Perineural Pseudoinvasion: An Unusual Phenomenon in Nonmalignancies.

Perineural invasion (PNI) is characterized as tumoral or nontumoral cells invading in or around the nerves. The neural invasion is considered as a histopathologic characteristic for malignancy and is considered a mechanism for its spread. Both of these patterns usually portend a poor prognosis and very often are markers to prompt additional treatment. There are also some nonmalignancies representing PNI, including benign neoplasms, mimicking lesions, and disorders, such as chronic pancreatitis and endometriosis. The previously recommended terms are PNI, spread, or infiltration. To distinguish PNI in malignancies from that in nonmalignancies, we propose the term "perineural pseudoinvasion" to convey their nonmalignant behavior. Despite the low prevalence, awareness of this benign pseudoinvasion is necessary to avoid aggressive treatment and its misdiagnosis with malignancies. We conducted a systematic search in PubMed and Scopus databases up to December 2015 to find articles reporting PNI in nonmalignancies. After screening, 63 articles were identified as relevant. There were also 2 review articles discussing PNI in nonmalignancies. We aim to present an overview of the perineural pseudoinvasion and to discuss the previously published review articles.

A study of the knowledge, attitudes, and practices (KAP) of the women referred to health centers for cardiovascular disease (CVDs) and their risk factors.

Hypertension, dyslipidemia, and diabetes are established risk factors for cardiovascular disease (CVD) morbidity and mortality. In the past decade a general increase in CVD risk factors in the population aged 65 and older, along with suboptimal control rates, have occurred. In this descriptive, cross-sectional study, the authors describe the knowledge, attitudes, and practices (KAP) of Iranian females regarding risk factors for CVD, in an attempt to help with the development of strategies to control risk factors and CVD. Participants were 200 women ages 15-49 referred to health centers in Yazd, selected from four different centers. Data were gathered through a questionnaire consisting of demographics and questions related to KAP. The validity of the questionnaire was determined by a health education specialist, with its reliability determined by piloting and measuring the related Cronbach's alpha (Alpha = 0.720). Measuring knowledge of CVD on a scale of 0-20, the mean knowledge score was 10.203.91. More than 76% of the participants knew that CVD is preventable. Ninety-one percent liked exercising and believed that exercising would make them feel better. The average mean scores for attitudes of participants toward CVD were 30.31 ± 3.21 out of 36. The authors conclude that there is a need for enhancing mothers' general knowledge about the disease, because of the increasing rates of CVD in females. This will lead to improvements in attitude and practice. Furthermore, learning in groups of 12 can be a beneficial educational method.

The comparison of intraarticular morphine-bupivacaine and tramadol-bupivacaine in postoperative analgesia after arthroscopic anterior cruciate ligament reconstruction.

PURPOSE: To compare intraarticular morphine-bupivacaine and tramadol-bupivacaine as postoperative analgesics in patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction. METHODS: A randomized, double blind, controlled trial study of 60 ASA I-II patients undergoing arthroscopic ACL reconstruction was performed under general anesthesia. Patients were randomly allocated into three groups. The MB group (n = 20) received 10 mg morphine and 0.5% bupivacaine; the TB group (n = 20) received 100 mg tramadol and 0.5% bupivacaine; and the control group (n = 20) received isotonic saline intraarticularly in a total volume of 20 ml after the operation. Postoperative pain was assessed with visual analogue scale (VAS) at 0, 30, 60, 90 min and 2, 4, 6, 12, 24 h being at rest. Analgesic duration as defined was the time of first request for analgesics, the first 24 h analgesic consumption, time to unassisted ambulation, discharge time and incidence of side effects were also evaluated. RESULTS: The VAS scores at 30, 60, 90 min and 2, 4, 12, 24 h were significantly less in the MB and TB groups in comparison with the control group (P < 0.05); VAS scores also decreased significantly in the MB group compared to the TB group at 2, 4 and 24 h (P < 0.05). Analgesic duration was longer and analgesic consumption was substantially less in the MB group (P < 0.05). Moreover, unassisted ambulation time and discharge time were significantly shorter in the MB group than the TB and control groups (P < 0.05). Side effects were similar among the groups. CONCLUSIONS: Intraarticular morphine-bupivacaine provides effective pain relief, longer analgesic duration, less analgesic requirement, shorter unassisted ambulation and discharge time were compared with intraarticular tramadol-bupivacaine after ACL reconstruction arthroscopy. LEVEL OF EVIDENCE: I.

