The effect of interleukins 27 and 35 and their role on mediating the action of insulin Like Growth Factor -1 on the inflammation and blood flow of chronically inflamed rat knee joint.

INTRODUCTION: Previous studies have shown that some cytokines mediate the effect of IGF-1 on inflammation and also association between IGF-1 and vascular endothelial dysfunction. Due to the discrepancies in the inflammatory and anti-inflammatory roles of IL-27 and IL-35, the effects of these cytokines and their IGF-1-mediating role were investigated regarding chronic joint inflammation and synovial blood flow. METHOD: Male rats were divided into two main groups of histopathology (n=80) and blood flow (n=72). These were further divided into ten subgroups of control, vehicle, IGF-1, IL-27, IL-35, their antagonists, IGF-1+IL-27 antagonist, and IGF-1+IL-35 antagonist. Inflammation was induced by intra-articular injection of complete Freund adjuvant. Two weeks later (in order to induce chronic inflammation), vehicle or drugs were injected into the joint space every other day until day 28, on which inflammatory indices were assessed histopathologically. In the second subgroups, vehicle or drugs were administered by super-fusion on day 28 and their effects on the joint blood flow (JBF, laser Doppler perfusion method) and the systemic blood pressure were assessed. RESULTS: Endogenous IL-27 and IL-35 had inflammatory roles and IGF-1 had no effect. IL-27 and IL-35 antagonists had the highest anti-inflammatory and anti-angiogenesis effects and these effects were inhibited by IGF-1. Total inflammation score was 4.5 ± 0.42, 3.50 ± 0.5, 2.25 ± 0.45 and 1.50 ± 0.42 for vehicle, IGF-1 antagonist, IL-27 antagonist and IL-35 antagonist respectively. A significant increase was induced in JBF by IGF-1 antagonist and combination of IGF-1+IL-35 antagonist. CONCLUSION: IL-27 and IL-35 antagonists may be suitable goals for the treatment of chronic joint inflammation while their anti-inflammatory effects are not exerted via the changes in JBF.

Relationship between craniofacial photographic analysis and severity of obstructive sleep apnea/hypopnea syndrome in Iranian patients.

BACKGROUND: Considering the effectiveness of craniofacial photographic analysis for diagnosis and management of obstructive sleep apnea-hypopnea syndrome (OSAHS) as well as ethnic differences in indexes measured by this method, this study designed to compare the surface facial dimensions, including nose width, intercanthal width and mandibular width of Iranian patients with mild, moderate and severe OSAHS. MATERIALS AND METHODS: In this cross sectional study subjects with mild, moderate and severe OSAHS based on apnea-hypopnea index, were studied. To determine cephalometric measurements, face and neck digital photographs were taken from participants following a standardized procedure. Cephalometric measurements including face, intercanthal and mandibular widths were compared between studied groups. RESULTS: In this study, 100 participants enrolled. From which 20 (20.8%), 35 (36.45%) and 41 (42.7%) of them had mild, moderate and severe OSAHS, respectively. Mean of nose, intercanthal and mandibular width were significantly higher in patients with severe OSAHS than those with mild or moderate OSAHS (P < 0.05). In both genders, mandibular width were higher in severe forms of OSAHS. Disease severity was significantly associated with increased age and mandibular width (P < 0.05). CONCLUSION: Mandibular width was the most important index, which had a significant association with the disease severity. It seems that our results could be used both for diagnosis and follow-up of OSAHS management. They could be used as baseline information as well as a clinical and research tool in the field of OSAHS.

Expression of IGF-1, IL-27 and IL-35 Receptors in Adjuvant Induced Rheumatoid Arthritis Model.

