"Hyperglycemic Memory": Observational Evidence to Experimental Inference.

Several epidemiological studies have appreciated the impact of "duration" and "level" of hyperglycemia on the initiation and development of chronic complications of diabetes. However, glycemic profiles could not fully explain the presence/absence and severity of diabetic complications. Genetic issues and concepts of "hyperglycemic memory" have been introduced as additional influential factors involved in the pathobiology of late complications of diabetes. In the extended phase of significant diabetes randomized, controlled clinical trials, including DCCT/EDIC and UKPDS, studies have concluded that the quality of glycemic or metabolic control at the early time around the diabetes onset could maintain its protective or detrimental impact throughout the following diabetes course. There is no reliable indication of the mechanism by which the transient exposure to a given glucose concentration level could evoke a consistent cellular response at target tissues at the molecular levels. Some biological phenomena, such as the production and the concentration of advanced glycation end products (AGEs), reactive oxygen species (ROS) and protein kinase C (PKC) pathway activations, epigenetic changes, and finally, the miRNAs-mediated pathways, may be accountable for the development of hyperglycemic memory. This work summarizes evidence from previous experiments that may substantiate the hyperglycemic memory soundness by its justification in molecular terms.

Experiences of family caregivers of people with intellectual disabilities from rural areas in southeastern Iran: a qualitative study.

BACKGROUND: Caring for people with intellectual disabilities can be a challenging task, but it can also bring about positive experiences for family caregivers. The present study aimed to explore these positive experiences and shed light on the ways in which family caregivers of people with intellectual disabilities can find meaning and fulfillment in their roles. METHODS: This qualitative study used conventional content analysis to explore the positive experiences of family caregivers of people with intellectual disabilities. Sixteen family caregivers from rural areas in southeastern Iran were purposively selected to participate in the study. Semi-structured in-depth interviews were conducted to collect data. The interviews were audio-recorded and transcribed verbatim. The data were analyzed using the method proposed by Graneheim and Lundman. RESULTS: The data analysis resulted in the emergence of a single theme, which was achievements of providing care for people with intellectual disabilities. This theme was comprised of four main categories: a new outlook on life, family caregivers' peace of mind, strengthening of family ties, and improvement of social status. The provision of care for people with intellectual disabilities created positive changes, affecting family functioning and care provision for people with intellectual disabilities. CONCLUSION: It is recommended that families of people with intellectual disabilities focus on these positive experiences and share them with other families who may be struggling with a recent diagnosis of intellectual disability in their child.

Cost-Effectiveness Analysis of Rapid Test Compared to Polymerase Chain Reaction (PCR) in Patients with Acute Respiratory Syndrome.

Background: It is important to have a rapid and cost-effective laboratory test for the early diagnosis of respiratory diseases.The aim of this study was to analyze the cost-effectiveness of rapid tests and PCR in patients with suspected influenza. Methods: This study was a cost-effectiveness analysis from a community perspective that in which patients who were referred to the emergency department of selected hospitals of IUMS university with suspected respiratory symptoms of influenza were studied by convenience sampling method. The intervention and comparator were rapid tests and PCR respectively. effectiveness indicators in this study include sensitivity, specificity, positive and negative predictive value of both tests, and it examines costs from a community perspective. After drawing the decision tree model in the TreeAge software, the incremental cost-effectiveness ratio was calculated and to evaluate the strength of the analysis results, one-way and two-way sensitivity analyses on all cost and effectiveness parameters were used. Results: According to the findings of this study, the effectiveness index in rapid test and PCR is equal to 0.90 and 0.91, respectively, and the average cost of the two tests is equal to 62.157 and 201.37$, respectively, the ICERwas 25450.27 and the cost-effectiveness threshold was estimated equal to 6000 according to the per capita GDP of the country. One-way and two-way sensitivity analysis showed that the result of cost-effectiveness analysis did not change, and the rapid test is cost-effective. Conclusion: Rapid test is less costly and effective than PCR, but the cost difference is greater than the difference in effectiveness and in terms of effectiveness indicators, both diagnostic tests are almost similar, and this cost difference has led to the choice of the rapid test as a cost-effective option. Therefore, it is recommended that physicians prioritize rapid tests in the diagnosis of respiratory diseases.

