for urolithiasis during pregnancy. However, most of the included studies had moderate quality according to critical appraisal checklists. Further prospective studies are needed to reach a conclusion.

Promoting oral and dental healthcare among the elderly in a residential care home in Isfahan: a best practice implementation project.

INTRODUCTION: Oral health is an important aspect of general health, which affects the wellbeing and quality of life of older adults. Residents in aged care facilities often suffer from overall dental neglect and insufficient oral healthcare, leading to moderate-to-high levels of oral diseases. Furthermore, physical or mental health concerns may result in difficulties in maintaining good oral health. OBJECTIVES: This implementation project aims to audit and improve the oral healthcare status of the elderly living in a residential care home in Isfahan, Iran using the JBI evidence summary. METHODS: The methods are preimplementation and postimplementation design using audit and feedback with a situational analysis to guide implementation planning. Seven evidence-based quality indicators were used to measure preintervention compliance with the best practice. Situational analysis was used to identify and target barriers through locally developed practice change strategies following which a repeat audit was conducted at 4 months. Four nursing staff, 11 caregivers, and 38 residents were interviewed for both the baseline and the follow-up audit. RESULTS: Compliance rates improved for all seven criteria except the use of a soft-bristled toothbrush (criterion 6). All eight categories of criterion 2 measuring assessment of oral health improved by at least 10%, with the largest improvements in saliva assessment and gingiva assessment. Criterion 1 (oral health training for caregivers) reached the greatest compliance rate (100%). CONCLUSION: The implemented strategies included improving knowledge and changing the attitudes of the caregivers through organizing educational sessions. These strategies were developed to address process and structural barriers to best practice and were helpful for staff uptake of evidence.

Experiences of patients and providers while using telemedicine in cancer care during COVID-19 pandemic: a systematic review and meta-synthesis of qualitative literature.

PURPOSE: The objective of this meta-synthesis was to identify, appraise, and synthesize patients and provider's experiences while using telemedicine in cancer care during the COVID-19 pandemic. METHODS: The databases Medline, Embase, Cinahl, PsycInfo, Web of Science, and other related databases were searched. Reviewers followed the Joanna Briggs Institute (JBI) meta-aggregation method to identify categories and synthesized findings and to assign a level of confidence to synthesized findings. The listed quotations and the original author interpretations were synthesized using MAXQDA software. RESULTS: Nineteen studies were included in the meta-synthesis. Three synthesized findings emerged from 243 primary findings: telemedicine assists but cannot be a substitute for face-to-face appointments in a health care crisis and in the provision of routine care to stable patients with cancer, infrastructural drivers and healthcare provider's support and attention affect patients' experiences and feelings about telemedicine, and patients who use telemedicine expect their health care providers to devote enough time and consider emotional needs, the lack of which can develop a negative response. The methodological quality of the studies ranged between 4 and 10, and the overall level of confidence of the synthesized findings was determined to be low and medium. CONCLUSION: The findings from this meta-synthesis gave a new insight to promoting the safe and evidence-based use of telemedicine during the current pandemic and future emergencies.

