Does Bromelain-Cisplatin Combination Afford In-Vitro Synergistic Anticancer Effects on Human Prostatic Carcinoma Cell Line, PC3?

Background: Bromclain enhances anticancer impacts to chemotherapeutic agents. The question as to whether bromelain does promote in-vitro cytotoxic and proapoptotic effects of cisplatin on human prostatic carcinoma PC3 cell line was investigated. Materials and Methods: PC3 (human prostatic carcinoma) cells were treated either single or in combination with bromelain and/or cisplatin. MTT, clonogenic assay, flow cytometry and real-time quantitative polymerase chain reaction were used to investigate cell viability, colony formation, proapoptotic potential and p53 gene expression, respectively. Results: Cisplatin (IC10) combined with bromelain (IC40) significantly affected PC3 cell viability, inhibited colony formation, as well increased p5.3 proapoptotic gene expression compared to cisplatin single treatment. Nevertheless, bromelain-cisplatin chemoherbal combination did not display any additive proapoptotic effect compared to single treatments. Conclusion: Bromelain-cisplatin chemoherbal combination demonstrated synergistic in-vitro anticancer effect on human prostatic carcinoma cell line, PC3, that drastically reduced required cisplatin dose. Keywords:PC3 Cells; Bromelain; Cisplatin; Synergistic Effect; Clonogenic Cell Assay; p53 Gen

The Rationality to Requesting in-ward Magnetic Resonance Imaging Investigation

Background: Magnetic Resonance imaging (MRI) is a valuable diagnostic tool by its non-invasive/non-ionizing nature.Objective: This study aims to determine justification of MRI in hospitalized patients at a tertiary provincial referent medical center in a one-year period.Material and Methods: In the present retrospective and descriptive cross-sectional study, 438 admitted patients referred for MRI during 2017 were selected using systematic random sampling. The age, gender, investigated organ, the specialty of requesting physician, MRI with and without contrast, MRI diagnostic outcome were collected using checklists. Descriptive statistics and chi-square test were used for data analysis.Results: The mean age of the patients was 42±26 years-old and female represented 53% of enrolled patients. The most and less prevalent investigated organs were the cerebrum and the orbit. After excluding cancer diagnosis, cancer staging, and therapeutic follow-up exams, MRI request was oriented in 64.3% and 77.2% of positive results was concordant with aforementioned diagnostic orientation (P<0.001). Oriented diagnostic MRI requesting is influenced by age, medical specialists and, investigated organ (P<0.001). The positive MRI is influenced significantly by oriented MRI request, gender, medical specialists and investigated organ (P<0.001). The diagnosis concordance of MRI is influenced significantly by oriented MRI request, medical specialists and investigated organ (P<0.001). Conclusion: Appropriate implementation of medical imaging requires boosting employed rationality by the concerned physicians. The current suboptimal results to requesting MRI rationality should mandate supplementary educational programs as to incite the medical corpus more closely implementing the published medical practice guidelines

Bromelain-based chemo-herbal combination effect on human cancer cells: in-vitro study on AGS and MCF7 proliferation and apoptosis

Aim. Chemo-herbal combinations promise new clinical anticancer therapeutic modalities. The current study investigated and compared the in vitro effects of a bromelain-based chemo-herbal combination to/with cisplatin or 5-FU, with regard to the proliferation and apoptosis of human gastric AGS and breast MCF7 cell lines. Material and methods. AGS and MCF7 cells were either treated with different concentrations of bromelain, cisplatin or 5-FU; or with bromelain-cisplatin and bromelain-5-FU combinations for 48h. Cell proliferative inhibition and inductive apoptosis were appraised using MTT assay and flowcytometry, respectively. Kruskal-Wallis and Dunn's tests were used to analyze differences in cell groups' means. Results. AGS proliferation was adversely affected by single treatments of bromelain and cisplatin (p<0.003) or 5-FU (p<0.05). The anti-proliferative impact of single treatments was more pronounced on MCF7 cells. The bromelain-cisplatin combinations displayed synergistic effect on MCF7 cells (CIs <= 1), while being additive or antagonistic with cisplatin IC30 and IC40 to AGS cell proliferation, respectively. In addition, bromelian-5-FU combinations showed synergistic effect on AGS cells, while antagonistic to MCF7 cells. In terms of cell apoptosis induction, bromelain (IC30)-cisplatin (IC20) displayed additive effect on MCF7, compared to cisplatin single treatment (p<0.04), while bromelain (IC40)-5-FU (IC10) and bromelain (IC30)-5-FU (IC20) afforded additive apoptotic effects on AGS (p<0.04) and MCF7 (p<0.05), respectively, in comparison to 5-FU single treatment. Conclusion. A bromelain-based combination using cisplatin showed concordant effects on cell proliferation impediment and apoptotic induction on MCF7, while the same results were noticed with a bromelain-5-FU combination to AGS cells. The bromelain-based chemo-herbal pathways should further be investigated in the frame of multi-chemotherapeutic drugs researches. Keywords:AGS cells; Bromelain; Cisplatin; 5-FU; MCF7 cell

