Glioma Migration Through the Corpus Callosum and the Brainstem Detected by Diffusion and Magnetic Resonance Imaging: Initial Findings

Purpose: Glioma cell infiltration, in which the glioma tumor cells spread long distances from the primary location using white matter (WM) or blood vessels, is known as a significant challenge for surgery or localized chemotherapy and radiation therapy. Following the World Health Organization (WHO), the glioma grading system ranges from stages I to IV, in which lower-grade gliomas represent benign tumors, and higher grade gliomas are considered the most malignant. Materials and Methods: We gathered magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) data for seven patients with right precentral gyrus-located tumors and six age- and sex-matched healthy subjects for analysis. Tract-Based Spatial Statistics (TBSS) was utilized to evaluate whole-brain WM implication due to probable tumor infiltration. Also, along-tract statistics were used in order to trace the implicated WM tracts. Finally, for cortical evaluation of probable tumor cell migration, voxel-based morphometry (VBM) was utilized, which allowed us to do whole-brain cortical estimation. Results: The TBSS results revealed significantly higher fractional anisotropy (FA) and lower mean diffusivity (MD) in the left side superior corona radiata. Also, higher FA was observed in the right corticostriatal tract. Along-tract statistics were also compiled on the corpus callosum (CC), which is anatomically known as a hub between hemispheres. The body of the CC, which connected with the superior corona radiata anatomically, showed significantly higher FA values relative to healthy subjects, which are in line with the TBSS results. Consistent with these results, whole-brain gray matter changes were analyzed via VBM, which showed significant hypertrophy of both sides of the brainstem. Conclusion: In future investigations, focusing on the genetic basis of the glioma patients in line with imaging studies on a larger sample size, which is known as genetics imaging, would be a suitable approach for tracing this process. © Copyright © 2020 Sharifi, Pajavand, Nateghinia, Meybodi and Hasooni

Case Report: Chemotherapy Indication in a Case of Neurofibromatosis Type 1 Presenting Optic Pathway Glioma: A One-Year Clinical Case Study Using Differential Tractography Approach

Neurofibromatosis type 1 (NF1) is associated with peripheral and central nervous system tumors. It is noteworthy that the regions in which these tumors frequently arise are the optic pathways (OPs) and the brainstem. Thus, we decided to trace the procedure of diffusion Magnetic Resonance Imaging (dMRI) alterations along with Short-Wavelength Automated Perimetry (SWAP) examinations of the OPs after surgery and chemotherapy over 1 year, which enabled us to evaluate chemotherapy's efficacy in an NF1 patient with an OP tumor. In this study, a 25-year-old woman with NF1 and left optic radiation (OR) glioma underwent surgery to remove the glioma. Immunohistochemistry (IHC) revealed a Pilocytic Astrocytoma (PA) WHO grade I. Post-operation chemotherapy done using nine treatment cycles of administering Temozolomide (TMZ) for 5 days every 4 weeks. Applying the region of interest (ROI) differential tractography method and SWAP four times every 3 months allowed us to follow the patient's visual acuity alterations longitudinally. The differential deterministic tractography method and statistical analyses enabled us to discover the white matter (WM) tracts anisotropy alterations over time. Furthermore, statistical analyses on the SWAP results along time illustrated possible alterations in visual acuity. Then, we could compare and associate the findings with the SWAP examinations and patient symptoms longitudinally. Statistical analyses of SWAP tests revealed a significant improvement in visual fields, and longitudinal differential tractography showed myelination and dense axonal packing in the left OR after 1 year of treatment. In this study, we examined an old hypothesis suggesting that chemotherapy is more effective than radiotherapy for NF1 patients with OP gliomas (OPGs) because of the radiation side effects on the visual field, cognition, and cerebrovascular complications. Our longitudinal clinical case study involving dMRI and SWAP on a single NF1-OPG patient showed that chemotherapy did not suppress the OP myelination over time. However, it should be noted that this is a clinical case study, and, therefore, the generalization of results is limited. Future investigations might focus on genetic-based imaging, particularly in more cases. Further, meta-analyses are recommended for giving a proper Field Of View (FOV) to researchers as a subtle clue regarding precision medicine. © Copyright © 2021 Pajavand, Sharifi, Anvari, Bidari-Zerehpoosh, Shamsi, Nateghinia and Meybodi

The prevalence of low back pain in emergency medical services personnel: A systematic review and meta-analysis

Background & Aim: Among musculoskeletal disorders, low back pain causes the most common complaints among emergency medical services personnel worldwide. This study aimed to investigate the prevalence of low back pain among emergency medical services personnel. Methods & Materials: We used the PRISMA guideline in the present systematic review and meta-analysis. The search was conducted in PubMed, Scopus, Web of Science, Cochrane, ProQuest, Science Direct, Google Scholar, and Embase using English keywords and SID, Irandoc, and Magiran data resources with equivalent Persian keywords. Studies were selected based on inclusion and exclusion criteria. The data were gathered without a time limit until the end of June 2021. The quality evaluation of the selected studies was performed using the Appraisal tool for Cross-Sectional Studies (AXIS) tool. The random-effects model was used for meta-analysis, applying the I2 index as a measure to estimate heterogeneity among studies. Results: In the present study, a total of 1038 articles were identified in the primary search, of which ten studies entered the final evaluation phase and meta-analysis after initial screening and removing duplicates. In these studies, 7499 emergency medical services personnel were examined; the prevalence of low back pain was 50.30 (95 CI: 37.98-62.62, I2= 99.1). Conclusion: Our results indicated a considerable prevalence of low back pain among emergency medical services personnel. Also, the heterogeneity between studies was very high. It is recommended to teach the correct methods of lifting the stretcher and equipment as well as redefining the duties of the staff with low back pain. © 2022 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences

