A cross-sectional study determining prevalence and factors associated with ST-segment elevation myocardial infarction and non-ST segment elevation myocardial infarction in Iran: results from fasa registry on acute myocardial infarction (FaRMI).

BACKGROUND: Acute myocardial infarction is still a leading cause of death worldwide, accounting for roughly three million deaths yearly. This study aimed to investigate the prevalence and factors associated with ST-Segment Elevation Myocardial Infarction and Non-ST Segment Elevation Myocardial Infarction in Iran. METHODS: This cross-sectional study was conducted using the databases of the Fasa Registry on Acute Myocardial Infarction (FaRMI) and the Fasa Adult Cohort Study (FACS). chi-squared and one-way ANOVA tests were utilized to calculate the unadjusted associations between the study variables. A multivariate multinomial logistic regression model was also employed to determine the adjusted association of each independent variable with the risk of ST-elevation myocardial infarction (STEMI). RESULTS: The prevalence of STEMI and non-STEMI was 31.60% and 11.80%, respectively. Multinomial logistic regression showed that older age, anemia, high WBC, and high creatinine levels were associated with higher odds of STEMI and non-STEMI compared to healthy individuals. In addition, based on the analysis being a woman(OR = 0.63,95%CI:0.51-0.78), anemia(OR = 0.67,95%CI:0.54-0.63)and hypertension (OR = 0.80,95%CI:0.65-0.97)decreased the likelihood of STEMI occurrence compared to non-STEMI, while high WBC(OR = 1.19,95%CI:1.15-1.23)increased the odds. CONCLUSION: In this study, significant predictors of MI risk included age, gender, anemia, lipid profile, inflammation, and renal function. Subsequent investigations ought to prioritize the comprehensive understanding of the underlying mechanisms that drive these connections and assess the effectiveness of specific interventions aimed at diminishing the occurrence of MI and improving patient outcomes.

Autophagy ATG16L1 rs2241880 impacts the colorectal cancer risk: A case-control study.

BACKGROUND: Despite many efforts to discover the important role of the autophagy process in the pathogenesis of colorectal cancer (CRC), the exact involved molecular mechanism still remains to be elucidated. Recently, a limited number of studies have been employed to discover the impact of autophagy genes' variants on the development and progression of CRC. Here, we evaluated the association between two single-nucleotide polymorphisms (SNPs) in the main components of the autophagy genes, ATG16L1 rs2241880, and ATG5 rs1475270, and the CRC risk in an Iranian population. METHODS: During this investigation, a total of 369 subjects, including 179 CRC patients and 190 non-cancer controls have been genotyped using Tetra-primer amplification refractory mutation system-polymerase chain reaction (TP-ARMS-PCR) method. RESULT: The results demonstrated that the T allele of the ATG16L1 rs2241880 was significantly associated with the increased risk of CRC in the studied population (OR 1.64, 95% CI: 1.21-2.22, p = 0.0015). Moreover, ATG16L1 rs2241880 TT genotype increased the susceptibility to CRC (OR 3.31, 95% CI: 1.64-6.69, p = 0.0008). Furthermore, a significant association was observed under the recessive and dominant inheritance models (p = 0.0015 and p = 0.017, respectively). No statistically significant differences were found in the ATG5 rs1475270 alleles and genotypes between the cases and controls. CONCLUSION: The results of the present study may be helpful concerning the risk stratification in CRC patients based on the genotyping approach of autophagy pathways and emphasize the need for further investigations among different populations and ethnicities to refine our conclusions.

Hospital discharge on the first compared with the second day after a planned cesarean delivery had equivalent maternal postpartum outcomes: a randomized single-blind controlled clinical trial.