Clinical application of stem cell therapy in neurogenic bladder: a systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: This review aims to investigate the effect of stem cell (SC) therapy on the management of neurogenic bladder (NGB) in four neurological diseases, including spinal cord injury (SCI), Parkinson's disease (PD), multiple sclerosis (MS), and stroke, in the clinical setting. METHODS: An electronic database search was conducted in the Cochrane Library, EMBASE, Proquest, Clinicaltrial.gov , WHO, Google Scholar, MEDLINE via PubMed, Ovid, Web of Science, Scopus, ongoing trial registers, and conference proceedings in June 2019 and updated by hand searching on 1 February 2021. All randomized controlled trials (RCTs), quasi RCTs, phase I/II clinical trials, case-control, retrospective cohorts, and comprehensive case series that evaluated the regenerative potential of SCs on the management of NGB were included. Cochrane appraisal risk of bias checklist and the standardized critical appraisal instrument from the JBI Meta-Analysis of Statistics, Assessment, and Review Instrument (JBI-MAStARI) were used to appraise the studies. RESULTS: Twenty-six studies among 1282 relevant publications met our inclusion criteria. Only SC therapy was applied for SCI or MS patients. Phase I/II clinical trials (without control arm) were the most conducted studies, and only four were RCTs. Four studies with 153 participants were included in the meta-analysis. The main route of transplantation was via lumbar puncture. There were no serious adverse events. Only nine studies in SCI and one in MS have used urodynamics, and the others have reported improvement based on patient satisfaction. SC therapy did not significantly improve residual urine volume, detrusor pressure, and maximum bladder capacity. Also, the quality of these publications was low or unclear. CONCLUSION: Although most clinical trials provide evidence of the safety and effectiveness of MSCs on the management of NGB, the meta-analysis results did not show a significant improvement; however, the interpretation of study results is difficult because of the lack of placebo controls.

Inhibitory effect of Bowman-Birk protease inhibitor on autophagy in MDAMB231 breast cancer cell line.

BACKGROUND: Autophagy has an essential role in cellular energetic balance, cell cycle, and cell death, so the change in autophagy level is crucial in many human diseases such as cancer. Herbal medicine has been widely used to treat cancer. Bowman-Birk protease inhibitor (BBI), a protease inhibitor extracted from soybean, has antitumorigenic, anti-inflammatory, and anti-angiogenic activities. In this study, we evaluated the effect of BBI on the growth of breast cancer cell line and transcript level of autophagy and apoptosis-related genes. MATERIALS AND METHODS: BBI was purified from soybean by ion-exchange chromatography method. The viability of MDA-MB-231 cells that were treated with BBI was measured by MTT assay, and the transcript level of genes involved in autophagy and apoptosis was measured by real-time-polymerase chain reaction (PCR) technique. RESULTS: The results of BBI purification showed that 100 g of the ethanolic fraction yielded 300-mg BBI with more than 95% purity. MTT results revealed that BBI inhibited the cell growth of MDA-MB-231 cell line in a dose-dependent manner, with an IC50 of 200 µg/mL. The results of real-time reverse transcription-PCR exhibited that BBI altered the expression of Atg5, Beclin1, light chain 3-II, and sequestosome1 and increased the Bax/Bcl2 ratio in MDA-MB-231 cell line. CONCLUSION: According to our results, BBI could inhibit autophagy and induce apoptosis in MDA-MB-231 cell line. Thus, BBI may be used as a therapeutic drug in the treatment of breast cancer whether alone or with chemotherapeutic drugs.

Clinical Presentation of Iranian Patients Affected with COVID-19: A Thousand Faces Disease.

The coronavirus disease 2019 (COVID-19) pandemic in Iran is part of the worldwide pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The present study aimed to demonstrate the clinical characteristics of patients affected by COVID-19, in our tertiary teaching hospital. Medical records and compiled data of 668 patients with suspected COVID-19 were obtained retrospectively between January to April 2020. The present study outcomes included demographic features of infected patients, underlying diseases and conditions, the relationship between the results of reverse transcription-polymerase chain reaction (RT-PCR) or CT-scan with the manifestations of the disease, mortality rate, and age distribution of fatalities among men and women. The median age of hospitalized patients was 63 years old (from 18 to 94). The patients' chief complaints in the admission time were cough, dyspnea, fever, and gastrointestinal problems, respectively. Hospitalized patients' common comorbidities were hypertension (HTN), and cardiovascular disease (CVD) (24%), diabetes mellitus (DM) (21.5%), asthma, or chronic obstructive pulmonary disease (COPD) (6%), or other underlying diseases (15.5%). One-third of patients had no comorbidity according to the data of medical records. In hospitalized patients, 169 (84.5%) had positive RT-PCR, and 156 (78%) had positive chest CT findings. The mortality rate of males was higher than females (66.3% vs. 33.3%) and in patients with positive RT-PCR compared to patients with positive chest CT-scan findings. The majority of deaths had a history of DM or HTN/CVD in their medical records. The chief complaint of patients was cough. DM and HTN or CVD were the common underlying disease related to death in hospitalized cases. Besides, the hospitalization and mortality rate in males was higher than in females. About 87% of dead hospitalized cases had positive RT-PCR results, and this rate was 82% for chest CT results.