The Risk Factors of Prolonged Mechanical Ventilation after Isolated Coronary Artery Bypass Graft Surgery

Background: Failure to wean a patient from mechanical ventilation after cardiac surgery is associatedwith poor outcome.Aim: The present study was performed aimed to investigate the risk factors of prolonged mechanicalventilation (PMV) following isolated coronary artery bypass graft (CABG) surgery.Method: This retrospective cohort study was performed on 2155 consecutive adult patientsundergoing isolated coronary artery bypass graft surgery (May 2012 to November 2016 at Imam Rezahospital, Mashhad, Iran). The subjects were assessed for duration of weaning from mechanicalventilation, predictive risk factors for prolonged mechanical ventilation and associated outcomesincluding intensive care unit (ICU) and hospital length of stay (LOS), and mortality. Data wereanalyzed by SPSS (version 22). P<0.05 was considered statistically significant.Results: The median (25 -75 percentile) duration of mechanical ventilation was 360 (225-540)minutes. Also, 51.20%, 45.80% and 2.30% patients were weaned from mechanical ventilation in lessthan 6 hours, 7 to 24 hours, and more than 24 hours, respectively. Cerebral vascular accident was themost common cause of PMV (34.04%). After adjustment for confounder variables, on-pump CABG(P<0.05), duration of surgery (P<0.01), preoperative renal failure (P<0.05) and New York HeartAssociation (NYHA) class 4 were associated with PMV (P <0.05). PMV was associated withincreased length of ICU and hospital stay (P<0.01). There was a higher mortality rates in patients withPMV (P<0.001).Implications for Practice: Most patients are weaned from mechanical ventilation within 24 hoursuneventfully after isolated CABG. Furthermore, on-pump CABG, prolonged surgery, preoperativerenal insufficiency, and NYHA class 4 were independent predictors of prolonged mechanicalventilation. Identifying the risk factors causing PMV can prevent its adverse consequences

The impact to demographic and academic factors on metacognition and academic self-efficacy: A study on Iranian students in health sciences

BACKGROUND: Metacognition and academic self-efficacy are two emerging resources in the process of learning. Basic levels of metacognition and academic self-efficacy may differ and be influenced by demographic and academic factors. This study investigated impacts of demographic and academic factors on metacognition, metacognitive skills, and academic self-efficacy in health sciences students. MATERIALS AND METHODS: A cross-sectional study was conducted among 404 participating students attending various fields of study in health sciences at Shahrekord University of Medical Sciences. Demographic and academic data were collected. Global metacognition, metacognitive skills, and academic self-efficacy scores were assessed using published or online questionnaires. Means were compared using Student's t-test, whereas intra-and intergroups' scores were compared using one-way ANOVA test. RESULTS: Global metacognition and academic self-efficacy were not impacted by demographic students' status. The gender and age impacted both knowledge and control of process-planning (favoring male gender), as well knowledge and control-of-self (disfavoring 20-30 age class) of metacognitive skills, (P < 0.05). Academic status did not influence academic self-efficacy. The school type influenced the metacognitive skill component to knowledge and control of process-regulation (disfavoring nursing school) (P < 0.05). The academic discipline impacted the global metacognition (P < 0.05) and its knowledge and control of self-component (P < 0.01). CONCLUSIONS: Demographic and academic status does impact metacognitive skills and global metacognition scores. Given the heterogeneous level to innate metacognitive skills, this study sheds lights on usefulness to screen learners' subgroups that require supplementary educational instructions to uniformly optimize metacognitive skills

Bromelain-based chemo-herbal combination effect on human cancer cells: in-vitro study on AGS and MCF7 proliferation and apoptosis

Aim. Chemo-herbal combinations promise new clinical anticancer therapeutic modalities. The current study investigated and compared the in vitro effects of a bromelain-based chemo-herbal combination to/with cisplatin or 5-FU, with regard to the proliferation and apoptosis of human gastric AGS and breast MCF7 cell lines

External Validation of European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) for Risk Prioritization in an Iranian Population