Early Failure of Arteriovenous Fistula (AVF): The Effect of Diabetes and Hypertension in a Cross-Sectional Study.

Background: Identification and control of clinical predictors of arteriovenous (AVF) failure can improve the long-term outcome of hemodialysis patients. The effects of these factors on the outcome of AVF are not still clear. So, we aimed this study to compare the effect of hypertension and diabetes on early failure of AVF. Methods: In this retrospective study, we evaluated 400 patients with ESRD referred to our clinic for the creation of the first AVF from July 14, 2001, through August 7, 2018. One month after AVF creation, the patients were referred to the clinic for patency control. Demographic characteristics, previous history of diabetes and hypertension, and laboratory data of all patients were recorded preoperatively. Data were entered to SPSS v.24 and Study data were analyzed with chi-square and independent student t-test. Then, early failure of AVF and its relationship with a history of diabetes and hypertension were assessed. Results: There was no statistically significant relationship between the history of diabetes and early AVF failure risk in ESRD patients (OR, 0.78; 95% CI, 0.25 to 2.43). Furthermore, the history of hypertension was significantly lower in the early failure of AVF group (OR, -2.82; 95% CI, -1.42 to -5.59). Although, this effect faded when using regression analysis (OR, -2.67; 95% CI, -0.97 to -7.36). There was a higher Body mass index in the non-early failure group (p = 0.041). There was no significant difference in age (p = 0.512), gender (p = 0.091), history of smoking (p = 0.605), treatment with insulin (p = 0.683), oral antidiabetic agents (p = 0.734), duration of diabetes (p = 0.384), and duration of hypertension (p = 0.093). Conclusion: We reported that the history of diabetes was not higher in the early failure group, while there was a lower risk of AVF failure in patients with a previous history of hypertension.

The Effect of Ceramic Membranes' Structure on the Oil and Ions Removal in Pre-Treatment of the Desalter Unit Wastewater.

Salts, organic materials, and hazardous materials can be found regularly in the effluent from a desalter unit of crude oil. These materials should be separated from the wastewater. Four kinds of inexpensive and innovative ceramic microfiltration membranes (mullite, mullite-alumina (MA 50%), mullite-alumina-zeolite (MAZ 20%), and mullite-zeolite (MZ 40%)) were synthesized in this research using locally available inexpensive raw materials such as kaolin clay, natural zeolite, and alpha-alumina powders. Analyses carried out on the membranes include XRD, SEM, void fraction, the average diameter of the pores, and the ability to withstand mechanical stress. Effluent from the desalter unit was synthesized in the laboratory using the salts most present in the desalter wastewater (NaCl, MgCl2, and CaCl2) and crude oil. This synthesized wastewater was treated with prepared ceramic membranes. It was discovered that different salt concentrations (0, 5000, 25,000, 50,000, 75,000, and 100,000 mg L-1) affected the permeate flux (PF), oil rejection, and ion rejection by the membrane. Results showed that in a lower concentration of salts (5000 and 25,000 mg L-1), PF of all types of ceramic membranes was increased significantly, while in the higher concentration, PF declined due to polarization concentration and high fouling effects. Oil and ion rejection was increased slightly by increasing salt dosage in wastewater due to higher ionic strength. Monovalent (Na+) and multivalent (Ca2+ and Mg2+) ion rejection was reported about 5 to 13%, and 23 to 40% respectively. Oil rejection varied from 96.2 to 99.2%.

Role of Screening for COVID-19 in Hemodialysis Wards, Results of a Single Center Study.