The Construction and Characterization of 1F5 Chimeric Anti-CD20 Monoclonal Antibodies: An Efficient Splicing by Overlap Extension-polymerase Chain Reaction Technique.

Despite the unparalleled success of anti-CD20-targeted immunotherapy, the currently available mAbs are not sufficiently efficacious in the treatment of lymphoma. 1F5 is one of a panel of anti-CD20 mAbs that was used in the B-cell lymphoma serotherapy. Despite the efficacy of murine 1F5 mAbs in lymphoma patients, the 1F5 chimeric antibodies with human effector functionality are yet to be approved and widely used in the treatment of lymphoma. In this study, the conversion of 1F5 mAb from mouse IgG2a to human-mouse chimeric IgG1 was achieved and the chimeric antibody was partially characterized. We constructed the 1F5 chimeric mouse-human anti-CD20 antibody genes using an efficient Splicing by overlap extension-polymerase chain reaction (SOE-PCR) technique and cloned the chimeric heavy and light genes in pBudCE4.1mammalian expression vector, followed by purification of the expressed chimeric 1F5 mAbs using affinity chromatography. Our investigation also included the biological properties of purified chimeric antibodies. The generated 1F5 chimeric mAbs mediate complement-dependent cytotoxicity (CDC) and antibody-dependent cellular cytotoxicity (ADCC) against Raji and Daudi Burkitt's lymphoma cell lines, which were comparable with rituximab and exhibit superior reduction in cell viability in vitro, compared to rituximab. The current study indicated that the generated chimeric 1F5 mAbs has potential CDC and ADCC activity which was comparable with rituximab whereas it exhibits a superior reduction in cell viability, compared to rituximab. Our work contributes to future studies involving in vivo biological functions and the application of the 1F5 chimeric antibody.

Misconduct in research integrity: Assessment the quality of systematic reviews in Cochrane urological cancer review group.

OBJECTIVE: Cochrane Library provides a powerful and authoritative database to aid medical decision making. We aimed to evaluate the quality of clinical trials and systematic reviews recorded in the Cochrane urology cancers group. MATERIAL AND METHODS: This analytic cross-sectional study was conducted on 44 published systematic reviews of the Cochrane urology group which were published until May 2020. In the current study, we selected the urological cancer reviews. All types of biases in the understudied randomized controlled trials (RCTs) or quasi-RCTs of these systematic reviews were evaluated using the Cochrane appraisal checklist. We also separated and stratified the types of biases in the included studies. In addition, the quality of systematic reviews was assessed using the Joanna Briggs Institute (JBI) appraisal checklist. RESULTS: A total of 44 systematic reviews and their understudied 340 RCTs were evaluated. On the basis of the JBI appraisal checklist results, 93.2% of systematic reviews had high quality. In terms of the quality of understudied RCTs in these reviews, the common prevalent risk of bias of the understudied RCTs or quasi- RCTs was unclear selection bias (allocation concealment and random sequence generation). The highest risk of bias was seen in the blinding of participants and personnel (performance bias). CONCLUSION: Although most Cochrane urological cancer reviews had high quality, performance bias was the highest one in their understudied RCTs. Regarding it and considering the increasing unclear risk of detection, attrition, and reporting biases, it is obvious that they have structural deficiencies; therefore, it is recommended to observe integrity principles for preventing research misconduct.

