Refractory Sinonasal Hemangiopericytoma: Rapid Recurrence or Growth of Residual Tumor

Hemangiopericytoma is a malignant vascular tumor that is rarely seen in the nasal cavity and paranasal sinuses. Biological behavior of the tumor is not completely known and its natural history is not predictable. According to the existing literature, local recurrence rate is not common and distant metastasis is exceedingly rare and majority of patients have a favorable clinical course. We have presented female Persian case of  sinonasal hemangiopericytoma in which recurrence of the tumor happened very rapidly after initial removal. It also recurred within two months after reoperation. We have discussed about the characteristics of these tumors and known prognostic factors. We have finally proposed that the sinonasal hemangiopericytoma may have significantly more aggressive clinical course than the previous assumption

COMPARISON OF VARIOUS MEASUREMENT TECHNIQUES FOR CHARACTERIZING THE HYDRODYNAMICS OF GAS-SOLID FLUIDIZED BEDS

There are various techniques to characterize the hydrodynamic of fluidized beds. Nowadays, sensor development is widely used to determine the hydrodynamic state of a fluidized bed to improve control and safety of the operation of such reactors. The objective of this study was to compare the advantages and disadvantages of the intrusive and novel non-intrusive techniques. The measurement techniques investigated in this work were vibration of the bed, acoustic emission and pressure. Extensive measurements were carried out at different superficial gas velocities with different particle sizes. Vibration and acoustic emissions were recorded at 25 KHz for 30 s using accelerometer and microphone, respectively. Pressure fluctuation signals were also collected at a sampling frequency of 400 Hz. These measurements were used for investigating the changes in the flow structure, specifically the flow regime transitions. The recorded signals were processed using wavelet analysis and statistical tools. It was shown that the variation of standard deviation, skewness and kurtosis of vibration signals against superficial gas velocity of the bed obey the same trend for different techniques. Results indicated that analyzing the vibration and acoustic signals can be considered as effective non intrusive techniques to characterize the hydrodynamics of gas-solid fluidized beds and in some cases they show better prediction of the hydrodynamic parameters

Late clinical events of drug eluting versus bare metal stenting; OPCES' ancillary study

Objective: To compare one year clinical outcomes of patients with chronic stable angina who underwent implantation of bare metal stent (BMS) or drug eluting stent (DES). Methodology: Four hundred forty two (442) participants of OPCES study (Osvix versus Plavix in Cardiovascular Events after Stenting) were included in this sub-study. After evaluation of exclusion criteria (combined DES and BMS stenting (n=31) and incomplete data (n=48) patients were divided in two groups according to selected stent(DES or BMS). Follow-up was conducted by a structured telephone interview after 6 and 12 months. The patients' documents were reviewed by the Study Event Committee in the Isfahan Cardiovascular Research Center to evaluate the occurrence of study endpoints which consisted of clinical success rate and major adverse cardiac events (Major Adverse Cardiac Events (MACE), cardiac death, non-fatal MI, target vessel revascularization and stroke) in hospital, after 6 and 12 months. Results: One hundred sixty six (45.7%) patients were in the DES and 197(54.3%) were in the BMS group. Procedural complications were seen more frequently in the DES group (1.0% vs. 4.8%, P=0.027), the prevalence of the in-hospital MACE, angiographic and clinical success rate were the same between both the groups. There was no significant difference regarding 6 and 12 months MACE rate in patients treated by BMS or DES (6 months: 1.1% vs. 0.6%, p>0.999 12 month: 3.4% vs 2.6%, P = 0.755). Conclusion: Considering the same clinical outcome and the economical parameters, use of the BMS after proper patient selection are recommended

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Salivary levels of interleukin-6 and tumor necrosis factor-α in patients undergoing hemodialysis

Background: Inflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) are elevated in end-stage renal disease (ESRD). IL-6 and TNF-α are toxins which deteriorate renal function, and their pathogenic role has been confirmed in cardiovascular and oral diseases. This study was designed to investigate the salivary levels of IL-6 and TNF-α in patients with ESRD undergoing hemodialysis (HD). Materials and Methods: Twenty patients with ESRD who were treated with 4 h HD sessions, with low flux membrane were included in this cross-sectional study. Average Kt/V index in patients was 1.19 ΁ 0.1. Twenty age-sex-matched healthy controls with no infectious diseases during 1 month before saliva sampling were selected. Unstimulated whole saliva was collected and TNF-α and IL-6, concentrations were measured using human IL-6 and TNF-α ELISA kits. Independent t-test was used to analyze the data using SPSS (α = 0.05). Results: There was a significant difference between dialysis and control groups regarding the salivary levels of TNF-α (P = 0.034) and IL-6 (P = 0.001). Conclusion: Considering the results of this study and reported role of inflammatory cytokines in the pathogenesis of cardiovascular and oral diseases, measurement of salivary IL-6 and TNF-α in HD patients may help in risk stratification of HD patients and in planning pertinent preventive strategies

