Idiopathic granulomatous mastitis: Management and predictors of recurrence in 474 patients.

Idiopathic Granulomatous Mastitis (IGM) is an uncommon inflammatory disease of the breast, with similar presentations as breast cancer and a relatively high recurrence rate. We reviewed the demographics, clinical presentations, and treatment modalities of a large cohort of patients in Iran. Most of the patients had history of pregnancy and breastfeeding. The most common clinical finding was pain and a palpable mass, respectively. Most of the patients received medical treatment, and about half of the patients had surgery. The recurrence rate was 24.8%, and breast skin lesions were associated with a significantly higher odds of recurrence.

Sustainable location and route planning with GIS for waste sorting centers, case study: Kerman, Iran.

One of the important issues in the world is the significant growth of waste production, including waste that is not biodegradable in nature. According to the Kerman Municipality, 440 tonnes of municipal waste is collected daily in Kerman consisting of five major parts of paper, plastic, metal, glass, and wet waste. The major problems of municipal solid waste disposal are soil erosion, air pollution, and greenhouse gas emissions. The most important factors related to recycling are waste sorting and the relevant environmental conditions. This study aims to create a sustainable approach by locating the optimal sites to reduce environmental pollution, decrease costs, and improve the service system to the society. Optimal locations for establishing the collecting and sorting centers in the city are specified by the use of geographic information system software, based on criteria consisting of population density, road network, distance to health centers, distance to disposal center, waste sorting culture, land space, and land cost, which were weighted by an analytical hierarchy process. It was noteworthy that the criterion "waste sorting culture", which has a foundation in human sciences and sociology, has been considered by experts in this study to be of the highest importance among other criteria at locating sorting centers. Subsequently, using a symmetric capacitated vehicle routing problem, the number and capacity of each vehicle are determined to serve the specified locations according to the economic, social, and environmental constraints.

A clinical trial of neoadjuvant concurrent chemoradiotherapy followed by resection for esophageal carcinoma.

BACKGROUND: Esophageal carcinoma is a common malignancy in the North East of Iran. Combined modality treatments have been adopted to improve survival in patients with esophageal carcinoma. In this trial, we evaluated the efficacy and toxicity of a preoperative concurrent chemoradiotherapy protocol in the patients with locally advanced esophageal carcinoma. MATERIALS AND METHODS: Between 2006 and 2011, eligible patients with locally advanced esophageal carcinoma underwent concurrent radiotherapy and chemotherapy and 3-4 weeks later, esophagectomy. Pathologic response, overall survival rate, toxicity, and feasibility were evaluated. RESULTS: One hundred ninety-seven patients with a median age of 59 (range: 27-70) entered the protocol. One hundred ninety-four cases (98.5%) had esophageal squamous cell carcinoma. Grades 3-4 of toxicity in patients undergoing neoadjuvant chemoradotherapy were as follows: Neutropenia in 21% and esophagitis in 2.5% of cases. There were 11 (5.6%) early death probably due to the treatment-related toxicities. One hundred twenty-seven patients underwent surgery with postsurgical mortality of 11%. In these cases, the complete pathological response was shown in 38 cases (29.9%) with a 5-year overall survival rates of 48.2% and median overall survival of 44 months (95% confidence interval, 24.46-63.54). CONCLUSION: The pathological response rate and the overall survival rate are promising in patients who completed the protocol as receiving at least one cycle of chemotherapy. However, the treatment toxicities were relatively high.

Can methylene blue dye be used as an alternative to patent blue dye to find the sentinel lymph node in breast cancer surgery?

BACKGROUND: Sentinel lymph node biopsy (SLNB) is standard care to evaluate axillary involvement in early breast cancer. It has fewer complications than complete lymph node dissection; however, using blue dye in SLNB is controversial. We have evaluated the detection rate and local complications associated with methylene blue dye (MBD) used in SLNB in early breast cancer patients and compared these results to patent blue dye (PBD). MATERIALS AND METHODS: In a cohort prospective study, 312 patients with early breast cancer without axillary lymph node involvement were divided into two groups according to dye type. All of the patients received radiotracer and one type of blue dye. We filled out a checklist for the patients that contained demographic data, size of tumor, stage, detection of sentinel lymph node, and complications and then analyzed the data. RESULTS: Demographic and histopathologic characteristics were not significantly different in both groups. Mean (standard deviation [SD]) tumor size in all patients was 2.4 (0.8) cm. Detection rate in the MBD group was 77.5% with dye alone and 94.2% with dye and radioisotope; and in the PBD group it was 80.1% and 92.9% respectively (P > 0.05). We had blue discoloration of the skin in 23.7% in the PBD and 14.1% in the MBD group (P < 0.05) local inflammation was detected in one patient in the PBD and five in the MBD group (P < 0.05). Skin necrosis and systemic complications were not observed. CONCLUSION: Methylene blue has an acceptable detection rate, which may be a good alternative in SLNB. Complication such as blue discoloration of the skin was also lower with MBD.

