Updated reference values for static lung volumes from a healthy population in Austria.

BACKGROUND: Reference values for lung volumes are necessary to identify and diagnose restrictive lung diseases and hyperinflation, but the values have to be validated in the relevant population. Our aim was to investigate the Global Lung Function Initiative (GLI) reference equations in a representative healthy Austrian population and create population-derived reference equations if poor fit was observed. METHODS: We analysed spirometry and body plethysmography data from 5371 respiratory healthy subjects (6-80 years) from the Austrian LEAD Study. Fit with the GLI equations was examined using z-scores and distributions within the limits of normality. LEAD reference equations were then created using the LMS method and the generalized additive model of location shape and scale package according to GLI models. RESULTS: Good fit, defined as mean z-scores between + 0.5 and -0.5,was not observed for the GLI static lung volume equations, with mean z-scores > 0.5 for residual volume (RV), RV/TLC (total lung capacity) and TLC in both sexes, and for expiratory reserve volume (ERV) and inspiratory capacity in females. Distribution within the limits of normality were shifted to the upper limit except for ERV. Population-derived reference equations from the LEAD cohort showed superior fit for lung volumes and provided reproducible results. CONCLUSION: GLI lung volume reference equations demonstrated a poor fit for our cohort, especially in females. Therefore a new set of Austrian reference equations for static lung volumes was developed, that can be applied to both children and adults (6-80 years of age).

The effects of dietary inclusion of Camelina sativa on performance and ascites incidence in broilers subjected to cold exposure.

BACKGROUND: Camelina sativa oilseed has a high amount of polyunsaturated fatty acids (FAs) especially α-linolenic acid. n - 3 FA can improve the deformability of erythrocytes and mediate relaxations in coronary artery such as nitric oxide (NO) that is the principal vasodilator responsible for diminution the pulmonary arterial hypertension response. METHODS: To investigate the effects of camelina sources on ascites incidence in broilers kept on altitude, 672 male chicks were fed with 7 dietary treatments, including control, 2% or 4% camelina oil (CO), 5% or 10% camelina meal (CM) and 5% or 10% camelina seeds (CS) diets. RESULTS: Supplementation of 2% CO had no negative impact on performance, whereas feed intake and body weight gains decreased (p < 0.05) by adding 4% CO, CM and CS. Birds fed camelina diets had lower serum triglyceride at day 42, total cholesterol and LDL cholesterol at both 28 and 42 days. Plasma aspartate aminotransferase decreased (p < 0.001) among 5% and 10% CS groups on day 42. Serum and liver concentrations of malondialdehyde declined (p < 0.05) by camelina treatments, whereas serum NO and liver glutathione peroxidase activity significantly elevated. Red blood cell, heterophils and H:L ratio were lower but lymphocyte was higher in camelina groups. Inclusion of camelina reduced (p < 0.05) relative weights of heart and right ventricle, the weight of right ventricle to total ventricle ratio and ascites mortality. CONCLUSIONS: Use of 2% CO as a source of n - 3 FA can improve ascites condition and mortality in broilers reared at high altitude without the reduction of growth performance. However, feeding 4% CO or 5% and 10% CS or CM reduced broiler performance.

Effect of IOF and its interaction with post-hatch feeding procedure on hatchability, some organs development and post-hatch performance in broiler chickens.