Assessment of the role of non-coding RNAs in the pathophysiology of Parkinson's disease

Parkinson's disease (PD) is the second main neurodegenerative disease causing motor abnormalities in the middle-aged and old individuals. In some cases, cognitive dysfunction also occurs. The clinical signs of PD are bradykinesia, rigidity and resting tremor. As these signs might be detected in other neurological conditions such as multiple systems atrophy and corticobasal degeneration, it is necessary to find specific and sensitive markers for this disorder. Non-coding RNAs are implicated in the different PD-associated features such as α-synuclein expression and Lewy body construction, mitochondrial dysfunction, apoptosis, neuroinflammation and defects in glial cell-derived neurotrophic factor. Several researches have confirmed dysregulation of long non-coding RNAs (lncRNAs) and microRNAs (miRNAs) in brain tissues, plasma exosomes and leukocytes of affected individuals or animal models of PD. A number of these transcripts directly regulate the neurodegenerative process in PD. In the current study, we review the current data about dysregulation of ncRNAs and the role of their genomic variants in the pathogenesis of PD. © 2021 Elsevier B.V

Challenges facing the health system in responding to mining accidents: The case of the zemestan-yurt mine explosion in iran (2017)

Background: Occupational accidents cause death and disabilities among millions of workers around the world. The mining industry is among the riskiest occupations in this respect. This study aims to investigate interventions made and challenges faced by the health system in response to the Zemestan-Yurt Mine explosion in the Golestan Province, Iran, 2017. Materials and Methods: In this article, being a field report, data were collected through direct observations and interviews with first responders involved in the response process, and by checking national and local reports from other organizations. Result: On Wednesday, May 4, 2017, at 11:58 AM, an explosion occurred in the Yurt coal mine, Golestan Province, in which 126 people were affected directly or indirectly. In fact, 43 workers were killed immediately after the explosion of a coal wagon, 55 were dispatched to hospitals, and 28 received outpatient health services. In this incident, more than 100 teams from various organizations, including the health system, arrived at the scene and carried out relief and rescue operations. Conclusions: The results of the current study indicate that the health system does not have specific instructions, training plans, as well as well-trained and prepared personnel for managing mine-related accidents. Besides, interactions are not integrated and coordinated among disaster management response teams. Therefore, developing preparedness instructions for responding to disasters, forming rapid response teams and training them for industrial accidents, as well as performing joint exercises and drills with responsible organizations can be effective in improving responses to such accidents. © The Author(s) 2021; All rights reserved. Published by Rafsanjan University of Medical Sciences Press

Challenges facing the health system in responding to mining accidents: The case of the zemestan-yurt mine explosion in iran (2017)

Background: Occupational accidents cause death and disabilities among millions of workers around the world. The mining industry is among the riskiest occupations in this respect. This study aims to investigate interventions made and challenges faced by the health system in response to the Zemestan-Yurt Mine explosion in the Golestan Province, Iran, 2017. Materials and Methods: In this article, being a field report, data were collected through direct observations and interviews with first responders involved in the response process, and by checking national and local reports from other organizations. Result: On Wednesday, May 4, 2017, at 11:58 AM, an explosion occurred in the Yurt coal mine, Golestan Province, in which 126 people were affected directly or indirectly. In fact, 43 workers were killed immediately after the explosion of a coal wagon, 55 were dispatched to hospitals, and 28 received outpatient health services. In this incident, more than 100 teams from various organizations, including the health system, arrived at the scene and carried out relief and rescue operations. Conclusions: The results of the current study indicate that the health system does not have specific instructions, training plans, as well as well-trained and prepared personnel for managing mine-related accidents. Besides, interactions are not integrated and coordinated among disaster management response teams. Therefore, developing preparedness instructions for responding to disasters, forming rapid response teams and training them for industrial accidents, as well as performing joint exercises and drills with responsible organizations can be effective in improving responses to such accidents. © The Author(s) 2021; All rights reserved. Published by Rafsanjan University of Medical Sciences Press

Barriers and requirements in the off-line emergency medical protocols implementation in Iranian Pre-hospital system: A qualitative study

BACKGROUND: To avoid making decisions based on the unproven opinions of emergency medical technicians (EMTs), many emergency medical service (EMS) systems rely on emergency medical protocols. As protocol-based on-scene decision-making is influenced by many challenges, identifying these challenges can result in providing appropriate conditions for EMTs' decision-making. Therefore, this study aimed to identify the barriers and requirements in the off-line emergency medical protocols implementation m in the prehospital emergency medical system. MATERIALS AND METHODS: To conduct this study, qualitative content analysis using 10 field observations, 22 interviews, and 2 rounds of focus group discussions was applied. The duration of interviews lasted from October 2019 to January 2020. The Graneheim and Lundman approach was used to analyze the data. RESULTS: Seven categories (15 subcategories) including education and awareness (professional training and education and community-based education); attitudes (professional attitude and community attitude); interactions and coordination (interpersonal interactions, organizational interferences, and community's interactions); rules and instructions (instructions and supportive rules); control system (monitoring and evaluation and motivational system); accessibility (recourses and communication); and organization (structure and process) were obtained as the obstacles and challenges in the offline emergency medical protocol implementation in the prehospital system. CONCLUSIONS: There are many challenges in implementing offline emergency medical protocols in the prehospital emergency system. To achieve the effectiveness and efficiency of offline prehospital emergency protocols, it is necessary to facilitate these challenges and improve the EMTs' knowledge, attitude, and performance through cooperative and skill-based education. The findings of this study can be useful for EMS systems from national to local levels