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Association of peripapillary retinal nerve fiber layer atrophy with cognitive impairment in patients with neuromyelitis optica spectrum disorder
No full textBACKGROUND: We aimed to explore the association between peripapillary retinal nerve fiber layer thickness (pRNFL), macular ganglion cell-inner plexiform layer (mGCIPL), and cognitive impairment (CI) in patients with neuromyelitis optica spectrum disorder (NMOSD). METHOD: In this cross-sectional study, 38 (28 aquaporin-4 (AQP4) IgG-seropositive) NMOSD patients and 20 healthy controls (HC) underwent cognitive assessment using Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) battery. Spectral-domain optical coherence tomography (OCT) was performed for both eyes of all NMOSD patients. First, we examined the association of pRNFL and mGCIPL with cognitive function in all patients, regardless of the history of previous optic neuritis (ON). We then included only eyes without a prior history of ON, incorporating non-ON eyes in patients with unilateral ON and the average of OCT measures for both non-ON eyes in patients without a history of ON. RESULTS: Sixteen (42.1) NMOSD patients exhibited global CI. There was a significant decrease in pRNFL (Delta: 24.33 mum, p = 0.002) and mGCIPL (Delta: 9.20 mum, p = 0.009) in NMOSD patients with CI compared to those without. The atrophy of pRNFL showed an inverse association with CI before (OR = 1.059, 95 CI: 1.015, 1.105) and after adjustment for age, sex, and disease duration (OR = 1.072, 95CI: 1.009, 1.139). An inverse significant association was observed between mGCIPL atrophy and CI before adjustment (OR = 1.102, 95 CI: 1.017, 1.194), but not after adjustment (OR = 1.106, 95CI: 0.999, 1.224). After narrowing our analysis to non-ON eyes, the same results for pRNFL and CI were observed (unadjusted: OR = 1.054, 95 CI: 1.004, 1.106; adjusted: OR = 1.081, 95CI: 1.000, 1.168). There was no significant association found between mGCIPL thickness and CI in both unadjusted and adjusted models. In sensitivity analyses, we observed no significant association between pRNFL and mGCIPL with CI in AQP-IgG-seropositive NMOSD patients. CONCLUSION: This study, for the first time, provide a preliminary evidence for a possible relation between pRNFL atrophy and occurrence of cognitive impairment in NMOSD patients. Further studies are required to explore the possible association of OCT parameters with cognition function in NMOSD patients
Clinical and Dermoscopic Comparison of the Efficacy and Safety of 5 Fluorouracil Topical Cream and 1 Niacinamide Topical Gel in the Treatment of Actinic Keratosis: A Randomized Controlled Trial
No full textBACKGROUND: Actinic keratosis (AK) is a common skin condition treated by dermatologists; however, the effectiveness, superiority, and potential side effects of current treatment protocols are still debated. AIM: This study aimed to compare the effectiveness and safety of 5 fluorouracil topical cream and 1 niacinamide topical gel in patients with AK. METHODS: In a randomized clinical trial, 26 patients with 95 AK lesions were assigned to receive either 5 fluorouracil topical cream twice daily for 4 weeks or 1 niacinamide topical gel twice daily for 3 months. Photography and dermoscopy before and after treatment were used to evaluate the outcomes. RESULTS: The study included 26 patients who underwent randomization and treatment. Analysis of the improvement response after treatment through photography and dermoscopy scores, as well as patients' perspectives, showed that the fluorouracil group had significantly better outcomes than the niacinamide group. However, treatment complications including burning, itching, and erythema were significantly more frequent in the fluorouracil group than in the niacinamide group. CONCLUSIONS: Although 5 fluorouracil cream is more effective than 1 niacinamide gel in treating AK lesions, it is also associated with more frequent side effects
Diagnostic performance of dual-energy computed tomography in detecting anterior cruciate ligament injuries: a systematic review and meta-analysis