BACKGROUND: Under commercial conditions, chickens are fasted for the first 36 to 72 h post-hatch. Delayed access to feed and water causes delayed development of the intestinal tract and retarded performance. OBJECTIVES: This study focused on the chick's life as affected by in ovo feeding (IOF) and the animal's interaction with the feeding procedure. The birds in a factorial arrangement (2 × 3) were placed into six treatment groups in a completely randomised design. The treatment groups differed in feed procedure, 6 h [early feeding (EF)] or 36 h [common feeding (CF)] post-hatch, with or without IOF with beta-hydroxy-beta-methyl butyrate (HMB) or calcium gluconate (CG) in a saline solution, and were examined for hatchability and performance parameters until 24 h post-hatch. In addition, physical and histological characteristics of breast, jejunum and serum indices in 14 days post-hatch and performance criteria until 35 days of age were recorded. METHODS: On day 17 of the incubation period, eggs were subjected to the IOF procedure. One mL of sterile IOF solution including 0.1% HMB or 0.4% CG dissolved in 5% saline solution was injected into the eggs. RESULTS: Results showed that IOF groups had lower (p < 0.05) FCR than the control group. The highest mortality rate was noted in the control-CF group. The lowest myofibril density was related to the HMB-CF group. Myofibril periphery, area and diameter for the HMB-CF group were larger (p < 0.05) than those of the other groups. CONCLUSIONS: Results indicated that injection of HMB increased hatchability by almost 15%. The IOF of HMB improved the digestive tract and breast muscle development and improved FCR.

Depth of Invasion as an Independent Predictor of Survival in Patients of Stage III Squamous Cell Carcinoma of the Oral Tongue.

OBJECTIVE: Depth of invasion (DOI) has been incorporated in the new AJCC 8th classification. However, even with this new AJCC classification stage III oral tongue squamous cell carcinoma (OTSCC) remains a heterogenous group. The study aims at finding a discreet group within stage III using DOI as a cut-off of 10 mm. METHODS: The institutional database was reviewed from 2012 to 2018 for postoperative stage III OTSCC patients who subsequently received postoperative radiotherapy. Ninety-six patients matched the inclusion criteria. Two groups were created using a DOI cut-off of 10 mm (superficial and deep groups). The groups were analyzed for overall survival (OS) and relapse-free survival (RFS). RESULTS: The baseline and treatment characteristics were comparable between the groups except for the higher number of extensive surgeries, endophytic configuration, pT3 and, DOI in the deep group. For a median follow-up of 40.5 (range: 4-139) months, the median OS and RFS for the superficial group were not reached. The median OS and RFS for the deep group were 101 (range: 73.7-128.3) and 60 (range: 46.6-73.4) months, respectively. The difference was statistically significant for median RFS (P = .008) and trended toward significance for median OS (P = .066) for the superficial group. Multivariate Cox regression analysis showed DOI cut-off as a significant predictor for RFS but not for OS. CONCLUSION: DOI significantly predicts poor RFS. However, showed a trend toward poor OS. This study hints toward a possibility of sub-dividing stage III OTSCC based on DOI cut-off. LEVEL OF EVIDENCE: 3 (Retrospective cohort study) Laryngoscope, 132:1594-1599, 2022.

Pitcher pot neourethral modification of ileal orthotopic neobladder achieves satisfactory long-term functional and quality of life outcomes with low clean intermittent self-catheterization rate.

Objective: To describe a decade of our experience with a neo-urethral modification of ileal orthotopic neobladder (pitcher pot ONB). Multiple investigators have reported similar modifications. However, long-term longitudinal functional and quality of life (QOL) outcomes are lacking. Methods: Prospectively maintained hospital registry for 238 ONB patients comprising a mix of open and robotic surgery cohorts from 2007 to 2017, and minimum of 2 years of follow-up was retrospectively queried. QOL was evaluated using Bladder Cancer Index (BCI). Longitudinal trends of QOL domain parameters were analysed. List of perioperative variables that have a biologically plausible association with continence, potency, and post-operative BCI QOL sexual, urinary, and bowel domain scores was drawn. Variables included surgery type, Body Mass Index (BMI), T and N stage, neurovascular bundle (NVB) sparing, age, and related pre-operative BCI QOL domain score. Prognostic associations were analysed using multivariable Cox proportional hazard models and multilevel mixed-effects modeling. Results: The study comprised 80 and 158 patients who underwent open and robotic sandwich technique cohorts, respectively. Open surgery was associated with significantly higher "any" complication (40% vs 27%, P-value .050) and "major" complication rate (15% vs 11%, P-value .048). All patients developed a bladder capacity >400 cc with negligible post-void residual urine, and all but one patient achieved spontaneous voiding by the end of study period (<1% clean intermittent self-catheterization [CISC] rate). By 15 months, QOL for all three domains had recovered to reach a plateau. About 45% of patients achieved potency, and the median time to achieve day and night time continence was 9 and 12 months respectively. Lower age and NVBs spared during surgery were found to be significantly associated with the earlier achievement of potency, day and night time continence, as well as better urinary and sexual summary QOL scores. Conclusions: Pitcher pot neobladder achieves satisfactory long-term functional and QOL outcomes with negligible CISC rate. Results were superior with incremental nerves spared during surgery.

