Quality of life in patients with advanced gastric cancer: a randomized trial comparing docetaxel, cisplatin, 5-FU (TCF) with epirubicin, cisplatin, 5-FU (ECF)

BACKGROUND: Health related quality of life (HRQOL) is an important outcome after treatment for upper gastrointestinal carcinoma. This study aimed to compare HRQOL in patients with advanced gastric cancer (GC) receiving either a standard or an experimental treatment. METHODS: Seventy-one patients have been treated in Cancer Institute (Tehran, Iran) with docetaxel, cisplatin, 5 FU (TCF) or epirubicin, cisplatin, 5-FU (ECF) and were followed from Jan 2002 to Jan 2005. End points were response rate, HRQOL and survival. HRQOL was assessed using the EORCT QLQ-C30 at baseline and after the third cycle of chemotherapy. RESULTS: The baseline HRQOL scores were comparable between two groups. After treatment improvement was seen in a number of items and domains except for cognitive functioning, and diarrhoea. Pain decreased and physical functioning improved in both groups. However, only the TCF group showed statistically and clinically meaningful improvement in global QOL (P = 0.001). Surgical and pathologic response was better with TCF but there was no difference in survival rate between two groups. CONCLUSION: Docetaxel based treatment (TCF) showed better palliation and improvement of global QOL as compared with epirubicin based treatment (ECF). However, it seems that regardless of treatment offered, effective chemotherapy was the most important factor affecting QOL in these patients

Features of Three- and Four-Part Proximal Humeral Fractures and Outcome of Internal Fixation Using the Philos® Locking Plate

Background: Proximal humeral fractures are among common types of fractures and remain a challenging issue for surgical management. This study aimed to assess the clinical outcomes and complication rates of three- vs. four-part proximal humeral fractures, treated with internal fixation using the Philos® plate.Material and Methods: In this cohort study, a total of 30 consecutive patients with three-part or four-part proximal humeral fractures based on the Neer classification were included. Surgical treatment was performed with open reduction and internal fixation using the Philos® plate. The constant score was evaluated 6 months later in follow-up. The P<0.05 was considered significant.Results: Four-part fractures were mainly caused by trauma from above, while insults of opposite direction were responsible for more than half of 3 part fractures (P=0.01). Open fractures were only observed in patients with a four-part fracture (P=0.018). No significant differences were noticed regarding gender, cause, and side of the fracture.The presence of other fractures, fracture of the implant, reduction loss, avascular necrosis (AVN) of humerus head, rotator cuff injury, and revision surgery were significantly higher in patients with four-part fractures.The mean constant score was 81.40±11.61 and 65.09±16.09 for three-part and four-part fractures, respectively (P=0.006).Conclusion: Open reduction and internal fixation with Philos® plate yield acceptable results in both types of fractures, however, the prognosis of this intervention is poorer four-part fractures

Quality of life in patients with gastric cancer: translation and psychometric evaluation of the Iranian version of EORTC QLQ-STO22

<p>Abstract</p> <p>Background</p> <p>Disease and treatment related events, can adversely affect the quality of life of patients with cancer. The purpose of this study was to translate and validate a gastric cancer specific health related quality of life questionnaire (EORTC QLQ-STO22) for Iranian patients suffering from gastric cancer.</p> <p>Methods</p> <p>Forward-backward procedure was applied to translate the English language version of the EORTC QLQ-STO22 into Persian (Iranian language). Then, the questionnaire and the EORTC core quality of life instrument (QLQ-C30) were administered to a sample of patients with confirmed diagnosis of gastric cancer. All patients filled in questionnaires before and after one month of treatment. Patients were divided into two groups based on intension of treatment (curative vs. palliative). Reliability and validity of the module was tested by internal consistency and known group comparisons, respectively.</p> <p>Results</p> <p>In all, 105 patients were entered into the study. Cronbach's alpha for multi-item scales (to test reliability) ranged from 0.54 to 0.87. The questionnaire discriminated well between clinically distinct subgroups of patients both before and after treatment lending support to its convergent and clinical validity.</p> <p>Conclusion</p> <p>Overall, the Iranian version of the EORTC QLQ-STO22 demonstrated a good reliability and clinical validity to support its use in combination with core questionnaire in outcome studies of gastric cancer in Iran. However, using the QLQ-STO22 in a wide range of Iranian patients with gastric cancer should allow further confirmation for its psychometric properties.</p

Risk Factors in Various Climates of Wheat Production in Western Iran: Experts’ Opinions