Bowman-Birk inhibitor modifies transcription of autophagy and apoptosis genes in an in vitro model of Alzheimer's disorder.

Alzheimer, a current neurodegenerative disorder has adverse effects on memory and behavior. ß-Amyloid peptide accumulations are the hallmarks of Alzheimer. Dysfunction of autophagy and apoptosis is detected in Alzheimer's disease. The effect of Bowman-Birk inhibitor (BBI), purified from soybean, was investigated in autophagy and apoptosis in Alzheimer treatment. Treated-PC12 cells with 1000 nM HgCl2 induced amyloid ß (Aß) accumulation. Treatment of PC12 cells with 1000 nM HgCl 2 and then 500 µg/mL BBI could decrease the expression ratio of Bax/Bcl2 and increase the expression of beclin1, Bnip3, Atg5, and autophagy-related genes. These results indicated that BBI could inhibit Aß accumulation by inducing autophagy, and also the neuroprotective effect was detected through decreasing apoptosis in the in vitro model of Alzheimer's disease. These results provided further evidence for the potential effectiveness of BBI in the treatment of Alzheimer's disease.

Comparison of the effect of mitomycin C and bevacizumab-methylcellulose mixture on combined phacoemulsification and non-penetrating deep sclerectomy surgery on the intraocular pressure (a clinical trial study).

PURPOSE: Comparison of the effect of mitomycin C (MMC) versus bevacizumab-methylcellulose mixture (BMM) on combined phacoemulsification and non-penetrating deep sclerectomy surgery on the intraocular pressure in patients with open-angle glaucoma was made. METHODS: The current study is a controlled, randomized, double-blind clinical trial. Thirty-eight patients were enrolled, with a total of 40 eyes, and underwent a combined phacoemulsification and non-penetrating deep sclerectomy surgery from 2016 to 2017. MMC with concentration of 0.2 mg/mL for 2 min was used for 20 eyes before separating the scleral flap, and 0.3 mL of BMM (bevacizumab 1.25 mg incorporated into 2% methylcellulose) was injected subconjunctivally following surgery. The success rate of surgery was categorized as complete, relative and failure. Fisher's exact, Mann-Whitney U and Chi-square tests were employed to data analysis. A p value < 0.05 was supposed significant. RESULTS: Patients had the same distribution in terms of age, sex, type of glaucoma and type of cataract. Patients were followed up for a mean of 6 months. The mean intraocular pressure before surgery in the MMC group was 24.85 ± 2.83 mmHg with 3.2 ± 0.523 anti-glaucoma drugs, which reached 13.75 ± 3.552 mmHg with 0.15 ± 0.489 anti-glaucoma drugs at the latest visit. The average intraocular pressure before surgery in the BMM group was 24.45 ± 2.48 mmHg with 2.9 ± 0.641 anti-glaucoma drugs, which reached 15.40 ± 3.267 mmHg with 0.25 ± 0.55 anti-glaucoma drug at the last follow-up. The intraocular pressure was notably lower in the MMC group than BMM group 6 months after surgery. There was not a significant difference from the aspect of success rate and failure rate among the two groups at the 6-month follow-up (p = 0.135). DISCUSSION: Based on the results of this study, MMC and bevacizumab-methylcellulose both seem to be effective in the success of combined phacoemulsification and non-penetrating deep sclerectomy surgery, but MMC decreases intraocular pressure in patients at 6 months post-surgery.

Comparative in vitro/theoretical studies on the anti-angiogenic activity of date pollen hydro-alcoholic extract: Highlighting the important roles of its hot polyphenols.

