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Purpose: 32-time scan duration reduction of 18F-Fluorodeoxyglucose (18F-FDG) Positron Emission Tomography (PET) images through the generation of standard scan duration images using a multi-slice cycle-consistent Generative Adversarial Network (cycle-GAN) was studied. Also, the effect of the image augmentation methods on the performance of the cycle-GAN model was evaluated. Materials and Methods: Four subsets of standard and 32-time short scan duration PET image pairs, each contacting image data of 10 patients were used to train and test (80 percent for training and 20 percent for testing) a multi-slice cycle-GAN separately. Another patient’s image data was used as the validation dataset for different training subsets. When training the cycle-GAN model for each subset, two approaches were followed: with and without image augmentation. Common image quality metrics of Peak Signal-to-Noise Ratio (PSNR), Structural Similarity Index Measure (SSIM), and Normalized Root Mean Squared Error (NRMSE) were used to assess the generation performance of the cycle-GAN model. Paired sample t-test statistical testing with a confidence interval of 0.95 was used to determine whether the differences between approaches were statistically significant or not. Results: For subsets 1-3, both training approaches improved the image quality of the short scan duration inputs (p < 0.001) while for subset 4 only the training approach with image augmentation was capable of improving the image quality. However, the training approach with image augmentation offered better results than the approach without image augmentation (p < 0.001). Conclusion: Employing the training approach with image augmentation, the cycle-GAN model was capable of improving the image quality of 1/32nd short scan duration images through the generation of synthetic standard scan duration images. In the case of the training approach without image augmentation, except for subset 4, the model trained on all subsets 1-3 was capable of improving the image quality. Image augmentation does indeed improve the performance of the cycle-GAN model, especially in the case of insufficient available training datasets.

This article presents the theory and implementation of a quadrature and differential RF front-end receiver. Combining balun, low-noise amplifier (LNA), mixer, and oscillator in a single stage, the proposed circuit, named the Blixator, is well suited for low-power applications. The baseband's transimpedance amplifier (TIA) also shares part of its dc current with the Blixator cell, resulting in sub-milliwatt power consumption. To avoid additional power and area by quadrature LO generation, the I/Q signals are generated at RF, employing the inductors already required for providing the dc current path of the LNA transistors. The expressions for gain, noise figure (NF), and phase noise of the voltage-controlled oscillator (VCO) are derived, and the behavior of the circuit is thoroughly investigated. The prototype of the Blixator receiver is implemented in a 0.18-μm CMOS technology. The experimental results show a NF of 10.5 dB, an IIP3 of -15.5 dBm, at the maximum gain, and an image rejection of 23 dB, which meets the requirements for the Bluetooth Low Energy (BLE) standard. The circuit consumes only 340-μW, from a 0.8-V supply, and its die area is 0.75 mm2.

