Knowledge-Based Deformable Surface Model with Application to Segmentation of Brain Structures in MRI

We have developed a knowledge-based deformable surface for segmentation of medical images. This work has been done in the context of segmentation of hippocampus from brain MRI, due to its challenge and clinical importance. The model has a polyhedral discrete structure and is initialized automatically by analyzing brain MRI sliced by slice, and finding few landmark features at each slice using an expert system. The expert system decides on the presence of the hippocampus and its general location in each slice. The landmarks found are connected together by a triangulation method, to generate a closed initial surface. The surface deforms under defined internal and external force terms thereafter, to generate an accurate and reproducible boundary for the hippocampus. The anterior and posterior (AP) limits of the hippocampus is estimated by automatic analysis of the location of brain stem, and some of the features extracted in the initialization process. These data are combined together with a priori knowledge using Bayes method to estimate a probability density function (pdf) for the length of the structure in sagittal direction. The hippocampus AP limits are found by optimizing this pdf. The model is tested on real clinical data and the results show very good model performance.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/85930/1/Fessler166.pd

Characterization of lung fibroblasts more than two decades after mustard gas exposure

Purpose: In patients with short-term exposure to the sulfur mustard gas, the delayed cellular effects on lungs have not been well understood yet. The lung pathology shows a dominant feature consistent with obliterative bronchiolitis, in which fibroblasts play a central role. This study aims to characterize alterations to lung fibroblasts, at the cellular level, in patients with delayed respiratory complications after short-term exposure to the sulfur mustard gas. Methods: Fibroblasts were isolated from the transbronchial biopsies of patients with documented history of exposure to single high-dose sulfur mustard during 1985-7 and compared with the fibroblasts of control subjects. Results: Compared with controls, patients' fibroblasts were thinner and shorter, and showed a higher population doubling level, migration capacity and number of filopodia. Sulfur mustard decreased the in vitro viability of fibroblasts and increased their sensitivity to induction of apoptosis, but did not change the rate of spontaneous apoptosis. In addition, higher expression of alpha smooth muscle actin showed that the lung's microenvironment in these patients is permissive for myofibroblastic differentiation. Conclusions: These findings suggest that in patients under the study, the delayed pulmonary complications of sulfur mustard should be considered as a unique pathology, which might need a specific management by manipulation of cellular components. © 2015 Pirzad Jahromi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Comparison of the effectiveness and safety of formoterol versus salmeterol in the treatment of patients with asthma: A systematic review and meta-analysis

Background: Formoterol and salmeterol are two long-acting β2-agonists given by inhalation, with bronchodilating eff ects lasting for at least 12 h after a single administration. Formoterol has a faster onset of action compared with salmeterol. Th e aim of this study was to perform a systematic review and meta-analysis on the data published from previous review in order to calculate pooled estimates of eff ectiveness and safety assessment of formoterol and salmeterol in treatment of patients with asthma. Materials and Methods: In this study, we conducted an electronic search for medical citation databases including Cochrane, PubMed, Scopus, PsycInfo, and IranMedex. Besides manual search of the databases that record randomized clinical trials, conference proceedings, and journals related to asthma were included. Studies were evaluated by two independent people based on inclusion and exclusion criteria, and the common outcomes of studies were entered into the RevMan 5.0.1 software, after evaluation of studies and extraction of data from them; and in cases where there were homogeneous studies, meta-analysis was performed, and for heterogeneous studies, the results were reported qualitatively. Results: Of the 1539 studies initially found, 13 were included in the study. According to the meta-analysis conducted, no signifi cant diff erence was found between the inhalation of formoterol 12 μg and salmeterol 50 μg in the two outcomes of mean forced expiratory volume 1 s (FEV1), 12 h after inhalation of medication and Borg score (A frequently used scale for quantifying breathlessness) after inhalation of medication. In addition, salmeterol was more eff ective than formoterol in the two outcomes of percent decrease in FEV1 after inhalation of methacholine and the number of days without an attack. Since the two outcomes of FEV1 30-60 min after inhalation of medication and morning peak expiratory fl ow after inhalation of medication were heterogeneous, they had no meta-analysis capabilities, and its results were reported qualitatively. Conclusion: Th e data from included studies shows that, more effi cacy has been achieved with Salmeterol, especially in some outcomes such as the percent decrease in FEV1 after inhalation of Methacholine, and the number of days without an attack; and therefore, the administration of Salmeterol seems to be benefi cial for patients, compared with Formoterol. © 2015 Journal of Research in Medical Sciences

Increased Expression of Transforming Growth Factor-beta and Receptors in Primary Human Airway Fibroblasts from Chemical Inhalation Patients

