Recent advancements in the targeted delivery of etoposide nanomedicine for cancer therapy: A comprehensive review.

Etoposide (ETO), a popular anticancer drug that inhibits topoisomerase II enzymes, may be administered more effectively and efficiently due to nanomedicine. The therapeutic application of ETO is constrained by its limited solubility, weak absorption, and severe side effects. This article summarizes substantial progress made in the development of ETO nanomedicine for the treatment of cancer. It discusses various organic and inorganic nanostructures used to load or affix ETOs, such as lipids, liposomes, polymeric nanoparticles (NPs), dendrimers, micelles, gold NPs, iron oxide NPs, and silica NPs. In addition, it evaluates the structural properties of these nanostructures, such as their size, zeta potential, encapsulation efficiency, and drug release mechanism, as well as their in vitro or in vivo performance. The article also emphasizes the co-delivery of ETO with other medications or agents to produce synergistic effects or combat drug resistance in the treatment of cancer. It concludes with a discussion of the challenges and potential avenues for clinical translation of ETO nanomedicine.

Prevalence and causes of unreported needle stick injuries among health care workers: a systematic review and meta-analysis.

OBJECTIVES: Health care workers (HCWs) are exposed to needle needles daily. Despite individual studies, there is no statistics on the prevalence of unreported needle stick injuries (NSIs) have been reported. This study was performed to determine the prevalence and causes of unreported NSIs among HCWs. CONTENT: In present systematic review and meta-analysis study, three international databases (Web of Science, Scopus, PubMed) were searched from January 1, 2000 to December 31, 2018. The random model was used to determine the prevalence of unreported needle stick among HCWs. SUMMARY AND OUTLOOK: Forty-one studies performed on 19,635 health care workers entered the final stage. Based-on random effect model, pooled prevalence of unreported needle stick injuries was 59.9% (95% CI: 52.0, 67.7; I2=98.9%). The most common cause of unreported NSIs was: They were not worried about NSIs (n=12). The high prevalence of unreported needle sticks injuries indicates the urgency and necessity of paying attention to strategies to improve reporting among health workers.

5-Fluorouracil nano-delivery systems as a cutting-edge for cancer therapy.

5-Fluorouracil (5-FU) is amongst the most commonly used antimetabolite chemotherapeutic agents in recent decades. However, its low bioavailability, short half-life, rapid metabolism and the development of drug resistance after chemotherapy limit its therapeutic efficiency. In this study, 5-FU applications as an anti-cancer drug for treating diverse types of cancers (e.g. colon, pancreatic and breast) have been reviewed. Different approaches lately designed to circumvent the drawbacks of 5-FU therapy are described herein, including 5-FU-loaded lipid-based nanoparticles (NPs), polymeric NPs (both stimuli and non-stimuli responsive), carbon-based nanostructures and inorganic NPs. Furthermore, co-delivery systems of 5-FU with other drugs (e.g. paclitaxel, gelatin-doxorubicin and naproxen) have been reviewed, which aid to attain better bioavailability, higher effectiveness at a lower concentration and lower toxicity. This review provides researchers with the latest progress on 5-FU-loaded nanocarriers, which show great potential as an advanced tool for cancer therapy.

Causes of chronic kidney disease in the general population of Iran: A systematic review and meta-analysis.

Chronic kidney disease is a significant public health problem worldwide. However, the causes of chronic kidney disease in Iran are unclear. This systematic review and meta-analysis identified the causes of chronic kidney disease in the general population of Iran. International databases (PubMed, Web of Science, Scopus, and Google Scholar) and national databases (Scientific Information Database and Magiran) were searched for studies published until March 1, 2018. The quality of the studies was assessed using the checklist developed by Hoy et al. Of 2518 retrieved studies, 26 studies involving 34,683 patients with chronic kidney disease stages 1 to 5 were included in the meta-analysis. The mean age of the cohort was 53.6±15.02 years. The results of the random-effects model showed that the three leading causes of chronic kidney disease were diabetes, hypertension, and glomerulonephritis, with an overall prevalence of 27.7%, 27.6%, and 6.4%, respectively. These results indicate the importance of addressing these risk factors at the national level to reduce disease prevalence.

Chitosan nanocarriers for microRNA delivery and detection: A preliminary review with emphasis on cancer.