Posterior pericardiotomy in cardiac surgery: systematic review and meta-analysis.

This systematic review with meta-analysis sought to determine the impact of posterior pericardiotomy on incidences of atrial fibrillation and supraventricular arrhythmias, pericardial effusion, pleural effusion, tamponade, and the length of hospital stay after cardiac surgery. We searched for randomized controlled trials, using Medline, Embase, Elsevier and Sciences online databases as well as Google Scholar literature. The effect sizes measured were odds ratio for categorical variables and standard mean difference with 95% confidence interval for calculating differences between mean values of hospital stay in intervention and control groups. A value of p < 0.1 for Q test or I(2 )> 50% indicated significant heterogeneity between the studies. The literature search of all major databases retrieved 20 studies. After screening, 12 suitable trials were identified, which reported outcomes of 2052 patients undergoing cardiac surgery. Posterior pericardiotomy had an odds ratio of 0.33 [95% confidence interval: 0.18-0.61] p < 0.001 for atrial fibrillation; odds ratio 0.32 [0.15-0.67] p = 0.003 for supraventricular arrhythmias; odds ratio 0.09 [0.04-0.19] p = 0.000 for early pericardial effusion and odds ratio 0.04 [0.02-0.08] p < 0.001 for late pericardial effusion; odds ratio 1.64 [1.23-2.20] p = 0.001 for pleural effusion, odds ratio 0.07 [0.02-0.27] p < 0.001 for tamponade, and standard mean difference = 0.01 [-0.12 to 0.14] p = 0.8 for hospital stay. Posterior pericardiotomy is a simple intraoperative technique that can improve postoperative clinical outcomes. However, the incidence of pleural effusion associated with posterior pericardiotomy might be higher.

Beneficial effects of cocoa on lipid peroxidation and inflammatory markers in type 2 diabetic patients and investigation of probable interactions of cocoa active ingredients with prostaglandin synthase-2 (PTGS-2/COX-2) using virtual analysis.

BACKGROUND AND AIM: Altered glucose metabolism, oxidative stress, lipid levels and inflammatory markers are important risk factors in diabetes, cardiovascular, and many other diseases. Cocoa has been shown to exert antioxidant and anti-inflammatory effects. The aim of this study is twofold: to assess the effect of Cocoa on the lipid profile and peroxidation in addition to the inflammatory markers in type 2 diabetic patients, and to represent a virtual model of probable action mechanism of observed clinical effects of Cocoa consumption using in silico analysis and bioinformatics data. METHODS: One hundred subjects with type 2 diabetes were included in a randomized clinical control trial. Fifty treatment subjects received 10 grams cocoa powder and 10 grams milk powder dissolved in 250 ml of boiling water, and the other fifty control subjects received only 10 grams milk powder dissolved in 250 ml boiling water. Both groups were on the mentioned regimen twice daily for 6 weeks. Blood samples were obtained prior to Cocoa consumption and 6 weeks after intervention. Serum lipids and lipoproteins profile, malondialdehyde and inflammatory markers including tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and high sensitive C-reactive protein (hs-CRP) were measured. For statistical analysis two independent and paired samples t-test and linear regression were used. Bioinformatics and virtual analysis were performed using string data base and Molegro virtual software. RESULTS: Cocoa consumption lowered blood cholesterol,triglyceride, LDL-cholesterol, and TNF-α, hs-CRP, IL-6 significantly (P < 0.01). The results showed that the levels of HDL-cholesterol decreased significantly (P < 0.05) but Cocoa inhibited lipid peroxidation in treatment group than control group (P < 0.0001). Virtual analysis showed that the most frequent Cocoa ingredients, (+)-Catechin and (-)-Epicatechin, can dock to the enzyme COX-2. CONCLUSION: These data support the beneficial effect of Cocoa on the lipid peroxidation prevention and inflammatory markers in type 2 diabetic patients. Cocoa ingredients block the Cox-2 activation and reduce inflammatory prostanoids synthesis according to virtual analysis.

The effect of ginger powder supplementation on insulin resistance and glycemic indices in patients with type 2 diabetes: a randomized, double-blind, placebo-controlled trial.

