Vol 59, No 5 (2021)

Review Article(s)

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    The emergence of patient-tailored medicine has changed all measurable disease outcomes. Among human diseases, cancers appear to be the most dangerous. Furthermore, lung cancers rank the first among human cancers in both morbidity and mortality. When lung cancer is clinically diagnosed, it is often too late for therapy. The absence of accurate and specific tools for early detection results in a poor prognosis for lung cancer. The discovery of microRNAs and their function in lung cancer offers a new mechanism for the detection of lung cancer cells. These molecules, derived from cancerous cells, circulate in the patient's blood. Recently, a revolutionary technique, i.e., liquid biopsy has shown promise in discovering these circulating microRNAs molecules in body fluids, namely peripheral blood. A liquid biopsy allows the detection and isolation of circulating tumor cells, circulating nucleotides, and cellular exosome as a source of genomic and proteomic information in cancerous patients, especially in the early stages of cancer cell development. In this review, by searching various databases, including PubMed, Google Scholar, and Scopus, we explore liquid biopsy as a novel tool and the application of miRNAs in lung cancer detection in diagnostic pathology.

SHORT COMMUNICATION

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     Lower gastrointestinal cancer patients, like other immunosuppressed patients, are vulnerable to develop more severe infections. Iran is one of the countries with a high incidence of COVID-19, and some modifications are needed to adjust international protocols to deal with this pandemic. Therefore, our cancer institute has implemented some changes in the current treatment guidelines. In each specialty, all members agreed to choose the minimal intervention. The members know that some recommendations may interfere with the routine best-practice recommendations and decrease the quality measures in the patient's outcome. Therefore, these recommendations are valid just in the epidemic COVID-19 situation in the country. According to the consensus of colorectal and cancer surgery professors, if a patient is a new case of rectal cancer, he or she should be referred to undergo neoadjuvant chemoradiotherapy. But if the patient comes eight to twelve weeks after receiving chemoradiotherapy in accordance with the COVID-19 epidemic phase, it may be possible to delay surgery. A stent can be implanted in a patient with rectal cancer who presents with obstructive symptoms, and surgery can be postponed until resolving the crisis of the COVID-19 epidemic or its downward trend. For colon cancer, we will request a thoracic spiral CT scan. If there was no evidence of pulmonary involvement with COVID-19, the patient would undergo open surgery considering the patient's health and protection tips.

Study Protocol

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    Most of the information on the natural history and management of cardiomyopathies and myocarditis in Iran has been obtained from cohort studies in a small number of patients. The prevalence of patients with cardiomyopathies referred to Rajaei Cardiovascular medical and research centers from all over the country is remarkable. Rajaie Cardiomyopathy and myocarditis Registry (RCMR) study is an observational registry of patients with four subtype of cardiomyopathy include: hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), and restrictive cardiomyopathy (RCM) as well as myocarditis designed to determine clinical characteristics, natural history, current therapeutic approaches, response to treatment and long-term outcomes of patients with cardiomyopathy and myocarditis. Prediction of mortality and response to different treatments in these patients using artificial intelligence is another aim of this Registry. COVID 19 Myocarditis and its sequence as cardiomyopathy seem a new challenge in forthcoming years. At the baseline visit, past medical history, clinical signs/symptoms, risk factors, physical examination and family history of cardiomyopathy, current standards for diagnostic workup and clinical follow-up, and relevant electrocardiogram echocardiography, cardiac magnetic resonance, Holter monitoring, or biomarker analyses will be checked. The outcome and results of various therapeutic approaches currently employed for patients, including implantable cardioverter defibrillator, cardiac resynchronization therapy, septal myomectomy, ablation, cardiac transplantation, and medications, will be assessed. Long-term outcomes, including the benefits and complications of therapeutic interventions, will be collected. A follow-up visit will be scheduled after 12 months for all patients, and survival status, hospitalizations, co-morbidities, medications will be assessed.

