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Radiomics analysis on CT images for prediction of radiation-induced kidney damage by machine learning models
No full textIntroduction: We aimed to assess the power of radiomic features based on computed tomography to predict risk of chronic kidney disease in patients undergoing radiation therapy of abdominal cancers. Methods: 50 patients were evaluated for chronic kidney disease 12 months after completion of abdominal radiation therapy. At the first step, the region of interest was automatically extracted using deep learning models in computed tomography images. Afterward, a combination of radiomic and clinical features was extracted from the region of interest to build a radiomic signature. Finally, six popular classifiers, including Bernoulli Naive Bayes, Decision Tree, Gradient Boosting Decision Trees, K-Nearest Neighbor, Random Forest, and Support Vector Machine, were used to predict chronic kidney disease. Evaluation criteria were as follows: accuracy, sensitivity, specificity, and area under the ROC curve. Results: Most of the patients (58) experienced chronic kidney disease. A total of 140 radiomic features were extracted from the segmented area. Among the six classifiers, Random Forest performed best with the accuracy and AUC of 94 and 0.99, respectively. Conclusion: Based on the quantitative results, we showed that a combination of radiomic and clinical features could predict chronic kidney radiation toxicities. The effect of factors such as renal radiation dose, irradiated renal volume, and urine volume 24-h on CKD was proved in this study. © 202
Mesenchymal Stem Cells Pretreatment With Stromal-Derived Factor-1 Alpha Augments Cardiac Function and Angiogenesis in Infarcted Myocardium
No full textBackground: Stem cell therapy is among the novel approaches for the treatment of post-myocardial infarction cardiomyopathy. This study aims to compare the effect of stromal-derived factor 1 α (SDF1α), mesenchymal stem cells (MSCs) in combination with the lentiviral production of vascular endothelial growth factor (VEGF) on infarct area, vascularization and eventually cardiac function in a rat model of myocardial infarction (MI). Methods: The influence of SDf1α on MSCs survival was investigated. MSCs were transduced via a lentiviral vector containing VEGF. After that, the effect of mesenchymal stem cell transfection of VEGF-A165 and SDf1α preconditioning on cardiac function and scar size was investigated in five groups of MI rat models. The MSC survival, cardiac function, scar size, angiogenesis, and lymphocyte count were assessed 72 hours and 6 weeks after cell transplantation. Results: SDF1α decreased the lactate dehydrogenase release in MSCs significantly. Also, the number of viable cells in the SDF1α-pretreated group was meaningfully more than the control. The left ventricular systolic function significantly enhanced in groups with p240MSC, SDF1αMSC, and VEGF-A165MSC in comparison to the control group. Conclusions: These findings suggest that SDF1α pretreatment and overexpressing VEGF in MSCs could augment the MSCs' survival in the infarcted myocardium, reduce the scar size, and improve the cardiac systolic function. © 2021 Southern Society for Clinical Investigatio
The association between dietary acid load with cardiometabolic risk factors and inflammatory markers amongst elderly men: A cross-sectional study
No full textBackground: Existing epidemiological data on dietary acid load and cardiovascular disease (CVD) are controversial. There is no literature evaluating the association between dietary acid load (DAL) with cardiometabolic risk factors and inflammatory markers in elderly. Objective: To evaluate the association between DAL and cardiometabolic risk factors amongst Iranian elders. Method: A cross-sectional study was completed using 357 Iranian elders above >60 years of age. Anthropometric, clinical, and biochemical measurements were performed. Dietary intake was assessed using a validated and reliable food frequency questionnaire. DAL was estimated using the Potential Renal Acid Load (PRAL) score, Net Endogenous Acid Production (NEAP) and the Net Endogenous Acid Excretion (NAE) score. Metabolic syndrome (MetS) was defined according to the ATP-III criteria. Multivariable-adjusted odds ratios (ORs) of CVD risk factors were estimated using logistic regression. Results: After adjustment for confounders, a higher PRAL score was associated with higher odds of hypertriglyceridemia (OR: 2.28, 95 CI: 1.15, 4.50). We also observed that the NEAP score was positively associated with MetS (OR: 17.2, 95 CI: 2.34, 127). Finally, there was a positive association between NAE and lipid accumulation product (LAP) (OR: 1.81, 95 CI: 1.04, 3.17) and hypertriglyceridemia (OR: 2.46 95 CI: 1.22, 4.95). Conclusion: Men with higher DAL scores had a higher risk of MetS, hypertriglyceridemia and LAP. Our findings suggest that further prospective studies are required to appraise DAL-CVD risk factors in populations with varying dietary patterns. © 2021 John Wiley & Sons Lt
