Deregulation of miR-1245b-5p and miR-92a-3p and their potential target gene, GATA3, in epithelial-mesenchymal transition pathway in breast cancer.

BACKGROUND: MicroRNAs (miRNAs) are small molecules that have prominent roles in tumor development and metastasis and can be used for diagnostic and therapeutic purposes. This study evaluated the expression of miR-92a-3p and miR-1245b-5p and their potential target gene, GATA3 in patients with breast cancer (BC). MATERIALS AND METHODS: In the search for BC-related microRNAs, miR-124b-5p and miR-92a-3p were selected using Medline through PubMed, miR2disease, miRcancer and miRTarBase. Moreover, target gene GATA3 and their possible interaction in the regulating epithelial-mesenchymal transition (EMT) and invasion was evaluated using in silico tools including miRTarBase, TargetScan, STRING-db, and Cytoscape. The expression level of miR-92a-3p, miR1245b-5p, and GATA3 were assessed on extracted RNAs of tumor and nontumor tissues from 36 patients with BC using qPCR. Additionally, clinical-pathologic characteristics, such as tumor grade, tumor stage, lymph node were taken into consideration and the diagnostic power of these miRNAs and GATA3 was evaluated using the ROC curve analysis. RESULTS: In silico evaluation of miR-92a-3p and miR-1245b-5p supports their potential association with EMT and invasion signaling pathways in BC pathogenesis. Comparing tumor tissues to nontumor tissues, we found a significant downregulation of miR-1245b-5p and miR-92a-3p and upregulation of GATA3. Patients with BC who had decreased miR-92a-3p expression also had higher rates of advanced stage/grade and ER expression, whereas decreased miR-1245b-5p expression was only linked to ER expression and was not associated with lymph node metastasis. The AUC of miR-1245b-5p, miR-92a-3p, and GATA3 using ROC curve was determined 0.6449 (p = .0239), 0.5980 (p = .1526), and 0.7415 (p < .0001), respectively, which showed a significant diagnostic accuracy of miR-1245b-5p and GATA3 between the BC patients and healthy individuals. CONCLUSION: MiR-1245b-5p, miR-92a-3p, and GATA3 gene contribute to BC pathogenesis and they may be having potential regulatory roles in signaling pathways involved in invasion and EMT pathways in BC pathogenesis, as a result of these findings. More research is needed to determine the regulatory mechanisms that they control.

FOXE1 Gene is a Probable Tumor Suppressor Gene with Decreased Expression as Papillary Thyroid Cancers Grow, and is Absent in Anaplastic Thyroid Cancers.

Papillary thyroid carcinoma (PTC), the most prevalent cancer of the thyroid, is more common in women than in men. To uncover the expression profile of FOXE1 gene in PTC tumor etiology. Microarray and RNA sequencing data on PTC in humans were analyzed. Eleven PTC tumor tissue samples and their neighboring normal tissue samples were collected. RT-qPCR was performed. Data normality, ROC construction, and logistic regression analysis were conducted. PTC tumors, normal tissues surrounding tumors, patients of different sexes and ages, metastasizing tumors, and tumor variants were assessed for FOXE1 expression. Eleven PTC tissues were obtained from seven women and four men. Among the PTC subtypes, there were two FV-PTCs, four C-PTCs, one microcarcinoma, and four tissues with an unknown subtype. FOXE1 gene expression was significantly increased in PTC tumors with dimensions less than 10 mm (relative expression = 14.437, p = 0.050). A significant increase in FOXE1 gene expression was observed in the normal tissue adjacent to the tumor, which was less than 10 mm in size, compared to the normal tissue adjacent to the tumor, which was larger than 10 mm (relative expression = 41.760, p = 0.0001). Females diagnosed with PTC showed a significant reduction in FOXE1 mRNA levels compared to their male counterparts (relative expression = 0.081, p = 0.042). In contrast to adjacent normal tissue, there was a significant reduction in FOXE1 gene expression in FV-PTC (relative expression = 0.044 and p = 0.0001). PTC tumors under 10mm had higher FOXE1 gene expression than larger tumors; normal tissue adjacent to smaller tumors also had higher FOXE1 expression. Females with PTC, regardless of their subtype, expressed less FOXE1 mRNA than males. FV-PTC tissues exhibited lower expression of FOXE1 mRNA than their adjacent normal tissues.