No full textOBJECTIVE: Anterior cruciate ligament (ACL) injuries are common and lead to significant physical limitations. While MRI is the diagnostic gold standard, its use is restricted in acute trauma cases due to contraindications and longer imaging times. Dual-energy computed tomography (DECT) has emerged as a potential alternative. This meta-analysis evaluates the diagnostic accuracy of DECT for ACL injuries. MATERIALS AND METHODS: Following PRISMA guidelines, a comprehensive literature search was conducted using PubMed, Web of Science, Scopus, and Embase for studies published up to June 2024. Studies that provided diagnostic accuracy data for DECT in ACL ruptures were included. Metrics of diagnostic accuracy were aggregated using a bivariate random effects model. RESULTS: The meta-analysis, which included five studies with a total of 191 patients, found that DECT had a pooled sensitivity of 88.1 (95 CI, 78.0-93.9) and a specificity of 82.0 (95 CI, 62.0-92.7) for diagnosing ACL ruptures, with an AUC of 0.92 (95 CI, 0.72-0.96). For complete ruptures, sensitivity was 83.2 (95 CI, 68.2-92.0), and specificity was 94.9 (95 CI, 92.2-96.7), with an AUC of 0.96 (95 CI, 0.81-0.98). In acute/subacute settings, sensitivity was 89.4 (95 CI, 76.8-95.6), and specificity was 82.1 (95 CI, 56.2-94.2), with an AUC of 0.93 (95 CI, 0.71-0.97). CONCLUSION: Our findings suggest that DECT is a valuable diagnostic tool for ACL injuries, particularly as an adjunct or alternative when MRI is unavailable or contraindicated, enabling timely and accurate diagnosis
Cervical kyphoscoliosis due to substance abuse: a case series on introduction and neurosurgical treatment
No full textSTUDY DESIGN: A prospective case series. OBJECTIVE: To investigate the possible associations of multi-directional cervical kyphoscoliosis (CKS) with substance abuse and evaluate treatment outcomes. CKS is a rare medical situation without a well-established pathology. Still there are many obscurities in treatment paradigms and outcomes. To our knowledge, there is no published report on the association between CKS with addiction. Besides the novel report of such a rare etiology for CSK, the complexity of the neurosurgical treatment makes this report the first of its kind. METHODS: In this series, we presented three patients with a history of crack cocaine addiction who suffered CKS due to prolonged hand-over-neck posture and treated all of them with a complex neurosurgical protocol. RESULTS: All cases were operated on and restored their normal spine alignment. Their long-term outcomes showed independent neurological status with no major surgical complications. CONCLUSION: Crack cocaine addiction might be associated with CKS in long-term cocaine abuse. A complex neurosurgical approach can achieve a sustainable clinical outcome
Molecular Mechanism of lncRNAs in Regulation of Breast Cancer Metastasis; a Comprehensive Review
No full textAlthough the number of breast cancer deaths has decreased, and there have been developments in targeted therapies and combination treatments for the management of metastatic illness, metastatic breast cancer is still the second most common cause of cancer-related deaths in U.S. women. Numerous phases and a vast number of proteins and signaling molecules are involved in the invasion-metastasis cascade. The tumor cells penetrate and enter the blood or lymphatic vessels, and travel to distant organs via the lymphatic or blood vessels. Tumor cells enter cell cycle arrest, adhere to capillary beds in the target organ, and then disseminate throughout the organ's parenchyma, proliferating and enhancing angiogenesis. Each of these processes is regulated by changes in the expression of different genes, in which lncRNAs play a role in this regulation. Transcripts that are longer than 200 nucleotides and do not translate into proteins are called RNAs. LncRNA molecules, whose function depends on their unique molecular structure, play significant roles in controlling the expression of genes at various epigenetic levels, transcription, and so on. LncRNAs have essential functions in regulating the expression of genes linked to cell development in healthy and pathological processes, specialization, programmed cell death, cell division, invasion, DNA damage, and spread to other parts of the body. A number of cancer types have been shown to exhibit aberrant expression of lncRNAs. In this review, we describe the general characteristics, potential molecular mechanisms and targeted therapy of lncRNAs and discuss the emerging functions of lncRNAs in breast cancer
Diagnostic Performance of TOF, 4D MRA, Arterial Spin-Labeling, and Susceptibility-Weighted Angiography Sequences in the Post-Radiosurgery Monitoring of Brain AVMs
No full textBACKGROUND: Brain AVMs are congenital anomalies of the cerebrovascular system, often discovered incidentally or through symptomatic presentations such as intracranial hemorrhage, seizure, headache, or neurologic deficits. Various treatment modalities exist for AVMs, including radiosurgery, a treatment technique that is noninvasive and efficient. Accurate imaging is crucial for risk assessment, treatment planning, and monitoring of these patients before and after radiosurgery. PURPOSE: Currently, DSA is the preferred imaging technique. Despite its efficacy, DSA is notably invasive, presenting inherent risks to the patients. This systematic review and meta-analysis aimed to evaluate the efficacy of MRI sequences for monitoring brain AVMs after radiosurgery. DATA SOURCE: We performed a comprehensive