INTRODUCTION: Seven months after the emergence of SARS-COV-2 virus, there is paucity of data regarding the epidemiology of the virus in hemodialysis patients. We aim to present the results of the screening program implied after outbreak of COVID-19 in a referral hemodialysis ward. METHODS: We started clinical screening and obligatory mask wearing for dialysis patients and personnel on 20-Feb-2020. However 11 symptomatic COVID-19 patients emerged till day +36. On days +39 and +40 a screening program was implied including measurement of SARS-COV-2 PCR and immunoglobulin G and M (IgG/IgM) and chest computerized tomography (CCT) scan. The results of CCT scan, classified according to the coronavirus disease 2019 (COVID-19) Reporting and Data System (CO-RADS) classification; as with very low (grade 1-normal), low, indeterminate, high, and very high likelihood of COVID-19 (grades 2, 3, 4, and 5; respectively), were used for compartmentalization of patients. RESULTS: Among 178 patients (68.2% male, mean age = 58.7 ± 16.6 years), 11 got COVID-19 before screening, two of whom died. CCT scans were normal in 71.3% and grade 2, 3, 4, and 5 in 7.9%, 4.5%, 5.6%, and 10.7%; respectively. PCR and IgG and/or IgM were positive in 27 and 32 patients. Eighty-three patients had evidence of COVID-19 infection, who were significantly older (62.2 ± 16.6 vs. 56.1 ± 16.02, P < .05). There was no difference in the rate of infection considering gender, diabetes mellitus, hypertension and different blood groups. CONCLUSION: Asymptomatic SARS- COV 2 infection may affect a large number of dialysis patients. We highly recommend a screening strategy whenever the number of patients is increasing.

Job Burnout, Stress, and Satisfaction among Emergency Nursing Staff after Health System Transformation Plan in Iran.

INTRODUCTION: Job burnout, stress, and satisfaction are linked to quality of care, patient outcomes and retention of staff. This study was conducted to determine the mentioned issues among emergency nurses. METHODS: This cross-sectional study was conducted on all nurses working in the emergency departments of 10 hospitals in Tehran, Iran, in 2017. Standard questionnaires were used for gathering the data of participants regarding job burnout, stress, and satisfaction. RESULTS: 709 (90%) participants returned the completed questionnaires (58.9% female). The mean age of the nurses was 33 (SD = 7) years. The level of job burnout was moderate in 76.1%, low in 22.5%, and high in 1.4% of the nurses. The level of burnout in the married nursing staff was lower than single nurses (3.78 ± 0.98 versus 4.14 ± 0.58, p = 0.049). The level of job satisfaction was moderate in 61.1%, low in 22.2%, and high in 16.7%. There was a significant correlation between age and job satisfaction (p = 0.027, r = 0.3). Job burnout was directly correlated with job stress (p ≤0.001, r = 0.57) and job burnout was negatively correlated with job satisfaction (p = 0.001, r = -0.41). CONCLUSION: More than 60% of the studied emergency nurses had moderate levels of job burnout, stress, and satisfaction. Job burnout had a direct correlation with job stress and indirect correlation with job satisfaction. Planning to reduce burnout of the emergency nursing staff seems to be necessary.

Adsorption behavior of Cu(II) and Co(II) using chemically modified marine algae.

In this study, brown algae-modified biomass Padina sanctae crucis was used for copper (Cu(II)) and cobalt (Co(II)) heavy metal ions adsorption in synthetic wastewater. The effects of solution pH and adsorption efficiency for Cu(II) and Co(II) removal from aqueous solutions were studied. In order to study the kinetic behavior of adsorption, pseudo-first-order, pseudo-second-order kinetic models, liquid film penetration, and Ritchie second-order models were used. The results showed that the pseudo-second-order kinetic model was able to describe adsorbent behavior in comparison to the other models. Moreover, in order to study adsorbent equilibrium behavior, Langmuir and Freundlich isothermal models were used. Based on the Langmuir model, the adsorption capacity of Co(II) and Cu(II) was determined and their values were 13.73 and 13.996 mg/g, respectively. It was shown that both metal ions adsorption process is favorable and adsorption is physical. In this research, thermodynamic parameters were also studied in order to determine Gibbs free energy for both metal ions which were negative, indicating that metal ions adsorption process is spontaneous and the degree of self-adsorption increases as temperature increases.

Oily wastewater treatment by adsorption-membrane filtration hybrid process using powdered activated carbon, natural zeolite powder and low cost ceramic membranes.