Comparing the Effectiveness of Bupivacaine Administration through Chest Tube and Intercostal Blockage in Patients with Rib Fractures.

Background: There are several methods to control pain, especially in traumatic patients with rib fractures. Intrapleural analgesia (IPA) and intercostal block methods are recommended in patients with rib fractures to control pain. Here, we aimed to evaluate and compare the effects of IPA and intercostal block on patients' clinical conditions. Materials and Methods: This is a randomized clinical trial that was performed in 2020-2021 on thirty traumatic patients with rib fractures. We collected the results of arterial blood gas in all patients before interventions including HCO3, pH, pO2, and pCO2 and also evaluated pain of patients. The first group underwent intercostal blockade with standard method with bupivacaine, and for the second group of patients, a chest tube was implanted. Patients were monitored for up to 12 h for pain intensity and need for analgesics. Results: The mean levels of HCO3 decreased in both groups after the interventions, and this decrease was more significant in patients in the intercostal blockade group (P < 0.05). The mean levels of pO2 increased in both groups after interventions, especially in patients in the intercostal blockade group (P < 0.05). The mean pCO2 levels also decreased in both groups (P < 0.05). The mean pain intensity in both groups decreased significantly after the intervention (P < 0.05) and also the mean pain intensity in the intercostal blocking group decreased significantly more than the group treated with chest tube (P < 0.05). Conclusion: Intercostal blockade through bupivacaine is more effective than chest tube administration of bupivacaine in patients with rib fractures.

Amelioration for an ignored pitfall in reference gene selection by considering the mean expression and standard deviation of target genes.

Routine tissue-specific reference genes are often used in expression studies, but target genes are not taken into account. Using the relative RT-qPCR approach, we evaluated the expression of three target genes. At the same time, meta-analyses were conducted in various ethnic groups, genders, and thyroid cancer subtypes. When eight common reference genes were examined, it was discovered that some of them not only lacked consistent expression but also had considerable expression variance. It is worth noting that while choosing a reference gene, the mean gene expression and its standard deviation should be carefully addressed. An equation was developed based on this, and it was used to perform statistical analysis on over 25,000 genes. According to the subtype of thyroid cancer and, of course, the target genes in this investigation, appropriate reference genes were proposed. The intuitive choice of GAPDH as a common reference gene caused a major shift in the quantitative expression data of target genes, inverting the relative expression values. As a result, choosing the appropriate reference gene(s) for quantification of transcription data, and especially for relative studies of the expression of target gene(s), is critical and should be carefully considered during the study design.

The effect of case-based teaching and flipped classroom methods in comparison with lecture method on learning and satisfaction of internship students in surgery.

INTRODUCTION: Teaching is one of the most important needs of human societies, and selecting the best method of teaching is so important to improve the teaching as well as learning of students. The purpose of this study was to determine the effect of case-based teaching (CBT) and flipped classroom methods in comparison with lecture method on students' learning and satisfaction at internship of Department of General Surgery, Isfahan University of Medical Sciences. MATERIALS AND METHODS: This experimental study was performed on fifty medical surgery internship students in Isfahan University of Medical Sciences in 2017. Students were randomly divided into two groups of control group and intervention group. The data were collected by a posttest after holding every class and a researcher-made form for evaluating students' satisfaction after the end of the project. The results of this study were analyzed by SPSS 21 software using descriptive statistical methods (mean and standard deviation) and paired t-test. RESULTS: The comparison of the mean posttest scores in the three classes showed that the mean scores of the students in the intervention group in the first and second sessions unlike the third session were higher than that in the control group; this difference was statistically significant in the first session (P = 005) and the third session (P = 0.002). Students' satisfaction with case-based learning method (4.03 ± 0.87) was higher than that of lecture method (2.88 ± 0.78). CONCLUSION: In CBT and flipped classroom, students' learning and the quality of teaching were improved. In addition, students were more satisfied with this method in comparison with the lecture method. However, it should be noted that the success of using this teaching method depends on choosing the appropriate subject.

The pseudogene problem and RT-qPCR data normalization; SYMPK: a suitable reference gene for papillary thyroid carcinoma.