Prospective Single-Arm Phase 1 and 2 Study: Ipilimumab and Nivolumab With Thoracic Radiation Therapy After Platinum Chemotherapy in Extensive-Stage Small Cell Lung Cancer.

PURPOSE: Consolidative thoracic radiation therapy (TRT) has been shown to improve outcomes for patients with extensive stage small cell lung cancer. We hypothesized that the addition of ipilimumab (IPI) and nivolumab (NIVO) after TRT would improve outcomes for patients with extensive stage small cell lung cancer. METHODS AND MATERIALS: Eligibility required stable disease or better after platinum doublet chemotherapy. Study therapy included consolidative TRT to 30 Gy in 10 fractions, targeting residual primary tumor and initially involved regional lymph nodes. Two weeks after TRT, patients received concurrent IPI (3 mg/kg) and NIVO (1 mg/kg) every 3 weeks for 4 doses followed by NIVO monotherapy (480 mg) every 4 weeks until progression or up to 1 year. RESULTS: The study enrolled 21 patients, with 6-month progression-free survival (PFS) of 24% (90% confidence interval [CI], 11%-40%) and a median PFS of 4.5 months (95% CI, 2.7%-4.6%). The 12-month overall survival (OS) was 48% (95% CI, 29%-64%) with a median OS of 11.7 months (95% CI, 4.7%-16.0%). Fifty-two percent of patients had ≥1 possibly related grade 3 to 4 immune-related adverse event. Grade 3 pulmonary and gastrointestinal immune-related adverse events were recorded in 19% and 24% of patients, respectively. Exploratory analysis showed increased cytotoxic T cell (CD3+CD8+) tumor infiltration was associated with favorable PFS (P = .01) and OS (P = .02). Reduction in peripheral blood CD3+CD8+ from baseline to after first dose of IPI/NIVO was associated with improved PFS (P = .02) and OS (P = .02). CONCLUSIONS: Consolidative IPI and NIVO after platinum-based chemotherapy and TRT demonstrated a toxicity profile consistent with the known adverse events attributable to IPI and NIVO. Although the study regimen did not significantly improve PFS, the OS was higher than historic expectations. CD3+CD8+ tumor infiltration and migration may identify patients most likely to have improved outcomes in small cell lung cancer.

Population Attributable Risk of Hyperuricemia in Hypertension Incidence in 20-74-Year-Old Population during a 10-Year Longitudinal Cohort: Yazd Healthy Heart Cohort.

BACKGROUND: The population attributable risk (PAR) percent has used widely in public health policy. We aimed to calculate the attribute risk of hypertension due to hyperuricemia by Levin's formulas compare to direct PAR calculation method. METHODS: This was a sub-study of Yazd Healthy Heart Cohort (YHHC). Overall, 1256 normotensive individuals were enrolled through multistage randomized cluster sampling and followed up for mean 9.8 years, from 2005-2015. The threshold cutoff point of the hyperuricemia was considered equal and more than 75th percentile that equal to 5.5 mg/dl for men and 4.3mg/dl for women. To calculate the attributable risk of hyperuricemia in developing hypertension, two methods were applied. Levin's formulas and direct PAR estimation by population risk calculation via exposure prevalence weighted formula. Multiple logistic regression was used for estimate of odds ratio (OR) of hyperuricemia in developing hypertension. We calculated Relative Risk (RR) from OR. The data were analyzed using SPSS software version 16. A significant level of 0.05 was considered. RESULTS: Hypertension developed in 44.7% of individuals with uric acid level ≥ 75th percentile vs. 35.6% of other individuals (P=0.024). Attributable risk (AR) of hyperuricemia in hypertension incidence was 9.1%. PAR of hyperuricemia for hypertension incidence by using two methods mentioned before was 6%, 5.8% respectively. CONCLUSION: The results of the study confirmed the noticeable contribution of hyperuricemia as an independent other risk factor for the occurrence of hypertension. PAR of hyperuricemia for hypertension incidence by using two methods almost near was 6%, 5.8% respectively.