In this research, four types of low cost and high performance ceramic microfiltration (MF) membranes have been employed in an in-line adsorption-MF process for oily wastewater treatment. Mullite, mullite-alumina, mullite-alumina-zeolite and mullite-zeolite membranes were fabricated as ceramic MF membranes by low cost kaolin clay, natural zeolite and α-alumina powder. Powdered activated carbon (PAC) and natural zeolite powder in concentrations of 100-800 mg L-1 were used as adsorbent agent in the in-line adsorption-MF process. Performance of the hybrid adsorption-MF process for each concentration of PAC and natural zeolite powder was investigated by comparing quantity of permeation flux (PF) and total organic carbon (TOC) rejection during oily wastewater treatment. Results showed that by application of 400 mg L-1 PAC in the adsorption-MF process with mullite and mullite-alumina membranes, TOC rejection was enhanced up to 99.5% in comparison to the MF only process. An increasing trend was observed in PF by application of 100-800 mg L-1 PAC. Also, results demonstrated that the adsorption-MF process with natural zeolite powder has higher performance in comparison to the MF process for all membranes except mullite-alumina membranes in terms of PF. In fact, significant enhancement of PF and TOC rejection up to 99.9% were achieved by employing natural zeolite powder in the in-line adsorption-MF hybrid process.

Cephalometric risk factors associated with myocardial infarction in patients suffering from obstructive sleep apnea: A pilot case-control study.

INTRODUCTION: Obstructive sleep apnea (OSA) and its craniofacial anatomic risk factors might play a role in several cardiovascular diseases, including myocardial infarction (MI). However, there are no data about cephalometric findings among OSA patients with MI. METHODS: In this pilot case-control study, about 2000 individuals referred to the sleep center were evaluated according to apnea - hypopnea index (AHI) and other inclusion criteria. Included were 62 OSA male patients (AHI > 10), of whom 6 had an MI history. In both control (n = 56) and MI groups (n = 6), 18 cephalometric parameters were traced. Data were analyzed using independent samples t-test. RESULTS: Compared with control OSA patients, OSA patients with MI showed a significantly larger tongue length (p = 0.015). The other cephalometric variables were not significantly different between the two groups. CONCLUSION: An elongated tongue might be considered a risk factor for MI in OSA patients. The role of other variables remains inconclusive and open to investigation with larger samples (determined based on pilot studies such as this report) collected in longitudinal fashion.

Cephalometric risk factors of obstructive sleep apnea.

INTRODUCTION: Previous studies on risk factors of obstructive sleep apnea (OSA) are highly controversial and mostly identifying a few cephalometric risk factors. METHODS: OSA diagnosis was made according to the patients' apnea-hypopnea index (AHI). Included were 74 OSA patients (AHI > 10) and 52 control subjects (AHI ≤ 10 + free of other OSA symptoms). In both groups, 18 cephalometric parameters were traced (SNA, SNB, ANB, the soft palate's length (PNS-P), inferior airway space, the distance from the mandibular plane to the hyoid (MP-H), lengths of mandible (Go-Gn) and maxilla (PNS-ANS), vertical height of airway (VAL), vertical height of the posterior maxilla (S-PNS), superior posterior airway space (SPAS), middle airway space, distances from hyoid to third cervical vertebra and retrognathion (HH1), C3 (C3H), and RGN (HRGN), the maximum thickness of soft palate (MPT), tongue length (TGL), and the maximum height of tongue). These parameters were compared using t-test. RESULTS: Significant variables were SPAS (p = 0.027), MPT, TGL, HH1, C3H, HRGN, PNS-P, S-PNS, MP-H, VAL, and Go-Gn (all p values ≤ 0.006). CONCLUSION: OSA patients exhibited thicker and longer soft palates, hyoid bones more distant from the vertebrae, retrognathion, and mandibular plane, higher posterior maxillae, longer mandibles, and smaller superior-posterior airways.

Ice Reduces Needle-Stick Pain Associated With Local Anesthetic Injection.

