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Engineered skin graft with stromal vascular fraction cells encapsulated in fibrin–collagen hydrogel: A clinical study for diabetic wound healing
No full textDespite the abundance of skin substitutes in the worldwide market, major hurdles in developing more complex tissues include the addition of skin appendages and vascular networks as the most important structure. The aim of this research was a clinical feasibility study of a novel prevascularized skin grafts containing the dermal and epidermal layer using the adipose stromal vascular fraction (SVF)-derived endothelial cell population for vascular network regeneration. Herein, we characterized hydrogel with emphasis on biological compatibility and cell proliferation, migration, and vitality. The therapeutic potential of the prevascularized hydrogel transplanted on five human subjects as an intervention group with diabetic wounds was compared with nonvascularized skin grafts as the control on five patients. Wound planimetric and biometric analysis was performed using a Mann–Whitney nonparametric t-test (p ≤.05). The fibrin–collagen hydrogel was suitable for skin organotypic cell culture. There was a significant (p ≤.05) increased in skin thickness and density in the vascular beds of the hypodermis measured with skin scanner compared with that in the control group. No significant macroscopic differences were observed between the intervention and control groups (p ≤.05). In summary, we report for the first time the use of autologous dermal–epidermal skin grafts with intrinsic vascular plexus in a clinical feasibility study. The preliminary data showed that SVF-based full-thickness skin grafts are safe and accelerate the wound healing process. The next stage of the study is a full-scale randomized clinical trial for the treatment of patients with chronic wounds. © 2019 John Wiley & Sons, Ltd
A low-dose chest CT protocol for the diagnosis of COVID-19 pneumonia: a prospective study
Get PDFPurpose: The increasing trend of chest CT utilization during the COVID-19 pandemic necessitates novel protocols with reduced dose and maintained diagnostic accuracy. We aimed to investigate the diagnostic accuracy of 30-mAs chest CT protocol in comparison with a 150-mAs standard-dose routine protocol for imaging of COVID-19 pneumonia. Methods: Upon IRB approval, consecutive laboratory-confirmed positive COVID-19 patients aged 50 years or older who were referred for chest CT scan and had same-day normal CXR were invited to participate in this prospective study. First, a standard-dose chest CT scan (150 mAs) was performed. Only if typical COVID-19 pneumonia features were identified, then a low-dose CT (30 mAs) was done immediately. Diagnostic accuracy of low-dose and standard-dose CT in the detection of typical COVID-19 pneumonia features were compared. Results: Twenty patients with a mean age of 64.20 ± 13.8 were enrolled in the study. There was excellent intrareader agreement in detecting typical findings of COVID-19 pneumonia between low-dose and standard-dose (intraclass correlation coefficient ICC = 0.98–0.99, P values < 0.001 all readers). The mean effective dose values in standard- and low-dose groups were 6.60 ± 1.47 and 1.80 ± 0.42 mSv, respectively. Also, absolute cancer risk per mean cumulative effective dose values obtained from the standard- and low-dose CT examinations were 2.71 × 10−4 and 0.74 × 10−4, respectively. Conclusions: According to our study, it was found that proposed low-dose CT chest protocol is reliable in detecting COVID-19 pneumonia in daily practice with significant reduction in radiation dose and estimated cancer risk. © 2020, American Society of Emergency Radiology
The measurement of thyroid absorbed dose by gafchromic™ EBT2 film and changes in thyroid hormone levels following radiotherapy in patients with breast cancer
No full textBackground: Radiotherapy is a main method for the treatment of breast cancer. This study aimed to measure the absorbed dose of thyroid gland using Gafchromic EBT2 film during breast cancer radiotherapy. In addition, the relationship between the absorbed dose and thyroid hormone levels was evaluated. Methods: Forty-six breast cancer patients, with the age ranged between 25 and 35 years, undergoing external radiotherapy were studied. The patients were treated with 6 and 18 MV X-ray beams, and the absorbed thyroid dose was measured by EBT2 film. Thyroid hormone levels, thyroid-stimulating hormone (TSH), triiodothyronine (T3), and thyroxin (T4), were measured before and after the radiotherapy. Pearson's, Spearman's, and Chi-square tests were performed to evaluate the correlation between the thyroid dose and hormone levels. Results: The mean thyroid dose was 26 ± 9.45 cGy with the range of 7.85-48.35 cGy. There were not any significant differences at thyroid hormone levels between preradiotherapy and postradiotherapy (P > 0.05). There was a significant relationship between increased thyroid absorbed dose and changes in TSH and T4 levels (P < 0.05), but it was not significant in T3 level (P = 0.1). Conclusion: Regarding the results, the thyroid absorbed dose can have an effect on its function. Therefore, the thyroid gland should be considered as an organ at risk in breast cancer radiotherapy. © 2020 Isfahan University of Medical Sciences(IUMS). All rights reserved