Adenoid Cystic Carcinoma of Bartholin’s Gland Clinically Mimics Endometriosis, A Case Report

Adenoid cystic carcinoma of Bartholin’s gland is a rare malignant tumor of female genital tract. We report a case of a 42-year-old woman, presenting a palpable painful mass and burning sensation on the left side of vulva during the preceding two months. Based on examination, a solid fixed painful nodule with intact mucosa was palpated on the left side of the vagina. Histological features were compatible with adenoid cystic carcinoma. Often, such lesion is clinically misdiagnosed as a cyst or inflammation. The present case was carried out with an impression of endometriosis. The possibility of cancer should be considered in any female older than 40 years of age with a lesion near the Bartholin’s glands

Periodontal Regeneration of Intrabony Defects in Animal Models Using Biologic Modifiers: A Systematic Review and Meta-analysis

Background and purpose: The ultimate goal in periodontal treatment is to achieve a functional and anatomical regeneration of lost tissues. Due to the promising outcomes of biologic modifiers in regenerative therapies, this systematic review aimed at evaluating the effects of various biologic modifiers used in intra-bony osseous defects in animal models. Materials and methods: Electronic databases were searched for articles published in March 2010-March 2020 that had evaluated the effect of bio-modifiers used in periodontal intra-bony osseous defects in animal models. Screening was performed based on inclusion/exclusion criteria and SYRCLE tool was used for studies’ quality assessment. Results: After screening the titles, abstracts, and full-texts, 18 studies were included in qualitative analysis and five studies entered the meta-analysis. According to the configuration of osseous defects, the studies were categorized into three subgroups. Based on histological findings, all these biologic markers significantly enhanced new bone and cementum formation compared to control groups (P<0.001). The meta-analysis showed that biologic modifiers could significantly increase bone regeneration (1.58 mm, 95% CI: 1.12-2.03, P˂0.001) and cementum regeneration (1.27 mm, 95% CI: 0.84-1.70, P˂0.001) in one-wall osseous defects. Conclusion: Biologic modifiers namely growth factors could positively affect periodontal regeneration, particularly the cementum and bone in animal models. Further human studies are necessary to address the clinical use of these biomaterials

Colonization and antifungals susceptibility patterns of Candida species isolated from hospitalized patients in ICUs and NICUs

Background: Several studies have shown that there are an increasing in invasive candidiasis during 2-3 last decades. Although, Candida albicans is considered as the most common candidiasis agents, other non-albicans such as C. glabrata, C. krusei, C. parapsilosis, and C. tropicalis were raised as infectious agents. Resistance to fluconazole among non-albicans species is an important problem for clinicians during therapy and prophylaxis. Objectives: The aim of current study was to detect the Candida species from hospitalized neonatal and children in intensive care units (ICUs) and neonatal intensive care units (NICUs). In addition, the susceptibility of isolated agents were also evaluated against three antifungals. Materials and Methods: In the present study 298 samples including 98 blood samples, 100 urines and 100 swabs from oral cavity were inoculated on CHROMagar Candida. Initial detection was done according to the coloration colonies on CHROMagar Candida. Morphology on cornmeal agar, germ tube formation and growth at 45°C were confirmed isolates. Amphotericin B, fluconazole and terbinafine (Lamisil) were used for the susceptibility tests using microdilution method. Results: In the present study 21% and 34% of urines and swabs from oral cavity were positive for Candida species, respectively. The most common species was C. albicans (62.5%) followed by C. tropicalis (15.6%), C. glabrata (6.3%) and Candida species (15.6%). Our study indicated that the most tested species of Candida, 70.3% were sensitive to fluconazole at the concentration of ≤8 μg/mL. Whereas 9 (14.1%) of isolates were resistant to amphotericine B at ≥8 μg/mL. Conclusions: This study demonstrates the importance of species identification and antifungals susceptibility testing for hospitalized patients in ICUs and NICUs wards