BACKGROUND: Local anesthetic injections are widely used in the emergency department for different purposes. Pain management for such injections is of great importance to both patients and the healthcare system. OBJECTIVES: Our study aimed to determine the effectiveness and safety of cryotherapy in patients receiving local anesthetic injections. METHODS: Subjects who presented with superficial lacerations were randomly assigned to 2 groups, the first group received ice packing prior to injection and the second did not. The pain severity, length and depth of the laceration, and the other necessary information before and after the pain-reducing intervention were measured, documented, and compared at the end of the study. Pain scores were measured using a numerical rating scale before and after the procedure, and the differences were compared using a t-test. RESULTS: Ninety subjects were enrolled in the study, 45 in each group. There were no statistical differences between the 2 groups in terms of baseline preoperative and operative characteristics (P > 0.05). The pain scores in the cryotherapy group were significantly lower before and after the procedure (P < 0.001). There was no statistically significant difference between the 2 groups for wound infection (P = 0.783). CONCLUSIONS: Cooling the injection site prior to local anesthetic injection is an effective and inexpensive method to reduce the pain and discomfort caused by the injection.

Application of Bow-tie methodology to improve patient safety.

Purpose - The purpose of this paper is to apply Bow-tie methodology, a proactive risk assessment technique based on systemic approach, for prospective analysis of the risks threatening patient safety in intensive care unit (ICU). Design/methodology/approach - Bow-tie methodology was used to manage clinical risks threatening patient safety by a multidisciplinary team in the ICU. The Bow-tie analysis was conducted on incidents related to high-alert medications, ventilator associated pneumonia, catheter-related blood stream infection, urinary tract infection, and unwanted extubation. Findings - In total, 48 potential adverse events were analysed. The causal factors were identified and classified into relevant categories. The number and effectiveness of existing preventive and protective barriers were examined for each potential adverse event. The adverse events were evaluated according to the risk criteria and a set of interventions were proposed with the aim of improving the existing barriers or implementing new barriers. A number of recommendations were implemented in the ICU, while considering their feasibility. Originality/value - The application of Bow-tie methodology led to practical recommendations to eliminate or control the hazards identified. It also contributed to better understanding of hazard prevention and protection required for safe operations in clinical settings.

The culture of patient safety in an Iranian intensive care unit.

AIM: To explore nurses' and physicians' attitudes and perceptions relevant to safety culture and to elicit strategies to promote safety culture in an intensive care unit. BACKGROUND: A strong safety culture is essential to ensure patient safety in the intensive care unit. METHOD: This case study adopted a mixed method design. The Safety Attitude Questionnaire (SAQ-ICU version), assessing the safety climate through six domains, was completed by nurses and physicians (n = 42) in an academic intensive care unit. Twenty semi-structured interviews and document analyses were conducted as well. Interviews were analysed using a framework analysis method. RESULT: Mean scores across the six domains ranged from 52.3 to 72.4 on a 100-point scale. Further analysis indicated that there were statistically significant differences between physicians' and nurses' attitudes toward teamwork (mean scores: 64.5/100 vs. 52.6/100, d = 1.15, t = 3.69, P < 0.001) and job satisfaction (mean scores: 78.2/100 vs. 57.7/100, d = 1.5, t = 4.8, P < 0.001). Interviews revealed several safety challenges including underreporting, failure to learn from errors, lack of speaking up, low job satisfaction among nurses and ineffective nurse-physician communication. CONCLUSION: The results indicate that all the domains need improvements. However, further attention should be devoted to error reporting and analysis, communication and teamwork among professional groups, and nurses' job satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers can contribute to promoting a safety culture by encouraging staff to report errors, fostering learning from errors and addressing inter-professional communication problems.

Serum S100B Protein as an Outcome Prediction Tool in Emergency Department Patients with Traumatic Brain Injury.

