Prospective Acid Reflux Study of Iran (PARSI): Methodology and study design

<p>Abstract</p> <p>Background</p> <p>Gastroesophageal reflux disease is a common and chronic disorder but long term, prospective studies of the fate of patients seeking medical advice are scarce. This is especially prominent when looking at non-erosive reflux disease (NERD) patients.</p> <p>Methods</p> <p>We designed a prospective cohort to assess the long term outcome of GERD patients referring to gastroenterologists. Consecutive consenting patients, 15 years of age and older, presenting with symptoms suggestive of GERD referring to our outpatient clinics undergo a 30 minute interview. Upper gastrointestinal endoscopy is performed for them with protocol biopsies and blood samples are drawn. Patients are then treated according to a set protocol and followed regularly either in person or by telephone for at least 10 years.</p> <p>Discussion</p> <p>Our data show that such a study is feasible and follow-ups, which are the main concern, can be done in a fairly reliable way to collect data. The results of this study will help to clarify the course of various subgroups of GERD patients after coming to medical attention and their response to treatment considering different variables. In addition, the basic symptoms and biological database will fuel further molecular epidemiologic studies.</p

Impact of Acute Phase Epigallocatechin-3-gallate Supplementation on Consciousness and S100B Serum Levels in TBI Patients: A Double Blind Randomized Clinical Trial

Background and Aim: Traumatic brain injury is one of the leading causes of mortality and disability in young adults. Epigallocatechin-3-gallate, the antioxidant compound of green tea, has been proposed to have antioxidant and anti-inflammatory properties. This study evaluates the potential effects of epigallocatechin-3-gallate on the early clinical outcome and serum S100B levels (biomarker for brain tissue damage severity) in patients with moderate to severe traumatic brain injury. Methods and Materials/Patients: Thirty patients with moderate to severe traumatic brain injury admitted to the intensive care unit were enrolled. The patients were randomly allocated to treatment with either a daily oral dose of 400 mg epigallocatechin-3-gallate or placebo (distilled water) for seven days. The main outcome measures were duration of mechanical ventilation and ICU stay, Glasgow Coma Scale, and S100B protein level. Results: The results revealed a significant improvement in consciousness level after seven days in the epigallocatechin-3-gallate group (2.93±3.9 unit improvement in GCS versus 0.14±3.05 reduction in GCS, p-value:0.033). There was also a significantly shorter duration of mechanical ventilation in the epigallocatechin-3-gallate compared to the control group (5.1 days versus 9.8 days, p-value:0.02). Reduction of the serum S100B level was slightly higher in the epigallocatechin-3-gallate group (23.96 versus 18.6 pg/ml) but the difference was not statistically significant. Conclusion: Epigallocatechin-3-gallate supplementation had beneficial effects on consciousness level of the patients with moderate to severe traumatic brain injury in the acute phase

The impact of immunohistochemical markers of Ki‑67 and p53 on the long‑term outcome of growth hormone‑secreting pituitary adenomas: A cohort study

Background and Objectives: The tumoral biomarkers have a rather well known effect upon the tumor control period of several types of malignant lesions. The aim of this study was to evaluate the impact of immunohistochemical (IHC) markers of Ki‑67 and p53 on the long‑term outcome of growth hormone (GH)‑secreting pituitary adenomas treated surgically. Materials and Methods: We conducted and followed a cohort of 47 consecutive patients with GH‑secreting pituitary adenomas referred to our department during a 4 year period for trans‑sphenoidal microsurgical adenomectomy. The expression levels of Ki‑67 and p53 were determined by IHC study of the tissue samples. Periodical pituitary magnetic resonance imaging (MRI), visual field studies and hormonal evaluations (GH and insulin‑like growth factor‑1 [IGF‑1]) performed during the follow‑up period were the outcome measures. Results: The level of Ki‑67 expression was higher among patients with postoperative residual tumor (3.5 vs. 1.7%) and those with a hormonal recurrence (4.3 vs. 1.6%). The p53 expression level was remarkably higher in patients with radiological recurrence (18 vs. 6.3%). Patients with invasive features (i.e. cavernous sinus and suprasellar invasion) had significantly higher p53 and Ki‑67 values and higher IGF‑1 levels during the follow‑up period. The patients younger than 30 years of age and those with mixed GH‑prolactin secreting adenomas had significantly higher hormonal remission and lower radiological recurrence rates. Conclusion: Each of the biomarkers, Ki‑67 and p53, along with patient’s age and mixed GH‑prolactin secretion showed a kind of correlation with each of aspects of the clinical, hormonal and radiologic outcome of GH‑secreting pituitary adenomas in this series

