Simple and Safe Packing Method for High-Grade Liver Injuries

Background: Injury to the liver is a commonly encountered problem in trauma cases and is a frequent cause of morbidity and mortality. Because gauze packing is easy to use and has the potential for rapid hemorrhage control, it is the most commonly used method for patients with severe liver injuries, particularly those with coagulopathy. Objectives: In this study, OpSite sheets were used to make three-layer packs for decreasing the complication associated with removing gauze packing. Patients and Methods: Twenty male patients with grade IV or V liver injuries that required laparotomy were enrolled in the study. Ten patients were treated using conventional packing, while the other 10 were treated using the three-layer pack. In the case group, the liver was mobilized as much as possible. The three-layer pack was then placed at the site of liver damage and extended onto the liver surface, and the other pads were placed on top of this pad. After 72 h, reoperation was performed, the packs were removed, and the packs causing injury were recorded. Additionally, if rebleeding due to the adhesive bands of the pack was observed, the blood was suctioned and bleeding volume was measured. Data were analyzed using the Mann–Whitney test. Results: Patients in the case and control groups were similar in age and admission vital signs. During the second operation, the bleeding volumes measured in the case and control groups were 66 ± 27.01 mL and 152 ± 85.4 mL, respectively. There was some pad-induced damage after the removal of the pad in the control group. Conclusions: Our study has provided a simple and safe packing method for high-grade liver injuries

The outcome of children with acute lymphoblastic leukemia without receiving sufficient dose of l-asparaginase

In acute lymphoblastic leukemia (ALL) patients treated with L-asparaginase, discontinuation of the drug occasionally occur due to severe drug complications or resistance, however, due to the high efficacy of this drug in the recovery of patients and the prevention of disease recurrence, resuming the drug regimen is preferred in most patients. What we did in this study was to evaluate and compare the effects of clinical outcomes in the two modes of continuing and discontinuing drug use. In this retrospective cohort study, all children with ALL who had been treated with L-asparaginase during the years 2005 to 2015 were included in the study and categorized into two groups receiving complete treatment regimen (n=160) and those who had to discontinue the drug due to appearing complications (n=9). The rate of relapse and mortality rate was determined and compared across the two groups with a median follow-up time of more than 5 years. 5-yrs Overall survival of all enrolled patients in the groups continued and discontinued was 91.4±2.5 and 71.4±17.1, respectively (P=0.792). Also, 5-yrs event-free survival of the two groups was 75.8±3.5 and 71.4±17.1, respectively (P=0.557. Relapse was revealed in 17.5 and 33.3 respectively and mortality in 16.9 and 0.0 (P=0.261). However, the overall prevalence of hypersensitivity reaction to the drug was significantly higher in those patients who discontinued their drug regimen (100 versus 24.4, P<0.001). Hypersensitivity reaction to drugs may be an important factor in discontinuing L-asparaginase in patients with ALL. The discontinuation of L-asparaginase supplementation due to various complications such as hypersensitivity reactions may be effective in the survival of these patients. However, accurate determination of the effect of discontinuation of this drug on the outcome of children with ALL requires a more comprehensive study with more complicated cases. © 2020 Tehran University of Medical Sciences

Ring diameter effects on determination of field-saturated hydraulic conductivity of different loam soils

Establishing ring diameter effects on the field-saturated soil hydraulic conductivity, Kfs, determined with ponding infiltrometer methods can help to find a compromise between the need to sample a large area with an individual measurement and the impracticality of using large rings in the field. Five ring sizes (diameter, D = 5.5, 10.9, 16.0, 27.8 and 31.8 cm) were used to determine Kfsby the simplified falling head (SFH) technique in four loamy soils with different salinity (electrical conductivity of saturated extract, ECe= 0.9\ue2\u80\u9329.4 dS/m) and sodicity (exchangeable sodium percentage, ESP = 2.7\ue2\u80\u9381.3%) levels. According to USDA classification, two soils were non-saline, non-sodic (NN1 and NN2), a soil was saline-sodic (SS) and another soil was non-saline and sodic (NS). Ring diameter did not have in general a statistically detectable influence on the mean Kfsof a given soil. The only exception was for the NS soil but also in this case the effect was negligible for many practical applications since Kfsincreased by 2.3 times as D increased from 5.5 to 31.8 cm. However, smaller rings implied either higher or lower estimates of Kfsvariability as compared with larger rings, depending on the soil. The former result probably occurred when only a part of total heterogeneity was sampled with a small ring. The latter result was probably obtained when insertion of small rings altered or even destroyed the fragile macroporosity and also when using small rings increased the probability to only sample relatively homogeneous soil volumes. As compared with the largest rings, those with a diameter in the range 10.9 to 27.8 cm yielded a similar information on the differences between the soil hydraulic conductivity of the four considered soils. More discrepancies were detected for the smallest rings (D = 5.5 cm). Even small rings appear usable to obtain a mean value of Kfsfor the sampled soils, perhaps with the exception of the smallest ones. However, as large as possible rings should be used if Kfsvariability has also to be determined

microRNAs in cancer stem cells: Biology, pathways, and therapeutic opportunities

Cancer stem cells (CSCs) are a small subpopulation of tumor cells that have been identified in most types of cancer. Features that distinguish them from the bulk of tumor cells include their pluripotency, self‐renewal capacity, low proliferation rate, and tumor‐initiating ability. CSCs are highly malignant, as they confer drug resistance and facilitate tumor progression, relapse, and metastasis. The molecular mechanisms underlying CSC biology are now beginning to be understood. In this context, microRNAs (miRNAs) occupy a prominent place. These endogenous, small noncoding RNA molecules control gene expression at the posttranscriptional level. This study reviews our current understanding of how the misexpression of tumor suppressor and oncogenic miRNAs in CSCs sustain their abundance and malignant properties. We discuss how they partly do so by acting on major CSC signaling pathways, including the Wnt, Notch, Hedgehog, and BMI‐1 pathways. Our current knowledge of miRNA functions in CSCs may now be used for cancer diagnostic and prognostic purposes. In addition, when combined with recent technical advances in the in vivo delivery of miRNAs, we are now in an excellent position to develop strategies that harness miRNA interference and replacement technologies for the therapeutic targeting of CSCs