OBJECTIVE: Determining the effect of discharge time after elective cesarean section on maternal outcomes. METHODS: This study is a randomized clinical trial that performed on 294 women who undergo elective cesarean section. The patients were randomized in two groups by simple randomization method: Group A (discharge 24 h after cesarean) and group B (discharge for 48 h after cesarean). In both groups, during the first 24 h, they received intravenous antibiotic (cefazolin as routine order) and pethidine at the time of pain. The patients were discharged with the hematinic and mefenamic acid. The main outcome variables were satisfaction of the patient, surgical site infection, separation of incision, endometritis, urinary tract infection, gastrointestinal complications, rehospitalization, secondary postpartum hemorrhage and pain of the patient on discharge day, one and six weeks after cesarean. RESULTS: Satisfaction scores and pain score at discharge day, one and six weeks after discharge were not significant different in the study groups (P > 0.05). Another key finding of this paper was no significant difference in the incidence of surgical site infection, separation of incision, endometritis, urinary tract infection, gastrointestinal complications, rehospitalization, secondary postpartum hemorrhage at one and six weeks after discharge in the study groups(P > 0.05). CONCLUSION: The time of discharge can be reduced to 24 h after surgery if the mother to be at good general condition, the vital signs are stable, the patient has no underlying problem and disease, and it is financed for the patient and the health system.

Arterial attenuation in individualized computed tomography pulmonary angiography injection protocol adjusted based on the patient's body mass index.

BACKGROUND: The aim of this study was to optimize computed tomography pulmonary angiography (CTPA) protocols with regard to improve vascular attenuation without increasing contrast media (CM) volumes. Therefore, we compared the standard CTPA protocol to an individualized contrast media injection protocols adjusted for the patient's body mass index (BMI). MATERIALS AND METHODS: Two groups of 295 patients with suspected pulmonary embolism (PE) have been receiving CTPA. Group 1 received a standard protocol without taking patient's BMI into account. Group 2 received a CTPA scan, where dose and flow rate of CM injections were adjusted for the patient's BMI. Images were retrospectively analyzed by drawing regions of interests in defined positions in the superior vena cava, descending aorta, the pulmonary main trunk as well as the left and right lower lobe arteries. Intravascular attenuation, contrast volumes, and flow rates were compared using unpaired t-tests. Furthermore, a qualitative image analysis was performed by two experienced readers blinded for the protocol used for image acquisition to evaluate the image quality and arterial attenuation. RESULTS: Patient's BMI was similar in both the groups (27.5 ± 1.5 kg/m2 vs. 28.4 ± 2.1 kg/m2; P = 0.67). Contrast volumes were lower (54.2 ± 4.8 ml vs. 55 ml; P < 0.05), and flow rates (4.1 ± 0.3 ml/s vs. 3.5 ml/s; P < 0.05) were significantly higher in the individualized protocol. The qualitative image analysis yielded an agreement on diagnostic interpretability in the individualized and standard group of 49% and 51% (95% Wilson confidence interval for mean), respectively. CONCLUSION: An individualized CTPA protocol based on the patient's BMI reduced the contrast media volume and led to an increased pulmonary artery enhancement improving image quality, particularly in the evaluation of the peripheral pulmonary arteries. Thus, contrast media volumes in CTPA should be adjusted for the patient's BMI.

Potential Prognostic Role for SPOP, DAXX, RARRES1, and LAMP2 as an Autophagy Related Genes in Prostate Cancer.

PURPOSE: Autophagy plays a critical role in PCa development. DAXX has a potent pro-survival effect by enhancing cell growth in PCa via suppression of autophagy. Here, we depicted a network governed by DAXX and SPOP by which the autophagy pathway is suppressed through the ubiquitination and modulation of key cellular signaling pathways mediators including LAMP2 and RARRES1. MATERIALS AND METHODS: Through network-based bioinformatics approaches, the expression levels of DAXX, RARRES1, LAMP2, and SPOP genes was assessed in 50 PCa tissues and 50 normal adjacent from the same sample as well as 50 benign prostatic hyperplasia (BPH) tissues by quantitative RT-PCR. The normal adjacent tissues were taken from regions more than 5mm away from the bulk of those tumor tissues with clearly distinct margins. RNA extraction, cDNA synthesis and Real-time Quantitative RT-PCR were done for assessment of gene expression. To evaluate the primary gene network centered on autophagy pathway, according to the Query-dependent weighting algorithm, these two networks were integrated with Cytoscape 3.4 software. RESULTS: We found that in PCa tissues the DAXX expression level was significantly increased (P < 0.001) and the expressions of SPOP, RARRES1, and LAMP2 were significantly down-regulated, when compared to both control groups including normal adjacent and BPH tissues. Moreover, significant correlations were observed between expression levels of all four genes. Additionally, ROC curve analysis revealed that LAMP2 had the most sensitivity and specificity. CONCLUSION: These findings suggest that the contribution of SPOP, DAXX, RARRES1, and LAMP2 together could be a putative regulatory element acting as a prognostic signature and therapeutic target in PCa.