The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017
Get PDFBackground: The burden of inflammatory bowel disease (IBD) is rising globally, with substantial variation in levels and trends of disease in different countries and regions. Understanding these geographical differences is crucial for formulating effective strategies for preventing and treating IBD. We report the prevalence, mortality, and overall burden of IBD in 195 countries and territories between 1990 and 2017, based on data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. Methods: We modelled mortality due to IBD using a standard Cause of Death Ensemble model including data mainly from vital registrations. To estimate the non-fatal burden, we used data presented in primary studies, hospital discharges, and claims data, and used DisMod-MR 2.1, a Bayesian meta-regression tool, to ensure consistency between measures. Mortality, prevalence, years of life lost (YLLs) due to premature death, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) were estimated. All of the estimates were reported as numbers and rates per 100 000 population, with 95 uncertainty intervals (UI). Findings: In 2017, there were 6·8 million (95 UI 6·4–7·3) cases of IBD globally. The age-standardised prevalence rate increased from 79·5 (75·9–83·5) per 100 000 population in 1990 to 84·3 (79·2–89·9) per 100 000 population in 2017. The age-standardised death rate decreased from 0·61 (0·55–0·69) per 100 000 population in 1990 to 0·51 (0·42–0·54) per 100 000 population in 2017. At the GBD regional level, the highest age-standardised prevalence rate in 2017 occurred in high-income North America (422·0 398·7–446·1 per 100 000) and the lowest age-standardised prevalence rates were observed in the Caribbean (6·7 6·3–7·2 per 100 000 population). High Socio-demographic Index (SDI) locations had the highest age-standardised prevalence rate, while low SDI regions had the lowest age-standardised prevalence rate. At the national level, the USA had the highest age-standardised prevalence rate (464·5 438·6–490·9 per 100 000 population), followed by the UK (449·6 420·6–481·6 per 100 000). Vanuatu had the highest age-standardised death rate in 2017 (1·8 0·8–3·2 per 100 000 population) and Singapore had the lowest (0·08 0·06–0·14 per 100 000 population). The total YLDs attributed to IBD almost doubled over the study period, from 0·56 million (0·39–0·77) in 1990 to 1·02 million (0·71–1·38) in 2017. The age-standardised rate of DALYs decreased from 26·5 (21·0–33·0) per 100 000 population in 1990 to 23·2 (19·1–27·8) per 100 000 population in 2017. Interpretation: The prevalence of IBD increased substantially in many regions from 1990 to 2017, which might pose a substantial social and economic burden on governments and health systems in the coming years. Our findings can be useful for policy makers developing strategies to tackle IBD, including the education of specialised personnel to address the burden of this complex disease. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens
Resilience and its relationship with exposure to violence in emergency nurses
Get PDFBackground: Workplace violence (WPV) is a detrimental factor affecting nurses' health and performance. Individual protective factors such as resilience can assist nurses in coping with and adapting to workplace adversity. Objectives: The present study was aimed to determine the relationship between resilience and exposure to WPV in emergency nurses. Methods: This cross-sectional study was carried out on 118 emergency nurses in Tabriz educational hospitals, Iran. The participants were selected through a convenience sampling method. A demographic questionnaire, the Conner-Davidson Resilience Scale, and the Modified Questionnaire of Workplace Violence in the health sector were used for data collection. The data were analyzed using descriptive statistics, logistic regression analysis, t-test, and one-way analysis of variance. Results: The mean resilience score of nurses was 25.05 ± 5.79 in the possible range of 0-40. Most of the cases of violence were verbal threats (80.5), and 56.7 of the exposures occurred during the night shift. Logistic regression showed that lower resilience predicted verbal threats (P = 0.001) and physical attacks (P = 0.038) against the individual. In addition to resilience, working on the night shift significantly predicted verbal threats (P< = 0.008) against nurses. Conclusion: The resilience score was lower in nurses who exposed to violence. Empowerment programs are suggested to improve the resilience of nurses
