Repository of Research and Investigative Information Isfahan University of Medical Sciences
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Association of myopia and parapapillary choroidal microvascular density in primary open-angle glaucoma
No full textBackground/Aims To compare parapapillary choroidal microvascular (PPCMv) densities between myopic eyes with and without glaucoma. Methods In this retrospective study, OCTA images (4.5 x 4.5 mm) were obtained using a commercial spectral-domain OCTA system. PPCMv density was calculated in inner and outer annuli using customized software. Marginal model of generalized estimating equations was established to adjust for confounding factors and intraclass correlations. Results This study included 35 myopic eyes with glaucoma (MG), 96 non-myopic eyes with glaucoma (NMG) matched for visual field mean deviation, 37 myopic eyes without glaucoma (MNG), and 73 control eyes from three tertiary centers. The participant ages were (mean standard deviation, SD) 57.43 11.49, 60.40 10.07, 52.84 9.35, and 54.74 12.07 years. Inner and outer annular PPCMv densities (mean SD) decreased in the following order: control (0.15 0.04 and 0.12 0.04), MNG (0.14 0.08 and 0.12 0.08), NMG (0.09 0.05 and 0.07 0.04), and MG (0.09 0.04 and 0.07 0.03). The mean differences in PPCMv density between glaucoma groups (NMG and MG) and the control group (mean difference 95% confidence interval) were -0.06 (-0.08 to -0.04, P 0.112). Conclusions Parapapillary choroidal microvascular density attenuation tends to be greater in eyes with glaucoma than in eyes with myopia
Smart Mesoporous Silica Nanoparticles in Cancer: Diagnosis, Treatment, Immunogenicity, and Clinical Translation
No full textIn cancer research and personalized medicine, mesoporous silica nanoparticles (MSNs) have emerged as a significant breakthrough in both cancer treatment and diagnosis. MSNs offer targeted drug delivery, enhancing therapeutic effectiveness while minimizing adverse effects on healthy cells. Due to their unique characteristics, MSNs provide targeted drug delivery, maximizing therapeutic effectiveness with minimal adverse effects on healthy cells. The review thoroughly investigates the role of MSNs as potent drug carriers, noted for their high drug-loading capacity and controlled release, which significantly improves drug permeability and retention. Additionally, it discusses surface modification techniques that enable MSNs to target cancer cells precisely. The manuscript provides comprehensive insights into various MSN applications, including their role in cancer diagnosis, the design of advanced biosensors, and the development of both conventional and stimuli-responsive drug delivery platforms. Special focus is given to stimuli-triggered MSN systems, responsive to internal stimuli (e.g., pH, redox, enzyme) and external stimuli (e.g., temperature, magnetic field, light, ultrasound), highlighting the cutting-edge progress in MSN technology. Additionally, the review delves into the immunogenicity and biosafety aspects of MSNs, underscoring their potential for clinical translation. Besides summarizing the current state of MSN research in oncology, this review also illuminates the path for future advancements and clinical applications
Mortality Associated with Surgical Site Infections Following Cardiac Surgery: Insights from the International ID-IRI Study
No full textObjectives: Surgical site infections (SSIs) after cardiac surgery increase morbidity and mortality rates. This multicenter study aimed to identify mortality risk factors associated with SSIs after heart surgery. Methods: Conducted from January to March 2023, this prospective study included 167 patients aged >16 years with post-heart surgery SSIs. The primary focus was the 30-day mortality. Univariate analysis and multivariate logistic regression utilizing the backward elimination method were used to establish the final model. Results: Several factors significantly correlated with mortality. These included urinary catheterization (odds ratio OR 14.197; 90% confidence interval CI 12.198-91.721), emergent surgery (OR 8.470 90% CI 2.028-35.379), valvular replacement (OR 4.487 90% CI 1.001-20.627), higher quick Sequential Organ Failure Assessment scores (OR 3.147 90% CI 1.450-6.827), advanced age (OR 1.075 90% CI 1.020-1.132), and postoperative re-interventions within 30 days after SSI (OR 