Evaluation of a Sentinel Lymph Node Biopsy with Patent Blue in Locally Advanced Gastric Cancer

Background: A sentinel lymph node (SLN) biopsy is an interesting issue in the field of surgical oncology and has recently been introduced to the treatment of gastric cancer. The purpose of this study is to assess accuracy, sensitivity, specificity, and false negative rates (FNRs) of SLN biopsies, and to ascertain whether or not this procedure is useful for locally advanced gastric cancer.Methods: From December 2013 to March 2014, 22 patients with gastric cancer were enrolled in this study. After laparotomy, patent blue was injected around the tumor subserosaly, resection was then done, and SLNs were detected on a back table. Afterward, D2 dissection was carried out. Finally, SLNs and other specimens were submitted for permanent pathology.Results: SLNs were detected in 20 of 22 patients. The total number of SLNs was 87. SLNs were positive in 7 patients, and the total number of positive SLNs was 17. In three patients, the SLNs were negative, whereas other LNs were positive, with an FNR of 15%. 18 patients received neoadjuvant. Complete pathologic responses with negative LNs were seen in 3 patients. Accuracy, sensitivity, specificity, and negative predictive values were 80%, 66%, 90%, and 76%, respectively.Conclusions: This research demonstrated that SLN mapping in advanced gastric cancer is an appropriate method with acceptable levels of accuracy, sensitivity, and negative predictive values, even in those patients who received neoadjuvant treatment

Hybrid renewable energy as power supply for shelter during natural disasters

People are very vulnerable in case of natural disasters. Power grid destruction is a common disaster in these situations. Numerous costumers might easily lose access to electric power and this condition can continue for a long time after the catastrophe. Emergency shelter after occurrence of disasters is usually offered by organizations or governmental emergency administration departments, as a comeback to natural disasters, such as an earthquake or flood. They tend to use tents or other temporary structures, or buildings. This paper focus on design of a Smart Hybrid power supply for shelter which is supported from three renewable energy source (wind, rain and solar) that is available in each condition in order to be used during emergency situation as a portable facility by analyzing the power generation ability and also the load demand characteristics during natural disaster for relief shelters

The Effect of Outpatient Management of Cystic Fibrosis Exacerbation on Pulmonary Function Tests: A Clinical Trial

Background: Cystic fibrosis (CF) is an inherited disease which involves multiple organs including respiratory tract. It results in chronic respiratory signs and symptoms which exacerbate with frequent lung infections. The majority of exacerbations require hospitalization and intravenous antibiotic therapy as part of the management. The aim of this survey was to study the effectiveness of outpatient management of pulmonary exacerbations on pulmonary function tests.Methods: This randomized clinical trial included all CF patients older than 6 years old who presented with a pulmonary exacerbation and were able to perform Spirometric tests. All eligible CF patients first referred to pulmonary function tests center to determine forced expiratory volume in the first second (FEV1), residual volume (RV), total lung capacity (TLC) and airway specific resistance (SRaw). Then, they were treated outpatiently for 2 to 4 weeks and after that, they underwent all the tests again; and the participants’ improvements in pulmonary function tests after outpatient treatment were investigated.Result: In this study, 32 patients were enrolled including 13 women (40.6%) and 19 men (59.4%). Mean and standard deviation (SD) of pulmonary variable, before and after the treatment were investigated. All of them were statistically significant. Sub-analysis of data based on gender was also performed showing that outpatient treatment led to significant improvements in all of the variables except for the percentage of RV in females (p value = 0.08).Conclusion: The findings revealed that outpatient management of CF exacerbations effectively improved values of FEV1, SRaw and TLC along with reducing RV values and air trapping. Thus, applying this method on appropriately selected CF patients, may prevent unnecessary hospitalization and subsequent disadvantages

Predictors of Death in the Liver Transplantation Adult Candidates: An Artificial Neural Networks and Support Vector Machine Hybrid-Based Cohort Study

Background: Model for end-stage liver disease (MELD) is currently used for liver transplantation (LT) allocation, however, it is not a sufficient criterion. Objective: This current study aims to perform a hybrid neural network analysis of different data, make a decision tree and finally design a decision support system for improving LT prioritization.Material and Methods: In this cohort follow-up-based study, baseline characteristics of 1947 adult patients, who were candidates for LT in Shiraz Organ Transplant Center, Iran, were assessed and followed for two years and those who died before LT due to the end-stage liver disease were considered as dead cases, while others considered as alive cases. A well-organized checklist was filled for each patient. Analysis of the data was performed using artificial neural networks (ANN) and support vector machines (SVM). Finally, a decision tree was illustrated and a user friendly decision support system was designed to assist physicians in LT prioritization. Results: Between all MELD types, MELD-Na was a stronger determinant of LT candidates’ survival. Both ANN and SVM showed that besides MELD-Na, age and ALP (alkaline phosphatase) are the most important factors, resulting in death in LT candidates. It was cleared that MELD-Na <23, age <53 and ALP <257 IU/L were the best predictors of survival in LT candidates. An applicable decision support system was designed in this study using the above three factors.  Conclusion: Therefore, Meld-Na, age and ALP should be used for LT allocation. The presented decision support system in this study will be helpful in LT prioritization by LT allocators