Background and Aims Some studies have shown that proteinuria more than 800 mg per day and glomerular filtration rate (GFR) less than 40 ml/min are the most important relative contraindications for mTOR inhibitors prescription. There is no pathophysiologic reason to put aside mTOR inhibitors in more advanced stages of chronic allograft nephropathy(CAN). To clarify the safety of conversion to mTOR inhibitors in more advanced stages of CAN we conduct a randomized clinical trial Method Among 1911 renal transplant recipients which was performed from May 1989 to May 2016, patients (pts) with CAN included to the study. CAN was defined by pathology results and rule out of other causes of renal dysfunction and GFR less than 60 ml/min. pts with recent acute rejection, chronic Ab mediated rejection, active viral infection, malignancy, advanced cardiac, liver and respiratory diseases, obstructive uropathy and non-adherence were excluded from the study. After exclusion there were 211 pts with CAN. Among CAN pts 112 pts have GFR less than 40 ml/min. These patients were assigned in two group randomly. Group 1 continued their immunosuppression which consists of mycophenolate mofetil/myfortic, Cyclosporin A /Tacrolimus and prednisolone. Group B which received Sirolimus 2 mg daily instead of CyclosporinA / tacrolimus. All pts followed for 18 months. allograft function and pts morbidity and mortality were monitored every two months. results were recorded in clinic sheets and were analyzed using SPss version 22 Results G1 consist of 53 and G2 59 pts. There were no differences in two group in respect to sex (M/F was 0.89 and 0.84 in G1 and G2 respectively), and age (mean age was 41 6 9.5 and 43 6 8.23 in G1 and G2 respectively). there were no differences in admission rate for medical reasons (0.43 and 0.39 admission per pts per year in G1 and G2 respectively p=0.23). There was no difference between two group in respect to cardiovascular events (0.23 and 0.27 events per pts per year in G1 and G2 respectively p=0.31). The average trough level of SRL was 8.38± 3.12 ng/mL at 18 months. At 18 months, the incidence of acute rejection was not higher in G2 (21% vs. 18.8 %, p = 0.21) and renal function was superior in patients converted to SRL (eGFR 32.3 vs. 23.4 mL/min/ 1.73 m2, p = 0.019) compared to those maintained on CsA/TAC. There were no significant differences in pts survival (one death in each group) Graft loss was higher in G1( 5 versus 2 at 18 months p= 0.014). there were no significant differences in respect to liver, respiratory, GI, hematologic and infectious complications. pts in G2 group had lower BP and uric acid levels. Conclusion Conversion to mTOR inhibitors in more advanced stages of CAN is safe and has beneficial effect on renal allograft function with no more side effect.

Background and Aims Preeclampsia (PE) is a complex disorder that is characterized by hypertension and proteinuria after the 20th week of pregnancy, and it causes most neonatal morbidity and perinatal mortality. Despite many efforts, the knowledge acquired regarding its pathogenesis and pathophysiology does not allow us to treat it efficiently. It is not possible to arrest its progressive nature, and the available therapies are limited to symptomatic treatment. MicroRNAs (miRNAs) are small non-coding RNAs of approximately 19–23 nucleotides that can bind to the 3’ untranslated region of target mRNAs resulting in the degradation and translation inhibition of the mRNA, thereby regulating gene expression at the post-transcriptional level. Many studies have confirmed deregulated miRNA in pregnant patients with PE, and the function and mechanism of these differentially expressed miRNA are gradually being revealed. Method Sample collection Among the patients in the maternity ward, Department of Obstetrics and Gynecology. pregnant women who carried fetuses from 26 to 40 weeks of gestation were selected for study. Plasma samples were obtained from a total of 90 women in two groups; 48 being preeclamptic and 42 being healthy pregnancies, forming the control group. None of these subjects had undergone an invasive procedure. A volume of 5 mL maternal venous blood was drawn and collected in an ethylenediamine tetraacetic acid (EDTA) tube. The blood samples were centrifuged initially at 1200 g for 10 min and a second time at 10,000 g for 10 min, and 500 mL from the supernatant layer were used. The supernatant layer of the plasma was taken to Department of Molecular Biology and Genetics, Molecular Diagnosis Laboratory for storage at -80°C until the time of study. Total RNA extraction Total RNA was isolated from plasma using Trizol (Invitrogen, Carlsbad, CA) following the manufacturer protocol. Total RNA was analyzed using the commercially available Bioanalyzer Agilent RNA 6000 picoassay. MicroRNA isolation from maternal plasma MicroRNAs were obtained with the High-Specificity miRNA QRT-PCR detection kit (Stratagene-an Agilent Technologies Company, USA-Canada) according to manufacturer recommendations. Micro RNAs were subjected to a polyadenylation reaction as previously described. Next, using an oligo dT primer harboring a consensus sequence, reverse transcription was performed using an Affinity Script RT/RNase Block Enzyme mixture (Stratagene). miRNA was anayzed using the Bioanalyzer 2100- Agilent Small RNA assay. QRT-PCR platform The cDNA was amplified by real-time PCR. The real-time PCR analysis was performed on a Stratagene Mx3005P. This reaction contained a microRNA-specific forward primer, a TaqMan probe complementary to the 3ꞌ of the specific microRNA sequence, as well as part of the polyA adaptor sequence, and a universal reverse primer complementary to the consensus 3ꞌ sequence of the oligodT tail. Results were recorded in clinic sheets and were analyzed using SPss version 22. Results G1 consist of 48 and G2 42 pts. There were no differences in two group in respect to age (mean age was 28± 9.5 and 27± 5.23 in G1 and G2 respectively). Micro RNA155, 210 and 494 were significantly higher in plasma of G1 (Pv 0.001, 0.0001, 0.005 respectively). Micro RNA 29b was significantly lower in G1 (Pv 003). And there was no difference between two groups in respect to Micro RNA 34a (Pv 0.09). And also PE patients with higher plasma creatinine have more plasma level of Micro RNA155 and 210. There was a significant correlation between Micro RNA 494 and anemia in PE patients Conclusion In this study we showed that Micro RNA155, 210 and 494 increased and Micro RNA 29b decreased in PE and after clarifying by further studies may use as a predictor in clinical practice.