The widespread use of sulfur mustard (SM) as a chemical warfare agent in the past century has proved its long-lasting toxic effects. Despite a lot of research over the past decades on Iranian veterans, there are still major gaps in the SM literature. Transforming growth factor (TGF-beta), a cytokine that affects many different cell processes, has an important role in the lungs of patients with some of chronic airway diseases, especially with respect to airway remodeling in mustard lung. Primary airway fibroblasts from epibronchial biopsies were cultured, and gene expression of TGF-beta 1, TGF-beta 2, TbR-I and TbR-II in fibroblasts of SM injured patients and controls were investigated. Expression of TGF-beta s and receptors was measured by RT-PCR. Protein level of TGF-beta 1 was surveyed by western blot. Our findings revealed that expression levels of TGF-beta 1, TGF-beta 2, TbR-I and TbR-II were upregulated in the airway fibroblasts of SM exposed patients in comparison with control samples. TGF-beta 1 expression was shown to be markedly increased in primary lung fibroblasts of chemically injured patients. Our novel data, suggested that over-expression of TGF-beta molecule and receptors in primary airway fibroblasts of mustard gas injured patients may be involved in progression of airway remodeling of these patients

Delayed effects of sulfur mustard on autophagy suppression in chemically-injured lung tissue

Background: Autophagy is an intracellular hemostasis mechanism, responding to extracellular or intracellular stresses. Sulfur mustard (SM) induces cellular stress. Iranian soldiers exposed to SM gas, during the Iraq-Iran war, suffer from delayed complications even 30 years after exposure. In this study, for exploring the SM effect on autophagy pathway, gene and protein expression of autophagy markers are evaluated in the lung of SM-exposed people. Methods: 52 FFPE lung tissues of SM-exposed people and 33 lung paraffin blocks of non-exposed patients to SM were selected. LC3 and Beclin-1 mRNA expressions were evaluated by QRT-PCR. LC3-B protein and LC3II/LC3I proteins ratio were detected by Immunohistochemistry and immunoblotting method. The collected data were analyzed in SPSS, and P value � 0.05 was considered significant. Results: LC3 gene expression in SM-exposed subjects (median CT value = 4.97) increased about 4 fold compared with the control group (median CT value = 0.46, P = 0.025). Beclin-1 mRNA expression had not significant difference between two groups. After adjusting the confounding variables such as drug usage, LC3-B protein (P = 0.041) and LC3II/LC3I ratio (P = 0.044) were found significantly lower in the lung cells of SM-exposed group. Conclusion: Upon exposure to SM gas, the lung cells are affected by acute cellular stress such as oxidative stress. The study results show that LC3 mRNA level increases in these patients, but, surprisingly, LC3-B protein via unknown mechanism has been down-regulated. N-acetyl cysteine and salbutamol drugs could induce the autophagy, and help to reduce the SM effects and improve the clinical condition of SM-injured patients. © 2019 Elsevier B.V

Determination of characteristics of erythromycin resistant Streptococcus pneumoniae with preferred PCV usage in Iran

Amongst 100 Streptococcus pneumoniae isolated from clinical cases and nasopharynx of healthy individuals, 60 erythromycin resistant strains were isolated and characterized using MLST, PFGE, transposon analysis and Quellung reaction. Most of the S. pneumoniae erythromycin resistant (80) were found to be attributable to the ermB-edncoded ribosome methylase activity which differs from the dominant mechanism of macrolide resistance seen in North America. The most predominant transposons were; Tn 1545/6003(27), Tn6002 (22), Tn2009 (20), Tn2010 (17). Number of the clinical isolates carrying Tn2010 was more significant than the normal flora. The serotypes found were; 14 (33), 3 (22), 23F (15), 19F (15), 19A (7), 6A (3), 9V (3) and 6B (2). The most prevalent serotypes among the clinical (n = 28) and normal flora (n = 32) isolates were serotypes 14 (46) and 3 (31), respectively. The most prevalent vaccine serotypes amongst the clinical isolates and the healthy individuals were pneumococcal conjugate vaccines (PCV) 13 and PCV10, respectively. PFGE revealed 34 pulsotypes with 9 common and 25 single types. Significant number of the normal isolates belonged to CT5 and CT6. On the other hand, significant number of clinical isolates belonged to CT8 as compared to the normal flora isolates. MLST showed 2 dominant sequence types. ST3130 (23) and ST180 (22) were the most predominant sequence types in the clinical and normal isolates, respectively. There was no significant difference in other sequence types between clinical and normal flora isolates. Three polyclonal complexes including Sweden15A -25, Spain23F-1 and Spain9V-3 constituted 58 of the isolates. Our results suggest that the genetic diversity and transposon distribution were high among S. pneumoniae, particularly in the isolates containing erm(B) and double antibiotic resistant genes (erm/mef). The results presented here could influence the change in the current vaccination practices in Iran which currently calls for vaccination with PCV7 or PCV10. � 2016 Talebi et al.This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Angiotensin-converting enzyme genotype and late respiratory complications of mustard gas exposure