Assessment of sentinel lymph node biopsy after neoadjuvant chemotherapy for breast cancer in two subgroups: Initially node negative and node positive converted to node negative – A systemic review and meta-analysis

Background: Neoadjuvant chemotherapy (NAC) is increasingly used to treat patients with breast cancer, but the reliability of sentinel lymph node biopsy (SLNB) following chemotherapy is in doubt. In this meta-analysis, we aimed to evaluate studies that examine the results of SLNB after NAC to assess identification rate (IR) and false-negative rate (FNR). Materials and Methods: Systemic searches were performed in the PubMed, ISI Web of Sciences, Scopus, and Cochrane databases from January 1, 2000, to November 30, 2016, for studies of SLNB after NAC for breast cancer and followed by axillary lymph node (LN) dissection in two subgroups: initially node negative and node positive converted to node negative. Two reviewers independently review quality of included studies. A random-effects model was used to pool IR and FNR with 95% confidence intervals (CI), and heterogeneity among studies was assessed by I2 and Q-test. Results: A total of 23 studies with 1521 patients in the initially node-negative subgroup and 13 studies with 1088 patients in the node-positive converted to node-negative subgroup, were included in this meta-analysis with IR and FNR of 94% (95% CI: 92–96) and 7% (95% CI: 5–9) in the initially node-negative subgroup and 89% (95% CI: 85–94) and 13% (95% CI: 7–18) in the node-positive converted to node-negative subgroup, respectively. Conclusion: Our meta-analysis showed acceptable IR and FNR in initially node-negative group and it seems feasible in these patients, but these parameters did not reach to predefined value in node-positive converted to node-negative group, and thus, it is not recommended in these patients

Word and nonword repetition in patients with Schizophrenia

Introduction: The assessment of the verbal repetition is important in the study of acquired language disorders and neuropsychology. It is helpful in differential diagnosis of aphasia subtypes, auditory breakdowns, and working memory (WM) performance. Though different linguistic disorders have been identified in patients with schizophrenia, very little is known about their verbal repetition ability. Methods: The present study was conducted in the inpatient ward of Razi Psychiatric Hospital, Tabriz University of Medical Sciences, Iran, during the year 2013. Participants were: 30 patients diagnosed with schizophrenia during the maintenance phase of treatment and 30 healthy people as control group. They were asked to repeat 15 words and 15 nonwords immediately. The stimuli were 1, 2, and 3 syllabic in Turkish language. Any incorrect repetition scored 1 and correct repetitions scored 0. Lexicalization errors were compared between groups too. Results: Both groups repeated words better than nonwords. Patients showed lower ability to repeat nonwords than controls, especially in 3 syllabics. There was no significant difference in the repetition of words between groups though it was better in controls. Patients with schizophrenia made more errors in both words and nonwords and lexicalization errors were twice more. Conclusion: Lower ability to repeat nonwords (than words) in patients with schizophrenia may show the involvement of phonological loop of WM. More lexicalization errors may take place because of dis-inhibition

The effect of saffron (Crocus sativus L.) hydro-alcoholic extract on liver and renal functions in type 2 diabetic patients: A double-blinded randomized and placebo control trial

Background and aim: Uncontrolled diabetes causes liver and renal dysfunctions. Since, saffron may improve diabetes control and indicate renal and liver protection, this study purposed to illustrate for the first time the effects of saffron extract on some liver and renal functional parameters among diabetic patients. Materials and methods: In this double-blind clinical trial, 54 type 2 diabetic patients were randomly recruited to consume either 15 mg saffron extract (n = 27) or placebo capsules (n = 27) twice a day for 8 weeks. Alkaline phosphatase, aspartate and alanine amino transferase, uric acid, blood urea nitrogen, and creatinine of the patients as well as their physical activity, dietary intakes, anthropometric measures and blood pressure were measured. Data were analyzed by SPSS.18 software. Results: Uric acid and blood urea nitrogen were significantly decreased in the saffron group (P < 0.05), however, there were no significant differences between the two groups at the end of the study (p = 0.29 and 0.14, respectively). Moreover, changes in other profiles, including liver enzymes, were not statistically significant in the two groups. Also, no significant changes in blood pressure, dietary intakes, and physical activity were seen among the two groups. Conclusion: Saffron hydro-alcoholic extract did not considerably improve renal and liver functions in T2DM patients in an 8-week randomized clinical trials. The results deserved further investigations with more accurate methods to confirm