Pancreatic and duodenal homeobox 1 (Pdx1) and Sonic hedgehog (Shh) are the key regulators of beta‐cell function. In vitro experiments have shown that there is significant cooperation between Pdx1 and Shh with regard to the production and maintenance of insulin‐producing cells (IPCs). In this study, the combined effect of Pdx1 overexpression and Shh manipulation on the function of adipose tissue‐derived IPCs was determined. A eukaryotic expression vector (Pdx1‐ pCDNA3.1(+)) was constructed and transfected into a Chinese hamster ovary (CHO) cell line. Adipose tissue‐derived mesenchymal stem cells (ADMSCs) obtained from rats were assigned to two groups [control (C) and manipulated (M)] and differentiated into IPCs. Manipulated cells were treated with a mixture of FGF‐β and cyclopamine and recombinant Shh protein at days 3 and 11, respectively, and transfected with Pdx1‐ pCDNA3.1(+) at day 10. The expression of multiple genes related to function of beta cells was analyzed using real‐time PCR. The functionality of IPCs in vitro was analyzed through dithizone (DTZ) staining and ELISA. IPCs were injected into the tail vein of diabetic rats, and blood glucose and insulin concentrations were measured. CHO cells transfected with Pdx1‐ pCDNA3.1(+) showed a significantly higher expression of Pdx1 compared with nontransfected cells. Manipulated IPCs exhibited a significantly higher expression of MafA, Nkx2.2, Nkx6.1, Ngn3, insulin, and Isl1 and a higher insulin secretion in response to glucose challenge in relation to control cells. Rats that received manipulated IPCs exhibited a higher ability to normalize blood glucose and insulin secretion when compared to controls. Our protocol might be used for more efficient cell therapy of patients with diabetes in the future.

Plants are such important keys of biological part of our environment, supply the human life and creatures. Understanding how the plant’s functions react with our surroundings, helps us better to make plant growth and development of food products. It means the plant phenotyping gives us bio information which needs some tools to reach the plant knowledge. Imaging tools is one of the phenotyping solutions which consists of imaging hardware such as the camera and image analysis software analyses the plant images changings such as plant growth rates. In this paper, we proposed a preprocessing algorithm to eliminate the noise and separate foreground from the background which results the plant image to help the plant image segmentation. The preprocessing is one of important levels has effect on better image segmentation and finally better plant’s image labeling and analysis. Our proposed algorithm is focused on removing noise such as converting the color space, applying the filters and local adaptive binarization step such as Niblack. Finally, we evaluate our algorithm with other algorithms by testing a variety of binarization methods.

