Appropriateness of referrals for single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in a developing community: A comparison between 2005 and 2009 versions of ACCF/ASNC appropriateness criteria

Appropriateness of referrals for myocardial perfusion imaging (MPI) in developing countries has not been extensively studied. Our study was conducted to describe the ordering practices of physicians and appropriateness of MPI referrals in Iran. We prospectively applied 2005 and 2009 versions of the Appropriateness Use Criteria published by the American College of Cardiology Foundation (ACCF) and the American Society of Nuclear Cardiology (ASNC) to 291 consecutive patients (age 55.3 ± 10.3 years) who underwent SPECT-MPI. For this purpose, we convened a panel, consisting of two academic cardiologists, one academic clinician in internal medicine, and one academic clinician in nuclear medicine. The panelists were invited for a face-to-face meeting to judge appropriateness of SPECT-MPI and independently assign a specific indication (scenario), whenever possible, for each case in accordance with ACCF/ASNC appropriateness scenarios. Based on the 2005 ACCF/ASNC criteria, SPECT-MPI studies were judged appropriate for 211 (72.5%), uncertain for 36 (12.4%), inappropriate for 32 (11.0%), and unclassifiable for 12 (4.1%) referrals. The same figures based on the 2009 version were 219 (75.3%), 15 (5.2%), 49 (16.8%), and 8 (2.7%) patients, respectively. Overall agreement between the 2005 and 2009 versions was good (κ 0.63). Lack of chest pain and age below 60 years were significant indicators increasing the likelihood of inappropriate referrals by 2.9-3.4 fold. Absence of diabetes mellitus and hypertension, a normal lipid profile, lack of a past history of myocardial infarction or cardiovascular interventions (CABGs or PCI), as well as lack of application and exercise ECG stress test as the gate keeper (keeping abnormal ETT or inability of the patient to perform exercise as the appropriate indication for SPECT-MPI referral) were significant indicators, decreasing the odds of appropriate referrals. Generally a higher percentage of referrals with inappropriate indications had normal MPI. Our study provides an evidence for the fact that SPECT-MPI ordering practices in our developing community largely parallel the ACCF/ASNC recommendations. The implementation of appropriateness criteria is feasible in clinical settings and might provide an alternative to utilization management. © 2011 American Society of Nuclear Cardiology

Utilizing the micron sized non-thermal atmospheric pressure plasma inside the animal body for the tumor treatment application

This study aimed to evaluate the effects of micron sized non-thermal atmospheric pressure plasma inside the animal body on breast cancer tumor. The μ-plasma jet consists of micron sized hollow tube in which pure helium gas is ionized by high voltage (4 kV) and high frequency (6 kHz). The efficiency of the plasma treatment in killing cancer cells was first investigated by cell viability measurements of treated 4T1 cells using flow cytometry and cell cycle analysis. For exploration of the in vivo effects of the plasma treatment, the BALB/c mice inoculated by 4T1 cell lines were exposed subcutaneously to plasma for 3 minutes. In addition, H&E staining, TUNEL and Western blotting assays were performed in order to observed the effects of the non-thermal plasma on the tumor cells. The results showed that the efficiency of the plasma in suppression of the tumor growth is comparable to that of a typical chemotherapy drug. Moreover, the results indicated that the plasma induces apoptosis in the tumor tissue and increases the ratio of the apoptotic to anti-apoptotic protein expression. We believe that these findings presented herein may extend our knowledge of the mechanisms by which the plasma exerts its promising anti-cancer effects

Distribution of inception times in repetitive pulsed discharges in synthetic air

Knowing which processes and species are responsible for discharge inception is important for being able to speed up, delay, or completely avoid it. We study discharge inception in 500 mbar synthetic air by app

Evaluation of the profile of alopecia areata and the prevalence of thyroid function test abnormalities and serum autoantibodies in Iranian patients