OBJECTIVE: To identify the effect of some herbal products on insulin resistance. Regarding the scientific evidences existing about ginger, this research was therefore carried out to identify the effect of ginger supplementation on insulin resistance and glycemic indices in diabetes mellitus. METHODS: This is a randomized, double-blind, placebo-controlled trial in which 88 participants affected by diabetes were randomly assigned into ginger (GG) and placebo (PG) groups. The GG received 3 one-gram capsules containing ginger powder whereas the PG received 3 one-gram microcrystalline-containing capsules daily for 8 weeks. HbA1c, fructosamine, fasting blood sugar (FBS), fasting insulin, homeostasis model assessment insulin resistance index (HOMA-IR), ß-cell function (ß%), insulin sensitivity (S%) and the quantitative insulin sensitivity check index (QUICKI) were assessed before and after the intervention. RESULTS: FBS mean showed a decrease of 10.5% (p=0.003) in the GG whereas the mean had an increase of 21% in the PG (p=0.01). Variation in HbA1c mean was in line with that of FBS. Statistical difference was found in the two groups before and after the intervention in terms of median of fasting insulin level, S% and HOMA-IR (P<0.005). Moreover QUICKI mean increased significantly in the two groups, the mean difference, however, was significantly higher in the GG. CONCLUSIONS: The study demonstrated that daily consumption of 3 one-gram capsules of ginger powder for 8 weeks is useful for patients with type 2 diabetes due to FBS and HbA1c reduction and improvement of insulin resistance indices such as QUICKI index.

Can preoperative serum level of creatinine predict new-onset atrial fibrillation in non-diabetic male patients undergoing open heart surgery? A retrograde view.

Renal dysfunction is a risk marker in patients who candidate for coronary artery bypass graft (CABG). Renal disorder is associated with prolonged stays in intensive care unit and hospital, morbidity and mortality. Aim of this study is specific evaluation of association between preoperative creatinine (Cr) with atrial fibrillation (AF) after elective off-pump CABG in non-diabetic male patients with normal ejection fraction. Two hundred non-diabetic male patients with normal ejection fraction undergoing elective off pump CABG surgery enrolled in this cross-sectional study and were stratified by present or absence of postoperative atrial fibrillation: patients with postoperative new-onset atrial fibrillation (n=100) as group 1 and patients without new-onset postoperative atrial fibrillation as group 2 (n=100). Preoperative serological test of the participants, such as serum creatinine, were recorded in their medical dossiers. Data were analyzed in SPSS-16 software and tested for association between atrial fibrillation with creatinine level by using student t test, chi-square test or logistic regression. Cr level in patients with and without AF three days before surgery were 1.8±0.3 and 1.0±0.4 respectively (P value for Cr=0.00). On surgical day, mean Cr level in patients with and without AF were 1.6±0.2 and 1.1±0.5 respectively (P value for Cr = 0.00). Of the 100, male patients with postoperative AF, duration and frequency of recurrence of AF were not associated with Cr at three days before surgery and on surgical days (P>0.05). Patients with postoperative AF had unsuitable status of renal function compare to patients without AF; however, preoperative serum creatinine cannot associate with duration and frequency of recurrence of AF.

Effect of pomegranate juice on paraoxonase enzyme activity in patients with type 2 diabetes.

OBJECTIVE(S): Paraoxonase-1 (PON1), an HDL-associated enzyme, prevents lipoprotein oxidation. PON1 enzymatic activity has been shown to decrease in patients with diabetes. Paraoxonase activity. HDL capacity to bind with PON1 is possible under specific experimental conditions, such as oxidation, addition of polyphenols, or in diabetic patients with polyphenols doses. The aim of this study was the effect of pomegranate juice (PJ) on paraoxonase and arylesterase activity of PON1. MATERIALS AND METHODS: Fifty patients with type 2 diabetes mellitus consumed 200 ml of PJ daily for a period of 6 weeks. Blood was collected from the patients before and after PJ consumption after 12 h of fasting. Blood sugar, total cholesterol, triglyceride, LDL- C and HDL-C were measured by colorimetric kit method. The malondialdehyde concentration (µmol/L) was determined by thiobarbituric acid (TBA) assay. Paraoxonase and arylesterase activity of PON1 enzyme were measured using paraoxone and phenylacetate as the substrates. RESULTS: The concentration of fasting blood sugar, total cholesterol, LDL-C and malondialdehyde significantly (p < 0.001) decreased after the intervention. Paraoxonase and arylesterase activity of PON1 significantly (p < 0.001) increased after the intervention. There were however no significant changes in serum triglyceride and HDL-C. There was a significant positive correlation between paraoxonase and arylesterase activity of PON1 and serum HDL-C concentration . A significant negative correlation was detected between paraoxonase and arylesterase activity of PON1 and FBS. CONCLUSION: It can be concluded that PJ consumption as an antioxidant may have a contribution in changing fasting blood sugar, lipid profiles, lipoprotein oxidation, and PON1 activity.