<p>Abstract</p> <p>Background</p> <p>Exposure to mustard gas frequently results in long-term respiratory complications. However the factors which drive the development and progression of these complications remain unclear. The Renin Angiotensin System (RAS) has been implicated in lung inflammatory and fibrotic responses. Genetic variation within the gene coding for the Angiotensin Converting Enzyme (ACE), specifically the Insertion/Deletion polymorphism (I/D), is associated with variable levels of ACE and with the severity of several acute and chronic respiratory diseases. We hypothesized that the ACE genotype might influence the severity of late respiratory complications of mustard gas exposure.</p> <p>Methods</p> <p>208 Kurdish patients who had suffered high exposure to mustard gas, as defined by cutaneous lesions at initial assessment, in Sardasht, Iran on June 29 1987, underwent clinical examination, spirometric evaluation and ACE Insertion/Deletion genotyping in September 2005.</p> <p>Results</p> <p>ACE genotype was determined in 207 subjects. As a continuous variable, FEV₁% predicted tended to be higher in association with the D allele 68.03 ± 20.5%, 69.4 ± 21.4% and 74.8 ± 20.1% for II, ID and DD genotypes respectively. Median FEV₁% predicted was 73 and this was taken as a cut off between groups defined as having better or worse lung function. The ACE DD genotype was overrepresented in the better spirometry group (Chi²4.9 p = 0.03). Increasing age at the time of exposure was associated with reduced FEV₁%predicted (p = 0.001), whereas gender was not (p = 0.43).</p> <p>Conclusion</p> <p>The ACE D allele is associated with higher FEV₁% predicted when assessed 18 years after high exposure to mustard gas.</p

The risk factors and related hospitalizations for cases with positive and negative COVID-19 tests: A case-control study

Background: The aim of this study was to evaluate the risk factors for hospitalizations of cases with positive and negative COVID-19 tests. Methods: In this case-control study, the case and control groups consisted of 292 COVID-19 patients and 296 non-COVID-19 patients. Patients who referred to a reference laboratory in Tehran (Iran) in March 2020 were selected and interviewed. The patients were contacted by telephone and data were recorded through a questionnaire. Results: The sample of this study consisted of 588 patients (349 59% females, 239 41% males) with a mean age of 42 ± 15. The results of this study showed that comorbidities like diabetes (OR = 7.42), hypertension (OR = 4.85), asthma and respiratory diseases (OR = 5.64) in addition to symptoms including fever (OR = 6.67), chills (OR = 11.2), anorexia (OR = 11.3), dyspnea (OR = 4.8), weakness and lethargy (OR = 5.7) were the most predictive variables for hospitalization of non-COVID-19 cases. Furthermore, demographical variables like male gender (OR = 3.71), high age (>50; OR = 3.12), BMI (>25; OR = 2.37), travel (OR = 2.79), comorbidities including diabetes (OR = 5.26), hypertension (OR = 3.7) and underlying immunosuppressant patients receiving corticosteroid therapy (OR = 3.62) in addition to symptoms like anorexia OR = 2.55 and dyspnea (OR = 6.99) tend to increase the risk of hospital admission in COVID-19 patients, suggesting their predictive values for hospitalization of COVID-19 patients. Conclusion: Our results indicated that different factors tend to increase the odds of hospital admission in patients with positive and negative COVID-19 tests, suggesting their predictive values for hospitalization. © 202