BACKGROUND: IGF-1 and certain other cytokines have been shown to exert inflammatory/anti-inflammatory roles in chronic joint diseases. OBJECTIVE: To assess the effect of IGF-1, IL-27 and IL-35, their interaction and their receptor expression in a rheumatoid arthritis model. METHODS: Freund's adjuvant-induced chronic joint inflammation was operated on 160 male rats. Animals were divided into histopathology and receptor expression groups, each composed of 10 subgroups including; control, vehicle, IGF-1, IL-27, IL-35, their antagonists, IGF-1+IL-27 antagonist and IGF-1+IL-35 antagonist. After two weeks, vehicle or agonist/antagonists were injected into the joint space every other day until day 28 where joint histopathology was performed. The expression of IGF-1, IL-27 and IL-35 receptors were assessed by western blot analysis. RESULTS: IGF-1 did not show pro- or anti- inflammatory functions; endogenous IL-27 and IL-35, on the other hand, exerted inflammatory effects. IL-27 and IL-35 antagonists exerted the highest anti-inflammatory effects. The total inflammation scores were 0.55 ± 0.06, 4.63 ± 0.40, 3.63 ± 0.60, 2.50 ± 0.38 and 1.63 ± 0.40 regarding control, vehicle, IGF-1 Ant., IL-27 Ant. and IL-35 Ant., respectively. IGF-1 receptor expression was reduced in chronic joint inflammation and all three antagonists augmented the IGF-1 receptor expression. IL-27 and IL-35 receptors were up-regulated by chronic joint inflammation. CONCLUSION: Overall, the results demonstrated the pro-inflammatory role of endogenous IL-27 and IL-35 along with the over expression of their receptors in chronic joint inflammation. IL-27 and IL-35 antagonists exerted the most anti-inflammatory effects and increased IGF-1 receptor expression. These two antagonists may be potential agents for new treatment strategies in chronic joint inflammatory diseases.

Eosinophilic gastroenteritis; a report of two cases with different presentations.

Eosinophilic gastroenteritis is a rare inflammatory disease, defined by infiltration of eosinophils in gastrointestinal (GI) tract, but the etiology of this disorder is unknown. Depends on the involvement region of Eosinophilic gastroenteritis, GI symptoms are variable including abdominal pain, malabsorption, gastric and duodenal ulcer. Due to its non-specific symptoms, the diagnosis is based on upper GI endoscopy followed by histopathological examination of the biopsies, which shows eosinophilic infiltration in different layers of GI tract. In this article we report two cases with gastrointestinal disorders. The first case was a 52-year-old man with a history of peripheral edema over the past 3 months and low level of serum albumin. All the necessary evaluations were done and increase number of eosinophils were found in duodenal biopsies. The second case was a 42-year-old man presented with a history of chronic diarrhea over the past two years. Main causes of diarrhea were ruled out and small intestine biopsies confirmed submucosal eosinophilic infiltration. Therefore, corticosteroid therapy was administered for both patients then they were followed for a year. During this time all of the symptoms were disappeared and they did not recur in the first year of follow up.

Assessment of fistulectomy combined with sphincteroplasty in the treatment of complicated anal fistula / Avaliação de fistulectomia combinada com esfincteroplastia no tratamento de fístula anal complicada

Abstract Introduction The ideal method of treating the complex anal fistula is to eradicate the sepsis and preserve the anal sphincter; since there is no definite consensus on the surgical method of treating it. Recent studies show that fistulectomy and immediate sphincteroplasy are a safe and appropriate way to treat the fistula-in-ano. The aim of this study was to evaluate the long term outcomes of fistulectmy and sphincteroplasty in the treatment of complex perianal fistula. Methods In this prospective study, we have analyzed the data of 80 patients who underwent fistulectomy and sphincteroplasty from May 2013 to May 2016. Preoperative information included physical examination, preoperative fecal incontinence evaluation and taking a complete history about underlying diseases and past related surgeries were collected. Results Of all 80 patients with complex fistula, 57.5% (46 patients) were male. 70-Patients were presented with high transsphincteric fistula (87.5%) and anterior fistula was diagnosed in 10 of them (12.5%). 9 patients (11.3%) suffered from hypertension and 43 patients (53.75%) had recurrent fistula after previous surgeries. During the follow-up period, the overall success rate was 98.8% (98.8%) and fistulectomy and sphincteroplasty failed in only one patient (failure rate: 1.3%). preoperative and post-operative scoring showed mild fecal incontinence in 8 patients (10%). We have found no significant relation between the age, gender, hypertension, previous surgery and post-operative recurrence. Conclusion Fistulectomy and sphincteroplasty is a safe surgical procedure in the treatment of anterior anal fistula in females and high transsphincteric fistulas.