Evaluation of Relationship between Intrinsic Radiosensitivity (Survival Fraction at 2 Gy) and Gamma-H2AX Test and Apoptosis of Lymphocytes in Breast Cancer Patients.

Background: Radiotherapy is one of the routine treatment strategies for breast cancer (BC) patients. Different responses of the patient to radiation due to different intrinsic radiosensitivity (RS) were induced to the researcher try to introduce a standard assay for the prediction of RS. Clonogenic assay is recognized as a gold standard method in this subject but because of some of its disadvantages, it is needed for alternative assays. In this study, two assays were evaluated for this reason in ten BC patients with different RSs. Methods: The peripheral blood of 10 volunteers with BC was obtained, and the peripheral blood mononuclear cells were extracted. After exposed with 2 Gy, survival fraction at 2 Gy (SF2) was calculated by clonogenic assay. γ-H2AX assay was performed for all patients, and apoptosis assay was evaluated for three represented categorized patients. Results: RS of patients showed SF2 and categorized in three groups (high, medium, and low RS). Double-strand breaks (DSBs) were decreased in high radiosensitive patients, but the residual DSBs were clearly higher than other two groups. It is shown that the repair system in these patients is lower active than others. Apoptosis frequency in patient 4 is highly active which could induce the enhancement of her RS. Conclusion: γ-H2AX and apoptosis assays could predict the intrinsic RS, but evaluation of them separately is not sufficient for this aim. It is necessary to consider all the parameters together and consideration of the combination of assays could fit a better prediction of intrinsic RS.

Psychometric properties of Persian version of irritable bowel syndrome- behavioral responses questionnaire (IBS-BRQ).

Aim: This study aimed to determine the psychometric properties of Persian version of Irritable Bowel Syndrome-Behavioral Responses Questionnaire (IBS-BRQ). Background: In addition to somatic symptoms and complaints, patients with irritable bowel syndrome have specific dysfunctional behaviors that lead to disease persistence and functional disturbance. Methods: Participants included 170 patients with irritable bowel syndrome, who were diagnosed based on ROM-IV criteria and selected from patients referring to the Gastrointestinal Disorders Clinic, as well as 100 persons from the general population in Isfahan in 2020. Both groups completed the 26-item Irritable Bowel Syndrome-Behavioral Responses Questionnaire (IBS-BRQ). Also, questionnaires including the Irritable Bowel Syndrome Symptom Severity Scale (IBS-SSS), Irritable Bowel Syndrome-Quality of Life IBS-QOL, Illness Perception Questionnaire (IPQ-R), Irritable Bowel Syndrome-Patient Satisfaction (IBS-SAT), Hope Scale, Interpersonal Forgiveness Inventory (IFI), and Dysfunctional Attitude Scale- 26-item (DAS-26) were completed to determine the validity of IBS-BRQ. Tests of internal consistency, principal components analyses (PCAs), differentiation analysis, and correlation were used to determine its reliability, along with criterion and construct validity. Results: IBS-BRQ was valid and reliable in both groups with a high degree of internal consistency. Cronbach's alpha was obtained in the sample of patients with IBS and the total sample of participants 0.87 and 0.95 respectively. This scale differentiated significantly between IBS patients and non-patients (p<.001). The criterion validity was high as evidenced by a high correlation with DAS-26 (r=0.53, p<0.001), IBS-QOL (r=0.76, p<0.001), IBS-SSS (r=0.44, p<0.001), IPQ-R (r=0.56, p<0.001), and reverse correlation with IFI (r=-0.031, p<0.001), IBS-SAT (r=-0.23, p<0.001), and HOPE (r=-0.49, p<0.001). Conclusion: The Persian version of the IBS-BRQ proved to be a well-defined behavioral response measure in IBS patients with high validity and reliability, making it a suitable measure to be used in future IBS clinical research in Iran.