Long-term Health Outcomes Among Survivors Exposed to Sulfur Mustard in Iran

Importance: The prevalence and severity of long-term health complications after exposure to sulfur mustard are unknown. Objective: To investigate the long-term health outcomes among survivors exposed to sulfur mustard during the Iran-Iraq War. Design, Setting, and Participants: In this retrospective cohort study, late-onset health complications of 64�190 Iranian survivors exposed to sulfur mustard during the Iran-Iraq War from 1980 to 1988 were investigated using descriptive statistics. Data involving affected organs and symptom severity were extracted from the Veterans and Martyr Affair Foundation (VMAF) database from 1980 to 2019. Assessments were conducted across 3 groups depending on whether survivors were (1) evacuated and admitted (EA) to a hospital; (2) not evacuated or admitted (NEA) to a hospital; or (3) evacuation or admission status was not documented. Exposures: Analysis of chronic symptom severity following exposure to sulfur mustard. Main Outcomes and Measures: Mild, moderate, or severe rankings of symptoms in lungs, eyes, and skin of survivors exposed to sulfur mustard using data from the VMAF database. Results: Of 64�190 chemical survivors registered in the VMAF database, 60�861 met the inclusion criteria. Of the included survivors, 98.0 were male, and the mean (SD) age was 23.5 (7.7) years. Most survivors (53�675 88.2%) had no symptoms or mild lesions, and 7186 survivors (11.8%) had moderate or severe complications. Moderate to severe lung (6540 10.7%), eye (335 0.6%), or skin (725 1.2%) injuries were documented in the exposed population. The proportion of moderate plus severe late complications in eyes was 3 times as high in male survivors compared with female survivors (0.6% 95% CI, 0.53%-0.65% vs 0.2% 95% CI, 0.09%-0.73%; P�<�.001), whereas dermal complications were significantly more common in female survivors (3.9% 95% CI, 2.92%-5.11% vs 1.14% 95% CI, 1.06%-1.23%; P�<�.001). Mild lung lesions were more prevalent in the NEA group than in the EA group (73.9% 95% CI, 73.4%-74.4% vs 11.0% 95% CI, 10.6%-11.3%; P�<�.001). In the NEA group, 83.2% (n�=�23�866) developed lung injuries that were mostly mild or moderate, whereas 77% (n�=�24�766) of the EA group did not develop lung injuries (P�<�.001). Conclusions and Relevance: The present study found sex differences in the frequencies of eye and skin complications following sulfur mustard exposure, and lung complications were more prevalent years after sulfur mustard exposure than soon after exposure. Mild lung lesions were observed more frequently among sulfur mustard-exposed survivors who had not been evacuated or hospitalized than among those who had been evacuated or hospitalized. These differences may be due to physiological response or dose of exposure. Close monitoring over an extended period may be required for detection of late pulmonary complications in individuals exposed to sulfur mustard

Breeding and reproduction of grey mullet (Mugil cephalus L.)

Mazandaran and Gorgan provinces have temperate climate, thus they have more potential for aquatic animal culture. There are thousands hectare of salt and useless lands in adjacent to Caspian Sea. As these areas have provided a favorable back ground for aquatic animal culture. As a result, the successful results obtained from imported gray mullet (Mugil cephalus) culture project in north climate, it has demonstrated that the gray mullet has a good biocharacteristic for culturing in pond enclosure environment and in different aquatic conditions (fresh water, brackish water and salt water). From 1998 until 2001, the broodstock yield and gray mullet artificial propagation projects were performed by fisheries research center of Mazandaran in Ghomishan prawn culture station in adjacent to Caspian Sea (East north of Mazandaran Province). This investigation executed during two stages (phases). At first stage, the goal of this project included the survey of possibility available about matured fish as well as induction of final maturation and artificial propagation for producing of broodstock and larva. In addition, in this way, we will obtain new information about gray mullet propagation and culture as marine species. We introduce mass production in aquaculture. At present research, the possibility of broodstock yield and artificial propagation of gray mullet have investigated by gray mullet fingerlings imported from Hong kong and then they have cultured in earth ponds of Ghomishan areas during five years (1994-1998). In order to broodstock production in spring 1998, two earth ponds (0.5 hectare) were prepared. 100 specimens of fish stock (1-2.5 kg weight average and 5 years of age) placed in each pond. For providing of suitable water and nutrition, fish were fed by food containing rich protein (40%) with 3-5% body weight and maintained in water with 30-35 ppt salinity. The survey of sexual maturation was performed by sampling of sexual glands through year. There were four stages in dominant female broodstocks. This survey indicated that oocytes have emerged stage 1 (immature) from March to June, stage 2 (yolk vesicle) in September and stage 4 (yolk globule) in October. Three stages (first, second and third) of yolk formation in oocytes will occur but these stages take place in October, December and January respectively. It's obvious that oocytes will progress into the end of third stage (yolk formation) and then their growth was arrested. Ovum with 600 m diameter was observed when the water temperature declined less than 18 c and day time was short (from middle autumn to middle winter), on that time, fish were induced by hormone because lack of final maturation and ovulation, therefore, natural spawning was not occurred in pond condition. Furthermore, artificial propagation of mugil cephalus was occurred by hormonal induction. Hormonal induction was utilized by inject of many hormones (LHRH, Cph, HCG). Using different components of hormones and also their different doses obtained the best results from broodstock that the average ovum diameter was about 600 m. Several types hormones which were injected into gray mullet with two or several intermittent (24 h intervals) along with 20-25 c temperature and 30-35 ppt salinity. This condition can provide stage 4 maturity for fertilization. Totally (as whole), three intermittent fertilization was necessary for exiting of larva, larva production in first, second and third intermittents that were 2000, 2500 and 300 specimens respectively. Larva fed on chlorella algae and rotifera and they have maintained for 14-15 days. The results of obtainable research indicated the possibility of gray mullet broodstock production in cultural condition, artificial propagation and larva production. This research took place for the first time in north climate of Iran