In recent years, gene therapy based on miRNA has been employed as a potential growing technique for treating various co-morbidities. Direct administration of miRNA is unrealistic due to their lower specificity, stability, and decreased penetration through the cellular membrane. Suitable delivery vectors must be required to deliver miRNA efficiently. Non-viral vectors can be composed of polymeric, lipids, or inorganic components/nanocarriers. Among different cationic polymers, chitosan nanocarriers are effectively utilized to deliver miRNA owing to its cationic nature, biodegradability, biocompatibility, and increased potential for functional modifications. Therefore, chitosan has been widely employed to effectively deliver several miRNAs to the target site. This review will discuss the recent signs of progress and future perspectives in delivering and detecting miRNAs via chitosan and its derivatives with an emphasis on cancer. The review will also provide an insight into the various challenges of these chitosan carriers to be used as delivery agents for miRNA.

Fluorescent-based nanosensors for selective detection of a wide range of biological macromolecules: A comprehensive review.

Thanks to their unique attributes, such as good sensitivity, selectivity, high surface-to-volume ratio, and versatile optical and electronic properties, fluorescent-based bioprobes have been used to create highly sensitive nanobiosensors to detect various biological and chemical agents. These sensors are superior to other analytical instrumentation techniques like gas chromatography, high-performance liquid chromatography, and capillary electrophoresis for being biodegradable, eco-friendly, and more economical, operational, and cost-effective. Moreover, several reports have also highlighted their application in the early detection of biomarkers associated with drug-induced organ damage such as liver, kidney, or lungs. In the present work, we comprehensively overviewed the electrochemical sensors that employ nanomaterials (nanoparticles/colloids or quantum dots, carbon dots, or nanoscaled metal-organic frameworks, etc.) to detect a variety of biological macromolecules based on fluorescent emission spectra. In addition, the most important mechanisms and methods to sense amino acids, protein, peptides, enzymes, carbohydrates, neurotransmitters, nucleic acids, vitamins, ions, metals, and electrolytes, blood gases, drugs (i.e., anti-inflammatory agents and antibiotics), toxins, alkaloids, antioxidants, cancer biomarkers, urinary metabolites (i.e., urea, uric acid, and creatinine), and pathogenic microorganisms were outlined and compared in terms of their selectivity and sensitivity. Altogether, the small dimensions and capability of these nanosensors for sensitive, label-free, real-time sensing of chemical, biological, and pharmaceutical agents could be used in array-based screening and in-vitro or in-vivo diagnostics. Although fluorescent nanoprobes are widely applied in determining biological macromolecules, unfortunately, they present many challenges and limitations. Efforts must be made to minimize such limitations in utilizing such nanobiosensors with an emphasis on their commercial developments. We believe that the current review can foster the wider incorporation of nanomedicine and will be of particular interest to researchers working on fluorescence technology, material chemistry, coordination polymers, and related research areas.

Opportunities and challenges of using high-sensitivity nanobiosensors to detect long noncoding RNAs: A preliminary review.

The two types ofncRNAs, including microRNAs (miRNAs) and long noncoding RNAs (lncRNAs), are responsible for several biological processes within cells, such as the immune responses, cell growth and invasion, and regulation of the cell cycle. Rapidly expanding class of ncRNAs, lncRNAsinteract with other molecules to form chromatin-remodeling complexes. These potential hallmarks of diseases contribute to transcriptional and post-transcriptional regulation of several genes, possibly via cross-talk with other RNAs. Aberrant expression of lncRNAshas drawn increasing attention to the pathophysiology of different diseases, includingcancer and cardiovasculardiseases. Unfortunately, circulating lncRNAs are presented in the bloodstream at very low levels, making sensitive detection difficult. Currently, there are few methods for detecting these ncRNAs from which quantitative real-time-polymerase chain reaction (qRT-PCR) is the most routinely used technique. These techniqueslack sensitivity for intracellular detection of lncRNAs. Moreover, they are tedious and require a large sample size. Currently, nanotechnology has taken over the diagnostic field because of the tunable properties and modification opportunities. Furthermore, these conventional techniques can be merged with nanotechnology to improve detection sensitivity.This review highlights some of the most recent findings on nanotechnology-based methods and possible obstacles intheir application for moreaccurate sensing of lncRNAs.

