Erythropoietin in the clinical trials of the cardiac disease, what is and what is not

Erythropoietin (Epo) is the main erythropoiesis hormone, activate the progenitor red blood cells through proliferation, differentiation and maturation of red blood cells. However, it's another receptor in other tissues, including heart and endothelium, confirm its pluripotent activities. A numerous preclinical studies have shown Epo would be cardioprotective against ischemic events, reperfusion injury and apoptosis. The results of Epo in clinical studies were inconclusive with even associated increased risk of adverse outcomes. In this article, a comprehensive review of the Epo effects is evaluated in the coronary artery disease, cardiac surgery, heart failure and its safety through the results of the most recent clinical trials related to Epo in the cardiovascular disease. The analysis of the available clinical trials demonstrates the most determining factors; Epo dose and administration time related to myocardial ischemia onset. It seems the low dose Epo treatment has tissue protective effect through its receptors, while the higher doses of Epo stimulates the other Epo receptors responsible for erythropoiesis. The safety of high dose Epo therapy to increase risk of thrombotic complications has been controversial. The erythropoiesis-stimulating agents have been proven to successfully correct hemoglobin levels, reduce the need to blood products after surgery and can improve the clinical outcomes, without an increased thromboembolic risk

Increased Demand for Blood Transfusion in Cardiac Surgery: Simple but Unsolved Common Problem

Background: Despite the general concern about the safety of blood transfusion and mounting evidence exist for more restrictive practice; there is no national consensus guideline and uniformity of institutions for blood transfusion associated with coronary artery bypass graft surgery in Iran. The aim of this study is an assessment of current transfusion practice and compares it with one decade ago.Method: The authors retrospectively analyzed the data of all patients undergoing elective surgery (first time operation) during one year, in two different decade interval (2003 and 2015) in a tertiary heart center.Results: A total of 801 patients were evaluated and compared (n=249 in 2015, n=552 in 2003). There is a significant increase in use of blood transfusion in both operating room and at ICU than the last decade (60.6% vs. 42.4%, P<0.001, and 54.4% vs. 39.9%, P <0.001, respectively). The incidence of preoperative anemia was four times higher in patients who received transfusion, compared to those who did not, in both groups. With compared to the past, the patients are older, have less preoperative hematocrit, more diabetic, more need to intra-aortic balloon pump, shorter operation time, and less postoperative bleeding .Conclusion: With advanced knowledge about transfusion complications and conservative approach to transfusion practice, the need to blood transfusion is increased in current cardiac operations in our center, due to association of more co-morbidities

Risky Decision Making and Impulsivity in Adolescents’ Chess Players: Does Chess Modify or Induce Risky Decisions?

Background: Our main goal in this study was to evaluate impulsivity and risky decision making in adolescents’ intermediate-expert chess players and compare them with non-players. We also looked at the relationship between impulsivity and risky decision making in the two groups. Method: The present study employed a comparative-correlational method which was performed in 2019 in Tehran. Based on the previous research, 55 chess players (14-17 years old) and 79 non-players (13-17 years old) participated in the study. Impulsivity was measured by the Go/no-go task; and risky decision making was assessed via the Iowa Gambling Task (IGT). Independent t-test and Pearson Correlation Coefficient were used for statistical analysis. Results: There were no significant differences between groups regarding age or education. In the go/no go tasks, there were significant differences between the groups in commission error, omission error and inhibition subscales. In the IGT, we observed significant differences between the groups in the net score, raw score and ratio of advantageous/disadvantageous choices in different subscales. In both groups, net scores, raw scores and ratio of advantageous/disadvantageous choices were negatively correlated with the commission error. Additionally, omission error was positively correlated with the inhibition subscale. We found that the relationship between impulsivity and risky decision making was stronger in non-chess players than chess players. Conclusion: The results of this study might put chess in the spotlight as an option to improve impulsivity and risky decision making in clinical settings

Mitral Valve Surgery in Patients with Systemic Lupus Erythematosus

Valvular heart disease is the common cardiac manifestation of systemic lupus erythematosus (SLE) with a tendency for mitral valve regurgitation. In this study we report a case of mitral valve replacement for mitral stenosis caused by Libman-Sacks endocarditis in the setting of SLE. In addition, we provide a systematic review of the literature on mitral valve surgery in the presence of Libman-Sacks endocarditis because its challenge on surgical options continues. Surgical decision depends on structural involvement of mitral valve and presence of active lupus nephritis and antiphospholipid antibody syndrome. Review of the literature has also shown that outcome is good in most SLE patients who have undergone valvular surgery, but association of antiphospholipid antibody syndrome with SLE has negative impact on the outcome

Multimorbidity as an important issue among women: results of gender difference investigation in a large population-based cross-sectional study in West Asia