A two-echelon location routing problem considering sustainability and hybrid open and closed routes under uncertainty.

Location-routing is an extremely important problem in supply chain management. In the location-routing problem, decisions are made about the location of facilities such as distribution centers as well as the set of vehicle routes. Today, organizations seek to reduce the transportation cost by outsourcing leading to a particular kind of transportation problems known as open routing. However, the increasing attention to environment have led to paying more attention to environmental issues and reducing the environmental impacts of logistics activities. To this end, in this paper, both open and closed routes were simultaneously addressed by developing a multi-objective mixed integer linear programming model that included three economic, environmental, and social responsibility aspects. The three objective functions of the proposed model encompass the minimization of total costs and greenhouse gas emissions, and the maximization of employment rate and economic development. Also, in this study, a different type of routing was considered in each echelon. A small-sized problem instance was solved using the Augmented Epsilon Constraint (AEC) method with the CPLEX Optimizer Solver for the validation of the proposed model. Moreover, the sensitivity analysis was performed to investigate the effect of changing main parameters on the values of the objective function. Due to the NP-Hardness of the problem, two efficient metaheuristic algorithms of Non-dominated Sorting Genetic Algorithm (NSGA-II) and Multi-Objective Stochastic Fractal Search (MOSFS) were exploited to solve the medium and large size problems. The performance of the algorithms was compared on the basis of six different well-known indexes of Time, MID, RAS, Diversity, Spacing, and SNS. According to the obtained results, the performance of the MOSFS algorithm was %20, %9, %11.22, %10.03, and %19.06 higher than the performance of the NSGA-II on the basis of SNS, RAS, MID, Diversity, and Time indexes, respectively. On the other hand, the NSGA-II performance was %6.3 higher than the MOSFS performance in terms of Spacing index.

Prevalence of occult metastases in axillary sentinel lymph nodes of breast carcinoma.

Recently, sentinel lymph node biopsy (SLNB) has been accepted as a standard method of assessment of axillary lymph nodes in breast cancer patients with no clinical lymphadenopathy. There is no standard pathologic method to evaluate sentinel lymph nodes. The purpose of this study is to evaluate the frequency of occult lymph node metastasis in sentinel lymph nodes via serial sectioning and immunohistochemical study with cytokeratin and its relationship with other clinicopathologic factors. Paraffin-embedded blocks of axillary sentinel lymph nodes of breast cancer patients, biopsied in 2005-2009 and reported as negative, were reviewed with 3 µm sections, H and E staining and immunohistochemical study with an epithelial cytokeratin marker. Clinicopathologic data and relapse, if occurred was recorded and its relationship with occult metastasis was statistically analyzed. Sixty-eight sentinel pathology blocks of 66 patients (65 women and one man, median age 49 years) were investigated. Four cases (5.8%) of occult metastases were found, one by HE staining, and three cases with IHC (1 micrometastasis, 2 isolated tumor cells). Accuracy of reported cases was 94.1% upon re-examination. Sixty-four patients were followed after surgery and adjuvant therapy (range: 6-38 months, median: 21 months). No relapse was reported. There was no significant statistical relationship between occult metastasis and disease-free survival. Although 4 cases (5.8%) of sentinel lymph nodes were positive in the complementary study, with a median follow-up of 21 months, we found no difference in disease-free survival between these patients and others. To show a significant, however small, difference, one needs further research with a greater number of patients and longer follow-up.

Comparison between one day and two days protocols for sentinel node mapping of breast cancer patients.