Image Quality Performance of Virtual Single-Source CT Using Dual-Source Computed Tomography.

RATIONALE AND OBJECTIVES: The aim of this study is to analyze the image quality provided by a dual-source (DS) data set and a single-source (SS) data set at the same radiation exposure, in order to evaluate a dose splitting method for dual-source scanning protocols. MATERIALS AND METHODS: A 192-slice dual-source third generation CT (Somatom Force; Siemens Healthcare, Forchheim, Germany) was used to image a Catphan phantom (Catphan503; The Phantom Laboratory, Salem, New York) utilizing different X-ray tube voltages from 70 to 120 kVp with an organ-based tube-current modulation technique (X-CARE; Siemens Healthcare, Forchheim, Germany). In order to keep the radiation dose (given by volume computed tomography dose index) in a clinically relevant range, different X-ray tube time-current products ranging from 80 to 300 mAs were selected. The data sets by each X-ray tube voltage were collected using a single-source as well as a dual-source mode. The measurements in the dual-source mode were performed with five different tube currents of the X-ray tube A and B. Thereby, the tube current ratios were 50%|50% (DS 0.5), 60%|40% (DS 0.6), 70%|30% (DS 0.7), 80%|20% (DS 0.8), and 90%|10% (DS 0.9). The images were reconstructed by the use of a filter-back projection (Br40) and an advanced mode led iterative reconstruction algorithms (advanced modeled iterative reconstruction algorithms [ADMIRE]; Siemens Healthcare, Forchheim, Germany) with a strength range of 1-5. The image quality was evaluated in terms of noise, contrast-to-noise ratio (CNR), low-contrast detectability expressed as the structural similarity index (SSIM) and spatial resolution quantified by the full width at half maximum of the line-spread function. RESULTS: Image noise decreased by the use of the dual-source mode, which led to improvement of their CNR compared to the single-source mode. SSIM showed an almost constant behavior by both modes. The spatial resolution indicated a lower trend by the dual-source mode in comparison to the single-source mode. However, the loss of the spatial resolution performance was lower than 5% for the dual-source modes. CONCLUSION: The presented phantom study demonstrated that SSIM and spatial resolution performance obtained by dual-source CT protocols showed a negligible variation to those by the single-source CT. However, the noise and CNR displayed an improvement for the dual-source CT. Therefore, the use of the dual-source CT enables to split the radiation dose between X-ray tubes and to compare the data sets with different radiation dose levels without loss in the image quality.

Circulating microRNAs as diagnostic and therapeutic biomarkers in gastric and esophageal cancers.