Objectives: To investigate the impact of gender on multimorbidity in northern Iran. Design: A cross-sectional analysis of the Golestan cohort data. Setting: Golestan Province, Iran. Study population: 49 946 residents (age 40–75 years) of Golestan Province, Iran. Main outcome measures: Researchers collected data related to multimorbidity, defined as co-existence of two or more chronic diseases in an individual, at the beginning of a representative cohort study which recruited its participants from 2004 to 2008. The researchers utilised simple and multiple Poisson regression models with robust variances to examine the simultaneous effects of multiple factors. Results: Women had a 25.0% prevalence of multimorbidity, whereas men had a 13.4% prevalence (p<0.001). Women of all age-groups had a higher prevalence of multimorbidity. Of note, multimorbidity began at a lower age (40–49 years) in women (17.3%) compared with men (8.6%) of the same age (p<0.001). This study identified significant interactions between gender as well as socioeconomic status, ethnicity, physical activity, marital status, education level and smoking (p<0.01). Conclusion: Prevention and control of multimorbidity requires health promotion programmes to increase public awareness about the modifiable risk factors, particularly among women

The Effects of Morphine on Tissue Structure of the Growth Plate in Male Rats

Objective(s) Studies have shown that morphine, in addition to its analgesic properties, has several effects on cell proliferation and apoptosis. There is also evidence that opioid receptors are present on chondrocytes. Our main objective in the present study was to investigate the effects of morphine on rat femur growth cartilage. Materials and Methods This research was carried out on 18 4-week-old male rats. Animals were divided into four groups: groups 1 (n= 3) and 2 (n= 4) were non morphine-dependent and groups 3 (n= 6) and 4 (n= 5) were morphinedependent. Groups 1 and 3 were followed up for 4 weeks and the others for 7 weeks. We prepared femur bone biopsies, fixed the samples in 10% formalin and 10% nitric acid and stained the samples with haematoxylin and eosin. The thickness of the growth cartilage and its proliferative zone (PZ) cell number were studied. In addition, the existence of necrosis, inflammation, fibrosis, and hyalinisation were evaluated. Results There were no signs of inflammation, fibrosis, necrosis or hyalinisation in the growth cartilages of all rats. The morphine-dependent groups had a statistically significant difference (P< 0.001) in the number of cells in the proliferative zone and thickness of the growth cartilage compared to other groups using ANOVA analysis. Conclusion It seems that morphine reduces the number of cell in the proliferative zone and decreases the thickness of the growth cartilage which may alter longitudinal growth of long bones

Effects of repeated anesthesia by thiopental in neonatal period on PTZ-induced convulsions and pain responses during maturation in rats

Introduction: General anesthetics during critical periods of brain development may cause some seriousmalformations or side effects. Anesthetic drugs can involve in the brain development and synaptogenesis atthe critical period of development. There are some controversy with regards the effects of(neurodegenerative or neuroprotective) barbiturates on brain. The aim of the present study was toinvestigate the possible relation between repeated induced thiopental (a GABAA agonist) anesthesia at thepostnatal period and pentylentetrazol-induced convulsions and pain responses in adult in the Wistar rats.Materials and methods: 40 male neonate rats were divided into experimental and sham groups. Theexperimental group (n=20) was deeply anesthetized with thiopental (30 mg/kg daily) during 10 to 20-daysof post- natal period and physiologic serum was used for sham animals. After maturation of male rats, thePTZ-induced seizures were induced by daily interapritoneally injection of PTZ (45 mg/kg), and thelatency of the appearance of generalized epileptiform behaviors was recorded. Pain responses were alsoevaluated using tail-flick and formalin tests.Results: No significant differences were found in the lantency of the appearance of behaviouralconvulsions and pain sensitivity between experimental and sham groups.Conclusion: Our findings indicate that prior exposure to thiopental during nenonatal stage has no effectson PTZ-induced seizures and also pain responses after maturation. Developmental compensatorymechanisms may protect the brian against the possible damage that induced by repeated thipopental duringneonatal period

Net analyte signal standard addition method for the simultaneous determination of cadmium and nickel

A novel net analyte signal standard addition method (NASSAM) is presented for the simultaneous determination of Cd2+ and Ni2+ in their mixture by differential pulse polarography. The method combines the advantages of the standard addition method with the net analyte signal concept, which enables the extraction of information concerning a certain analyte from voltammograms of multi-component mixtures. This method has some advantages, such as: the use of a full voltammogram, realization in a single step, therefore it does not require calibration and prediction steps and only a few measurements are required for the determination. The simultaneous determination of Cd2+ and Ni2+ was performed in Britton–Robinson buffer (pH 2.87) and 0.40 M potassium thiocyanate solution.saturated with water were determined