Automated pipeline framework for processing of large-scale building energy time series data.

Commercial buildings account for one third of the total electricity consumption in the United States and a significant amount of this energy is wasted. Therefore, there is a need for "virtual" energy audits, to identify energy inefficiencies and their associated savings opportunities using methods that can be non-intrusive and automated for application to large populations of buildings. Here we demonstrate virtual energy audits applied to large populations of buildings' time-series smart-meter data using a systematic approach and a fully automated Building Energy Analytics (BEA) Pipeline that unifies, cleans, stores and analyzes building energy datasets in a non-relational data warehouse for efficient insights and results. This BEA pipeline is based on a custom compute job scheduler for a high performance computing cluster to enable parallel processing of Slurm jobs. Within the analytics pipeline, we introduced a data qualification tool that enhances data quality by fixing common errors, while also detecting abnormalities in a building's daily operation using hierarchical clustering. We analyze the HVAC scheduling of a population of 816 buildings, using this analytics pipeline, as part of a cross-sectional study. With our approach, this sample of 816 buildings is improved in data quality and is efficiently analyzed in 34 minutes, which is 85 times faster than the time taken by a sequential processing. The analytical results for the HVAC operational hours of these buildings show that among 10 building use types, food sales buildings with 17.75 hours of daily HVAC cooling operation are decent targets for HVAC savings. Overall, this analytics pipeline enables the identification of statistically significant results from population based studies of large numbers of building energy time-series datasets with robust results. These types of BEA studies can explore numerous factors impacting building energy efficiency and virtual building energy audits. This approach enables a new generation of data-driven buildings energy analysis at scale.

Uncertainty quantification in epidemiological models for the COVID-19 pandemic.

Mathematical modeling of epidemiological diseases using differential equations are of great importance in order to recognize the characteristics of the diseases and their outbreak. The procedure of modeling consists of two essential components: the first component is to solve the mathematical model numerically, the so-called forward modeling. The second component is to identify the unknown parameter values in the model, which is known as inverse modeling and leads to identifying the epidemiological model more precisely. The main goal of this paper is to develop the forward and inverse modeling of the coronavirus (COVID-19) pandemic using novel computational methodologies in order to accurately estimate and predict the pandemic. This leads to governmental decisions support in implementing effective protective measures and prevention of new outbreaks. To this end, we use the logistic equation and the SIR (susceptible-infected-removed) system of ordinary differential equations to model the spread of the COVID-19 pandemic. For the inverse modeling, we propose Bayesian inversion techniques, which are robust and reliable approaches, in order to estimate the unknown parameters of the epidemiological models. We deploy an adaptive Markov-chain Monte-Carlo (MCMC) algorithm for the estimation of a posteriori probability distribution and confidence intervals for the unknown model parameters as well as for the reproduction number. We perform our analyses on the publicly available data for Austria to estimate the main epidemiological model parameters and to study the effectiveness of the protective measures by the Austrian government. The estimated parameters and the analysis of fatalities provide useful information for decision-makers and makes it possible to perform more realistic forecasts of future outbreaks. According to our Bayesian analysis for the logistic model, the growth rate and the carrying capacity are estimated respectively as 0.28 and 14974. Moreover for the parameters of the SIR model, namely the transmission rate and recovery rate, we estimate 0.36 and 0.06, respectively. Additionally, we obtained an average infectious period of 17 days and a transmission period of 3 days for COVID-19 in Austria. We also estimate the reproduction number over time for Austria. This quantity is estimated around 3 on March 26, when the first recovery was reported. Then it decays to 1 at the beginning of April. Furthermore, we present a fatality analysis for COVID-19 in Austria, which is also of importance for governmental protective decision-making. According to our analysis, the case fatality rate (CFR) is estimated as 4% and a prediction of the number of fatalities for the coming 10 days is also presented. Additionally, the ICU bed usage in Austria indicates that around 2% of the active infected individuals are critical cases and require ICU beds. Therefore, if Austrian governmental protective measures would not have taken place and for instance if the number of active infected cases would have been around five times larger, the ICU bed capacity could have been exceeded.