Global Prevalence of Depression among Heart Failure Patients: A Systematic Review and Meta-Analysis.

The present study aimed to evaluate the prevalence of depression among heart failure (HF) patients. Depression is one of the main risk factors of mortality and reduction in quality of life in patients with HR. Despite individual studies, there is no comprehensive study on depression in HF patients. In the present systematic review and meta-analysis, databases (Web of Science, Scopus, and PubMed) were searched from January 1, 2000, to December 15, 2020. The keywords used included: depression and heart failure. The research stages including search, screening, quality evaluation, and extraction of study data were performed separately by two researchers. A total of 149 studies performed on 305,407 HF patients entered the final stage. The global prevalence of any severity and moderate to severe severity of depression was 41.9% and 28.1%, respectively. The results of the subgroup analysis showed that the prevalence of depression was higher in women (45.5%) than in men. Also, according to the NHYA classification, the prevalence of depression in patients in stages three and four (54.7%) was higher than stages 1 and 2. The prevalence of depression was higher in the EMRO region (70.1%) and lower economic status countries (56.7%).The high prevalence of depression among HF patients indicates the importance of paying more attention and providing the necessary training for patients to reduce depression.

Are the clinical manifestations of CT scan and location associated with World Health Organization histopathological grades of meningioma?: A retrospective study.

INTRODUCTION: meningioma is the most common intracranial tumor. CT scan is a common method for diagnosis. WHO classified meningioma into 3 histological grades? This study aims to evaluate the relation of different meningioma signs on CT and tumor distribution regard to WHO histological types. METHODS: In this single-center observational retrospective study, authors reviewed data of 75 meningioma patients confirmed by the WHO histological grades (WHO I/II/III) which were underwent CT scans from January 1, 2005 to December 30, 2019 at a teaching hospital, in XXXX. Data collected using patients medical records. Data were analyzed by SPSS 20 and P less than 0.05 was assumed as significant. RESULT: Our study confirmed that only edema (P = 0.005) and heterogeneity (P = 0.014) had a significant association with malignant histological types. Other signs were not statistically different among WHO histology types (p > 0.05). On the subject of tumor location, atypical/malignant meningioma was significantly more common in parasagittal (P = 0.031) and front-parietal (P = 0.035) regions. DISCUSSION: meningiomas with Edema, heterogeneity on CT, and tumors located in parasagittal and frontoparietal regions are related to malignant histology and should be evaluated and treated more precisely.

Radiation protection among health care workers: knowledge, attitude, practice, and clinical recommendations: a systematic review.

OBJECTIVES: This study was performed to determine the knowledge, attitude, and practice (KAP) of health care workers (HCWs) towards radiation protection. METHODS: In this systematic review study, three international databases (Web of Science, PubMed, Scopus) were searched for related published articles in the English language from 1 January 2000 to 1 February 2020. The quality of the included studies was evaluated using the Hoy et al. tool. RESULTS: Out of the 1,848 studies examined, 41 studies that were performed on 11,050 HCWs were included in the final stage. The results indicated that in most studies, more than half (50%) of the participants had average knowledge. Furthermore, 60% of the participants had a positive attitude, but in most studies, they had average practice regarding radiation protection. The most important recommendation for improving KAP among the participants was incorporating radiation protection standards in the student curriculum. CONCLUSION: Considering the results of the study, further attention should be paid to proper education regarding radiation protection standards and improvement of HCW performance.

Is contrast enhanced ultrasonography an accurate way to diagnose gallbladder adenoma? A systematic review and meta-analysis.