Introduction: Date palm pollen (DPP) is the male reproductive soft powder from date flowers widely used as the valuable dietary supplement to fortify the size of testis and ovarian to increase the power of sex. This part of date palm significantly exhibited anti-diabetic, anti-inflammation and protective effects against male and female infertility. Though the anticancer activity of date fruits was previously reported, the DPP anti-angiogenic effects were not reported, and as the first study, its inhibitory effects were examined in the current study. Methods: The DPP soft powder was collected to prepare its hydro-alcoholic extract to examine its anti-angiogenic activity in an in vitro model. At different concentrations, the cytotoxicity of the prepared extract was examined on human umbilical vein endothelial cells (HUVECs) using lactate dehydrogenase method. Cell proliferation was determined using the MTT assay and cytodex-3D model in collagen gel was used to assay its possible anti-angiogenic activity. The expression of VEGF, MMP-2 and MMP-9 genes was measured using real-time polymerase chain reaction (PCR). Finally, molecular docking simulation was used to highlight the possible role of DPP polyphenols to interact with the associated receptors. Results: The prepared hydro-alcoholic extract exhibited significant anti-angiogenic activity in a dose-dependent manner and decreased the endothelial cell proliferation. The calculated IC50 value for the examined extract in angiogenesis model was 260 µg·mL, respectively. Also, the expression of VEGF, MMP-2 and MMP-9 genes were significantly decreased. Docking simulation results unveiled that the isolated DPP polyphenols have the affinity to interact with ctDNA, VEGF and its receptors. Conclusion: The DPP is the new source of non-toxic anti-cancer agents to use as a dietary supplement in the pre-treatment of cancer.

Caffeine alters the effects of bone marrow-derived mesenchymal stem cells on neutrophils.

BACKGROUND: It has been shown that mesenchymal stem cells (MSCs) express all four adenosine receptors' subtypes, and stimulation of these receptors plays an active role in bone marrow-derived mesenchymal stem cell proliferation and differentiation. The interaction between MSCs and immunocytes, such as neutrophils, has been investigated in some recent studies. OBJECTIVES: This study was carried out to investigate the effects of caffeine as an adenosine antagonist on the effects of bone marrow-derived MSCs on neutrophils. MATERIAL AND METHODS: Mesenchymal stem cells were isolated from the bone marrow of rats and pulsed with different concentrations of caffeine (0.1, 0.5 and 1 mM) at different times (24, 48 and 72 h). Mesenchymal stem cells were co-cultured with neutrophils for 4 h and the functions of neutrophils were evaluated. RESULTS: The findings showed that MSCs pulsed with caffeine at low to moderate concentrations preserved the neutral red uptake by neutrophils and established the MSCs' ability to protect neutrophils from apoptosis. Mesenchymal stem cells treated with caffeine increased the phagocytosis of neutrophils and simultaneously diminished the production of potentially harmful reactive oxygen substances, more profound than MSCs without treatment. Nevertheless, a high concentration of caffeine could interfere with some aspects of the crosstalk between MSCs and neutrophils. CONCLUSIONS: These findings may offer new insight into the potential mechanisms underlying the immunomodulatory effects of caffeine.

The effect of Tribulus terrestris extract on motility and viability of human sperms after cryopreservation.

BACKGROUND: Semen cryopreservation produces significant amounts of reactive oxygen species (ROS), which may lead to impairment of sperm morphology, function, and ultimately, male fertility. Since Tribulus terrestris has antioxidant and free-radical-scavenging properties, this study aims to reveal the effect of the Tribulus terrestris extract on motility and vitality of human sperms after cryopreservation. MATERIALS AND METHODS: Semen specimens from 80 healthy volunteers were divided into eight groups: fresh control (group I), freeze control (group II), groups III, IV, and V, which had 20, 40, and 50 µg/mL doses of Tribulus terrestris extract added before cryopreservation, and groups VI, VII, and VIII, which were supplemented by these extract doses after the freeze-thaw process. To evaluate the effects of the Tribulus terrestris extract, the semen samples were incubated with the extract and evaluated with a light microscope for motility and viability. RESULTS: After cryopreservation, a significant improvement in spermatozoa viability was observed in group VII. In groups VII and VIII, motility, according to World Health Organization (WHO) criteria, increased considerably (p < 0.001). There was no significant difference among groups III, IV, and V. CONCLUSION: The present study demonstrated that the protective effects of Tribulus terrestris, which improves human sperm motility and viability, may be due to its antioxidant properties. On the basis of the results, the researchers concluded that Tribulus terrestris can be used as a safe therapeutic alternative to current modalities for the management of motility dysfunction in males.