Molecular typing of Acinetobacter baumannii clinical strains by enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR)
No full textAcinetobacter baumannii is one of the most important causes of nosocomial infections. Because of the prevalence and recurrence of infections associated with A. baumannii that occur in different regions of hospitals, such as the ICU ward, is important to find the source of the infection by different techniques including molecular methods. This study aimed to determine A. baumannii isolates by ERIC-PCR. In this cross-sectional study, 80 A. baumannii isolates were retrieved from patients admitted to ICU, CCU, and post CCU wards of Ghaem hospital, Karaj, Iran. After detecting the isolates by phenotypic methods, standard biochemical tests were first used to identify the isolates and then API 20NE System kits (Biomerieux, France). The final confirmation was done by tracking the blaOXA-51 gene through PCR. Then, isolates were typed by the ERIC-PCR technique. The gel electrophoresis image was then analyzed by GEL compareII software and the relating dendrogram was depicted. The dendrogram obtained from the results of the study showed that the isolates were divided into 14 clusters using ERIC-PCR method. The present study showed that the ERIC-PCR technique is a useful tool for studying the genetic diversity of A. baumannii isolates. Also, A. baumannii isolates were rotating between ICU, CCU, and post CCU of Ghaem hospital, Karaj, Iran. And also, no specific pattern was observed in the distribution of the isolates from one ward to another. © 2019 Elsevier Inc
Improvement of the sensitivity of PASSAG polymer gel dosimeter by urea
Get PDFThe severe toxicity in compound of polymer gel dosimeters has been reported as one of their major limitations for utilization in clinical applications. Recently, PASSAG polymer gel dosimeter has been introduced as a safe polymer gel dosimeter. Despite the excellent dosimetric results reported for this gel dosimeter, its R2-dose sensitivity is relatively low. Therefore, the present study is aimed to improve the sensitivity of PASSAG gel dosimeter by adding urea to its structure. Moreover, it was tried to obtain the optimal amount of urea for the new gel dosimeter. After preparation of the PASSAG-U (PASSAG and Urea) gel dosimeters, they were irradiated using 6 MV photon energy and their responses were read by a 1.5 T MRI scanner. Then, the R2-dose response and the R2-dose sensitivity of the PASSAG-U gel dosimeters with various percentages of the urea were assessed at a 0�10 Gy dose range, various scanning temperatures (15�24 °C), and post irradiation times (1�30 days). The radiological properties of PASSAG-U gel dosimeters con�rmed soft tissue and water equivalence of the new gel dosimeters. Compared to the PASSAG gel dosimeter, the R2-dose sensitivities of PASSAG-U gel dosimeters with 1, 3, and 5 urea were improved by 12.14, 25.15, and 27.90, respectively. Although the addition of urea improves the R2-dose sensitivity of the gel dosimeter, it leads to the degradation of dose resolution (especially for 5 urea). Moreover, the dosimetric evaluation of characteristics related to the PASSAG-U gel dosimeters with various urea concentrations resulted to following conclusions: 1) the optimal amount of urea was determined 3; 2) there was a stability in the R2 values for 18�22 °C scanning temperatures; 3) there was a temporal stability at the response of PASSAG-U gel dosimeters from 14 to 30 days after irradiation; 4) the R2-dose sensitivity of PASSAG-U gel dosimeters varied over post irradiation time. © 2019 Elsevier Lt
Inhibitory effects of Cinnamaldehyde, Carvacrol, and honey on the expression of exoS and ampC genes in multidrug-resistant Pseudomonas aeruginosa isolated from burn wound infections