Agriculture is the origin of existence and survival in any society. However, this sector is always associated with risk and uncertainty, and farmers are faced with many challenges. Therefore, the main aim of this research was to explore the (production) risk factors of irrigated wheat production systems among farmers in Kermanshah province, Iran. The exploratory nature of this study on the one hand and the need for expert judgment on the other hand necessitated a Delphi research design. Thus, this study utilized a three-round Delphi technique. The population comprised of 10 subject-matter experts (SME) and 32 agricultural extension experts in two climates (warm and semi-arid and cold and moderate) in seven counties in Kermanshah province. A purposeful (complete) sample of 42 experts in the agricultural field participated in this study. Data were collected using a questionnaire designed on the basis of the Delphi technique. The findings indicated that, after three rounds of Delphi technique, the panel members reached a consensus on 75 factors which were categorized into biological, natural, managerial, and technological-structural groups for production risk. The results of this research provide useful insights for researchers, extension agents, and farmers

Comparison of the Effect of Financial Integration on Economic Growth of Developed and Developing Countries: Empirical Evidence from Generalized Method of Moments

The wide range of impact has transformed economic growth into one the most important key variables in macroeconomic theories. In this survey, according to the hypothesis and empirical results of Grilli & Feretti (1995), the effect of financial integration on the growth of selected developed and developing countries during (2000-2010) has been examined.For this aim, panel data based on generalized method of moments (GMM) is used to examine the model. This survey showed that the effect of financial integration (net foreign assets as a measure of financial integration) on economic growth in two groups of surveyed countries is not the same. Based on the results of this survey, the financial integration in the selected countries of the Organization for Economic Cooperation and Development (OECD) has a positive effect and in the selected countries of the Middle East and North Africa has a negative effect on economic growth. Therefore, it seems that the level of financial market development and the degree of homogeneity of these markets between countries play a decisive role in the impact of financial integration on economic growth

Promoting Teacher Professional Development: the Role of Individual and Contextual Factors

The purpose of this study was to investigate the individual and contextual factors conducive to teacher professional development. The study which aimed at identifying the predictors of teacher development consisted of in-depth interviews with 15 teachers. Data gleaned from in-depth interviews were analyzed utilizing content analysis. Some common themes that emerged from the qualitative data included (a) learning goal orientation (b) teacher self-efficacy, (c) professional commitment (d) organizational climate, and (e) learning organization culture.  Theoretical and practical implications of the study are discussed.

Rethinking Professional Development in Iran: Embracing Lifelong Learning

The central role of teachers in enhancing education quality and promoting education reform has been largely acknowledged by various researchers. However, professional development (PD) in Iran is far from satisfactory. This paper initially outlines major shifts in professional development. It then provides a critical appraisal of professional development in Iran in both pre service and in service education. Finally, it concludes by offering ways to revitalize continuing teacher professional development.

Association between JMJD1A Expression and Sperm Retrieval in Non-Obstructive Azoospermic Patients

Identification of molecular markers which can predict the outcome of sperm retrieval non-invasively in patients with non-obstructive azoospermia (NOA) are valuable in clinical andrology. Jumonji domain-containing 1a (JMJD1A) is a significant epigenetic regulator during spermatogenesis, which plays an important role in the differentiation of post-meiotic germ cells into mature spermatozoa. We therefore aimed to examine the potential association between JMJD1A expression and the outcome of sperm retrieval in patients with NOA. Testicular biopsy specimens from 50 NOA patients with either successful sperm retrieval (sperm+, n=22) or failed sperm retrieval (sperm-, n=28) were collected and then examined for JMJD1A expression by reverse transcription-quantitative polymerase chain reaction (RT-qPCR). In addition, conventional clinical parameters including luteinizing hormone, follicle-stimulating hormone, testosterone, age, and testicular volume were compared between the two NOA groups. The expression of JMJD1A in the sperm+ group was significantly higher than in the sperm- group (P<0.001), however, no significant difference was observed between the two groups in clinical parameters. The receiver operating characteristic (ROC) curve of JMJD1A expression in predicting the sperm retrieval outcome showed a sensitivity of 90.91% and a specificity of 89.29% with significant discriminatory ability between the sperm+ and sperm- groups [area under the ROC curve (AUC)= 0.91]. This study demonstrates a significant association between the expression of JMJD1A and the success of sperm recovery in patients with NOA, and thus suggests that JMJD1A expression quantification in testicular biopsies may be a valuable biomarker along with conventional parameters in predicting the presence of spermatozoa

Primary Right Atrial Sarcoma Presenting with Cardiac Tamponade and Massive Pleural Effusion

Primary cardiac sarcomas are very rare and there is no consensus on management. Clinical presentation is usually late. Despite newer diagnostic technology, prognosis remains dismal. We report a case of right atrial sarcoma in a 28-year-old man who presented with acute cardiac tamponade. Emergency subxiphoid pericardial drainage stabilized the patient's critical condition. The lesion was advanced. Therefore, we only performed a suboptimal surgical resection. Despite planning for radiation, the patient's status deteriorated. Only palliative measures continued during the next four months before his death due to disseminated metastasis and progressive cardiopulmonary failure