INTRODUCTION: Gallbladder adenoma (GA) is a precancerous neoplasm and needs surgical resection. It is difficult to differentiate adenoma from other gallbladder polyps using imaging examinations. The aim of present systematic review and meta-analysis was to evaluate the diagnostic accuracy of contrast-enhanced ultrasound in the diagnosis of gallbladder adenoma. METHODS: The searches were conducted by two independent researchers to find the relevant studies published from 1/1/2009 until end of 30/06/2019. The search included published literature in the English language in MEDLINE via PubMed, EMBASE via Ovid, The Cochrane Library, and Trip databases. For literature published in other languages, national databases (Magiran and SID), KoreaMed, and LILACS were searched. The risk of bias of every article was evaluated by using QUADAS-2. On the basis of the results from the 2 × 2 tables, pooled measures for sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curves (AUC) along with their 95% confidence intervals (CIs) were calculated using the DerSimonian Lair methodology. RESULTS: Overall, 868 patients were studied in the 10 studies chosen for inclusion. Of these 10 studies, 5 (50%) were retrospective and 5 (50%) were prospective. The total prevalence of gallbladder adenoma in 10 studies was 16% (95% CI 13%, 18%). The sensitivity and specificity of contrast-enhanced ultrasound were 0.846 (95% CI 0.818-0.871) and 0.870 (95% CI: 0.844-0.894), respectively. The diagnostic odds ratio was 40.807 (95% CI 18.838-88.393). CONCLUSION: CEUS is a reliable, non-invasive, and no-radiation-exposure imaging modality with a high sensitivity and specificity for detection of gallbladder adenoma. Nonetheless, it should be applied cautiously, and large scale, well-designed trials are necessary to assess its clinical value.

Effect of complementary and alternative medicine interventions on cancer related pain among breast cancer patients: A systematic review.

OBJECTIVE: This systematic review aimed to evaluate the efficacy of CAM interventions for cancer-related pain in breast cancer patients. METHODS: Databases (PubMed, Scopus, Web of Science, and EMBASE) were searched from January 1, 2000, up to April 31, 2019, using the keywords: Complementary and alternative medicine therapies and cancer related pain. Standard tools were used to evaluate the quality of the studies included. RESULTS: Of the 3742 articles found, 46 articles comprising 3685 participants entered the final phase. Our results indicate that interventions including acupuncture/acupressure, tai chi/qi gong, hypnosis, meditation, music therapy, yoga, massage, reflexology, and Reiki improve cancer-related pain in breast cancer patients. However, aromatherapy had no effect on the same. CONCLUSIONS: Despite the positive effect of various CAM interventions in reducing cancer-related pain, necessary precautions should be adopted to use them alongside other treatments to control cancer pain in the clinical setting.

Quality of life of chronic heart failure patients: a systematic review and meta-analysis.

Despite various individual studies on the quality of life (QOL) in patients with CHF, a comprehensive study has not yet been conducted; therefore, this study aims to assess the QOL of CHF patients. In the present systematic review and meta-analysis, PubMed, Scopus, and the Web of science databases were searched from January 1, 2000, to December 31, 2018, using QOL and heart failure as keywords. The searches, screenings, quality assessments, and data extractions were conducted separately by two researchers. A total of 70 studies including 25,180 participants entered the final stage. The mean QOL score was 44.1 (95% confidence interval (CI) 40.6, 47.5; I2 = 99.3%) using a specific random effects method in 40 studies carried out on 12,520 patients. Moreover, according to the geographical region, heart failure patients in the Americas had higher scores. In 14 studies, in which a general SF-36 survey was implemented, the average physical component score (PCS) and mental component score (MCS) were 33.3 (95% CI 31.9, 34.7; I2 = 88.0%) and 50.6 (95% CI 43.8, 57.4; I2 = 99.3%), respectively. The general and specific tools used in this study indicated moderate and poor QOL, respectively. Therefore, it is necessary to carry out periodic QOL measurements using appropriate tools as part of the general care of CHF patients.

The effect of Cobb angle correction on spinal length gain in patients with adolescent idiopathic scoliosis.

The relationship between curve correction and spinal length gain in adolescent idiopathic scoliosis was examined. A total of 102 patients who underwent posterior spinal correction and fusion alone or in combination with anterior spinal correction and fusion (ASF) were studied. The Cobb angle correction, increase in the main thoracic length, T1-L5 spinal length gain, and T1-L5 spinal length gain/Cobb angle correction were reported. The length gain/Cobb angle correction value was not significantly associated with sex, fusion approach, and the number of fused levels. Surgical T1-L5 spinal length gain (mm) equaled (70.20)-(3.51)×(degrees of Cobb angle correction)+(0.08)×(degrees of Cobb angle correction).

Cholelithiasis in Thalassemia Major Patients: A Report from the South-East of Iran.