Articles

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    Rheumatoid arthritis (RA) is a progressive and common autoimmune disease with multifactorial etiology. Several pieces of research show that genetic factors play a major role in the incidence of RA. Several genome-wide association studies (GWAS) have identified the autoimmune regulator (AIRE) gene as one of the candidate loci. This gene encodes a transcription factor, which is involved in the presentation of self-antigens and negative selection of self-reactive T-cells in the thymus. Studies have indicated that single nucleotide polymorphisms (SNPs) in the AIRE gene can change the gene expression and/or function. In the present study, we assessed the possible association between SNP rs2075876 (intronic variant) in the AIRE gene with RA risk in the Iranian population. A case-control study using 56 RA patients and 58 control subjects was undertaken to evaluate rs2075876 genotypes using real-time PCR high resolution melting method (HRM). Logistic regression analysis demonstrates that homozygous AA and heterozygous AG genotypes compared with GG genotype increase the risk of RA (AA vs GG; OR= 16.43; 95%CI [5.33-50.71] and AG vs GG; OR= 3.21; 95%CI [1.22-8.45]). Also, individuals with allele A were more frequently affected with RA than subjects with G allele (OR= 5.81; 95%CI [3.28-10.30]). Furthermore, in the patient group, we found a significant correlation between erythrocyte sedimentation rate and C-reactive protein concentration with rs2075876 polymorphism (P< 0.05). Our findings propose a substantial correlation between rs2075876 polymorphism and RA risk.

  • XML | PDF | downloads: 78 | views: 148 | pages: 265-279

    HOIL-1/RBCK1 deficiency is a new autosomal receive disorder with unstable cellular responses to pro-inflammatory cytokines, resulting in auto-inflammation, pyogenic bacterial disease, as well as the development of muscular amylopectinosis. This study explored the molecular mechanisms of RBCK1 deficiency with integrated bioinformatics analyses of the feature genes and the correlative gene functions. The expression profile of GSE24519 was downloaded from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) between RBCK1, MYDK88, NEMO deficient fibroblast, and healthy fibroblast specimens were identified. Gene ontology (GO) enrichment analysis on gene functions and the Kyoto Encyclopedia of Gene and Genome (KEGG) pathway analysis were performed by using Database for Annotation, Visualization, and Integrated Discovery (DAVID). Cytoscape was used to visualize the protein-protein interaction (PPI) of these DEGs. GO analysis revealed that the “Skeletal system development, Extracellular matrix organization, Positive regulation of cell migration, Negative regulation of canonical Wnt signaling pathway, Cell adhesion, Angiogenesis and Negative regulation of BMP signaling pathway, Serine-type carboxypeptidase activity, Polysaccharide binding, Calcium ion binding, frizzled binding, Neuropilin binding, and cell adhesion molecule binding, extracellular exosome, extracellular space, extracellular region, lysosomal lumen, endoplasmic reticulum lumen, cell surface and focal adhesion to BP, MF, and CC, respectively. The KEGG pathway analysis showed that the complement and coagulation cascade, ECM receptor interactions, PI3K- Akt signaling pathway, PPAR signaling pathway, TGF-beta signaling pathway, Pathway in Cancer, Viral carcinogenesis and Focal adhesion pathway were closely associated with RBCK1 deficiency occurrence. Importantly, TK1, AURKB, CDCA2, UBE2C, KIFC1, CEP55, CDCA3, GINS2, MCM6, and CDC45 were predicted to be significantly related to RCBK1 deficiency. Our discovery provides a registry of genes and pathways that are disrupted in RCBK1, which will enhance in understanding the pathogenesis of RBCK1 deficiency and other innate immunodeficiency diseases. This study has the potential to be used in the clinic for diagnosis and targeted therapy of RCBKI and other innate immunodeficiencies in the future.