Sentinel node biopsy can decrease the morbidity of breast cancer treatment significantly by sparing many patients of axillary lymph node dissection and resulting arm lymphedema. Despite widespread use of sentinel node mapping for breast cancer patients almost all aspects of this procedure are controversial; such as: type of the radiotracer, eligibility, time of injection, etc. One of these controversial issues is the efficacy of 2 days protocol (injection of the tracer on one day and sentinel node mapping and surgery on the following day). The main reason to perform 2 days protocol is the ease of operation room scheduling the patient does not need to complete injection and imaging in the nuclear medicine department. Despite widespread use of 2 days protocol for sentinel node mapping, very few studies have specifically evaluated this protocol in comparison to 1 day protocol and also the false negative rate which is the better index of sentinel node mapping success. Most of the above studies used tracers with large particle size such as (99m)Tc-sulfur colloid. Tracers with small particle size can theoretically be washed out from the real sentinel nodes and move to the second echelon nodes, so some recommended using large particle size radiotracers for the 2 days protocol. In this study, we compared the false negative rate of sentinel node mapping between 1 and 2 days protocols using intradermal injection of (99m)Tc-antimony sulfide colloid ((99m)Tc-SbSC) which has very small particle size. Eighty patients with early stage breast cancer (clinical stages of I and II) were evaluated. The diagnosis of the breast cancer was established by either excisional or core needle biopsy. The patients didn't take any chemotherapeutic drug before surgery and were divided into two groups: 1 day (Group I) and 2 days (Group II) protocols (45 in Group I and 35 in Group II). For Group I, periareolar intradermal injections of 0.5Bq/0.2mL (99m)Tc-SbSC were applied for patients without previous excisional biopsy. For patients with excisional biopsy two intradermal injections of 0.5Bq/0.2mL (99m)Tc-SbSC were used on both sides of the incision line. All injections were followed by gentle massage for 1min. For Group II, the same injection techniques were used but the dose of the tracer was doubled. Anterior, and lateral spot views were acquired 30min after the injection (5min/image, 128Χ128 matrix) using a dual head gamma camera (E.CAM Siemens) and parallel hole low energy high resolution collimator. The operation was performed 4h (for Group I) or 20h (for Group II) post radiotracer injection. All patients received 2mL patent blue V dye in a subdermal and periareolar fashion, 2min after general anesthesia. A surgical gamma probe (EUROPROBE, France) was used for harvesting the sentinel lymph nodes during surgery. As sentinel node was defined any blue node or any node with an ex vivo radioisotope count of twofold or greater than the axillary background. After completion of sentinel node biopsy, all patients underwent standard axillary lymph node dissection. The study was approved by our local ethical committee and all patients gave their informed consent before inclusion into the study. Quantitative data were expressed as mean±SD. For comparison between groups, independent sample student's t-test for quantitative variables, and chi-square or Fisher's exact tests for categorical variables were used. P-values less than 0.05 were considered statistically significant. SPSS version 11.5 was used for statistical analyses. The patients characteristics are shown in Table I. These general characteristics were not significantly different between the study groups (P>0.05). Detection rate was 100% for both Groups. The median number of sentinel nodes in both Groups was one sentinel node. The mean number of detected sentinel nodes during surgery was not statistically different between groups (1.28±0.7 and 1.32±0.6 for Group I and II respectively). One false negative sentinel node case with positive axillary nodes after dissection was found in both groups. This amounts to 6.25% and 6.66% false negative rate for Group I and II patients respectively. During surgery mean count rate at the injection site was 243123±22134 and 29430±2125 for Groups I and II, respectively. Mean count rate at the sentinel nodes was 4345±457 and 2375±356 for Groups I and II, respectively. Although the mean count rate at the injection site and the sentinel nodes were both higher in Group I of the study compared to Group II (P<0.0001 for both), the mean ratio of sentinel to injection site was statistically higher in Group II (P<0.0001). The 2 days protocol allows that the required lymphoscintigraphy imaging (including delayed views) can be performed before and during operation without any time limits. Most studies have reported similar to ours detection or false negative rates for both protocols. Our study showed comparable mean number of harvested sentinel nodes by the two protocols which is against the hypothesis of moving the tracer to other sentinel nodes by time. Others had similar results. The count rate of the sentinel nodes during surgery was statistically acceptable. Similar results have been reported by others too. Although we didn't evaluate radiation exposure in our study, this was acceptable in other studies and Buscombe et al showed a maximum effective dose of 2.6µSv/MBq for these patients and even assuming this highest value the patient exposure was very low compared to many other procedures. In conclusion, two days protocol gives the sentinel node biopsy team considerable flexibility and lymphoscintigrpahy imaging can be completed before surgery. Finding of the axillary sentinel node during surgery is also being easier. False negative rates as well as the detection rate for one day and two days protocols are comparable.

Lymphoscintigraphy in the Time of COVID-19: Effect of Molybdenum-99 Shortage on Feasibility of Sentinel Node Mapping.