14.832 90% CI 2.684-81.972). No pathogens were isolated from the wound cultures of 53 (31.7%) patients. A total of 43.1% of SSIs (n = 72) were due to gram-positive microorganisms, whereas 27.5% of cases (n = 46) involved gram-negatives. Among the gram-positive bacteria, Staphylococci (n = 30, 17.9%) were the predominant microorganisms, whereas Klebsiella (n = 16, 9.6%), Escherichia coli (n = 9, 5.4%), and Pseudomonas aeruginosa (n = 7, 4.2%) were the most prevalent. Conclusions: To mitigate mortality after heart surgery, stringent infection control measures and effective surgical antisepsis are crucial, particularly, in the elderly. The clinical progression of the disease is reflected by the quick Sequential Organ Failure Assessment score and patient re-intervention, and effective treatment is another essential component of SSI management
Effects of Spirulina platensis supplementation on quality of life, severity of disease and serum total antioxidant capacity, malondialdehyde and zonulin in constipation-predominant irritable bowel syndrome: protocol for a randomised, double-blinded, placebo-controlled clinical trial from Iran
No full textINTRODUCTION: Irritable bowel syndrome (IBS) is one of the most common chronic gut-brain interaction disorders. Nevertheless, there is currently no treatment for IBS. Low-grade inflammation and oxidative stress are contributing factors to the increased perception of abdominal pain and heightened sensitivity of the nervous system in these patients. Spirulina platensis is a rich source of essential nutrients, including amino acids, vitamins, minerals, phytochemicals, essential fatty acids and fibre. It has been found that Spirulina possesses a variety of therapeutic properties such as antioxidant, anti-inflammatory and antidepressant effects, which may be advantageous in reducing complications of IBS. The aim of present randomised clinical trial (RCT) is to assess the efficacy of Spirulina supplementation on IBS. METHODS AND ANALYSIS: This study is a 12-week, 1:1 parallel-group, double-blinded, randomised controlled trial. Sixty adult individuals diagnosed with IBS according to the Rome IV criteria will be randomised to consume either Spirulina capsules (500 mg) or a placebo, two times a day. The primary outcomes of this RCT are the changes in the IBS quality of life, severity of IBS symptoms, and gut permeability from baseline to 12 weeks of the intervention. The secondary outcomes are the changes in the serum total antioxidant capacity and serum malondialdehyde from baseline to the end of intervention. If this RCT demonstrates significant results in gut permeability, antioxidant status and reduction in IBS symptoms, it could support the use of Spirulina in managing IBS and could potentially reduce healthcare costs. ETHICS AND DISSEMINATION: The study protocol has been approved by the Medical Ethics Committee of Isfahan University of Medical Sciences, Isfahan, Iran (ID: IR.MUI. RESEARCH: REC.1401.370). Findings will be presented in subsequent publications. TRIAL REGISTRATION NUMBER: IRCT20140208016529N8; Iranian Registry of Clinical Trials; registered on 25 April 2023
Perioperative Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement with Concomitant Mitral Regurgitation: A Meta-Analysis
No full textTranscatheter aortic valve replacement (TAVR) is widely performed in high-risk patients with severe aortic stenosis. However, the effects of baseline concomitant mitral regurgitation (MR) on perioperative outcomes remain unclear. This study evaluated the impact of concomitant MR severity on short-term TAVR outcomes. A systematic search of 6 electronic databases was conducted. Studies that stratified patients based on MR severity (MR >/=2 vs. /=3 vs. /=2) had a 49 (95 confidence interval (CI), 1.32-1.70) increased risk of short-term mortality, a 41 (95 CI, 1.22-1.63) higher risk of in-hospital mortality, and a 38 (95 CI, 1.17-1.62) higher risk of AKI than those with none-to-mild MR (MR/=3 had an even greater 72 (95 CI, 1.37-2.16) increase in short-term mortality. No significant differences were observed in pacemaker implantation, bleeding, or vascular complications between groups. Additionally, after TAVR, MR improved in 36 of patients by at least 1 grade within 1 week, increasing to 44 by 1 month. In TAVR patients, MR >/=2 was associated with significantly higher early mortality and AKI risk, underscoring the need for a comprehensive perioperative risk assessment. Future studies should examine the differential impact of functional and degenerative MR