Age-, sex-, and height-based blood pressure reference charts, Yazd children 6-18 years, Iran.

BACKGROUND: Pediatric hypertension is the main cause of morbidity and mortality in pediatric populations. PURPOSE: To examine pediatric hypertension in a clinical setting, we used the percentile rank approach and defined hypertension as that above the 95th percentile. METHODS: The present study was linked to the a national analytical cross-sectional community-based Iranian Children and Adolescents' Psychiatric Disorders (IRCAP) survey. The survey was nationwide and funded by the National Institute of Medical Research Development. The IRCAP survey included 31,000 children and adolescents aged 6-18 years in all 31 Iran provinces. The current study included 1,035 children and adolescents and linked the data of the risk factors of cardiovascular disease only in Yazd province via random cluster sampling. RESULTS: Of the total participants, 456 (44.1%) were male and 579 (55.9%) were female. The mean age was 11.2±3.8 years (11.7±3.7 years for males, 11.0±3.6 years for females), while mean height was 146±20.0 cm overall, 147.2±22.0 cm for males, and 144.6±17.0 cm for females (P=0.009). The blood pressure distributions and percentiles were evaluated. CONCLUSION: Here we determined age- and height-specific 50th, 90th, 95th, and 99th percentiles of systolic and diastolic blood pressures in Yazd boys and girls using 10-cm height intervals.

Aggressive Local Control With Multisite Stereotactic Body Radiation in Metastatic Ewing Sarcoma: A Literature Review and Case Report.

Ewing sarcoma (ES) is an undifferentiated small round blue cell tumor most commonly originating in the bone of adolescents 10-20 years of age, although 30% are diagnosed in adults. The most important prognostic factor is the presence of metastatic disease. Results of the EURO-EWING 99 trial of ES patients showed that local treatment of not only the primary, but also of the sites of metastatic disease should be considered to improve event-free survival. The use of stereotactic body radiotherapy (SBRT) has been extensively reported for tumors of lung, liver, pancreas, and spine. The use of SBRT in these sites is well-accepted. Here, we report a detailed case of SBRT to multisite metastatic ES. We demonstrate the feasibility, safety, and efficacy of aggressive local control with multisite SBRT for the treatment of metastatic ES.

Bayesian inversion for a biofilm model including quorum sensing.

We propose a mathematical model based on a system of partial differential equations (PDEs) for biofilms. This model describes the time evolution of growth and degradation of biofilms which depend on environmental factors. The proposed model also includes quorum sensing (QS) and describes the cooperation among bacteria when they need to resist against external factors such as antibiotics. The applications include biofilms on teeth and medical implants, in drinking water, cooling water towers, food processing, oil recovery, paper manufacturing, and on ship hulls. We state existence and uniqueness of solutions of the proposed model and implement the mathematical model to discuss numerical simulations of biofilm growth and cooperation. We also determine the unknown parameters of the presented biofilm model by solving the corresponding inverse problem. To this end, we propose Bayesian inversion techniques and the delayed-rejection adaptive-Metropolis (DRAM) algorithm for the simultaneous extraction of multiple parameters from the measurements. These quantities cannot be determined directly from the experiments or from the computational model. Furthermore, we evaluate the presented model by comparing the simulations using the estimated parameter values with the measurement data. The results illustrate a very good agreement between the simulations and the measurements.

Health-related quality of life assessment for head-and-neck cancer patients during and at 3 months after radiotherapy - A prospective, analytical questionnaire-based study.