In RT-qPCR, accuracy requires multiple levels of standardization, but results could be obfuscated by human errors and technical limitations. Data normalization against suitable reference genes is critical, yet their observed expression can be confounded by pseudogenes. Eight reference genes were selected based on literature review and analysis of papillary thyroid carcinoma (PTC) microarray data. RNA extraction and cDNA synthesis were followed by RT-qPCR amplification in triplicate with exon-junction or intron-spanning primers. Several statistical analyses were applied using Microsoft Excel, NormFinder, and BestKeeper. In normal tissues, the least correlation of variation (CqCV%) and the lowest maximum fold change (MFC) were respectively recorded for PYCR1 and SYMPK. In PTC tissues, SYMPK had the lowest CqCV% (5.16%) and MFC (1.17). According to NormFinder, the best reference combination was SYMPK and ACTB (stability value = 0.209). BestKeeper suggested SYMPK as the best reference in both normal (r = 0.969) and PTC tissues (r = 0.958). SYMPK is suggested as the best reference gene for overcoming the pseudogene problem in RT-qPCR data normalization, with a stability value of 0.319.

Early Intubation vs. Supportive Care in Management of Severe Blunt Chest Trauma; a Randomized Trial Study.

INTRODUCTION: Early intubation is one of the critical issues in patients with chest trauma. This study aimed to examine the effect of early intubation on outcomes of patients with severe blunt chest trauma. METHODS: This clinical trial was performed on patients with blunt chest trauma referring to emergency department. Patients were randomly divided to intervention (early intubation) and control (supportive care) groups and the duration of hospitalization, complete recovery rate, laboratory changes, and in hospital mortality were compared between the two groups. RESULTS: 64 cases were divided into two equal groups of early intubation and control. There were no significant differences between two groups regarding age (p=0.36), sex (p=0.26), type of trauma (p>0.05), and comorbid diseases (p>0.05). The duration of hospitalization in the early intubation group was significantly lower than that of the control group (p = 0.01). 90.6% of those in early intubation group and 68.8% of those in the control group showed complete recovery (p = 0.03). There was no case of mortality in either group. There was a significant difference in venous blood pH between the groups at 6, 12, 18 and 24 hours after intubation (p < 0.05). Also, there was a significant difference in the HCO3 level at 6 and 12 hours after intubation (p <0.05). CONCLUSION: Early intubation is better than supportive treatment in patients with severe chest trauma because of a better complete recovery rate, lower duration of hospitalization, and better acid/base situation.

Preventive Effect of Dexamethasone Therapy on the Transient Hypoparathyroidism through Total Thyroidectomy.

INTRODUCTION: This study aimed to investigate whether pre-operative dexamethasone could ameliorate transient hypoparathyroidism outcome through total thyroidectomy. MATERIALS AND METHODS: This randomized clinical trial study was conducted on 128 patients underwent total thyroidectomy from March 2014 to April 2015. Patients were randomly assigned to two groups of experimental receiving 8 mg IV of intravenous dexamethasone (n=45) 45 min before skin incision treatment and control (n=83). After the surgery, all patients were evaluated for clinical and laboratory hypocalcaemia. RESULTS: Post-operative transient biochemical hypoparathyroidism and hypocalcaemia did not occur more often in the control group, compared to the dexamethasone group while controlling for the baseline variables. However, there was a significant difference in phosphorus level between the dexamethasone and control groups (P=0.028). A total of 50 (39.1%) patients developed hypocalcaemia after surgery. Moreover, post-operative symptomatic hypocalcemia occurred more frequently in the control group (68%) compared to the dexamethasone group (32%); however, this difference was not statistically significant (P=0.54). CONCLUSION: The pre-operative administration of dexamethasone reduced post-operative hypocalcemia rate. It is essential to conduct future studies with validated means for better results.

Preoperative Mechanical Bowel Evacuation Reduces Intraoperative Bleeding and Operation Time in Spinal Surgery.