  • XML | PDF | downloads: 104 | views: 114 | pages: 280-284

    Down syndrome (DS) is a genetic impairment associated with comorbidities such as Congenital Heart Disease (CHD). Pulmonary Arterial Hypertension (PAH) is a complication of CHD in most patients. Due to insufficient documents about the prevalence of PAH in DS with CHDs compared to non-DS (NDS)+CHD patients, this study aimed to compare the prevalence of PAH between DS-CHD and NDS-CHD patients. This is a cross-sectional study conducted on DS-CHD patients referred to the Pediatric and Congenital Cardiology Division at Imam Reza training hospital in Mashhad, Iran, between April 2015 and February 2016. The comparison group included NDS-CHD children matched in terms of age and gender. A comprehensive Echocardiography was run for all patients to determine the types of CHD and pulmonary arterial pressure. Seventy-seven patients were enrolled in the study (47 in the DS-CHD group and 30 in the NDS-CHD group). 48.9% of the DS-CHD patients and 23.3% of the NDS-CHD group developed PAH, which revealed a significantly higher rate of PH among DS-CHD patients (P=0.025). Our findings denote a higher prevalence of PAH among DS-CHD patients compared to NDS-CHD patients. Such an observation is a meaningful warning for DS patients to take early necessary medical or corrective therapies for CHD in order to prevent complications and irreversible pulmonary vascular disease.

  • XML | PDF | downloads: 70 | views: 125 | pages: 285-289

    Deformities of burn scars in the chin and upper neck are a tragedy for patients and pose a great challenge to plastic surgeons due to limited available methods for the reconstruction of three-dimensional appearance. In this paper, we present a new technique for the correction of cervicomental angle with a dermal fat flap. Fourteen patients ages 18 to 24-year-old with extensive neck deformities were enrolled in the study. During the operation, first, we deepithelialized a triangular scar area in the upper neck, then created a dermal fat flap and flip it up to the chin, restoring the chin shape and volume, after that for subsequent reconstruction of cervicomental angle, after releasing skin from lateral sides of the triangle defect, we approximated the AB and AC line to the upper edge of the defect by V-Y advancement. The remaining defect is covered with a full-thickness skin graft. In all cases, the chins were reshaped with a dermal fat flap. The mean cervicomental angle was 144+14.6° preoperatively, which was reduced to 108.9+6.15° postoperatively. The neck and chin were preserved with better contours. This is a new technique that has never been described before in the literature, and it is innovative compared to the traditional techniques. Good cosmetic outcomes make this technique preferable for all burn neck deformities with an obtunded cervicomental angle.

  • XML | PDF | downloads: 68 | views: 100 | pages: 290-297

    Colorectal cancer is one of the most common cancers in Iran. Regarding the prevalence of this cancer and its mortality and morbidity, in this study, 5 Year Survival Rate and its Effective Factors of patients with colorectal cancer were investigated. This study was conducted using the retrospective cohort method. All patients diagnosed with colorectal cancer in Hamadan Imam Khomeini Clinic of Hematology and Oncology and Mahdieh Oncology Center between 2006 and 2011 were studied. Data were extracted from the patients’ medical records, and to obtain extra information about them, telephone calls were made. The data were analyzed by SPPS version 16, and the assessment of survival rates was conducted using Kaplan-Meier methods and Cox regression method. A total number of 108 patients with colorectal cancer were studied. The status of 74 patients was determined at the end of the study by making follow-up phone calls. The one, two, three, four, and five survival rates were 77, 66, 50, 45, and 42%, respectively. The median overall survival was 46.8 months (1.3-135.6 months). Cox regression analysis showed that Metastatic tumor (P=0.001), lymphatic involvement (P=0.043), and is associated with underlying disease (P=0.025) was accompanied by increased risk. Multivariate cox regression test showed that metastasis was associated with an increase in the risk of death significantly (HR=2.83, P=0.013). According to the findings of the study, early screening is recommended for people with greater risk to increase the survival rate.