INTRODUCTION: Health-related quality of life (HRQoL) is a more specific area of QoL that deals with the evaluation and assessment of the impact of the disease and its treatment-related morbidities on a patient's physical, psychological, and social aspects. The aim of the present study was to assess the HRQoL of patients with head-and-neck cancer (HNCs) during and at 3 months after completion of radiotherapy (RT) by intensity-modulated RT. MATERIALS AND METHODS: This study was a prospective, longitudinal, observational, and self-completed questionnaire-based study that included 120 patients with HNC who underwent intensity-modulated RT. The questionnaire had adequate internal consistency. The questionnaires were given to each patient at the beginning of treatment (pretreatment), weekly visits during the course of RT (at the end of 1st, 2nd, 3rd, 4th, 5th, and 6th week), on the day of completion of RT, and then finally at 3 months after completion of RT. Thus, a total of successive nine time points were assessed. RESULTS AND CONCLUSIONS: One hundred and eleven patients completed the questionnaires at all nine time points. HRQoL usually decreases during treatment and then increases to pretreatment levels by 3 months after treatment. The Quality of Life Questionnaire, Core Module and Quality of Life Questionnaire, Head and Neck Module were found to be both valid and reliable. There was a significant QoL reduction for the patients throughout treatment in relation to functions and symptoms in the treatment of HNC. However, all the functions and most of the symptoms returned to baseline at the 3-month follow-up.

Methionine supplementation improves reproductive performance, antioxidant status, immunity and maternal antibody transmission in breeder Japanese quail under heat stress conditions.

This study was conducted to determine the effects of methionine (Met) supplementation on productive and reproductive performance, immune response and antioxidant status in breeder quails reared under heat stress (HS). A total of 125 breeder quails were divided into five groups. One group was kept in an environmentally controlled room at 22  ∘ C and considered as thermoneutral, and four groups were kept at 34  ∘ C and fed a basal diet (heat stressed) or a basal diet with Met concentrations 1.15, 1.30 and 1.45 times the quail requirements per NRC (1994) recommendations. HS decreased egg production in birds fed the basal diet ( P < 0.05 ). Higher feed intake ( P < 0.05 ), egg production ( P < 0.05 ), improved feed efficiency ( P < 0.05 ) and Haugh unit and hatchability variables ( P < 0.05 ) occurred in Met supplemented groups. Birds receiving Met under HS had higher maternal serum IgG, egg yolk IgY and offspring serum IgG (mg mL - 1 ). Quails receiving the Met supplementation diets exhibited higher ( P < 0.05 ) plasma levels and liver activity of superoxide dismutase, catalase and glutathione peroxidase as well as lower ( P < 0.05 ) plasma and liver levels of malondialdehyde compared to the HS group fed the basal diet. All breeder quails receiving the Met supplement had lower ( P < 0.05 ) heterophil and H / L ratios as well as higher ( P < 0.05 ) lymphocytes than quails fed the basal diet under the same stress conditions. Our results suggest that dietary supplementation with Met could improve the performance, immunity and antioxidant status of quails by reducing the negative effects of HS.

The incidence rate of diabetes mellitus (type II) and its related risk factors: A 10-year longitudinal study of Yazd Healthy Heart Cohort (YHHC), Iran.

BACKGROUND AND OBJECTIVES: Diabetes Mellitus (DM) is a metabolic disease characterized by chronic hyperglycemia, which occurs due to insufficient production of insulin by the pancreas or resistance to insulin produced by the body. The most dangerous and Long-term complications of diabetes include renal failure, heart failure, cardiovascular disease, stroke, diabetic foot ulcers, and diabetic neuropathy. MATERIALS AND METHODS: This longitudinal cohort study was conducted on 1641 non-diabetic people of 2000 participants enrolled in phase I of Yazd Healthy Heart project (YHHP) aged 20-74 year-old resident of the city of Yazd. They were selected randomly through cluster sampling method and included in follow up a project for ten years (2004-2014). In order to analyze the data, Chi-Square, independent t-test and logistic regression statistical models were used through the SPSS Ver20. RESULTS: The incidence rate of DM type II among the people aged 20-74 years in Yazd was 21.4 per 1000 of a population-year. Univariate analysis revealed that the relative risk of DM incidence increased by smoking, increasing BMI, abdominal obesity, hypertension, and increased cholesterol, triglyceride and uric acid levels (p < 0.0001). Variables with a significant p-value < 0.05 using the univariate analysis were included in the logistic regression model. Age, family history of diabetes mellitus in relatives, abdominal obesity, triglyceride values greater than 150 and uric acid more than the 75th percentile were recognized as independent risk factors of diabetes. CONCLUSION: In the present study, Age, family history of DM, abdominal obesity, high triglycerides, and high uric acid are the most important risk factors for diabetes.