STUDY DESIGN: Randomized clinical trial. PURPOSE: In this study, we evaluated the effect of mechanical evacuation of the bowels prior to operation on intraoperative bleeding. OVERVIEW OF LITERATURE: Bleeding is the most significant complication in patients undergoing spinal surgery. METHODS: We randomly divided 108 individuals planned to undergo spinal surgery into two age-, sex-, and co-morbidity (especially preoperative hemoglobin [Hb])-matched groups of 54. The treatment group was administered polyethylene glycol (PEG) before the operation, whereas the control group was not. The exact amount (mL) of bleeding during operation, operative time, and approximate amount of blood transfused were recorded. The volume of bleeding and Hb level were also recorded 24 and 48 hours postoperatively. RESULTS: T-tests revealed that intraoperative bleeding, the volume of transfusion, and operative time were significantly lower in the treatment group than in the control group. Statistically significant correlations of intraoperative bleeding with age, body mass index (BMI), preoperative Hb levels, operative time, the volume of transfusion, hospitalization time, and 24- and 48-hour postoperative bleeding were observed (p =0.001, all). Repeated measures analysis of covariance after adjusting the covariate variables revealed that the volume of bleeding showed a near-significant trend in the treatment group compared with that in the control group (p =0.056). Diabetic females had the highest bleeding amount between the groups (p =0.03). Bleeding was higher in patients with higher BMI (p =0.02) and was related to operative time (p =0.001) in both the groups. CONCLUSIONS: Preoperative gastrointestinal tract evacuation by PEG administration can decrease intraoperative bleeding in spinal surgeries; however, more research is imperative regarding PEG administration in surgical procedures for this purpose.

The Impacts of Gastroileostomy Rat Model on Glucagon-like Peptide-1: a Promising Model to Control Type 2 Diabetes Mellitus.

BACKGROUND: One of the new current treatment options for Diabetes Mellitus is about increasing glucagon-like peptide-1 (GLP-1) activity. GLP-1 with its incretin effect showed major role in glucose homeostasis. Gastroileostomy can increase GLP-1 secretion by rapid delivery of undigested food to the terminal ileum. We studied the early effects of a gastroileostomy on serum levels of GLP-1, glucose, and insulin in rats. METHODS: Gastroileostomies with side-to-side anastomosis were performed on 15 male New Zealand rats. Blood samples were obtained before and 1 week after the gastroileostomy. RESULTS: Our results showed that the rats lost a lot of weight from start (330 ± 15 g) to the end (240 ± 25 g) of the experiment (p = 0.048). The data analysis showed that the gastroileostomy surgery elevates the level of GLP-1in plasma significantly (89.1852 vs. 177.440 respectively; p < 0.001) and caused a significant decrease in plasma glucose as well (92.00 and 66.29 mg/dL respectively; p < 0.001). However, the insulin state elevated after the surgery significantly (8.03 vs. 9.89; p < 0.001). CONCLUSION: In this study, we showed the effectiveness of gastroileostomy treatment to decrease body weight and plasma glucose with increased GLP-1 in rats. This small rat model suggests the potential of this surgery to treat type 2 diabetes mellitus.

Diagnostic Accuracy of Focused Assessment with Sonography for Blunt Abdominal Trauma in Pediatric Patients Performed by Emergency Medicine Residents versus Radiology Residents.

INTRODUCTION: Focused assessment with sonography for trauma (FAST) has been shown to be useful to detect intraperitoneal free fluid in patients with blunt abdominal trauma (BAT). OBJECTIVE: We compared the diagnostic accuracy of FAST performed by emergency medicine residents (EMRs) and radiology residents (RRs) in pediatric patients with BAT. METHOD: In this prospective study, pediatric patients with BAT and high energy trauma who were referred to the emergency department (ED) at Al-Zahra and Kashani hospitals in Isfahan, Iran, were evaluated using FAST, first by EMRs and subsequently by RRs. The reports provided by the two resident groups were compared with the final outcome based on the results of the abdominal computed tomography (CT), operative exploration, and clinical observation. RESULTS: A total of 101 patients with a median age of 6.75 ± 3.2 years were enrolled in the study between January 2013 and May 2014. These patients were evaluated using FAST, first by EMRs and subsequently by RRs. A good diagnostic agreement was noted between the results of the FAST scans performed by EMRs and RRs (κ = 0.865, P < 0.001). The sensitivity, specificity, positive and negative predictive values, and accuracy in evaluating the intraperitoneal free fluid were 72.2%, 85.5%, 52%, 93.3%, and 83.2%, respectively, when FAST was performed by EMRs and 72.2%, 86.7%, 54.2%, 93.5%, and 84.2%, respectively, when FAST was performed by RRs. No significant differences were seen between the EMR- and RR-performed FAST. CONCLUSION: In this study, FAST performed by EMRs had acceptable diagnostic value, similar to that performed by RRs, in patients with BAT.

Is Decline Rate of Intact Parathyroid Hormone Level a Reliable Criterion for Early Discharge of Patients after Total Thyroidectomy?