Text segmentation is a live research field with vast new areas to be explored. Separating text layer from graphics is a fundamental step to exploit text and graphics information. The language used in the map is a challenging issue in text layer separation problem. All current methods are proposed for non-Persian language maps. In Persian, text strings are composed of one or more subwords. Each subword is also composed of one to several letters connected together. Therefore, the components of the text strings in Persian are more diverse in terms of size and geometric form than in English. Thus, the overlapping of the Persian text and the lines usually produces a complex structure that the existing methods cannot handle with the necessary efficiency. For this purpose, the stroke width variety of the input map is calculated, and then the average line width of graphics is estimated by analyzing the content of stroke width. After finding the average width of graphical lines, we classify the complex structure into text and graphics in pixel level. We evaluate our method on some variety of full crossing text and graphics in Persian maps and show that some promising results in terms of precision and recall (above 80% and 90%, respectively) are obtained.

The electronic, phonon, and transport properties of ternary ZrSxSe2-x (x = 0, 1, and 2) have been calculated based on density functional theory (DFT), density functional perturbation theory (DFPT), and Boltzmann transport theory. Two methods for engineering of the electronic and transport properties of ternary ZrSxSe2-x (x = 0, 1, and 2) shall be treated: (i) doping which can be achieved by the help of the rigid band approximation could be valid for the low doping levels of n- and p-type of ZrSxSe2-x (x = 0.1, 2). (ii) The substitution of S by Se in ZrSxSe2-x (x = 0.1, 2). Here, both methods have been applied to engineer the bandgap and power factor. This enables us to look at the optimal power factor and figure of merit for the n- and p-type doped ternary ZrSxSe2-x (x = 0, 1, and 2). It has been found that the p- doped ZrSe2 has the highest power factor and the lowest bandgap between three compounds while the highest Seebeck coefficient is observed in ZrS2. But the highest figure of merit (ZT) is found in ZrSeS which has the lowest lattice thermal conductivity such that at 300 K it is about 0.33 and 0.32 for the n- and p-doped, respectively. The minimum total thermal conductivity has also been obtained in ZrSeS which is 0.61 and 0.18 along the a- and c-directions, respectively at 1000 K. This value of the lattice thermal conductivity along the c-axis is even lower than the reported value for the well-known low lattice thermal conductivity of SnSe [L.D. Zhao, et al. Nature, 508, 373 (2014)].

Background aims Sonic hedgehog (Shh) is an intercellular signaling molecule that regulates pancreas development in mammals. Manipulation of Shh signaling pathway can be used as reliable approach to improve the generation of functional insulin-producing cells (IPCs) from mesenchymal stromal cells (MSCs). Methods In the present study, a novel differentiation protocol was used to produce IPCs from adipose tissue–derived MSCs (ATDMSCs) based on sequential inhibition and reactivation of Shh pathway. ATDMSCs were differentiated into IPCs via a 14-day basic protocol using 1% insulin transferrin selenium (ITS) and 1% nicotinamide in Dulbecco's Modified Eagle's Medium medium. A mixture of 0.25 µmol/L cyclopamine + 64 ng/mL basic fibroblast growth factor at day 3 of differentiation and 150 ng/mL recombinant Shh at day 11 of differentiation were used, respectively, to promote sequential inhibition and reactivation of Shh pathway. Insulin granule formation, glucose-stimulated insulin secretion and gene expression pattern related to the pancreatic endocrine development and function were analyzed in manipulated and unmanipulated IPCs. Results IPCs obtained after Shh manipulation secreted higher amounts of insulin in vitro . This phenotype was accompanied by increased expression of both genes critical for β-cell function and transcription factors associated with their mature phenotype including Pdx1 , MafA , Nkx2.2 , Nkx6.1 , Ngn3 , Isl1 and insulin at day 14 of differentiation. Conclusions Our findings indicated that the early inhibition and late reactivation of Shh signaling pathway during the differentiation of ATDMSCs improved the functional properties of IPCs, a novel method that could be considered as an alternative approach for cell-based therapy for type 1 diabetes.