Background: In the current study, we reported our experience on sentinel node mapping of breast cancer patients during the extreme shortage of Mo99-Tc99m generators using Tc-99m phytate. Methods and Results: During the period from March 7, 2019, to April 18, 2020, due to disruption of molybdenum supply chain, we used low specific activity Tc-99m pertechnetate elute (0.5-2 mCi of 99mTcO4 in 5 mL) for each kit preparation. Two or three intradermal periareolar injections were done for each patient (0.02-0.1 mCi/0.2 mL for each injection). Immediately following injection, dynamic lymphoscintigraphy was done. Surgery was done the same day of injection and the axillary sentinel node was sought using a gamma probe. Overall, 35 patients were included in the study. The specific activity of the Tc-99m elute (in 5 mL) used for kit preparation was 2 mCi/10 mg in four, 1.5 mCi/10 mg in eight, 1.25 mCi/10 mg in eight, 1 mCi/10 mg in three, 0.75 mCi/10 mg in five, and 0.5 mCi/10 mg of 99mTc-Phytate in seven patients. For the first four groups of patients, we used two 0.2 mL injections, while in the latter two groups, three 0.2 mL injections were used. At least one sentinel node was detected in all patients but three in whom axilla was involved. Conclusion: Sentinel node biopsy can be achieved with low specific activity of Tc-99m elute at the time of Mo99-Tc-99m generator shortage. If special personal protection is used, sentinel node mapping can be done in nuclear medicine departments with excellent results despite the COVID-19 pandemic and disruption of generator shipment.

Induction of cytotoxic T lymphocytes primed with tumor RNA-loaded dendritic cells in esophageal squamous cell carcinoma: preliminary step for DC vaccine design.

BACKGROUND: Dendritic cells (DC) are potent antigen presenting cells with the ability to prime naïve T cells and convert them to cytotoxic T-lymphocytes (CTL). We evaluated the capability of autologous DCs transfected with total tumor and normal RNA to induce cytotoxic CTL as the preliminary step to design a DC-based vaccine in the esophageal squamous cell carcinoma (ESCC). METHODS: Monocytes-derived DCs were electroporated with either total tumor RNA or normal RNA. T cells were then primed with tumor RNA transfected DCs and lytic effects of the generated CTL were measured with Cytotoxicity assay and IFN-gamma Release Elispot assay. RESULTS: Cytotoxicity was induced against DCs loaded with tumoral RNA (%24.8 +/- 5.2 SEM) while in normal RNA-loaded DCs, it was minimal (%6.1 +/- 2.4 SEM) and significantly lower (p < 0.05). INF-gamma secretion was more than 2-folds higher in tumoral RNA-loaded DCs when compared with normal RNA-loaded DCs (p < 0.05). CONCLUSION: Electroporating DCs with tumor RNA generated tumor antigen presenting cells which in turn enhanced cytotoxic effects of the T cells against ESCC. This may be a useful autologous ex vivo screening tool for confirming the lytic effects of primed T cells on tumors and evaluate probable further adverse effects on noncancerous tissues. These data provide crucial preliminary information to establish a total tumor RNA-pulsed DC vaccine therapy of ESCC.

The effect of excisional biopsy on the accuracy of sentinel lymph node mapping in early stage breast cancer: comparison with core needle biopsy.

Despite the successful application of sentinel node mapping in breast cancer patients, its use in patients with a history of previous excisional biopsy of the breast tumors is a matter of controversy. In the present study we evaluated the accuracy of sentinel node biopsy in this group of patients and compared the results with those in whom the diagnosis of breast cancer was established by core needle biopsy. Eighty patients with early stage breast carcinoma were included into our study. Forty patients had a history of previous excisional biopsy and the remainder 40 had undergone core needle biopsy. Intradermal injections of 99mTc-antimony sulfide colloid as well as patent blue were both used for sentinel node mapping. Sentinel nodes were harvested during surgery with the aid of surgical gamma probe. All patients underwent standard axillary lymph node dissection subsequently. Detection rate was 97.5 per cent for both groups of the study. Number of detected sentinel node during surgery was not significantly different between groups. False negative rate was 0 per cent for both groups of the study. In conclusion sentinel node biopsy is reliable in patients with previous history of excisional biopsy of the breast tumors and has a low false negative rate.

The value of touch imprint cytology and frozen section for intra-operative evaluation of axillary sentinel lymph nodes.