Molecular detection of ALS1, ALS3, HWP1 and SAP4 genes in Candida Genus isolated from hospitalized patients in Intensive Care Unit, Tehran, Iran.

Candida species are considered as one of the important cause of nosocomial and community infections. Candidacies are fourth caused by septicemia in some countries and possess extra cost to the health care system. The aim of this study was survey the presence of virulence factors associated with various candida geniuses in samples which have been collected from the intensive care unit. In this cross-sectional study, various clinical specimens have been collected from patients which hospitalized in the Intensive Care Unit (ICU) of Milad hospital, Tehran, Iran. The species of candida has been determined by CHROM agar. Finally, adherence factors genes and proteinase gene have been detected by PCR. In this research, 100 samples have been collected from patients that colonized with candida. C. albicans (63%) and C.glabrata (19.4%) are the most identified species, respectively. The species of four specimens have been not detected according to the color of CHROM agar candida medium and two different genus of candida has been isolated from 7 patients. The frequency of Als1, Als3, HWP1 and SAP1 genes among C. albicans was (92%), (94%), (95%) and (88%), respectively. The most detected virulence factor was HWP1 and SAP4 was the lowest one. At least two virulence factors have been detected in 95% of different Candida species that can cause invasive fungal properties. These results are important for infection control committee in the hospital because invasive fungal diseases can make a serious problem for patients that hospitalized in ICU.

Proinflammatory Cytokine Gene Polymorphisms in Bullous Pemphigoid.

Bullous pemphigoid (BP) is a rare autoimmune skin blistering disease, characterized by the presence of autoantibodies against hemidesmosomal autoantigens. Cytokine expression is altered in BP patients, and several of these differently expressed cytokines, including IL-1α, IL-1ß, IL-8, and TNF-α, contribute to disease pathogenesis. Since genetic polymorphisms in the genes of these cytokines might be implicated in susceptibility to BP disease, we aimed at testing this implication in susceptibility to BP in an Iranian cohort. Blood samples were collected from the subjects and genomic DNA was extracted. To detect the single nucleotide polymorphisms (SNPs), IL-1α (rs1800587), IL-1ß (rs1143627, rs16944, rs1143634), IL-8 (rs4073), and TNF-α (rs1799964, rs1800630, rs1799724, and rs361525) genes were genotyped in BP patients and healthy controls as well as IL-8 (rs4073) in pemphigus vulgaris (PV) patients. Quantitative gene expression was evaluated by RT-PCR analysis. A significant difference was observed in the distribution of genotypes or alleles of IL-8 SNP between the BP patients and controls. The A-allele of IL-8 SNP is significantly more prevalent in the control individuals compared to the BP patient. To further validate this observation, we included PV patients as an additional control. Again, the A-allele of IL-8 SNP is significantly more prevalent in the PV compared to the BP patients. While we observed a trend toward significant differences regarding alleles of TNF-α rs1799724 as well as alleles of TNF-α rs1799964, this difference was, however, not evident after correction for multiple analysis. There was no significant difference in all other studied SNPs. In contrast to IL-1α, IL-1ß, and TNF-α, IL-8 gene expression levels were significantly higher in the patients than that of controls. The minor allele in IL-8 SNP might play a protective role in susceptibility to BP in Iranian patients. Although higher expression levels of IL-8 gene was found in the patients compared with healthy controls, these levels, however, suggest no association with the examined polymorphism. Moreover, further investigation revealed an elevation in gene expression between wild and polymorphic genotypes of IL-1α rs1800587 and TNF-α rs361525 in the patient group and these SNPs are therefore associated with altering the levels of gene expression.