Therapeutic and prognostic values of ferroptosis signature in glioblastoma
No full textFerroptosis is a regulated cell death process that results in decreased tumor growth and aggressiveness when targeted in various cancer cells. Studying the impact of ferroptosis in glioblastoma (GBM) will provide important knowledge about tumor biology and potential treatment strategies. The high metabolic activity resulting in ROS production, iron content and active lipid metabolism of glioblastoma cells make them particularly susceptible to ferroptosis. Single-cell RNA sequencing reveals the molecular signature of GBM and its tumor microenvironment, introducing ferroptosis-related biomarkers pathways and drug resistance mechanisms to enhance treatment outcomes for GBM patients. The relationship between ferroptosis and the immune landscape in GBM is complex and can have either positive or negative effects. These effects can be identified through single-cell RNA sequencing to develop targeted chemo-, radio- and immuno- therapies against glioma stem cells and tumor-supportive immune cells. Additionally, the implication of oncolytic virotherapy in combination with ferroptosis induction can lead to improved treatment of GBM in a clinical setting
Enhancing clinical faculties' knowledge, attitudes, and performance in clinical supervision: a workplace-based faculty development program using proctor's model
No full textBACKGROUND: Clinical supervision is crucial for developing medical trainees' independence. Faculty development programs can enhance faculty performance by changing their faculty attitudes and knowledge. This study examined the impact of such programs on pediatric faculty members' supervisory knowledge, attitudes, and performance. METHODS: This was a quasi-experimental, pre-post, single-group study. The participants included 20 pediatric faculty members conveniently selected from the Isfahan University of Medical Sciences in Iran. The program's design used the Proctor model and ASSURE instructional design model. The 34-day program was delivered in a blended format (online and workplace) and included feedback. An observational checklist was used to assess faculty performance, and a self-report questionnaire was used to measure faculty members' knowledge and attitudes toward clinical supervision. Paired t-tests, independent t-tests, Spearman correlation coefficients, Cohen's -d values, and descriptive statistics were used. RESULTS: The mean self-reported scores of knowledge (before: 5.55 +/- 2.31, after: 8.25 +/- 1.53) and attitudes (before: 4.07 +/- 0.52, after: 4.28 +/- 0.43) among faculty members increased significantly after the development program. Additionally, 90.63 of the faculty members applied the components of the Proctor model of clinical supervision. CONCLUSION: These results suggest that structured faculty development programs can improve faculty knowledge, attitudes, and performance in clinical supervision
The Prognostic Yield of Admission Shock Index in Patients with ST-Segment Elevation Myocardial Infarction: SEMI-CI Study
No full textBACKGROUND: Early identification of high-risk patients presenting with ST-segment elevation myocardial infarction (STEMI) helps prevent complications. The shock index (SI) is a bedside risk-stratification tool used in emergency departments. In this study, we aimed to assess the SI's predictive value for prognosticating in-hospital and one-year mortality, as well as one-year major cardiovascular events (MACEs). As secondary endpoints, we assessed the age SI's performance and the influence of prehospital transport factors on SI's predictive value. METHODS: This prospective cohort study is named SEMI-CI and enrolled patients with STEMI who were referred to a cardiology hospital in Isfahan. We analyzed data on 867 patients with STEMI. Systolic blood pressure (SBP) and heart rate (HR) upon admission were used to calculate SI. Patients were divided into two groups based on SI, and 277 patients had SI > 0.7. RESULTS: In-hospital death, one-year mortality, and MACE were more prevalent in those patients presenting with SI >/= 0.7. However, after multivariate adjustment, SI was an independent predictor of in-hospital mortality and MACE, but it was not associated with one-year mortality. Furthermore, mortality rates increased from lower to higher age groups. Among patients transferred by emergency medical services to our hospital, SI showed prognostic implications for in-hospital mortality but not for one-year mortality. CONCLUSIONS: The current study showed that a positive SI and age SI are valuable risk-stratification tools to identify high-risk patients presenting with STEMI