Perceived satisfaction of ophthalmology residents with the current Iranian ophthalmology curriculum.

OBJECTIVE: To assess the level of perceived satisfaction with the current Iranian ophthalmology curriculum in ensuring that residents acquire required competencies in various ophthalmology fields. METHODS: A closed-ended questionnaire was circulated to 100 residents or recently graduated ophthalmologists in Iran to measure their level of satisfaction about clinical conferences, journal clubs, scientific lectures, wet lab, simulation, evidence-based practice, and outpatient clinic and operating room training. They also cited the main barriers to a successful board exam. RESULTS: Ninety-nine questionnaires were completed and returned. Mean age of the responders was 31 ± 4.56 years. A total of 36 (36.4%) responders expressed an overall satisfaction about the residency program, and 49 (49.5%) did not feel happy about the state of teaching evidence-based decision making. They identified cataract surgery and eyeglass prescription as the most common regularly functioning modalities in their centers. The majority of the participants stated they have received appropriate training in cataract surgery (71%), but only 9% were satisfied with the provided training in glaucoma or vitreous and retinal surgery. Nevertheless, their overall satisfaction with their outpatient skills was good. CONCLUSION: The ophthalmologists felt quite confident in management of uncomplicated cases, especially cataract surgery at the level of general ophthalmology, but future studies can assess the effect of new practice-based teaching methods on the residents' clinical training and eventually on patient care.

Low-dose subconjunctival bevacizumab to augment trabeculectomy for glaucoma.

BACKGROUND: The purpose of this study was to assess the effect of bevacizumab in maintaining intraocular pressure lowered by trabeculectomy in refractory open-angle glaucoma. METHODS: Thirty-seven eyes from 37 patients referring to Nikoukari Ophthalmology University Hospital in Tabriz were enrolled in this randomized clinical trial. Seventeen patients were randomly assigned to receive bevacizumab augmentation after trabeculectomy, and 20 patients were assigned to a control group receiving a placebo injection of normal saline. Bevacizumab was injected subconjunctivally at a dose of 0.2 mg. Intraocular pressure was measured on eight occasions, ie, at baseline, 24 hours, 3 days, 7 days, 2 weeks, 1 month, 2 months, and 3 months after treatment. RESULTS: Men constituted 81% of the participants, who were of mean age 67.5 years. Twenty-nine patients had secondary open-angle glaucoma, while eight patients had primary open-angle glaucoma. Intraocular pressure decreased from a mean of 28.4 mmHg at baseline to a mean of 12.1 mmHg during the first day and to 15.1 mmHg after 3 months. Adding bevacizumab to trabeculectomy was not found to affect intraocular pressure differently to placebo. Neither the results of repeated measurements analysis nor single comparison statistical tests were significant for a difference in efficacy of bevacizumab versus placebo. CONCLUSION: Subconjunctival bevacizumab 0.2 mg was not found to affect the trend in intraocular pressure more than placebo after trabeculectomy for open-angle glaucoma.

Augmenting trabeculectomy in glaucoma with subconjunctival mitomycin C versus subconjunctival 5-fluorouracil: a randomized clinical trial.