Gastric and esophageal cancers are as main cancers of the gastrointestinal (GI) tract, which are associated with poor diagnosis and survival. Several efforts were made in the past few decades to finding effective therapeutic approaches, but these approaches had several problems. Finding new biomarkers is a critical step in finding new approaches for the treatment of these cancers. Finding new biomarkers that cover various aspects of the diseases could provide a choice of suitable therapies and better monitoring of patients with these cancers. Among several biomarkers tissue specific and circulating microRNAs (miRNAs) have emerged as powerful candidates in the diagnosis of gastric and esophageal cancers. MiRNAs are small noncoding single-stranded RNA molecules that are found in the blood and regulate gene expression. These have numerous characteristics that make them suitable for being used as ideal biomarkers in cancer diagnosis. Research has indicated that the level and profile of miRNA in serum and plasma are very high. They are potentially noninvasive and sensitive enough to detect tumors in their primary stages of infection. Multiple lines of evidence indicate that the presence, absence, or deregulation of several circulating miRNAs (i.e., let-7a, miR-21, miR-93, miR-192a, miR-18a, and miR-10b for gastric cancer, and miR-21, miR-375, miR-25-3p, miR-151a-3p, and miR-100-3p for esophageal cancer) are associated with initiation and progression of gastric and esophageal cancers. The aim of this review is to highlight the recent advances in the roles of miRNAs in diagnosis and treatment of gastric and esophageal cancers.

Correlation of size-dependent conversion factor and body-mass-index using size-specific dose estimates formalism in CT examinations.

PURPOSE: The aim of this investigation is to establish the relationship between the size-dependent conversion factor (fsize) and the body-mass-index (BMI) and to test whether BMI can be substituted for the conventionally used patients' anterior-posterior (AP) and lateral (LAT) dimensions for calculation of fsize. By calculating fsize on the basis of BMI instead of the AP and LAT measurements, size-specific dose estimates (SSDE) could be determined prior to image acquisition. METHODS: Our institute utilizes a dose monitoring software to record radiation exposure during CT examinations. The datasets gathered during each examination contain information regarding the scan protocol, the volumetric computed tomography dose index (CTDIvol), SSDE and BMI. fsize is traditionally calculated through measurement of AP and LAT dimensions. In this work, the dose monitoring system calculates AP and LAT diameters at the middle of scout views. For purpose of this investigation, we used data from 13544 patients who underwent CT examinations of the torso, head or knee (both) to compare fsize as calculated from the AP and LAT dimensions to fsize calculated as a function of BMI. RESULTS: In the examinations of the torso, we observed an exponentially decreasing correlation between fsize and BMI. In the examinations of the head and knee (both), fsize reflected an almost independent behavior to BMI. CONCLUSION: This study demonstrates that it is possible to estimate fsize by using the patients' BMI for the torso as well as the head and knee CT, thereby enabling calculation of the probable SSDE prior to image acquisition on the basis of the presumed CTDIvol provided by the scanner. By providing information on the expected patient dose prior to image acquisition, this method is advantageous over the traditional calculation of fsize via the AP and LAT dimensions.

Role of anxiety and depression in adolescents with chest pain referred to a cardiology clinic.

BACKGROUND: We carried out this study in order to evaluate the causes of chest pain in teenagers and the role of anxiety and depression in this age group compared with the normal population. METHODS: In this prospective case-control study, all patients aged 11-18 years with chest pain and no history of trauma and referred to a paediatric cardiology clinic from March, 2009-April, 2010 were selected. A chest pain protocol including a detailed history, full physical examination, required blood tests, electrocardiography, and echocardiography was performed for all. The presence of depression and anxiety and their severity were assessed by Beck questionnaires. The patients were compared with age- and sex-matched, randomly selected healthy controls. RESULTS: In total, 194 patients with a mean age of 14±2 years were selected. The most frequent presentation was idiopathic chest pain (43.3%), followed by the psychological group (29.9%). These groups had no abnormal points in history, physical, and para-clinical tests. Moderate-to-severe depression was found in 45.9% in the patients group, compared with 17.6% of controls, which was statistically significant (p=0.016). Moreover, anxiety was detected in 67.5% of patients versus 15.4% in controls, which is a statistically significant difference (p=0.009). Cardiac chest pain with 9.27% was the most common type of organic causes. CONCLUSION: Chest pain during teenage is more prevalent, but not risky. Undergoing a detailed history and full physical examination can help diagnose the causes in the majority of cases. Given the prevalence of a psychological group as well as role of anxiety and depression in most patients, referring to a psychiatrist is suggested.