Resumo Introdução o método ideal para tratar a fístula anal complexa consiste em erradicar a sepse e preservar o esfíncter anal, uma vez que não existe consenso definitivo com relação ao método cirúrgico para tratamento desse problema. Estudos recentes demonstram que a fistulectomia, seguida imediatamente pela esfincteroplastia, é procedimento seguro e apropriado no tratamento da fístula perianal. O objetivo deste estudo foi avaliar os resultados em longo prazo da fistulectomia e da esfincteroplastia no tratamento da fístula perianal complexa. Métodos Neste estudo prospectivo analisamos os dados de 80 pacientes tratados por fistulectomia e esfíncteroplastia no período de maio de 2013 até maio de 2016. Foram coletadas as seguintes informações pré-operatórias: exame físico, avaliação pré-operatória de incontinência fecal e história completa sobre doenças subjacentes e cirurgias prévias afins. Resultados De todos os 80 pacientes com fístula complexa, 57,5% (46 pacientes) pertenciam ao gênero masculino. Setenta pacientes se apresentaram com fístula trans-esfinctérica alta (87,5%); em 10 desses pacientes (12,5%), foi diagnosticada fístula anterior. Nove pacientes (11,3%) sofriam de hipertensão (HT), tendo sido observada recorrência de fístula após cirurgias prévias em 43 pacientes (53,75%). Durante o período de seguimento, o percentual de sucesso global foi de 98,8%, e em apenas um paciente os procedimentos de fistulectomia e esfincteroplastia não obtiveram sucesso (percentual de falha: 1,3%). Os escores pré-operatórios e pós-operatórios revelaram incontinência fecal leve em 8 pacientes (10%). Não observamos nenhuma relação significativa entre idade, gênero, HT, cirurgia prévia e recorrência pós-operatória. Conclusão Fistulectomia e esfincteroplastia constituem procedimento cirúrgico seguro no tratamento de fístulas anais anteriores em mulheres e de fístulas trans-esfinctéricas altas.

Comparative Study of Two Silicone Hydrogel Contact Lenses used as Bandage Contact Lenses after Photorefractive Keratectomy.

BACKGROUND: Silicon hydrogel bandage contact lenses are used to enhance epithelial healing, control surface-generated pain, and prevent epithelial erosions after refractive surgery. Considering the importance of faster reepithelialization in preventing complications of photorefractive keratectomy (PRK) and the fact that the features and specifications of these commercially-available lenses are different and their performance as a postoperative bandage lenses would be different also, the aim of this study was comparison the efficacy of senofilcon A and lotrafilcon A after PRK. METHODS: In this prospective study, 44 patients with PRK in both eyes randomly received a silicon hydrogel contact lens of senofilcon A in one eye and lotrafilcon A in other eye. Then the epithelial defect size, visual acuity and subjective level of pain and discomfort were measured for both eyes and compared on day 1, 3 and 5 postoperatively. RESULTS: There was no statistical difference in rate of reepithelialization between senofilcon A and lotrafilcon A (P > 0.05). The mean pain and discomfort index was significantly lower in eyes with senofilcon A (P < 0.05). The mean subjective visual scores were similar with both bandage contact lenses (BCLs) (P > 0.05). CONCLUSION: Silicon hydrogel BCLs are safe and effective for corneal reepithelialization and have great therapeutic outcome on visual outcomes after PRK. But, senofilcon A had better effect on postoperative pain and discomfort which made it superior than lotrafilcon A. However for more conclusive results, it is recommended to study larger sample size with evaluation the possible factors responsible for the obtained findings regarding postoperative pain and discomfort.