OBJECTIVES: Traumatic brain injury is a common cause of death and disability worldwide. Early recognition of patients with brain cellular damage allows for early rehabilitation and patient outcome improvement. METHODS: In this prospective study, the clinical conditions of patients with mild to moderate traumatic brain injury (TBI) were assessed, and patient serum S100B levels were measured. Patients were followed up one month later and evaluated for level of consciousness, presence or absence of post-traumatic headache, and daily activity performance (using the Barthel scale). Student's t-test and the chi-square test were used for data analysis, which was performed using SPSS software. RESULTS: The mean serum S100B value was significantly lower for patients with minor TBI than for patients with moderate TBI (23.1±14.2 ng/dl and 134.0±245.0 ng/dl, respectively). Patients with normal CT scans also had statistically significantly lower serum S100B levels than patients with abnormal CT findings. The mean S100B value was statistically significantly higher for patients with suspected diffused axonal injury (632.18±516.1 ng/dl) than for patients with other abnormal CT findings (p=0.000): 24.97±22.9 ng/dl in patients with normal CT results; 41.56±25.7 ng/dl in patients with skull bone fracture; 57.38 ±28.9 ng/dl in patients with intracranial hemorrhage; and 76.23±38.3 ng/dl in patients with fracture plus intracranial hemorrhage). CONCLUSIONS: Serum S100B levels increase in patients with minor to moderate TBIs, especially in those with diffused axonal injury. However, serum S100B values cannot accurately predict one-month neuropsychological outcomes and performance.

Diagnostic accuracy of ultrasonographic examination in the management of shoulder dislocation in the emergency department.

STUDY OBJECTIVE: Emergency physicians frequently encounter shoulder dislocation in their practice. The objective of this study is to assess the diagnostic accuracy of ultrasonography in detecting shoulder dislocation and confirming proper reduction in patients presenting to the emergency department (ED) with possible shoulder dislocation. We hypothesize that ultrasonography could be a reliable alternative for pre- and postradiographic evaluation of shoulder dislocation. METHODS: This was a prospective observational study. A convenience sample of patients suspected of having shoulder dislocation was enrolled in the study. Ultrasonography was performed before and after reduction procedure with a 7.5- to 10-MHz linear transducer. Shoulder dislocation was confirmed by taking radiographs in 3 routine views as a criterion standard. The operating characteristics of ultrasonography to detect dislocation in patients with possible shoulder dislocation and to confirm reduction in patients with definitive dislocation were calculated as the primary endpoints. RESULTS: Seventy-three patients were enrolled. The ultrasonography did not miss any dislocation. The results of ultrasonography and radiography were identical and the sensitivity of ultrasonography in detection of shoulder dislocation was 100% (95% confidence interval 93.4% to 100%). The sensitivity of ultrasonography for assessment of complete reduction of the shoulder joint reached 100% (95% confidence interval 93.2% to 100%) in our study as well. CONCLUSION: We suggest that ultrasonography be performed in all patients who present to the ED with a clinical impression of shoulder dislocation on admission time. The results of this study provide promising preliminary support for the ability of ultrasonography to detect shoulder dislocation. However, further investigation is necessary to validate the results and assess the ability of ultrasonography in detecting fractures associated with dislocation.

Disaster medical assistance teams after earthquakes in iran: propose a localized model.

BACKGROUND: In the past 10 years, 13 fatal earthquakes have occurred in Iran and led to death of 30,000 people whom most of them were killed in the earlier hours of the disaster. Disaster Medical Assistance Teams are groups of trained medical and non-medical personnel with various combinations that on the optimal conditions are deployed just within 8 hours of notification and are able to work self-sufficiently for at least 72 hours without any outside help and can treat up to 250 patients per day. Currently there are no such rapid-response teams in case of unexpected events in Iran, which causes the responses to such disasters, not to be organized or practiced. For instance, there were many rescue forces in 2003 Bam earthquake but not enough skilled ones to cope with; consequently they themselves became a problem in crisis management instead of solving the problem. OBJECTIVES: IN THIS STUDY, WE HAVE INVESTIGATED WHICH OF THE FOLLOWING IS MORE EFFICIENT: changing the size and combination of the team depending on the type of disaster and environmental conditions or, determine a fixed combination team. MATERIALS AND METHODS: Totally, several reasons for dynamic combination and size of the teams are presented. later, earthquake disaster is divided into 3 phases in terms of time including the acute phase (1(st) to 4(th) day after disaster), the sub-acute phase (5(th) to 14(th)day) and the recovery phase (after the 14(th) day), and finally the appropriate team combinations in every phases are offered. RESULTS: Regarding to introduction and considering the existing statistics in different legal Iranian resources and by division of the earthquake disaster to three phases including acute phase (1st to the 4th day after disaster), sub-acute phase (5th to 14th day) and recovery phase (after the 14th day). CONCLUSIONS: The countries pioneer in disaster medical assistance teams, now are inclined to deploy different teams consistent with each kind of disasters or with other effective components on the combination of system. Every disaster has its own condition and would require different combination of relief and medical forces. For example, people's health needs in flood is different from the earthquake.