Get PDFThis study aimed to evaluate the effects of Cinnamaldehyde, Carvacrol, and honey either alone or in combinations on the expression of exoS and ampC genes in multidrug-resistant (MDR) P. aeruginosa isolates. Thirty-five P. aeruginosa isolates were recovered from burn wound infections of patients admitted to the burn ward of Besat hospital of Hamadan, Iran, during 2018. Antibiotic susceptibility testing was performed using the Kirby-Bauer disk diffusion method to identify MDR isolates. The antibacterial effects of Cinnamaldehyde, Carvacrol, and honey either alone or in combinations with each other were compared to Imipenem (as the control group) using the broth dilution method. The expressions of exoS and ampC genes were determined in bacteria treated with sub-minimum inhibitory concentration (MIC) of the ternary combination of Cinnamaldehyde, Carvacrol, and honey by Real-Time-PCR. The data were analyzed using SPSS software applying student t-test, Kruskal-Wallis, and Mann-Whitney U tests. The P-value less than 0.05 was considered as statistically significant. The average MICs of Cinnamaldehyde, Carvacrol, and honey were 0.82�0.01, 0.01�0.6, and 62.5�250 μg/mL, respectively. The average MIC of the mentioned compounds was 430 times lower than that of Imipenem. A synergistic effect was detected between these drugs against 70 of the isolates. At sub-MIC concentration, the triple combination of Cinnamaldehyde, Carvacrol, and honey reduced the expressions of exoS and ampC genes by 6.12 and 2.85 folds, respectively. The combination of Cinnamaldehyde, Carvacrol, and honey showed a higher antibacterial effect than Imipenem. However, it needs confirmation with more isolates. © 2019 Elsevier Lt
Evaluation of psychometric properties of the caregiver burden inventory in parents of iranian children suffering from cancer
Get PDFBackground: The parents of children with cancer suffer from different physical and psychological health problems due to the burden of caregiving to their ill children. The Caregiver Burden Inventory (CBI) is among the most commonly used instruments for caregiver burden assessment. There is no data about its psychometric properties among the parents of children with cancer in Iran. Objectives: This study aimed to evaluate the psychometric properties of the caregiver burden inventory in parents of Iranian children suffering from cancer. Methods: This methodological study was conducted from April to September 2018 in the southwest of Iran. CBI was translated into Persian through the forward_backward method, and its face and content validity were assessed through both qualitative and quantitative methods. Then, its construct validity was assessed using exploratory and confirmatory factor analyses, and its reliability was assessed using the internal consistency and the test-retest stability assessment methods. The data for exploratory and confirmatory factor analyses were obtained from two separate samples of 125 parents. Results: From the 24 items, two items were deleted during content validity assessment due to their incompatibility with the Iranian culture. The impact scores, content validity ratios, and content validity indices of the remaining 22 CBI items were respectively more than 1.5, 0.46-1, and 0.80-1, and the scale-level content validity index was 0.8. Exploratory factor analysis revealed a five-factor structure for the Persian CBI which explained 64.24 of the total variance. Confirmatory factor analysis confirmed the five-factor structure. The Cronbach's alpha and the test-retest intraclass correlation coefficient of the Persian CBI were 0.907 and 0.90, respectively. Conclusion: The Persian CBI has acceptable psychometric properties and can be used to assess caregiver burden among the parents of children with cancer in Iran
Comparing the effects of muscle relaxation and music therapy on anxiety among candidates for coronary angiography: A randomized clinical trial
Get PDFBackground: Coronary angiography is associated with some levels of anxiety. Anxiety in turn can cause different complications, and hence, interventions are needed for its management. Recently, nonpharmacological therapies for anxiety management have gained great attention. Objectives: This study aimed to evaluate the effects of muscle relaxation and music therapy on anxiety among candidates for coronary angiography. Methods: This randomized controlled trial was conducted on 105 candidates for coronary angiography. Participants were consecutively recruited from the cardiology wards of Namazi hospital, Shiraz, Iran, and were randomly assigned to three 35-person groups, namely music, relaxation, and control groups. Participants in the music and the relaxation groups received 20-min music therapy and were performed 20-min muscle relaxation. Anxiety level was assessed both before and after the interventions using the Spielberger State Anxiety Inventory. Data were analyzed through the Chi-square test, the paired-sample t-test, and the one-way analysis of variance. Results: The mean score of anxiety in the relaxation and the music groups significantly reduced from 51.08 ± 6.98 and 49.02 ± 7.74 at the baseline to 41.88 ± 5.16 and 44.28 ± 5.21 at posttest (P < 0.01); however, it did not significantly change in the control group (P = 0.081). Conclusion: Both muscle relaxation and music therapy are effective in significantly reducing anxiety among candidates for angiography