Tschermak fractionation in calc-alkaline magmas : the Eocene Sabzevar volcanism (NE Iran)

Calc-alkaline arc magmatism at convergent plate margins is volumetrically dominated by metaluminous andesites. Many studies highlighted the importance of differentiation via fractionation processes of arc magmas, but only in the last decades, it has been demonstrated that not all rock-forming minerals may affect the evolution of calc-alkaline suites. In particular, a major role exerted by Al-rich hornblende amphibole as fractionating mineral phase has been documented in many volcanic arc settings. The aim of this work is to understand the role of the Tschermak molecule (CaAlAlSiO₆) hosted in the hornblende and plagioclase fractionation assemblage in driving magma differentiation in calc-alkaline magmatic suites. We explore this issue by applying replenishment–fractional crystallization (RFC) and rare earth element–Rayleigh fractional crystallization (REE-FC) modeling to the Sabzevar Eocene (ca. 45–47 Ma) calc-alkaline volcanism of NE Central Iran, where hornblende-controlled fractionation has been demonstrated. Major element mass balance modeling indicates RFC dominated by a fractionating assemblage made of Hbl₅₂.₀₋₅₂.₅ + Pl₄₄.₁₋₄₄.₂ + Ttn₃.₃₋₃.₉ (phases are expressed on total crystallized assemblage). REE-FC modeling shows, instead, a lower degree of fractionation with respect to RFC models that is interpreted as due to hornblende and plagioclase resorption by the residual melt. Calculations demonstrate that fractionation of the Tschermak molecule can readily produce dacite and rhyolite magmas starting from a calc-alkaline andesite source (FC = ca. 30 %). In particular, the Tschermak molecule controls both the heavy rare earth elements (HREE) and light rare earth element (LREE) budgets in calc-alkaline differentiation trends.12 page(s

The effect of saffron (Crocus sativus L.) hydroalcoholic extract on metabolic control in type 2 diabetes mellitus: A triple-blinded randomized clinical trial

Background: Metabolic control is a major concern in preventing diabetic complications. Saffron as a natural source of antioxidants could play a role in alleviating diabetes insults. The aim of this study was to investigate effect of saffron hydroalcoholic extract on metabolic control in type 2 diabetes (T2D) mellitus. Materials and Methods: This randomized triple blind study was included 54 T2D patients which randomly received either saffron (Group 1) or placebo (Group 2) twice daily other than routine antidiabetic treatments for 8 weeks. Serum concentration of fasting blood sugar (FBS), 2-h plasma glucose, hemoglobin A1c (HbA1c), total cholesterol, triglyceride (TG), low-density lipoprotein, and high-density lipoprotein were measured as the markers of metabolic control. Anthropometric measures and blood pressure were also measured at the baseline, every 2 weeks during the intervention and the end of the study. Data analyzed using repeated measure analysis of variance test. Results: The baseline metabolic parameters were the same in two group (P > 0.01). FBS serum level significantly decreased within 8 weeks in the saffron group (128.84 ± 31.86) as compared to the placebo (153.76 ± 41.23), (P 0.01). Conclusion: Saffron hydroalcoholic extract may improve blood glucose control by reducing FBS in T2D patients. However, saffron extract has no significant effect on other aspects of diabetic control in diabetic patients

A Review of Impact of Bam Earthquake on Cutaneous Leishmaniasis and Status: Epidemic of Old Foci, Emergence of New Foci and Changes in Features of the Disease

Background: Global findings indicate that incidence rate of cutaneous leishmaniasis (CL) has significantly in­creased during the past decade, as documented in many countries. This review was aimed to evaluate the trend of CL cases in terms of demographic and clinical characteristics during a decade after the earthquake (2003–2012) com­pared to the corresponding period before the earthquake in Bam (1993–2003). Methods: Direct smear preparations along with different intrinsic methods were used for detection and identification of the causative agents. Results: Overall, 20999 cases of CL have occurred during the last 20 years (1993–2012), 6731 cases before and 14268 cases after the earthquake (P< 0.001). Conclusions: Following a major earthquake, several risk factors could activate epidemics of cutaneous leishmaniasis in old foci and induce emerging foci in new areas