Design of tall telecommunication masts is usually governed by serviceability criteria under high wind conditions, typically combined with icing in cold climates. However, there is a need for seismic design checks for guyed masts constructed in zones with moderate to high seismicity, as is routinely prescribed for buildings in modern codes. There have been few efforts towards proposing a robust simplified method of general applicability for the seismic analysis of tall masts. These structures can be represented by the simple concept of a continuous beam-column (the lattice mast) on nonlinear elastic supports (the guy cable clusters at various stay levels). In this study, the guy cables are replaced by equivalent linear lumped parameters (stiffness, mass, and viscous damping) and the effects of their interaction with the mast stiffness and inertia on the structural characteristics are discussed. The approach was tested with nine case studies of real telecommunication masts subjected to five differen...

There are various methods that can be used to understand the fundamental concepts of each of the branches of human knowledge, one of which is philosophy. Philosophy inquires into the nature of things in such a way that can act as a prelude to the practical application of a particular subject. 'Place' is one of the fundamental concept in architecture and urban design. In this article placelessness of human being in today world, was investigated as today crisis. In the contemporary world, technology has deprived humanity from having the world and made him alienated and rootless. The alienation of humanity has made him lost, and the meaning of building has been forgotten. 'Martin Heidegger' found the solution to this problem in the phenomenology of being. Studying place as a phenomenon is an aid toward understanding its substance and essence. In this article at first the hermeneutical phenomenology are explained. Second we studied Daseinplaceness and aspect of it. Finally this question is tried to answer: how placeness of Dasein is translated to architecture and building?These subjects are so useful for architect and urbanist who try to clarify the concept of place as a phenomenon.

Telecommunication structures are essential components of communication and post-disaster networks and critically important facilities require reliable earthquake-resistant design procedures in seismically active regions. Calculation of the nonlinear seismic response of tall guyed masts using detailed time-step finite element methods is far more complex than linear response spectrum analysis that is routinely used in structural engineering practice. It is recognized that detailed computational procedures are not always necessary, in particular when the goal of the analysis is to provide a global earthquake-resistant design check on a regular structure with predictable response: this is when rational simplified methods are called upon to calculate the seismic demand. However, up until now, no such method exists for tall guyed masts that can account for the dynamic cable–mast interactions which dominate seismic effects in these structures. In the study reported here, the writers explore the dynamic behavior of guy cables under harmonic and seismic support ground motion through detailed computational modeling and propose a novel frequency-dependent method to evaluate the equivalent dynamic stiffness of guy clusters. This development will contribute efficiently towards a new robust rational model of general applicability for simplified seismic analysis of tall guyed telecommunication masts. Detailed numerical simulations involving 57 guy cables from eight existing towers with varying heights of 150–607 m were used in the study. A mathematical procedure was developed to replace the nonlinear time-variant cable stiffness with an equivalent linear frequency-dependent spring/mass system, based on the response spectrum of individual guy cables and the frequency content of the seismic excitation. Comparison of the main response indicators of these equivalent models and the detailed nonlinear finite element analysis results confirmed the reasonable and consistent engineering accuracy of the proposed simplified method with considerable savings in analysis effort.

At present, high-speed computing capabilities and advanced nonlinear dynamic finite element procedures enable detailed dynamic analysis of cable structures. Although deterministic approaches require considerable analysis time and effort in relation to modeling, running, and data processing, they seem to be the only alternative to obtain high accuracy. Detailed dynamic analysis of cable roof networks is sophisticated and requires advanced modeling expertise. This paper presents a comparison between detailed nonlinear dynamic analysis and a simplified frequency domain approach to estimate the maximum probable response of weakly nonlinear cable roofs. The approach can be considered as alternative to detailed time-domain analysis in the preliminary design phase, or can be used to validate results obtained from more elaborated numerical models. The proposed method is illustrated with two examples of cable net roofs that were also analysed in the time domain.