Whole Cerebral Blood Flow Originating From Vertebral Arteries After Bilateral Internal Carotid Arteries Occlusion: A Case Report

Bilateral occlusion of internal carotid arteries is a rare condition usually associated with severe neurological symptoms. It is very uncommon finding among patients with ischemic stroke. In this article, we report a rare case of bilateral occlusion of internal carotid artery who presented with mild reversible neurological symptoms. Angiographic evaluation of her cerebral vasculature revealed no flow across the both cervical internal carotid arteries, but a run off through both posterior communicating arteries from the vertebrobasilar system. We performed a review of the pertinent literature and discussed different management option in these patients

Initial Experience with Brain Mapping under Awake Craniotomy for Resection of Insular Gliomas of the Dominant Hemisphere

Background & Importance: Insular lobe is located at the depth of sylvian fissure and is hidden by frontal, temporal and parietal lobes in close vicinity of internal capsule and basal ganglia and adjacent to the speech centers in the dominant hemisphere. Thus, radical resection of insular gliomas can be even more difficult. Brain mapping techniques can be used to maximize the extent of tumor removal and minimize postoperative morbidities. Case Presentation: Patients with newly diagnosed gliomas of dominant insula were enrolled. The exclusion criteria were severe cognitive and/or psychological disturbances, those with difficulty in communication, older than 65 years, severely obese patients, those with difficult airways for intubation and severe cardiovascular or respiratory diseases. All patients were evaluated by contrast enhanced brain MRI, functional brain MRI and diffusion tensor tractography of language and motor systems preoperatively. All were operated under awake craniotomy with the same anesthesiology protocol. Intraoperative monitoring included continuous motor evoked potential, electromyography, electrocorticography, direct electrical stimulation of cortex and subcortical tracts. They were followed with serial neurological examination and imaging. Conclusion: Seven patients were enrolled including 3 man and 4 women with mean age of 44.4 years. 5 patients suffered from low grade and 2 from high grade glioma. The most common clinical presentation was seizure followed by speech disturbance, hemiparesis and memory loss. Extent of tumor resection ranged from 73 to 100%. No mortality or major postoperative neurological deficit was encountered. Seizure control improved in 3/4 of patients with medical refractory epilepsy. One patient suffered from permanent deterioration of speech after surgery. Brain mapping under awake craniotomy may be considered a safe method to maximize the extent of tumor resection, while preserving neurological function in patients with gliomas of the dominant insular lobe

Photoacoustic-MR Image Registration Based on a Co-Sparse Analysis Model to Compensate for Brain Shift

Brain shift is an important obstacle to the application of image guidance during neurosurgical interventions. There has been a growing interest in intra-operative imaging to update the image-guided surgery systems. However, due to the innate limitations of the current imaging modalities, accurate brain shift compensation continues to be a challenging task. In this study, the application of intra-operative photoacoustic imaging and registration of the intra-operative photoacoustic with pre-operative MR images are proposed to compensate for brain deformation. Finding a satisfactory registration method is challenging due to the unpredictable nature of brain deformation. In this study, the co-sparse analysis model is proposed for photoacoustic-MR image registration, which can capture the interdependency of the two modalities. The proposed algorithm works based on the minimization of mapping transform via a pair of analysis operators that are learned by the alternating direction method of multipliers. The method was evaluated using an experimental phantom and ex vivo data obtained from a mouse brain. The results of the phantom data show about 63% improvement in target registration error in comparison with the commonly used normalized mutual information method. The results proved that intra-operative photoacoustic images could become a promising tool when the brain shift invalidates pre-operative MRI