BACKGROUND: The study aimed at evaluating the prevalence of thyroid function abnormalities in patients with alopecia areata (AA) and its association with other autoimmune diseases and various autoimmune antibodies. METHOD: We retrospectively analyzed medical records of 123 patients with AA. The main site of involvement, pattern, and extent of alopecia as well as presence of the similar disease in first-degree family members and serologic status of patients were recorded. RESULTS: Participating in the study were 57 males and 66 females (6 to 59 years old). In the majority of patients (69.9%) the disease was manifested in the first two decades of life. Patients with family members having alopecia were recorded in 24.4%. Thyroid function abnormalities were found in 8.9% of patients. Positive autoimmune antibodies were associated with AA in 51.4% of patients with no significant association between the severity and duration of disease and presence of these antibodies. CONCLUSION: The incidence of positive auto-immune antibodies in Iranian patients is higher than previous reports. Concerning the female:male ratio, thyroid function tests and the prevalence of alopecia in first-degree relatives, our results are compatible with previous data obtained from different ethnic populations. Previous reports documented that a greater severity and longer duration of AA were seen in the early onset forms; however our result are relatively different which could be explained by differences in genetic factors

Effect of blood glucose level on standardized uptake value (SUV) in F-18- FDG PET-scan : a systematic review and meta-analysis of 20,807 individual SUV measurements

Objectives To evaluate the effect of pre-scan blood glucose levels (BGL) on standardized uptake value (SUV) in F-18-FDG-PET scan. Methods A literature review was performed in the MEDLINE, Embase, and Cochrane library databases. Multivariate regression analysis was performed on individual datum to investigate the correlation of BGL with SUVmax and SUVmean adjusting for sex, age, body mass index (BMI), diabetes mellitus diagnosis, F-18-FDG injected dose, and time interval. The ANOVA test was done to evaluate differences in SUVmax or SUVmean among five different BGL groups (200 mg/dl). Results Individual data for a total of 20,807 SUVmax and SUVmean measurements from 29 studies with 8380 patients was included in the analysis. Increased BGL is significantly correlated with decreased SUVmax and SUVmean in brain (p <0.001, p <0.001,) and muscle (p <0.001, p <0.001) and increased SUVmax and SUVmean in liver (p = 0.001, p = 0004) and blood pool (p=0.008, p200 mg/dl had significantly lower SUVmax. Conclusion If BGL is lower than 200mg/dl no interventions are needed for lowering BGL, unless the liver is the organ of interest. Future studies are needed to evaluate sensitivity and specificity of FDG-PET scan in diagnosis of malignant lesions in hyperglycemia.Peer reviewe

Investigating CO2streamer inception in repetitive pulsed discharges

In this study, we investigate the responsible species and processes involved in repetitive pulsed streamer inception in CO2. We applied a 10 kV high-voltage (HV) pulse with a repetition frequency of 10 Hz and pulse width of 1 ms to a pin electrode which is placed 160 mm apart from the grounded plane electrode. We measured the inception times by a photo-multiplier tube (delay between the rising edge of the HV pulse and the rising edge of the photo-multiplier waveform) for 600 high voltage cycles. We observed one peak in the histogram of inception times with a median of 1.2 μs. To identify the source of this peak, we applied a negative or positive low-voltage (LV) pulse before the main HV pulse to manipulate the leftover space charges. Three different phenomena are observed: (1) drift, (2) neutralization, and (3) ionization in the LV pulse. At low LV amplitude and pulse width, the peak starts to drift toward the faster and slower inception times under a positive and negative LV pulse, respectively. However, under the same LV pulse configuration for positive and negative LV pulse, the observed shift in inception times is not the same. We present a hypothesis to explain this asymmetry based on the difference of the detachment processes between air and CO2

Experimental investigation on streamer inception from artificial hydrometeors

In this study we use an experimental investigation to shed light on the lightning inception problem. From atmospheric observations, it is known that the electric fields in thunderclouds are significantly lower than required for electric breakdown in air. One theory to explain lightning inception is that hydrometeors, i.e. any liquid or solid water particles formed in the atmosphere, greatly enhance the local electric field and can thereby initiate an electron avalanche leading to a streamer discharge. In this study, we investigate streamer initiation in the presence of artificial particles with different shapes. A metal or dielectric (TiO2) particle is suspended between a high-voltage and a grounded planar electrode which are separated by 16 cm in 50 mbar air. The particles are shaped as ellipsoids with a length of 8, 4, 2, and 1 cm and with different aspect ratios. A negative high voltage pulse is applied with a rise time of 30 ns, a pulse width of 1-10 μs, a repetition rate of 1 Hz, and a maximum voltage between 1 and 50 kV. Results show that the required background electric field for breakdown in the presence of a dielectric particle is decreased to 0.4 times the air breakdown field. Moreover, we observed bipolar streamer development from the particles where negative streamers are thicker and slightly slower than positive streamers. Finally, we found that streamers from longer particles are thicker and faster