BACKGROUND: Sentinel lymph node (SLN) biopsy is a procedure of choice to determine the axillary involvement in breast cancer. The most important intraoperative evaluation methods are touch imprint cytology (TIC) and frozen section (FS). Each of these techniques has its own drawbacks and it is still unclear which is preferred. MATERIAL AND METHODS: 97 consecutive patients with recently diagnosed breast cancer and no clinical evidence of lymph node involvement were included in the study. The SLN was determined with lymphoscintigraphy. Touch imprint cytology and FS were performed and their results were compared with permanent histopathological examination. RESULTS: Using a permanent section as the gold standard TIC showed sensitivity of 71.4%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 88.7%. These figures were 87.5%, 98.5%, 96.5%, and 95% for FS, respectively. CONCLUSIONS: Frozen section is a reliable method for SN assessment during surgery. Using the frozen section during surgery can give the surgeon an opportunity to avoid the second surgery. Touch imprint cytology is also a reliable method for intra-operative SN evaluation. Due to its high predictive value, TIC can be used first in the surgery room and FS can be saved for cases with negative results of TIC.

The efficacy of Tc-99m sestamibi for sentinel node mapping in breast carcinomas: comparison with Tc-99m antimony sulphide colloid.

BACKGROUND: To study the value of periareolar intra-dermal injection of Tc-99m sestamibi (MIBI) for sentinel node mapping in breast carcinoma. MATERIAL AND METHODS: Fifty patients with early-stage breast cancer were included in our study. 17.5 MBq Tc-99m-MIBI was injected intradermally to 25 patients and the remainders were injected with the same dose of Tc-99m-antimony sulphide colloid. Anterior and lateral static images were taken at 2 minutes. If sentinel lymph node was not detected, delayed imaging by up to 180 minutes was carried out. The patients were operated on 2-4 hours post-injection. Sentinel lymph node biopsy was performed by the aid of gamma probe and blue dye during surgery. RESULTS: In the Tc-99m-MIBI group, 23 patients had lymph nodes on scintigraphy images, and sentinel nodes were detected during surgery in all 23 patients. In the Tc-99m-antimony sulphide colloid group, 24 patients had lymph nodes on scintigraphy images, and sentinel nodes were identified during surgery in 24 patients. CONCLUSIONS: We concluded that 99mTc-MIBI is a suitable radiopharmaceutical for sentinel node detection.

Novel Biomarkers Aim at Detecting Metastatic Sentinel Lymph Nodes in Breast Cancer

Background: Intra-operative molecular diagnostic assays are currently used for the detection of lymph node metastases. The objective of this study was to find new biomarkers to improve diagnostic accuracy in the detection of metastatic axillary lymph nodes in breast cancer patients. Methods: We applied an absolute quantitative real-time reverse transcription-PCR to quantitate the expression of CK19, KLK11, and CLEC3A mRNAs in 79 FFPE sentinel lymph nodes (SLNs) from 35 breast cancer patients. The CK19 was confirmed as a standard biomarker, and the level of expression of selected new markers, KLK11 and CLEC3A, was evaluated in pathologically negative and positive SLNs by using absolute quantitative real-time PCR. Results: The overall concordance of the CK19 gene with pathological results was 92.4% (less than 250 copies) in negative SLNs and 85% in positive SLNs (more than 250 copies). The sensitivity and specificity of CK19, which were detected by real-time PCR, was 85% and 46%, respectively. Our results revealed that lower CLEC3A was associated with more lymph node involvement. We could set a cut-off point for CLEC3A with the sensitivity of 78% and specificity of 60%. Also, the mean KLK11 had a statistically significant reverse correlation with tumor grade (p = 0.017). Higher CK19 levels were related to more tumor invasion (p < 0.0001). Conclusion: Regarding the findings, CLEC3A along with CK19 can be used as a promising marker with high sensitivity and specificity for the detection of metastatic SLN.

Overexpression and interactions of interleukin-10, transforming growth factor beta, and vascular endothelial growth factor in esophageal squamous cell carcinoma.