Learning and memory disorders related to hippocampal inflammation following exposure to air pollution
No full textIt has been demonstrated that sub-chronic exposure to air pollution containing nanoscale (�100 nm) diesel exhaust particles (DEPs) may lead to excessive oxidative stress and neuro-inflammation in adult male mice. Hereby, we investigated the effects of DEPs on hippocampus-dependent spatial learning and neuro-inflammation and memory-related gene expression in male mice. In this study, we divided 48 adult NMRI male mice into control group VS. three exposure groups. Mice were exposed to 300-350 μg/m3 DEPs for 2, 5, and 7 h daily for 12 weeks. The Morris Water Maze (MWM) and Elevated Plus Maze device were used to examine anxiety, spatial memory and learning, respectively. The mRNAs expression of pro-inflammatory cytokines, N-methyl-D-aspartate (NMDA) receptor subunits, and glutaminase were studied in hippocampus (HI) by real-time RT-PCR. Besides, malondialdehyde (MDA) tests were used to determine the state of oxidative stress. After 5 and 7 h. of DEPs exposure, mRNA expression of NR2A and NR3B IL1α, IL1β, TNFα, NMDA receptor subunits and MDA levels increased significantly (P < 0.05). Also, DEPs exposed mice for 2, 5, and 7 h. showed diminished entrance into open arms with short time spent there. Indeed, 5 and 7 h/day exposed mice required a longer time to reach the hidden platform. Sub-chronic exposure to DEPs increased oxidative stress markers, neuroinflammation, anxiety, impaired spatial learning and memory. © 2021, Springer Nature Switzerland AG
Umbilical cord mesenchymal stem cells as well as their released exosomes suppress proliferation of activated PBMCs in multiple sclerosis
No full textMultiple sclerosis (MS) is a central nervous system (CNS) degenerative disorder which is caused by a targeted autoimmune-mediated attack on myelin proteins. Previously, mesenchymal stem cells were considered as a novel and successful treatment of MS. One of the underlying mechanisms behind their immunomodulatory function is the release of extracellular vesicles, particularly exosomes. In this study, we aimed to evaluate the suppressive efficacy of MSCs and their exosomes on the proliferation of peripheral mononuclear blood cells (PBMC) in relapsing-remitting MS (RRMS) patients and healthy subjects. To do, mesenchymal stem cells were derived from human umbilical cord tissues and used for exosome isolation through ultracentrifugation. Suppressive function of MSCs and MSC-derived exosomes was examined in a coculture with CFSE-labelled PBMCs in vitro. PBMC proliferation of the patients and healthy individuals was measured using flow cytometry. We first demonstrated that proliferation of PBMCs decreased in the presence of MSCs and suppression was more efficient by MSC-derived exosomes, with a minimum alloreaction rate. However, suppression capacity of MSCs and their exosomes significantly decreased during extensive sub-culturing. The present study showed that MSC-derived exosomes as an effective cell-free therapy could prevent proliferation of PBMCs. However, further evaluations are need to move towards a functional approach that can be translated to the clinic. © 2020 The Scandinavian Foundation for Immunolog
Mutation Status and Prognostic Value of KRAS and BRAF in Southeast Iranian Colorectal Cancer Patients: First Report from Southeast of Iran
No full textMain Purpose: This study aimed to determine any association of KRAS and BRAF mutations in colorectal cancer with clinicopathological features and overall survival (OS) of Southeast Iranian colorectal cancer (CRC) patients. Methods: Overall, KRAS and BRAF status were assessed in 100 Iranian CRC subjects. A hundred consecutive stages I�IV CRC patients, who underwent surgical tumor resection from February 2012 to August 2015, were prospectively attained from three centers and were enrolled in the research. Direct sequencing and real-time PCR methods were used to the detection of KRAS and BRAF mutations, respectively. Logistic regression models were used to detect associations of KRAS and BRAF mutations with clinical/clinicopathological features. Kaplan�Meier model was used to estimate overall survival. Results: In total, KRAS and BRAF mutations were detected in 29 (29) and 7 (7) of 100 CRC patients, respectively. BRAF mutations that all comprised V600E and KRAS mutations were found in codon 12, 13, and 61 (72.4, 20.7 and 6.9), respectively. In a multivariate analysis, older age (� 60) was significantly associated with higher KRAS mutations rate and high BRAF mutation rate was significantly associated with older age (� 60) and poorly differentiated tumors. KRAS and BRAF mutant vs. wild type of KRAS and BRAF, 5-year OS was 62.1 vs. 71.8 (p value > 0.05) and 57.1 vs. 67.7 (p value > 0.05), respectively. Conclusion: Mutations were found in both KRAS and BRAF genes in Iranian colorectal cancers patients and were associated with clinical/clinicopathologic features. Our data emphasizes the importance of these molecular features in Iranian CRC patients. © 2020, Springer Science+Business Media, LLC, part of Springer Nature