  • XML | PDF | downloads: 61 | views: 91 | pages: 298-307

    In order to induce sedation during cataract surgery, various medications with different side effects are used in separation or in combination. Dexmedetomidine has no effect on the respiratory system, but being dependent on dosage, it may cause cardiovascular disorders. The present study aims to compare the hemodynamic and sedative effects of dexmedetomidine and the combination of sufentanil-midazolam on patients undergoing cataract surgery. In a randomized clinical trial study, 60 patients were randomly divided into two dexmedetomidine and sufentanil-midazolam groups. In sufentanil-midazolam group, dexmedetomidine (DEX infusion at 0.5 μg/ kg for 10  minutes, then adjusted to 0.2 µg/kg/h) was prescribed. In the sufentanil-midazolam group, sufentanil (0.1 μg/kg for 5 minutes) and midazolam (0.2 µg/kg) were injected five minutes before the operation. Hemodynamic variables (Systolic blood pressure, diastolic blood pressure, heart rate), complications (nausea, vomiting, hypoxia), sedation level, and pain intensity were recorded (at the beginning of the study, 5, 10 minutes after anesthesia, at the start of surgery, 5, 10, 15 minutes after the surgery) as well as patient’s satisfaction, surgeon's satisfaction, and complications. Results suggest that apart from gender, other primary characteristics of patients, including age, history of blood pressure, diabetes history, ASA score, mean of systolic, diastolic blood pressure, heart rate, and SPO2 levels, were similar in both groups (P>0.05). Systolic blood pressure patients receiving dexmedetomidine declined significantly more than that of patients receiving sufentanil-midazolam (P>0.5). Diastolic blood pressure suddenly fell 5 minutes after the infusion of sufentanil-midazolam (P>0.05), but then a relative increase and finally a relative decrease occurred, while diastolic blood pressure in patients receiving dexmedetomidine decreased steadily. The mean heart rate in patients receiving dexmedetomidine and sufentanil-midazolam declined gently (P>0.05). SPO2 was reduced significantly in the sufentanil-midazolam group (P<0.05). Drugs used in both groups reduced pain intensity equally (P>0.05). From the beginning of the study, dexmedetomidine produced a relatively stable sedation level (score 2) based on Ramsay's criteria, while the combination of sufentanil-midazolam-medications causes deeper sedation (score 3) in patients (P<0.05). Despite this fact, 23.33% of the patient receiving sufentanil-midazolam could have movements during the surgery, which was 6.66% higher in patients receiving dexmedetomidine (P=0.071). The satisfaction of patients receiving dexmedetomidine was significantly higher (P=0.044), while the surgeon's satisfaction was almost identical in both anesthesia procedures (P=0.94). In the end, the results of the present study showed that although dexmedetomidine is associated with few respiratory problems and higher satisfaction of patients, it decreases blood pressure and heart rate progressively. However, it seems that this medicine is more effective than a combination of midazolam-sufentanil because of more patient satisfaction, lack of hypoxia, fewer complications, and more suitable immobility.

     

  • XML | PDF | downloads: 50 | views: 100 | pages: 308-310

    Bilious vomiting is highly suggestive of an acute and emergent condition among neonates. The aim of this study was to investigate the non-surgical causes of bilious vomiting in neonates admitted to a tertiary center and to compare them with the surgical causes. This cross-sectional study was performed on 80 infants with bilious vomiting who were admitted at the neonatal intensive care unit of a pediatric tertiary center over two years. The demographic characteristics, clinical symptoms and signs, diagnostic assessments, and therapeutic approaches were recorded. The mean age of neonates was 9.07±8.84 days, and 55% of them were males. The most common final diagnosis was: Necrotizing Enterocolitis (NEC), duodenal atresia, Hirschsprung’s disease, gastroesophageal reflux disease (GERD), volvulus, sepsis, meconium plug, isolated mal-rotation, metabolic abnormalities, imperforate anus, and Ladd’s bands, respectively. Abnormal findings in ultrasound and X-rays were detected in 35% and 46.3%, respectively. About half of the affected neonates were treated non-surgically. Overall, 17.5% of the patients died. Most deaths were seen in infants with NEC. Using multivariable logistic regression analysis, the presence of NEC as an underlying etiology was the only predictor of neonatal death in neonates with bilious vomiting (OR=12.455, 95%CI: 1.365-113.618, P=0.025). The most common cause of bilious vomiting was NEC, followed by duodenal atresia. Half of the neonates with bilious vomiting were treated medically without operation.