BACKGROUND: Sharing the role of immune suppression, interleukin-10 (IL-10), transforming growth factor beta (TGF-beta), and vascular endothelial growth factor (VEGF) are critical genes in several aspects of tumorigenesis. To elucidate the role of these cytokines in esophageal squamous cell carcinoma (ESCC), their relative mRNA expression in tumoral tissue compared with corresponding tumor-free tissue was evaluated. METHODS: A total of 49 patients with histologically confirmed ESCC were included in the study prior to any therapeutic interventions. Quantitative analysis of the mRNA expression was performed by real-time reverse transcription-polymerase chain reaction and the clinicopathologic associations were assessed. RESULTS: The mRNA of IL-10, VEGF, and TGF-beta was frequently overexpressed in 53.2%, 44.9%, and 37.5% of ESCC patients, respectively. TGF-beta was significantly co-expressed with IL-10 and with VEGF. Although VEGF was not independently associated with increased tumor size (p = 0.065), concomitant overexpression of VEGF with TGF-beta was significantly correlated with increased size of the tumor (p < 0.05). CONCLUSIONS: Overexpression of IL-10, TGF-beta, and VEGF plays an important role in ESCC and consequently leads to the frequent event of immune evasion in ESCC. TGF-beta is concomitantly overexpressed with IL-10 and with VEGF in ESCC. A stimulatory signal from TGF-beta to VEGF is necessary for VEGF to promote tumor progression.

Comparison of pre-operative lymphoscintigraphy with inter-operative gamma probe and dye technique regarding the number of detected sentinel lymph nodes.

Sentinel lymph node (SLN) identification by lymphoscintigraphy (LS) and biopsy are the standard method for axillary lymph node staging in low stage breast cancer patients. Many previous studies did not compare the number of SLN on LS with SLN detected during surgery. We aimed to study the accuracy of pre-operative LS for the prediction of the number of SLN detected by surgical gamma probe and the dye technique during surgery. Sixty patients were included in our study. SLN biopsy was performed using the combined radioactive and blue dye methods. Patients without previous excisional biopsy of the tumor (45 patients) received periareolar intra-dermal injections of 17.5MBq/0.2mL technetium-99m-antimony sulfide colloid ((99m)Tc ASC). The remainder of the patients, with the history of excisional biopsy of the tumor (15 patients); received two intra-dermal injections of 17.5MBq/0.2mL (99m)Tc-ASC in both ends of the surgical incision. All injections were done 2-4 h before surgery and gentle massage was applied to the injection site. Results showed that the number of SLN was correctly detected by LS in 58 patients. Eighty SLN were totally detected during surgery. All these SLN were radioactive and could be identified by surgical gamma probe. No SLN was detected only by the blue dye. Of the 80 detected SLN, 60 (75%) were both radioactive and colored. Pre-operative LS correctly predicted the number of harvested SLN during surgery in 77.5% of the patients. Only 78.7% (63/80) of the total harvested SLN were detected by pre-operative LS. We conclude that pre- operative LS identifies 78.7% and the blue dye technique can identify 75% of the SLN found by the gamma probe during surgery. The pre-operative LS technique can correctly identify the number of SLN in 77.5% of the patients.

Measurement of the serum levels of serum troponins I and T, albumin and C-Reactive protein in chronic hemodialysis patients and their relationship with left ventricular hypertrophy and heart failure.

BACKGROUND: Hemodialysis patients are at high risk for cardiovascular diseases. The prognostic value of cardiac troponins, albumin and CRP in hemodialysis patients and their association with cardiac diseases has been proven. The aim of this study was to investigate the relationship between these factors and heart failure and left ventricular hypertrophy in hemodialysis patients in Sanandaj city. METHODS: A total of 90 hemodialysis patients referred to hemodialysis ward of Tohid Medical Center of Sanandaj were enrolled in the study. After receiving the required information from patients and recording them in questionnaire, blood samples were taken from them and were sen to Lab for Measurement. Finally, the data were analyzed using SPSS software and Spearman correlation coefficient for independent variables and Chi square test and correlation coefficient of Choprovert's for independent qualitative variable. RESULTS: In the case of LVH, 23.3% of patients were with normal thickness, 38.9% had mild LVH, 30% had moderate LVH and 7.8% had severe LVH. The mean serum albumin level in patients was 3.8 g/dl, CRP 9.4 mg/dL, and troponins I and T were 0.4 and 685.06 ng/dL, respectively. There was a statistically significant relationship between cardiac I and T troponins levels and CRP levels in patients with chronic hemodialysis (P < 0.05. There was a significant relationship between serum albumin level, troponins I, T and CRP with left ventricular hypertrophy in chronic hemodialysis patients (P < 0.05). CONCLUSION: Serum levels of I and T troponins, albumin, as well as CRP, are related to heart failure and left ventricular hypertrophy in hemodialysis patients, and this can be used by physicians to determine the patient's ability and risk of disease Cardiovascular diseases.