Efficacy of liquid biopsy for genetic mutations determination in non-small cell lung cancer: a systematic review on literatures
No full textBACKGROUND: Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related mortality worldwide and is often diagnosed at advanced stages, limiting treatment options. This systematic review aims to evaluate the efficacy of liquid biopsy in detecting genetic mutations in NSCLC, focusing on its sensitivity, specificity, clinical utility, and potential to guide personalized treatment strategies. METHODS: A systematic search was conducted in PubMed, Scopus, Embase, Web of Science, and Cochrane Library to identify relevant studies published between 1990 and September 2024. Eligible studies included comparative analyses of liquid biopsy techniques for NSCLC diagnosis, prognosis, progression, or treatment response. This review adheres to the PRISMA 2020 guidelines and assesses study quality using the QUADAS framework. RESULTS: A total of 30 studies were included. Digital droplet PCR (ddPCR) demonstrated the highest sensitivity, detecting low-frequency mutations such as EGFR T790M at levels as low as 0.01. Next-generation sequencing (NGS) provided comprehensive mutational profiling, revealing tumor heterogeneity and co-existing mutations but required high-quality plasma samples. The cobas EGFR Mutation Test, while less sensitive than ddPCR, remains widely used due to its clinical accessibility. Emerging methods, including extracellular vesicle analysis, show promise but require further validation. Additionally, liquid biopsy effectively identified non-EGFR mutations, such as KRAS, ALK, and MET amplifications, expanding its clinical applicability. CONCLUSION: Liquid biopsy is a transformative tool in NSCLC management, offering a minimally invasive approach for mutation detection, disease monitoring, and treatment guidance. Future research should focus on multicenter trials and emerging technologies to enhance clinical integration and broaden applicability across different cancer types
The effect of remineralization pretreatments on the enamel bond strength of demineralized and sound enamel: An in vitro study
No full textBACKGROUND: During tooth preparation, the clinician may face a hard remineralized enamel surrounding the cavity with unknown effects on the enamel bond strength. This study aims to assess the effect of remineralizing pretreatments with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) or CPP-amorphous calcium fluoride phosphate (CPP-ACFP) on the bond strength of composite resin and sound or demineralized enamel. MATERIALS AND METHODS: This study employed an in vitro experimental factorial design. A total of 144 enamel surfaces were prepared and randomly divided into 12 groups (G1-G12). The surfaces of G7-12 were demineralized to create a lesion (L), while G1-6 were assigned to the sound (S) enamel group. The three pretreatment protocols were CPP-ACFP, CPP-ACP, or no pretreatment for a 10-day pH-cycling period. A composite rod was bonded to the surfaces using a self-etch or total-etch bonding system. Shear force was applied, and the bond strengths of the specimens were measured. The data were analyzed using the Kruskal-Wallis test, followed by pairwise comparisons using Dunn's test. The significance level for all tests was set at 0.05. RESULTS: The sound (S) groups (33.81 +/- 8.48) showed a significantly higher bond strength than the lesion (L) groups (25.77 +/- 6.69). Among the pretreatments, CPP-ACFP-pretreated groups had the highest bond strength (33.86 +/- 8.87). Pairwise comparisons showed significant differences between CPP-ACFP-treated demineralized enamel and control demineralized enamel in both bonding systems (P = 0.019 and P = 0.025 for Clearfil SE and Optibond FL, respectively). CONCLUSION: Pretreatment of demineralized enamel with CPP-ACFP before using total-etch and self-etch systems results in a bond strength comparable to that of sound enamel, making it clinically acceptable