Idiopathic Membranous Nephropathy (iMN) is the most common cause of nephrotic syndrome in adults. Approximately one third of patients with iMN progress to end-stage renal disease. Anti-phospholipase A2-receptor (anti-PLA2R) antibodies are present in patients with iMN and appear to play a role in the pathogenesis of iMN.In this study, we explored the prevalence of anti-PLA2R antibodies in a cohort of patients with iMN in Iran. We also sought to determine circulating levels of anti-secretory PLA2 (anti-sPLA2) antibodies in those with anti-PLA2R antibodies.Using an indirect immunofluorescence assay, we measured anti-PLA2R antibodies in a group of patients with iMN in Iran. The serum levels of anti-sPLA2 antibodies were also measured in those with positive results for anti-PLA2R antibodies.We studied 23 patients with iMN (M/F 12/11, 34±9.8 year), two patients with secondary MN and five patients with the nephrotic syndrome of other causes.Anti-PLA2R antibodies were detected in 17/23 (74%) of patients with iMN, but not in those with secondary MN or other forms of primary glomerular diseases. We found no correlation between anti-PLA2R antibody titer and the degree of proteinuria. We found high titers of anti-sPLA2 antibodies in a subset of patients with high levels of anti-PLA2R antibodies.Anti-PLA2R antibodies are specific for iMN. Proteinuria may also reflect glomerular structural damage rather than immunological activity of the disease. The preliminary idea of any presumptive role of anti-sPLA2antibodies in iMN needs further investigation.

The process of kidney failure in renal transplant recipients with chronic allograft dysfunction is characterized by a progressive decline in glomerular filtration rate over time that it is determined by the 5-stage model. This study used stage-based statistical survival analysis to predict graft survival in renal transplant recipients with chronic allograft dysfunction. Materials and Methods: In a single-center, retrospective study, 214 renal transplant recipients with chronic allograft dysfunction were investigated at a university hospital in Iran from 1997 to 2005. At each patient visit, kidney function was assessed using glomerular filtration rate and stage of disease. Results: The estimated stage-specific hazard rates of disease progression are stage one, 453.936; stage two, 485.040; stage three, 545.808; and stage four; 649.488 per 1000 person-years. The estimated mean times in each stage were as follows: kidney damage with normal or increased glomerular filtration rate, 26.43 months; kidney damage with mildly decreased glomerular filtration rate, 24.74 months; moderate kidney disease, 21.98 months; and severe kidney disease; 18.48 months. These estimates yield a mean time from stage 1 to kidney failure of 91.63 months. The probability of graft survival was predicted using estimated stage-specific hazard rates. The 18th, 58th, 118th, and 155th months’ death-censored graft survival probabilities were 0.99, 0.75, 0.25, and 0.10. Conclusions: In this method of survival analysis, we can determine a statistical model according to a real clinical model in renal transplant recipients with chronic allograft dysfunction. It enables us to determine the stage-specific hazard rates of disease progression. These findings can help nephrologists to understand the kidney disease process and better predict graft survival.

In this study, structural features of alumina–titanium diboride nanocomposite (Al 2 O 3 –TiB 2 ) were simulated from the mixture of titanium dioxide, boric acid and pure aluminum as raw materials via mechanochemical process using the optimized artificial neural network. The phase transformation and structural evolutions during the mechanochemical process were characterized using X-ray powder diffractometry (XRD). For better understanding the refining crystallite size and amorphization phenomena during the milling, XRD data were modeled and simulated by artificial neural network (ANN). An ANN consisting of three layers of neurons was trained using a back-propagation learning rule. Also, the ANN was optimized by Taguchi method. Additionally, the crystallite size, interplanar distance, amorphization degree and lattice strain were compared for the simulated values and experimental results.