search of PubMed, Scopus, Web of Science, and EMBASE databases and a methodologic quality assessment with the QUADAS-2 checklist diagnostic test accuracy. STUDY SELECTION: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 3,220 abstracts were screened, 98 articles were reviewed in full text, and 14 articles met the inclusion criteria. DATA ANALYSIS: We used the bivariate random-effects meta-analysis model with STATA/MP 17 software for data analysis. DATA SYNTHESIS: No publication bias was detected. Fourteen studies were eligible for qualitative and quantitative analysis. MRI offers high sensitivity (85) and specificity (99) in detecting residual AVMs. Different MRI sequences, including 3D TOF-MRA, 4D MRA, and arterial spin-labeling (ASL) demonstrated varying diagnostic accuracies with areas under the curve of 0.92, 0.97, and 0.96, respectively. 4D MRA had a sensitivity of 72 and specificity of 99, ASL showed a sensitivity of 90 and specificity of 92, while 3D TOF-MRA had 90 sensitivity and 87 specificity. LIMITATIONS: Meta-regression did not fully explain the sources of heterogeneity. Only 1 study assessed the susceptibility-weighted angiography (SWAN) method, and most studies involved small participant groups with varied MR techniques and sequences. Additionally, the retrospective nature of most studies may introduce bias, warranting cautious interpretation of the results. CONCLUSIONS: MRI sequences show acceptable diagnostic performance in postradiosurgery monitoring of brain AVMs, with ASL and 4D MRA showing acceptable diagnostic accuracy. Combining different MRI sequences may further enhance diagnostic reliability. However, further investigation is needed to assess whether MRI sequences can serve as a feasible substitute for DSA, considering their risk-benefit profile, with the potential to establish them as the recommended standard
Folate Biomarkers, Folate Intake, and Risk of Death From All Causes, Cardiovascular Disease, and Cancer: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies
No full textCONTEXT: Existing evidence on the relation between folate intake and biomarkers with mortality risk is controversial. OBJECTIVE: Previous cohort studies were examined regarding folate intake and biomarkers in relation to risk of all-cause, cardiovascular disease- (CVD), and cancer-related mortality through a systematic review and meta-analysis. DATA SOURCES: A systematic search was performed of the PubMed, Scopus, and ISI Web of Science databases up to July 2023. DATA EXTRACTION: Prospective cohort studies examining the association of folate biomarkers (in serum, plasma, red blood cells) and intake with risk of all-cause, CVD-, and cancer-related mortality were considered. A random-effects model was applied to combine study-specific risk estimates. Dose-response relations were assessed by 1-stage weighted mixed-effects meta-analysis. DATA ANALYSIS: A total of 25 cohorts with 423 304 participants, 36 558 all-cause, 12 662 CVD-, and 2426 cancer-related deaths were included. No significant association was observed between the highest levels of folate biomarkers and all-cause mortality risk (hazard ratio HR, 0.91; 95% CI, 0.77-1.06; n = 17; I2 = 89.4%; P < .001), CVD-related mortality risk (HR, 0.97; 95% CI, 0.87-1.06; n = 11; I2 = 0.0%; P = .57), and cancer-related mortality risk (HR, 0.85; 95% CI, 0.69-1.05; n = 6; I2 = 57.8%; P = .04) compared with the lowest. Furthermore, each 10 nmol/L increase was marginally related to a 12% reduced all-cause mortality risk but not to CVD- and cancer-related mortality risk. A significant inverse association was found between highest intake of dietary folate and the lowest, and risk of all-cause (HR, 0.87; 95% CI, 0.78-0.96; n = 3; I2 = 63.6%; P = .06) and CVD (HR, 0.77; 95% CI, 0.57-0.93; n = 4; I2 = 80.2%; P = .002) mortality. CONCLUSIONS: This meta-analysis revealed a significant inverse relation between dietary folate intake and risk of all-cause and CVD mortality. Such an association was not found in the case of folate biomarkers. Further prospective studies are warranted to confirm these findings. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42023401700
Exploring the Effects of Sub-Dissociative Doses of Ketamine on Sedation Quality in Bronchoscopy: A Double-Blind Clinical Study