Ultrasound-guided simultaneous irrigation and drainage of facial abscess.

The establishment of drainage and the elimination of the origin of infection are essential procedures for successful management of odontogenic infections. Irrigation and aspiration are considered as the 2 main procedures for the treatment of facial space infections; we invented a new method named simultaneous irrigation and aspiration. The simultaneous irrigation and aspiration method is significantly less painful and less invasive compared with the standard surgical incision and drainage. This method was thought to be useful for managing facial infections if proper patient selection is performed.

The effect of ghrelin pretreatment on epididymal sperm quality and tissue antioxidant enzyme activities after testicular ischemia/reperfusion in rats.

Ghrelin, the endogenous ligand for growth hormone secretagogue receptor, has been reported to prevent ischemia/reperfusion (I/R) injury in various tissues by its antioxidant activity. Therefore, this study was aimed to investigate the effect of ghrelin on sperm quality and antioxidant enzyme activity in a rat testicular ischemia/reperfusion injury model. Forty-two male Wistar rats were divided into groups control, I/R, and I/R plus ghrelin. The right testes were rotated 720° for 1 h and were allowed to reperfuse for 4 h and 30 days thereafter. Ghrelin (40 nmol/kg IP) or vehicle (physiological saline) was administrated 15 min before reperfusion. After 4 h of reperfusion, a right orchiectomy was performed to measure the biochemical parameters. In addition, the sperm was collected from the epididymis after 30 days of reperfusion, and sperm characteristics were examined. The malondialdehyde levels of the testis tissues were significantly increased, but a statistically significant decrease was found in the superoxide dismutase, glutathione peroxidase, and catalase activities in the I/R group as compared with the control, indicating I/R injury. The sperm evaluation showed a significant reduction in all characteristics resulted from I/R compared with the control. In the ghrelin-treated group, the malondialdehyde values were significantly lowered, and only enzyme activity of glutathione peroxidase showed significant increases compared with the I/R group. Ghrelin significantly enhanced sperm motility, movement, and concentration but did not prevent I/R-induced reduction in membrane integrity in the testes of rats compared to the I/R group. Our results suggest that ghrelin treatment has a protective role on IR-induced testicular injury, and this effect may be due to its antioxidant properties.

Mutations in CNNM4 cause Jalili syndrome, consisting of autosomal-recessive cone-rod dystrophy and amelogenesis imperfecta.

The combination of recessively inherited cone-rod dystrophy (CRD) and amelogenesis imperfecta (AI) was first reported by Jalili and Smith in 1988 in a family subsequently linked to a locus on chromosome 2q11, and it has since been reported in a second small family. We have identified five further ethnically diverse families cosegregating CRD and AI. Phenotypic characterization of teeth and visual function in the published and new families reveals a consistent syndrome in all seven families, and all link or are consistent with linkage to 2q11, confirming the existence of a genetically homogenous condition that we now propose to call Jalili syndrome. Using a positional-candidate approach, we have identified mutations in the CNNM4 gene, encoding a putative metal transporter, accounting for the condition in all seven families. Nine mutations are described in all, three missense, three terminations, two large deletions, and a single base insertion. We confirmed expression of Cnnm4 in the neural retina and in ameloblasts in the developing tooth, suggesting a hitherto unknown connection between tooth biomineralization and retinal function. The identification of CNNM4 as the causative gene for Jalili syndrome, characterized by syndromic CRD with AI, has the potential to provide new insights into the roles of metal transport in visual function and biomineralization.