Abstract Introduction: The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is a prediction model which maps 18 predictors to a 30-day post-operative risk of death concentrating on accurate stratification of candidate patients for cardiac surgery. Objective: The objective of this study was to determine the performance of the EuroSCORE II risk-analysis predictions among patients who underwent heart surgeries in one area of Iran. Methods: A retrospective cohort study was conducted to collect the required variables for all consecutive patients who underwent heart surgeries at Emam Reza hospital, Northeast Iran between 2014 and 2015. Univariate and multivariate analysis were performed to identify covariates which significantly contribute to higher EuroSCORE II in our population. External validation was performed by comparing the real and expected mortality using area under the receiver operating characteristic curve (AUC) for discrimination assessment. Also, Brier Score and Hosmer-Lemeshow goodness-of-fit test were used to show the overall performance and calibration level, respectively. Results: Two thousand five hundred eight one (59.6% males) were included. The observed mortality rate was 3.3%, but EuroSCORE II had a prediction of 4.7%. Although the overall performance was acceptable (Brier score=0.047), the model showed poor discriminatory power by AUC=0.667 (sensitivity=61.90, and specificity=66.24) and calibration (Hosmer-Lemeshow test, P<0.01). Conclusion: Our study showed that the EuroSCORE II discrimination power is less than optimal for outcome prediction and less accurate for resource allocation programs. It highlights the need for recalibration of this risk stratification tool aiming to improve post cardiac surgery outcome predictions in Iran

External Validation of European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) for Risk Prioritization in an Iranian Population

<div><p>Abstract Introduction: The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is a prediction model which maps 18 predictors to a 30-day post-operative risk of death concentrating on accurate stratification of candidate patients for cardiac surgery. Objective: The objective of this study was to determine the performance of the EuroSCORE II risk-analysis predictions among patients who underwent heart surgeries in one area of Iran. Methods: A retrospective cohort study was conducted to collect the required variables for all consecutive patients who underwent heart surgeries at Emam Reza hospital, Northeast Iran between 2014 and 2015. Univariate and multivariate analysis were performed to identify covariates which significantly contribute to higher EuroSCORE II in our population. External validation was performed by comparing the real and expected mortality using area under the receiver operating characteristic curve (AUC) for discrimination assessment. Also, Brier Score and Hosmer-Lemeshow goodness-of-fit test were used to show the overall performance and calibration level, respectively. Results: Two thousand five hundred eight one (59.6% males) were included. The observed mortality rate was 3.3%, but EuroSCORE II had a prediction of 4.7%. Although the overall performance was acceptable (Brier score=0.047), the model showed poor discriminatory power by AUC=0.667 (sensitivity=61.90, and specificity=66.24) and calibration (Hosmer-Lemeshow test, P<0.01). Conclusion: Our study showed that the EuroSCORE II discrimination power is less than optimal for outcome prediction and less accurate for resource allocation programs. It highlights the need for recalibration of this risk stratification tool aiming to improve post cardiac surgery outcome predictions in Iran.</p></div

Risk Factors and Outcome of Acute Kidney Injury after Isolated CABG Surgery: a Prospective Cohort Study

Abstract Background: Acute kidney injury (AKI) is a frequent event after cardiac surgery with increased mortality and morbidity. We explored frequency, risk factors, and associated morbidity and mortality of AKI after isolated coronary artery bypass grafting (CABG) surgery at a single institution. Methods: All consecutive adults undergoing CABG surgery from March 2013 to October 2016 were assessed for development and severity of AKI based on Acute Kidney Injury Network (AKIN) criteria. The patients were also investigated regarding their need for renal replacement therapy (RRT), predictive risk factors, and associated outcomes, including duration of mechanical ventilation, mortality, intensive care unit (ICU) and hospital length of stay. Results: Of 1737 patients in the study, 275 (15.8%) developed AKI. Twenty-five (12.8%) cases required RRT. Patients with AKI had longer ventilation time, ICU and hospital length of stay (P<0.001). Mortality rates were 28 (10.2%) and 22 (1.5%) in patients with and without AKI, respectively (P<0.001). There was a strong association between advanced age (aOR=1.016, 95% CI=1.002-1.030, P=0.028), diabetes (aOR=1.36, 95% CI=1.022-1.809, P=0.035), on-pump surgery (aOR=2.63, 95% CI=1.543-4.483, P<0.001), transfusion of more than 1 unit of red blood cells (aOR=2.154, 95% CI=1.237-3.753, P=0.007), and prolonged mechanical ventilation and development of AKI (aOR=2.697, 95% CI=1.02407.071, P<0.001). AKI was seen less frequently in those with opium abuse (aOR=0.613, 95% CI=0.409-0.921, P=0.018). Conclusion: We demonstrated that advanced age, diabetes, on-pump surgery, red blood cell transfusion, and prolonged mechanical ventilation were independent positive risk factors for the development of AKI after isolated CABG while opium abuse was a protective factor