Background: Cholelithiasis and its predisposing factors are less characterized in thalassemia syndromes. In the present study, we assessed the prevalence of gallstones and related-risk factors among thalassemia major (TM) patients in south-east of Iran. Materials and Methods: The patients were recruited form a single center in Zabol city, south-east of Iran. Demographic and clinical information were retrieved from medical histories. Abdominal ultrasonography was performed to scrutinize gallstones and organ dimensions of liver, spleen, gallbladder and kidney. Results: The study participants (n=127) consisted of 50 (39.4%) males and 77 (60.6%) females. The mean age of the patients was 15.2±7.9 years. Cholelithiasis was observed in 11 (8.7%) patients. Cholelithiasis was significantly associated with age (P=0.002) and splenectomy (P=0.001). The patients with cholelithiasis received a significantly higher blood volume than patients without cholelithiasis (546±108.7 ml and 425.1±134.7 ml, respectively, P=0.007). There were significant differences between cholelithiasis and non- cholelithiasis TM patients regarding the length of right and left liver lobes (P=0.001), as well as the length of gallbladder (P=0.006). Ferritin level was not associated with cholelithiasis in our patients. In multivariate analysis, age older than 15 (OR=10.4, 95% CI: 1.2-86.3, P=0.02) and 30 years old (OR=42.6, 95% CI: 2.9-613, P=0.006), and splenectomy (OR=8.7, 95% CI: 2.1-35.4, P=0.002) were significant risk factors for cholelithiasis. Conclusion: Cholelithiasis is a relatively common complication among TM patients in our region. The most prominent risk factors of cholelithiasis were advanced age, splenectomy and large-volume blood transfusion.

Brain Imaging Findings in Children with Headache.

BACKGROUND: Headache is a common problem in children, but a small percentage of them have positive findings on CT scan and MRI, and considering that CT scan and MRI is costly and risks of radiation is high for children. Therefore the aim of this study is evaluating CT scans and MRI finding in children with headache. MATERIALS AND METHODS: This cross-sectional study was performed on 353 children with headaches that 217 patients underwent CT and 136 patients underwent MRI. The data collected through the report sheet of CT scan and MRI and analyzed using SPSS software and chi-square test. RESULTS: According to the study, 88.9% of MRI and 75.7% of CT scan were normal. Abnormal findings on CT scan was significantly higher in boys (12.2% vs. 9.5%) (P= 0.03) and it was determined that MRI findings was also significantly higher in boys (26.3% vs. 21.5%) (P=0.04). The most common abnormal findings on CT scan was mass (16.6%) and hematoma (16.6%) and the most common abnormal findings on MRI was cysts (26.3%). CONCLUSION: The results of our study showed that the majority of imaging results in patients with headache was normal or benign lesions. Therefore, imaging should be performed only in children with abnormal findings on physical examination.

Infrarenal aortic diameter, aortoiliac bifurcation level and lumbar disc degenerative changes: a cross-sectional MR study.

PURPOSE: To examine a possible correlation of infrarenal aortic diameter and aortoiliac bifurcation level with lumbar disc degenerative changes. METHODS: This was a cross-sectional, single-center retrospective study on lumbar magnetic resonance images of patients with low back pain (n = 496). Lumbar disc degenerative changes were reported on the basis of the Pfirrmann grading system and accordingly, patients were grouped as with grade I-II findings (n = 192), with grade III findings (n = 64) and with grade IV-V findings (n = 240). The groups were matched for sex, body mass index and the history of diabetes mellitus, hypertension, hyperlipidemia and smoking. Infrarenal aortic diameter and aortoiliac bifurcation level were compared between the three groups. RESULTS: Pairwise comparisons between the three groups of patients with Pfirrmann grades of I-II, III and IV-V revealed significant differences (p < 0.05) in terms of the median infrarenal aortic diameter (17 mm [interquartile range 4], 18 mm [4] and 19 mm [4], respectively) and the median aortoiliac bifurcation level (3 [2], 4 [2] and 5 [3], respectively; the higher the value, the more the caudal displacement). These associations were independent of conventional risk factors of atherosclerosis (including age) and from each other. CONCLUSIONS: This study showed a significant, direct correlation of the infrarenal aortic diameter and the level of aortoiliac bifurcation with lumbar intervertebral degenerative changes according to the Pfirrmann grading system. The associations were independent of well-known risk factors of atherosclerosis and from each other.

Diffusion-weighted magnetic resonance imaging in differentiating acute infectious spondylitis from degenerative Modic type 1 change; the role of b-value, apparent diffusion coefficient, claw sign and amorphous increased signal.