A scoping review of public hospitals autonomy in Iran: from budgetary hospitals to corporate hospitals
Get PDFBackground: Organizational reforms of hospitals in Iran are mainly aimed at improving efficiency, reducing government spending on health care, and improving the quality of services. These reforms began with hospital autonomization and have continued with other initiatives such as formation of board of trustees, independent and corporatized hospitals. Objective: The purpose of this scoping review was to summarize and compare the results of studies conducted on organizational reform of hospitals in Iran to paint a more clear picture of the status quo by identifying knowledge gaps, inform policymakers, and guide future studies and policies. Method: This review�s methodology was inspired by Arksey and O�Malley�s methodological framework to examine the extent, range, and nature of research activity about organizational hospital reforms in Iran. A literature search was performed using PubMed, Scopus, Web of Science, and Google Scholar for English papers as well as SID, IranDoc, Magiran, and the Social Security Research Institute Database for Persian papers from 1991 to April 2020. Results: Twenty studies were included in the review. Studies were grouped by the types of organizational reform, study�s objective, setting, methodology, data collection and analysis techniques, and key findings. Thematic construction was used based on the types of organizational reform to present a narrative account of existing literature. Conclusions: The autonomy granted to the hospitals was unbalanced and paradoxical in terms of key effective dimensions. Poor governance and regulatory arrangements, low commitment to corporate governance, Inappropriate board composition, weak internal controls, unsustainable financing and inefficient payment mechanisms, poor interaction with stakeholders and ignoring contextual factors have been cited as the main reasons for the failure of organizational reforms in Iran. The limited use of evidence and research was obvious at different stages of policymaking, especially in the policy formulation phase and evaluation of its results. © 2021, The Author(s)
Clinico-Hematological and cytogenetic spectrum of adult myelodysplastic syndrome: The first retrospective cross-sectional study in Iranian patients
Get PDFBackground: Myelodysplastic syndrome (MDS), a heterogeneous group of hematopoietic malignancy, has been shown to present different cytogenetic abnormalities, risk factors, and clinico-hematological features in different populations and geographic areas. Herein, we determined the cytogenetic spectrum and clinico-hematological features of Iranian MDS patients for the first time. Methods: This prospective cross-sectional study was conducted on 103 patients with MDS in Ahvaz, southwest of Iran, from 2014 to 2018. Clinical presentations, complete blood counts (CBC), and bone marrow (BM) biopsy samples were assessed. Perls' staining was used to evaluate BM iron storage. The cytogenetic evaluation was performed using the conventional G banding method on the BM. Results: Patients� median age was 62.3 (ranged from 50�76), and the majority were male (72.8). The most common clinical symptom at the time of admission was fatigue (n = 33) followed by pallor (n = 27). The most common subgroup was MDS-Multi Lineage Dysplasia (MDS-MLD) (n = 38, 36.8), followed by MDS-Single Lineage Dysplasia (MDS-SLD) (n = 28, 18.4). A normal karyotype was observed in 59 patients (57.3), while 44 patients (42.7) had cytogenetic abnormalities. Trisomy 8 (+ 8) was the most common cytogenetic abnormality (n = 14) followed by del 17p (n = 9) and monosomy 7 (� 7) (n = 7). Twelve patients (11.65) were transformed to AML. Conclusion: Our data betokened that among our MDS patients, Trisomy 8 is the predominant cytogenetic abnormality, and MDS-MLD and MDS-SLD are the most common of subtypes. Noteworthy, the male: female ratio was slightly higher in Iran than in previous reports from other parts of the world. Our study is the first report of the clinical, hematological, and cytogenetic spectrum of MDS patients in Iran © 2021, The Author(s)