No full textBackground: Sedation is recommended during flexible fiberoptic bronchoscopy (FFB) to aid in airway evaluation, minimize patient mobility, and enhance patient safety. This study was conducted to compare the impact of different sub-dissociative ketamine (SDK) doses on the quality of sedation within FFB. Methods: This research utilized randomized clinical trial design involving three cohorts, each consisting of 30 participants. The cohorts were administered varying doses of ketamine: 0.2 mg/kg (SDK1), 0.4 mg/kg (SDK2), and 0.5 mg/kg (SDK3). After receiving ketamine, all participants received propofol in bolus dose 0.4 mg/kg followed by infusion 50-100 µg/kg. FFB started when sedation level 4 was reached, according to Ramsey's sedation score. Results: Regarding demographic variables revealed no statistically notable discrepancy among the cohorts (P>0.05). The SDK3 cohort exhibited a higher average sedation score and longer duration of sedation compared to the SDK2, with both metrics also surpassing those of the SDK1 cohort. (P>0.001). Furthermore, the satisfaction levels reported by the bronchoscopist (P=0.78) and the participants (P=0.019) were notably greater in the SDK3 cohort than in the other groups. Additionally, the amount of propofol administered to the SDK3 cohort was less than that given to the SDK2, and both cohort received lower doses than the SDK1 cohort (P>0.001). Conclusion: Elevating the SDK from 0.2 mg/kg to 0.5 mg/kg when administered alongside propofol correlates with a rise in the score of sedation, increasing patient and bronchoscopist satisfaction, and decreasing propofol consumption in FFB in adults. A dosage of 0.5 mg/kg might be more advantageous compared to alternative dosages for FFB in adult patients. © 2025 Tehran University of Medical Sciences
Comparative Study of Blind Dilation versus Dilation Under Fluoroscopic Guidance in Percutaneous Nephrolithotomy Surgery
No full textIntroduction Percutaneous nephrolithotomy (PCNL) has turned to one of the major therapeutic approaches for renal stones. PCNL under fluoroscopic guidance is the most common modality applied to access the pyelocaliceal system. The purpose of this article is to compare the results of blind and fluoroscopy-guided dilation in PCNL candidates. Methods Over 20-year-old individuals with either over 2 centimeters pelvic/pyelocalis renal stone(s) or over 1 centimeter compact renal stone in the proximal of ureter confirmed in ultrasonography or computed tomography (CT) scan were included. Renal anomalies or single kidney, uncontrolled coagulopathy, previous history of PCNL, pregnancy, active urinary tract infection, full staghorn renal stone and serum creatinine level above 1.5 mg/dl were considered as the exclusion criteria. The study population was gathered through convenience sampling. Then, they were randomly assigned into either blind or fluoroscopy-guided dilatation groups using Random Allocation Software. accordingly, each patient was given a number by the software, if the number was odd the patient was allocated to the blind group, otherwise, he/she entered into the flouroscopy-guided PCNL group. Results In the present article, data of 96 patients undergoing PCNL in two groups of blind versus fluoroscopy-guided Dilatation were evaluated. The studied patients had the mean age of 49.57±12.15 years old and predominantly consisted of males (57.3). The assessed groups were similar in terms of age (P-value=0.544), gender distribution (P-value=0.536), and body mass index (P-value=0.210). Besides, the stone-related characteristics including the largest renal stone diameter (P-value=0.403), the location of the stones (P-value>0.05) and the targeted calyx (P-value>0.05) did not differ between the study groups. Conclusions According to findings of the present research, despite the similar success rate, stone residual fragments and complications of both blind versus fluoroscopy-guided dilatation, the remarkable longer duration of irradiation fluoroscopic modality convinced us that blind technique might be superior. © 2025 Urology Research Center (URC), Tehran University of Medical Sciences
The Effectiveness of Phytosomal Curcumin on Inflammation in Patients with Multiple Trauma Admitted to the Intensive Care Unit: A Double-Blind Randomized Placebo-Controlled Trial
No full textBackground: Multiple trauma has serious complications, which increases the risk of morbidity and mortality in the patients. This study aimed to evaluate the impact of supplementation with phytosomal curcumin on CRP in critically ill patients with multiple traumas. Methods: In this double-blind trial, 53 patients with multiple trauma who were admitted to the intensive care unit (ICU) were randomized to receive either two capsules, each capsule containing 250 mg phytosomal (a total of 500 mg daily) as an intervention group or two identical capsules (placebo capsules), each containing 250 mg maltodextrin for 7 days. Clinical and laboratory parameters were assessed before and after the intervention. Findings: After seven days of intervention, quantitative C-reactive protein (CRP) (P = 0.044) levels significantly decreased in the curcumin compared with the placebo group. Conclusion: Phytosomal curcumin had a beneficial effect on laboratory factor (CRP) in ICU-admitted patients with multiple trauma. © 2025 Isfahan University of Medical Sciences(IUMS). All rights reserved