Failure patterns of head and neck squamous cell carcinoma treated with radical radiotherapy by intensity modulated radiotherapy technique using focal volume and dosimetric method.

BACKGROUND: Labeling locoregional failures in head and neck cancer (HNC) as "local" and "regional" becomes incomplete when treating with intensity modulated radiotherapy (IMRT). Target delineation and delivery errors, dose in-homogeneity complicate the assessment of failures. A combination of focal point and dosimetric method might attempt at simplifying failure analysis. METHODS: One hundred eleven patients with locally advanced HNC treated with chemoradiation using IMRT were enrolled. Patients with documented failure had their recurrence volume assessed using focal point and dosimetric method. RESULTS: With a median follow-up of 20 (range 0-39) months and median locoregional control (LRC) of 30 (range 24.8-34.5) months, the patients had a 3-year overall survival and LRC of 70.6% and 48.9%, respectively. Of 39 failures, there were 69.2%, 7.6%, 5.1%, 12.8%, and 5.1% type A, B, C, D, and E, respectively using the focal point and dosimetric method. CONCLUSION: With the current classification, majority of the recurrences were high dose failures suggesting inherent radioresistance. While minority of failures were potentially preventable and needed modifying existing IMRT workflow.

Randomized controlled study comparing simultaneous modulated accelerated radiotherapy versus simultaneous integrated boost intensity modulated radiotherapy in the treatment of locally advanced head and neck cancer.

OBJECTIVES: Comparison of two fractionation schedules of intensity modulated radiotherapy (IMRT) for locally advanced head and neck cancer - simultaneous integrated boost (SIB-IMRT) and simultaneous modulated accelerated radiotherapy (SMART) boost in terms of toxicity and survival end-point measures. PATIENTS AND METHODS: Sixty patients with locally advanced head and neck cancer were randomized in two treatment arms (SIB-IMRT [control arm] and SMART boost arm [study arm]). In the control arm, patients received 70, 63 and 56 Gy in 35 fractions to clinical target volumes (CTV) 1, 2 and 3, respectively. In the study arm, patients received 60 and 50 Gy to CTV 1 and CTV 3, respectively. Toxicities, progression free survival (PFS) and overall survival (OS) were compared between both arms. RESULTS: Baseline patient-related characteristics were comparable between the arms except for primary site of tumour. No significant differences were noted in acute toxicities between the arms except for fatigue which was statistically higher for control arm. No significant differences in 2-year late toxicities were observed. The median follow-up duration was 25.5 (range, 1.8-39.9) months. The 2-year PFS was 53.3% and 80.0% (p = 0.028) for control and study arm, respectively. The 2-year OS was 60.0% and 86.7% (p = 0.020) in control and study arms, respectively. Multivariate analysis showed clinical stage and site to be significant predictors for OS and PFS, respectively. CONCLUSIONS: The SMART boost technique can be a feasible alternative fractionation schedule that reduces the overall treatment time, maintaining comparable toxicity and survival compared with SIB-IMRT.

The use of adaptive intensity-modulated radiotherapy in the treatment of small-cell carcinoma lung refractory to chemotherapy in a patient with preexisting interstitial lung disease.

This is a case report of a 60-year-old diabetic, hypertensive male with a good performance status and a history of bilateral interstitial lung disease with a left upper lobe lung mass diagnosed to be a Stage IIB mixed small-cell/squamous cell carcinoma which was refractory to carboplatin- and etoposide-based chemotherapy. The patient was then taken up for adaptive intensity-modulated radiotherapy with tighter margin under image guidance with a mid-treatment replanning done at 25#. Acute toxicities were assessed weekly and showed no Grade 3 or more reactions. Pulmonary function test showed no detrimental changes during or after radiation. Response assessment at 12 and 20 weeks showed a partial response with decrease in metabolic activity on serial scans.