Intra-operative grading of coronary artery atherosclerosis associated with homocysteine levels in postmenopausal women undergoing elective off-pump CABG surgery.

BACKGROUND: Atherosclerosis is one of the common causes of morbidity and mortality, in postmenopausal women. Homocysteine, a sulfur-containing amino acid product of methionine metabolism, may play an important role in the development of cardiovascular diseases. This study was designed to evaluate the relationship between intra-operative grading of coronary artery atherosclerosis and homocysteine level in postmenopausal women who were candidates for off-pump coronary bypass graft surgery (CABG). MATERIALS AND METHODS: In this cross-sectional study, 136 postmenopausal women (with the mean age of 54.9±4 years) were enrolled as candidates for elective off-pump CABG. For each patient the extent and severity of atherosclerosis was assessed by intra-operative grading (IOG) and Gensini score system. Total homocysteine was determined with ELISA method after 12 hours of fasting. The patients were classified into two groups (diffuse vs. discrete) based on intra-operative findings. Finally the relation between age, IOG, and Gensini score with homocysteine level was assessed by ANOVA, T-test, and Tukey HSD test. RESULTS: There was a positive correlation between intra-operative grading and homocysteine level in both groups (P=0.005). The association between Gensini score and homocysteine was significant in higher levels of hyperhomocysteinemia (P<0.05). The homocysteine level also increased with age; therefore, patients were classified into two categories (<54 years and ≥54 years) by Levene test. Statistical analysis indicated no relationship between IOG, Gensini score, and homocysteine level in the patients who were younger than 54 years (P=0.3, P=0.2), but significant relation was detected between IOG, Gensini score, and homocysteine in the patients who were older than 54 years with diffuse or discrete lesions in coronary arteries (P=0.001, P=0.001). CONCLUSION: According to our findings, homocysteine level increases in post-menopausal women that can be an important risk factor for atherosclerosis and cardiovascular diseases.

Preoperative C-reactive protein can predict early clinical outcomes following elective off-pump CABG surgery in patients with severe left ventricle dysfunction.

PURPOSE: Atrial fibrillation (AF) is the most common type of arrhythmia following elective off-pump coronary bypass graft (CABG) surgery, occurring on the 2(nd) or 3(rd) postoperative day. Postoperative atrial fibrillation and early complications may be the cause of long term morbidity and mortality after hospital discharge. High sensitive C-reactive protein (hsCRP) seems to be most significantly associated with cardiovascular disorders. This study was designed to evaluate whether preoperative hsCRP (≥3 mg/dl) can predict post-elective off-pump CABG, AF, and early complications in patients with severe left ventricle dysfunction (Ejection Fraction (EF)<30%). METHODS: This study was conducted on 104 patients with severe left ventriclar dysfunction (EF < 30%), undergoing elective off-pump CABG surgery during April to September 2011 at the Afshar Cardiovascular Center in Yazd, Iran. Patients undergoing emergency surgery and those with unstable angina, creatinine higher than 2.0 mg/dl, malignancy, or immunosuppressive disease were excluded from the study. The subjects were divided into two groups: Group I with preoperative increased hsCRP (>3 mg/dl) (n=51) and group N with preoperative normal hsCRP (<3 mg/dl) (n=53). We evaluated post-CABG variables including incidence, duration, and frequency of AF, early morbidity (bleeding, infection, vomiting, renal and respiratory dysfunctions), ICU or hospital stay and early mortality. Data were then analyzed by Analysis of Variance (ANOVA), Chi-square and Fisher exact test for quantitative and qualitative variables. RESULTS: The average age of the patients was 62.5 years, 75 cases (72.1%) were male, and 39 (37.5%) were female. Postoperative AF occurred in 19 cases (18.2%); 17 cases (33.3%) had hsCRP≥3 mg/dl and 2 cases (3.8%) had hsCRP≤3 mg/dl (P=0.03). Postoperative midsternotomy infection, respiratory dysfunction, and hospital stay were significantly higher in group I compared with group N (P<0.05). No statistical significant differences were identified between the two groups concerning other postoperative complications (bleeding, vomiting, renal dysfunction and ICU stay) (P>0.05). CONCLUSION: Preoperative hsCRP ≥3 mg/dl can predict incidence of postoperative atrial fibrillation and early complications such as midsternotomy infection, respiratory dysfunction, and hospital stay following elective off-pump CABG.