Association of genetic variations in the mitochondrial D-loop with ß-thalassemia.

Beta-thalassemia, one of the most common single-gene disorders, is the result of reduced or absent production of ß-globin chains. Patients with ß-thalassemia show weak genotype-phenotype correlations. Mitochondrial DNA polymorphisms are a potential source for different physiological and pathological characteristics and have been found to be associated as genetic modifiers with various pathophysiologies, including cancers and neurodegenerative diseases. A group of 35 patients with ß-thalassemia was investigated for the presence of mtDNA D-loop polymorphisms in comparison with 504 normal controls. We found four mtDNA D-loop polymorphisms at nucleotides 16,069C > T, 16,189T > C, 16,319G > A, and 16,519T > C that showed significant differences between patients and normal subjects. There is no strong proof for the association of these polymorphisms with ß-thalassemia. It is hypothesized that iron overload or its effects on sequestration of calcium or zinc can lead to oxidative stress and ROS production inside the mitochondria. Therefore, possible accompanying of mtDNA polymorphisms with ß-thalassemia disease may complicate the genotype-phenotype correlation and could affect the clinical outcomes in the patients.

Characterising the spectrum of autosomal recessive hereditary hearing loss in Iran.

BACKGROUND: Countries with culturally accepted consanguinity provide a unique resource for the study of rare recessively inherited genetic diseases. Although hereditary hearing loss (HHL) is not uncommon, it is genetically heterogeneous, with over 85 genes causally implicated in non-syndromic hearing loss (NSHL). This heterogeneity makes many gene-specific types of NSHL exceedingly rare. We sought to define the spectrum of autosomal recessive HHL in Iran by investigating both common and rarely diagnosed deafness-causing genes. DESIGN: Using a custom targeted genomic enrichment (TGE) panel, we simultaneously interrogated all known genetic causes of NSHL in a cohort of 302 GJB2-negative Iranian families. RESULTS: We established a genetic diagnosis for 67% of probands and their families, with over half of all diagnoses attributable to variants in five genes: SLC26A4, MYO15A, MYO7A, CDH23 and PCDH15. As a reflection of the power of consanguinity mapping, 26 genes were identified as causative for NSHL in the Iranian population for the first time. In total, 179 deafness-causing variants were identified in 40 genes in 201 probands, including 110 novel single nucleotide or small insertion-deletion variants and three novel CNV. Several variants represent founder mutations. CONCLUSION: This study attests to the power of TGE and massively parallel sequencing as a diagnostic tool for the evaluation of hearing loss in Iran, and expands on our understanding of the genetics of HHL in this country. Families negative for variants in the genes represented on this panel represent an excellent cohort for novel gene discovery.

Determination of prostate cancer risk factors in Isfahan, Iran: a case-control study.

BACKGROUND: This study was conducted in order to determine the risk factors of prostate cancer in Isfahan, Iran. METHODS: In this case-control study 95 cases of incident, pathologically confirmed PC and 95 controls were recruited. Odds ratios (OR) and the corresponding 95% confidence intervals (CIs) were estimated using conditional logistic regression models. RESULTS: The risk of prostate cancer increased with increasing age (OR: 1.09, 95% CI: 1.04-1.13; p < 0.001). A positive family history of prostate cancer was also a significant risk factor (OR: 2.5, 95% CI: 1.1-2.9; p = 0.03). Increased dietary intake tomato sauce was associated with a significantly declined risk of prostate cancer (OR: 0.05, 95% CI: 0.01-0.40; p < 0.001). Prostate cancer risk was not affected by Smoking, alcohol consumption, history of vasectomy, diabetes mellitus, sexually transmitted diseases, and dietary garlic and fat intake. CONCLUSIONS: We found that increased age and positive family history of prostate cancer could be considered as some potential risk factors of prostate cancer in the studied population. Moreover, a higher intake of tomato sauce was found to have a protective effect against prostate cancer. Key words: Prostate cancer, risk factor, Iran.