OBJECTIVE: The aim of this study was to compare the efficacy of augmenting trabeculectomy with subconjunctival mitomycin C (TMMC) versus 5-fluorouracil (T5-FU) in lowering intraocular pressure (IOP). METHODS: Forty eyes from 40 patients referred to the Nikoukari Ophthalmology University Hospital, Tabriz University of Medical Sciences, Tabriz, Iran, were enrolled in a randomized clinical trial. Patients with high-risk open angle glaucoma were allocated to receive either subconjunctival TMMC or T5-FU. RESULTS: Mean overall preoperative IOP was 30.8 mmHg. Mean preoperative IOPs in the TMMC and T5-FU groups were 31.2 ± 9.8 and 30.6 ± 9.9 mmHg, respectively. Postoperatively, mean IOPs were 11.4.3 ± 4.9 and 13.6 ± 3.9 mmHg, respectively for TMMC and T5-FU groups after 6 months. In spite of some existing descriptive differences in IOP between the groups, statistical tests showed no difference in mean and median IOP. Three cases of hypotonia (IOP < 6 mmHg) and 1 case of epithelial keratitis were detected. CONCLUSION: TMMC and T5-FU appeared to have similar efficacy in lowering IOP.

Tehranolide molecule modulates the immune response, reduce regulatory T cell and inhibits tumor growth in vivo.

Tehranolide named as new type of a sesquiterpene lactone with an endoperoxide group which purified from Artemisia diffusa and having similar structure to Artemisinin. Tehranolide is hypothesized to possess effects akin to Artemisinin, which is active against cancer cells. In the present research we emphasized on the direct correlation between the tumor sizes, immune response; including cytokin network, T regulatory cells and Tehranolide intraperitoneally injected Tehranolide. In this study, Tehranolide was purified from Artemisia difussa. First we evaluated the effects of Tehranolide on cell growth inhibition (in vitro) by MTT assay and second investigated the immune responses, these include measuring tumor growth in the female Balb/c mice transplanted with spontaneous mouse mammary tumor and treated with Tehranolide, splenocyte proliferation detected by using the BrdU kit, measurement of cytokine profile by ELISA and analysis of T-lymphocytes subpopulation in spleen by Flow cytometry. Our results showed a significant (p<0.05) decrease in the tumor volume and the level of IL-4 in the animals treated with Tehranolide, compared to untreated group. In addition, a significant (p<0.05) increase in the lymphocytes proliferation and the level of IFN-gamma in the animals treated with Tehranolide in comparison with control group. Furthermore, we regulate the regulatory T cells in order to improve the outcome of cancer immunotherapy. The measurement of splenic CD4(+)CD25(+)Foxp3(+) T lymphocytes indicated that Tehranolide significantly (p<0.05) decreased the number of these lymphocytes. These findings show that the use of Tehranolide molecule represents a novel strategy with major suggestions for cancer therapy approaches.

Human coagulated plasma as a natural and low cost matrix for in vitro angiogenesis.

BACKGROUND: Angiogenesis, the development of new blood vessels, is an important process in tissue development and wound healing, but becomes pathologic when associated with solid tumor growth, proliferative retinopathies, and rheumatoid arthritis. Accurate and reliable qualification of neovascular (angiogenic) response, both in vitro and in vivo, is an essential requirement for the study of new blood vessel growth. The complexity of currently used three-dimensional in vitro angiogenesis systems makes it difficult to approve material in its models. Capillary-like structure occurs on basement membrane components such as collagen and/or laminin, while in other models, CLS formation occurs on transitional matrices such as fibrin. To solve this problem, we were interested in developing an angiogenesis system which allows rapid and reliable quantification of three-dimensional neovessel formation in vitro. METHODS: Human bone marrow endothelial cells were seeded on gelatin-coated microcarriers and suspended in a solution of platelet-poor plasma which was induced to polymerize by addition of calcium chloride. In this way, microcarriers were entrapped in three-dimensional coagulated plasma. RESULTS: Within a few hours, endothelial cells begin to leave these supporting microcarries and migrate into the coagulated-plasma matrix and formed CLS within 48-72 hours. CONCLUSION: We developed a convenient angiogenesis in vitro system which allows reliable quantification of capillary formation in a three-dimensional environment.