The efficacy and safety of a high dose of vitamin d in mothers with gestational diabetes mellitus: a randomized controlled clinical trial.

BACKGROUND: During pregnancy and lactation outstanding changes occur in mother's vitamin D metabolism. This study was carried out to evaluate the efficacy of 300,000 IU vitamin D given intramuscularly on body status in new cases of gestational diabetes mellitus (GDM). METHODS: This is a randomized clinical trial with the follow-up period of 3 months. Totally 45 participants were randomly divided into intervention group (IG) and control group (CG). The IG received an IM injection of 300,000 IU of vitamin D, whereas CG did not. The glycosylated hemoglobin A1C (HBA1C), serum 25-OH-D, parathyroid hormone (PTH), serum calcium and phosphorus were measured. RESULTS: Forty five patients including 24 with the mean age of 30.7±6.2 years in the IG and 21 with the mean age of 29.5±4.0 years in the CG participated in the study. The median concentration of serum 25(OH)D3 in the IG was to 62.10 nmol/l after the intervention, showing an increase of around 158%, compared to before intervention (24.25 nmol/l) whereas the CG showed a decrease of around 4.5%. Of the patients, 79.2% of IG and 81.9% of CG suffered to some degree from vitamin D deficiency. These figures were 4.2% and 71.4% for the IG and CG, respectively after the intervention.For the IG, the PTH was significantly lower and Ca was significantly higher after the intervention. The serum Phosphorus before and after the intervention in each group or between the two groups was not significant. CONCLUSIONS: The single 300,000 IM dose of vitamin D is regarded as an effective and safe to promptly improve vitamin D status in GDM. TRIAL REGISTRATION NUMBER: IRCT138902113840N1.

A comparison of the effect of honey, dextromethorphan, and diphenhydramine on nightly cough and sleep quality in children and their parents.

OBJECTIVES: Coughing is a prevalent symptom of upper respiratory infections (URIs) that cause disturbance in the sleep of children and their parents. There is as yet no reliable treatment to control URIs and their related cough; however, drugs such as dextromethorphan (DM) and diphenhydramine (DPH) are now mainly used in the world. The aim of this study is to compare the effect of honey, DM, and DPH on the nightly cough and sleep quality of children and their parents. DESIGN: This was a clinical trial study in which 139 children aged 24-60 months suffering from coughing due to URIs were selected and assigned randomly to 4 groups. The first group received honey (HG), the second one DM (DMG), the third DPH (DPHG), but the fourth group or control group (CG) was assigned to a supportive treatment. OUTCOME MEASURES: After approximately a 24-hour intervention, the 4 groups were reexamined and their cough frequency, cough severity, and sleep quality in children and their parents were recorded by using the questionnaire with Likert-type questions. RESULTS: The mean of cough frequency score HG is 4.09 +/- 0.72 and 1.93 +/- 0.65 before and after the intervention, respectively, while these figures for the CG are 4.11 +/- 0.78 and 3.11 +/- 0.57, respectively. After the intervention, the difference of the mean score of the variables in all groups became statistically significant. The mean score of all variables in HG has stood significantly higher than those in other groups. There is also a significant relationship between the DMG and CG groups, even though there is no statistically difference between DMG and DPHG groups. CONCLUSIONS: The result of the study demonstrated that receiving a 2.5-mL dose of honey before sleep has a more alleviating effect on URIs-induced cough compared with DM and DPH doses.