INTRODUCTION: Parathyroid dysfunction leading to symptomatic hypocalcemia is not uncommon following a total thyroidectomy and is often associated with significant patient morbidity and a prolonged hospital stay. The current study aimed at evaluating the comparative predictive role of serum calcium and intact parathyroid hormone (iPTH) for post-thyroidectomy hypocalcemia. MATERIALS AND METHODS: This prospective study was performed in 83 consecutive patients undergoing total thyroidectomy. Laboratory data such as serum calcium, vitamin D level, serum iPTH and serum phosphorus levels before surgery, postoperative calcium, and PTH levels measured after 1 and 6 hours and on the first postoperative day (1POD) were recorded. RESULTS: Among the 83 patients, the mean (SD) age was 45.87 (12.57) years (range, 21-72 years); 70 (84.3%) patients were female. Final pathology was benign for 47 (56.6%) patients and malignant for 36 (43.4%) patients. In total, lymph node dissections were performed in 19 subjects (22.9%). On histological examination of the specimens, the parathyroid gland was found to have been removed inadvertently in 13 (15.7%) cases. In total, 35 (40.9%) patients developed hypocalcemia after thyroidectomy; receiver operating characteristic (ROC) analysis showed that a cut-off value of 15.39 pg/ml for iPTH, with a decline rate of 73% 1 hour after thyroidectomy is a significant predictor of hypocalcemia (area under the curve [AUC], 0.878; 95% confidence interval [CI], 0.79-0.96, P<0.0001) compared with calcium <8 mg/dl (2 mmol/L) with AUC=0.639; 95% CI, 0.51-0.76); P=0.067). CONCLUSION: The current study showed that the decline rate in iPTH is a more reliable factor for hypocalcemia after total thyroidectomy than serum calcium. Patients with a decline rate <73% in iPTH could be discharged at 1POD without supplementation.

The Role of Intraoperative Thyroglobuline Level of Lymph Node in the Management of Papillary Thyroid Cancer (Determination of a Cutoff Point).

BACKGROUND: Some studies have shown that a preoperative high concentration of thyroglobulin (Tg) in wash out of fine-needle aspiration cytology of cervical lymph nodes mandate therapeutic lymph node dissection. However, there is disagreement about the minimum concentration of Tg which could have diagnostic value. Hence, according to our literature review, this study is the first one which designed to do intraoperatively. Therefore, this study was conducted and aimed to determine the clinical diagnostic value of Tg lymph nodes in the diagnosis of metastatic thyroid cancer. METHODS: In a cross-sectional study, 65 patients with papillary thyroid carcinoma (PTC) who were thyroidectomy candidates were chosen and during surgery, before the removal of lymph nodes in the neck, fine-needle sampling was performed and the level of Tg in the samples, nature of the sample sent for biopsy and Tg levels in affected and unaffected lymph nodes were determined. RESULTS: The mean levels of washout Tg in malignant and nonmalignant lymph nodes were 622.1 ± 66.2 and 1.38 ± 0.43 ng/ml, respectively, and the difference between the two groups was significant (P < 0.001). The Tg cut-off point for the detection of lymph node metastases was 0.7 ng/dl, and according to it, Tg washout sensitivity was 93.8%, specificity of 92.4%, false positives 7.76%, false negatives 6.3%, positive predictive value was 92.3%, and negative predictive value was 93.8% and accuracy was 93.1%. CONCLUSION: Based on the results, Tg level of cervical lymph nodes in patients with PTC is a suitable criterion for the diagnosis of lymph node which can be determined through fine-needle biopsy. Therefore, it is suggested that in patients with suspicion of lymph nodes involvement during surgery, fine-needle biopsy and determination of the Tg level performed.

Determinants of Mortality and the Lethal Area 50 Index (LA50) in Burn Patients Admitted to a Large Burn Center; A Single Center Experience.