Disparities in the quality of and access to services in children with autism spectrum disorders: a structural equation modeling
Get PDFBackground: Socioeconomic disparities in health and healthcare are global issues that affect both adults as well as children. Children with exceptional healthcare needs, especially those with developmental impairments, including Autism Spectrum Disorders (ASD), encounter major disparities in access to and quality of health services. However, disparities in the population of children are rarely studied. The main aim of this paper is to study the socioeconomic disparities in children with ASD by examining the association between their Social Determinants of Health (SDH) status and access to and the quality of services. Methods: This is a cross-sectional study on 202 children with ASD conducted in 2019 in two provinces including Ardabil and East-Azerbaijan, in the North-West of Iran. A structured, valid questionnaire was used to collect data on demographic, SDH status, quality of services, and access to services in a population of children with ASD aged 2�16-year-old. Around 77 participants were male and the mean age of children was 2 years and 6 months. Structural Equation Modeling (SEM) were used to assess the relationship. Results: Based on the results of this study, the overall mean scores of the quality of services, access to services, and SDH status were 61.23 (30.01), 65.91 (21.89), and 29.50 (22.32) out of 100, respectively. All the associations between the quality and access dimensions and quality (B: 0.464�0.704) and access (B: 0.265�0.726) scales were statistically significant (P < 0.001). By adjusting to covariates, the access was also significantly related to service quality (P = 0.004). Finally, the associations between SDH score with service quality (P = 0.039) and access (P < 0.001) were positively significant. Conclusions: There are socioeconomic disparities in the quality of and access to services among children with ASD, who use ASD services, in the North-West of Iran. We recommend health/medical centers, where children are diagnosed with ASD, conducting SDH screening and providing families of low-SDH status with specific information about the quality of and access to services for children with ASD. Additionally, medical universities must have a plan to routinely monitor the quality of and access to services provided for the children with low SDH. © 2021, The Author(s)
Nurses� perception of patient safety culture and its relationship with adverse events: a national questionnaire survey in Iran
Get PDFBackground: Patient safety culture is an important factor in determining hospitals� ability to address and reduce the occurrence of adverse events (AEs). However, few studies have reported on the impact of nurses� perceptions of patient safety culture on the occurrence of AEs. Our study aimed to assess the association between nurses� perception of patient safety culture and their perceived proportion of adverse events. Methods: A cross-sectional survey was carried out among 2295 nurses employed in thirty-two teaching hospitals in Iran. Nurses completed the Persian version of the hospital survey of patients� safety culture between October 2018 and September 2019. Results: Positive Response Rates of overall patient safety culture was 34.1 and dimensions of patient safety culture varied from 20.9 to 43.8. Also, nurses estimated that the occurrence of six adverse events varied from 51.2�63.0 in the past year. The higher nurses� perceptions of �Staffing�, �Hospital handoffs and transitions�, �Frequency of event reporting�, �Non-punitive response to error�, �Supervisor expectation and actions promoting safety�, �Communication openness�, �Organizational learning continuous improvement�, �Teamwork within units�, and �Hospital management support patient safety� were significantly related to lower the perceived occurrence at least two out of six AEs (OR = 0.69 to 1.46). Conclusions: Our findings demonstrated that nurses� perception regarding patient safety culture was low and the perceived occurrence of adverse events was high. The research has also shown that the higher level of nurses� perception of patient safety culture was associated with lowered occurrence of AEs. Hence, managers could provide prerequisites to improve patient safety culture and reduce adverse events through different strategies, such as encouraging adverse events� reporting and holding training courses for nurses. However, further research is needed to assess how interventions addressing patient safety culture might reduce the occurrence of adverse events. © 2021, The Author(s)