OBJECTIVE: To examine the effect of using different b-values on the utility of diffusion-weighted (DW) MRI in differentiating acute infectious spondylitis from Modic type 1 and the discriminative accuracy of related apparent diffusion coefficient (ADC), claw-sign and amorphous increased signal. METHODS: 43 patients with equivocal diagnosis of acute infectious spondylitis/Modic type 1 by using MR images were prospectively studied. The discriminative accuracy of DW MRI using three b-values of 50, 400, 800 s mm(-2), ADC, claw sign and amorphous increased signal was examined. RESULTS: DW MRI differentiated infectious spondylitis from Modic type 1 change most accurately when a b-value of 800 s mm(-2) was chosen [sensitivity, 91.7%; specificity, 96.8%; positive-predictive value (PPV), 91.7%; negative-predictive value (NPV), 96.8%; and accuracy, 95.3%]. The optimal cut-off ADC value was 1.52 × 10(-3) mm(2) s(-1) (sensitivity, 91.7%; specificity, 100%; PPV, 100%; NPV, 96.9%; and accuracy, 97.7%). Best visualized at a b-value of 50 s mm(-2), claw sign (for degeneration) and amorphous increased signal (for infection) were 100% accurate. CONCLUSION: Should DW MRI be used in differentiating acute infectious spondylitis from degeneration, large b-values are required. With low b-values, however, claw sign and amorphous increased signal are very accurate in this regard. ADVANCES IN KNOWLEDGE: DW MRI using large b-values could be used in differentiating acute infectious spondylitis from Modic type I.

Normal Values of Spleen Length and Volume: An Ultrasonographic Study in Children.

We aimed to determine normal ultrasonographic limits of spleen length and volume in healthy Caucasian neonates and children. A total of 458 healthy cases (age, 1 d to 15 y; sex, 241 males and 217 females) with normal body measurements were included. Spleen length and volume were obtained ultrasonographically. The two genders were comparable for the mean spleen length and volume. Lower and upper normal limits were tabulated according to age and sex groups. Significant correlations (Pearson r > 0.80; p < 0.001) were present between spleen length/volume and age, height and weight. Two equations were created to estimate spleen length and volume by age. Normal spleen lengths and volumes and their lower and upper limits were obtained ultrasonographically in a large sample of Caucasian pediatric patients.

Orientation of the facet joints in degenerative rotatory lumbar scoliosis: an MR study on 52 patients.

BACKGROUND: Because of a degenerative component, degenerative rotatory scoliosis seems different from congenital and idiopathic subtypes of the disease. This study aims to examine the orientation of facet joints, as a known cause of degeneration, in patients with degenerative rotatory scoliosis. METHODS: Lumbar magnetic resonance (MR) images and plain radiographs of 52 symptomatic patients (mean age, 50.17 years) with degenerative rotatory lumbar scoliosis (mean curve, 19.22 degrees) and 50 healthy individuals were reviewed. Facet joint angles in rotated segments and the minimum neural foramen width at all lumbar levels were measured by three observers and the average was recorded. RESULTS: The maximum vertebral rotation was most frequent at L4-L5 (75 %), and the majority was of type I (84.6 %) according to the Nash-Moe classification. At all lumbar spinal levels the mean facet joint angles were significantly higher on the side of rotation (L2-L3, 57.92 degrees; L3-L4, 45.00 degrees; L4-L5, 43.88 degrees) compared to those on the contralateral side (L2-L3, 20.42 degrees; L3-L4, 15.48 degrees; L4-L5, 13.12 degrees) and in controls (L2-L3, 30.21 degrees; L3-L4, 40.81 degrees; L4-L5, 45.20 degrees) (p < 0.001 for all comparisons). The mean facet joint angle increased significantly from L4-L5 to L2-L3 in cases and reversely in controls. The mean minimum neural foramen width was 1.29 ± 0.85 mm on the side of rotation, 5.50 ± 1.09 mm on the contralateral side, and 6.78 ± 1.75 mm in controls (p < 0.001). CONCLUSIONS: Substantial asymmetries and abnormal orientations in facet joints were documented in patients with degenerative rotatory lumbar scoliosis. Such asymmetries may adversely affect neural foramen width.