OBJECTIVES: To investigate the determinants of mortality and the lethal area 50 (LA50) in large series of Iranian burn patients admitted to a single burn center. METHODS: This cross-sectional study was conducted in Shahid Motahari burn center of Tehran, Iran during a 1-year period from 2011 to 2012. We included all the burn patients who were admitted to our center during the study period. Those with incomplete medical records and those referred to other centers were excluded from the study. The medical records of the included patients were reviewed and the demographic, clinical, laboratory and outcome measures were recorded. The mortality rate was recorded and the determinants of LA50 were analyzed in a univariate and stepwise multivariate model. RESULT: Overall we included a total number of 1200 subjects with mean age of 30.8 ±18 years. There were 907 (75.6%) men and 293 (24.4%) women among the patients. The total LA50 was 55.5% (95% CI: 52.98%-58.3 %). There was a significant difference between age group >61 years and two 11-20 and 21-30 groups regarding LA50. The advanced age (p<0.001), female gender (p=0.002), inhalational injury (p<0.001) and burn extension determined by TBSA% (p<0.001) were significantly associated with mortality. In addition, male gender (p=0.087), flame (p=0.156), scald (p=0.088) and chemical injuries (p=0.071) were not associated with mortality. CONCLUSION: The LA50 determine din our study is still much lower than that reported in developed countries, as a result, the quality of medical care is lower. Female gender, age, inhalational injury and extension of burn determined by TBSA% were found to be the independent risk factors of mortality in burn patients in our series.

Foreign Body Aspiration in Adults (Two Unusual Foreign Bodies; Knife and Tube Tracheostomy).

INTRODUCTION: Foreign body aspiration is usually a serious condition that is most common among the pediatric population, and rare in adults. In adults, aspiration may be tolerated for a long time. CASE REPORTS: Our first case is a 38-year-old man who presented with a 2-day history of swallowing a foreign body. He was completely asymptomatic. Chest X-ray revealed the presence of 5-cm foreign object in the right main bronchus. Rigid bronchoscopy was performed and a knife was removed from the right main bronchus. Second, a 57-year old man with a known case of laryngeal cancer from 15 years previously was admitted for respiratory distress. He had previously undergone a permanent tracheostomy and had received radiotherapy for his cancer. At the first visit, the patient had prominent distress and was transferred to the operating room as an emergency. A tube was seen on chest X-ray. On bronchoscopy, we found the tracheostomy situated in the carina. The cleaved tracheostomy was removed using the grasper, by grasping the cuff line. CONCLUSION: We conclude that foreign body aspiration might be completely asymptomatic, especially in an adult. A good history and imaging findings can help us to diagnose and treat the condition carefully.

Impalement Thoracoabdominal Trauma Secondary to Falling on Metallic (Iron) Bars: An Extremely Rare and Unique Case.

INTRODUCTION: Penetrating thoracoabdominal injuries are potentially life threatening due to the associated hemorrhagic shock and visceral injury. Through and through penetrating injury with polytrauma is rarely encountered. CASE PRESENTATION: Here we report on a 25-year-old male with penetrating thoracoabdominal injury caused by a metallic (iron) bar projecting from a pillar of a construction site after he fell down from a height. CONCLUSIONS: Anesthetic and surgical management was difficult due to the inability to position in supine and rapidly progressing hemorrhagic shock. Surgical management for extraction of this iron bar and intensive monitoring and resuscitation resulted in an uneventful successful outcome.

Inserting central venous catheter in emergency conditions in coagulopathic patients in comparison to noncoagulopathic patients.

BACKGROUND: The current study was designed to compare the complications and adverse effects of central venous catheter (CVC) insertion under ultrasound guidance in patients with and without coagulopathy. MATERIALS AND METHODS: In this clinical trial, 59 patients who needed CVC for various reasons were enrolled. Patients were divided into two groups of those with and without coagulopathy based on complete blood count, prothrombin time, partial thromboplastin time, and international normalized ratio test results, and then, CVC was inserted with ultrasound guidance in both groups. The CVC inserting site was examined for hematoma and hemorrhage in four stages at different times. RESULTS: There was no significant difference in the terms of demographic features, catheter lumen size (P = 0.43), and number of attempting for CVC placement (odds ratio [OR] =2.35, 95% confidence interval [CI] = 0.36-15.3, P = 0.39) between two groups. Seven out of 59 patients suffered from complications (11.9%) that the complications in coagulopathic patients were oozing (5.7%) and superficial hematoma (8.6%) while in noncoagulopathic patients were 4.2% for both complications (OR = 0.54, 95% CI = 0.09-3.07, P = 0.767). CONCLUSION: According to our results, it can be concluded that inserting CVC with ultrasound guidance under emergency conditions causes no serious and life-threatening complications in coagulopathic patients.

Ultrasound surface probe as a screening method for evaluating the patients with blunt abdominal trauma.

BACKGROUND: Blunt abdominal trauma is one of the causes of mortality in emergency department. Free fluid in the abdomen due to intra-abdominal blunt trauma can be determined by the surface probe of ultrasound. Since the importance of this free fluid in hemodynamic stable patients with blunt trauma is associated with the unknown outcome for surgeons, this study was performed to evaluate the role of ultrasound surface probe as a screening method in evaluating the patients with blunt abdominal trauma. MATERIALS AND METHODS: A descriptive-analytical study was done on 45 patients with blunt abdominal trauma and hemodynamic stability. The patients were evaluated twice during the three-hours, including repeated ultrasound surface probe and clinical examinations. Computerized tomography was also performed. The patients were divided based on the amount of the free fluid in the abdomen during the evaluations into two groups: Fixed or increased, and decreased free fluid. The results of the different evaluated methods were compared using the sensitivity and specificity. RESULTS: From 17 patients with CT abnormalities, free fluid increased in 14 patients (82.4%). Free fluid was decreased in three patients who were discharged well from the surgery service without any complication. Surface probe in prognosis detection had a sensitivity of 82.4% and specificity of 92.9%. The percentage of false positive and negative ultrasound compared with CT scan was 7.1% and 17.6%. Also, positive and negative predictive value of the ultrasound with surface probe was 87.5% and 89.7% respectively. CONCLUSION: The use of the ultrasound with surface probe in the diagnosis of free fluid in blunt abdominal trauma in hemodynamic stable patients can be considered as a useful screening method.

Evaluating validity of clinical criteria for requesting chest X-rays in trauma patients referred to emergency room.

BACKGROUND: Our goal was to identify the clinical criteria for requesting the chest X-ray in patients with blunt trauma and whether its findings such as clinical signs with a high sensitivity could be used to codify the final criteria. MATERIALS AND METHODS: 386 patients with multiple trauma or blunt chest trauma examined by a physician and the injury mechanism, vital signs, O(2) saturation, auscultation findings, abrasions and ecchymosis, crepitation, tenderness on palpation, and pain on lateral compression were noted. The physician's clinical judgment on the necessity of a chest X-ray was also noted in a questionnaire. After taking the X-ray, a digital photo was taken and showed to a radiologist to report any significant chest injury. Data were collected and the positive and negative predictive values, sensitivity and specificity were estimated. RESULTS: 350 males (90.9%) and 35 females (9.1%) with the mean age of 47.1 ± 15.5 years old were evaluated. Falling down (37.7%) was the major mechanism of injury and chest pain (48%) the first complaint of patients. In 87.3% of the chest X-rays, there was no abnormal finding. Among several pathological findings in the chest X-rays, hemothorax, and rib fracture (each with 3.4% prevalence) had a higher prevalence. Tenderness on palpation with clinical judgment had a higher sensitivity about 95% and higher specificity about 100% in crepitation detected. CONCLUSION: Results showed the combination of positive chest pain and tachypnea in the patients could identify a significant chest injury with 100% sensitivity. More studies on this issue are warranted.

Micrometastasis in non-small-cell lung cancer: Detection and staging.

BACKGROUND: The clinical relevance of bone marrow micrometastasis (BMM) in non-small-cell lung cancer is undetermined, and the value of such analyses in advanced stage patients has not been clearly assessed previously. This study was conducted to estimate the accuracy of both polymerase chain reaction (PCR) and immunohistochemistry (IHC) in micrometastases detection and determine the best site for bone marrow biopsy in order to find micrometastasis. METHODS: This prospective cross-sectional study was performed in the Department of Thoracic Surgery, Alzahra University Hospital from September 2008 to June 2009. To evaluate the bone marrow, a 3-cm rib segment and an aspirated specimen from the iliac bone prior to tumor resection were taken. PCR and IHC were performed for each specimen to find micrometastasis. RESULTS: Of 41 patients, 14 (34%) were positive for BMM by PCR compared with two positive IHC (4.8%). All BMMs were diagnosed in rib segments, and iliac specimens were all free from metastatic lesion. Our data showed no significant association between variables such as age, sex, histology, tumor location, side of tumor, involved lobe, smoking, or weight loss and presence of BMM. CONCLUSION: PCR could use as a promising method for BMM detection. BMM in a sanctuary site (rib) is not associated with advanced stages of lung cancer. In addition, when predictor variables such as age, sex, histology, tumor location, smoking, or weight loss are analyzed, no correlation can be found between micrometastasis prevalence and any of those variables.