Malignancy is a common complication after renal transplantation. However, limited data are available on post-transplant malignancy in living kidney transplantation. Therefore, we made a plan to evaluate the incidence and types of malignancies, association with the main risk factors and patient survival in a large population of living kidney transplantation. We conducted a large retrospective multicenter study on 12525 renal recipients, accounting for up to 59% of all kidney transplantation in Iran during 22 years follow up period. All information was collected from observation of individual notes or computerized records for transplant patients. Two hundred and sixty-six biopsy-proven malignancies were collected from 16 Transplant Centers in Iran; 26 different type of malignancy categorized in 5 groups were detected. The mean age of patients was 46.2±12.9 years, mean age at tumor diagnosis was 50.8±13.2 years and average time between transplantation and detection of malignancy was 50.0±48.4 months. Overall tumor incidence in recipients was 2%. Kaposis' sarcoma was the most common type of tumor. The overall mean survival time was 117.1 months (95% CI: 104.9-129.3). In multivariate analysis, the only independent risk factor associated with mortality was type of malignancy. This study revealed the lowest malignancy incidence in living unrelated kidney transplantation.

Robust artificial neural network (ANN) was developed based on experimental data to predict dehydration of isopropanol by means of novel PVA–APTEOS/TEOS nanocomposite membranes in pervaporation (PV) process. The input properties were water concentration, feed temperature and nanoparticles content, while pervaporation separation index (PSI) was output. The Bayesian Regularization (BR) training method with full sampling was employed to train the network. Then, optimal ANN architecture was determined as 3:3:3:1 with log-sigmoid transfer function for hidden and output layers. The model finding revealed that nanoparticles content has significant effect on membrane performance (about 70%). The results demonstrated that the ANN model prediction and experimental data are quite match and the model can be employed with confidence for prediction of each nanocomposite membrane performance. Simulated annealing (SA) was also employed to determine controllable conditions to find the biggest PSI.

Graft loss owing to chronic allograft dysfunction is a major concern in renal transplant recipients. We assessed the affect of immune and nonimmune risk factors on death-censored graft loss in renal transplant recipients with chronic allograft dysfunction.We performed a retrospective, single-center study on 214 renal transplant recipients with chronic allograft dysfunction among 1534 renal transplant recipients at the Urmia University Hospital from 1997 to 2005. Data registry includes details from all renal transplants. The renal transplant recipient information is regularly updated to determine current graft function, graft loss, or renal transplant recipient's death. The selection criteria were a functional renal allograft for at least 1 year and a progressive decline in allograft function.Increasing donor age (RR=1.066; P.001), recipient age (RR=1.021, P = .00), recipient weight (RR=1.024; P = .029), and waiting time on dialysis to transplant (RR=1.047; P = .006), pretransplant hypertension (RR=3.126; P.001), pretransplant diabetes (RR=5.787; P.001), delayed graft function (RR=6.087; P.001), proteinuria (RR=2.663; P = .001), posttransplant diabetes (RR=2.285; P = .015), posttransplant hypertension (RR=2.047; P = .017), and AR (RR=3.125; P.001). Patients in stage 2 at the beginning of chronic allograft dysfunction relative to stage 1 (RR=4.823; P.001) and patients in stage 3 at the beginning of chronic allograft dysfunction relative to stage 1 (RR=123.06; P.001) were significant risk factors for death-censored graft loss. Using mycophenolate mofetil versus azathioprine reduced death-censored graft loss (RR=0.499; P = .001).We found that age of donor, pretransplant hypertension, pretransplant diabetes, type of immunosuppression (mycophenolate mofetil vs azathioprine), delayed graft function, proteinuria, and stage of allograft dysfunction at the start of chronic allograft dysfunction are the major risk factors for late renal allograft dysfunction.

Erectile dysfunction (ED) is common among patients with end-stage renal disease (ESRD), who undergo hemodialysis (HD). The aim of this study was to evaluate the safety and effectiveness of sildenafil in male HD patients with ED. Twenty-seven HD patients were recruited for this prospective, randomized, double-blind, placebo-controlled, clinical trial study of sildenafil during a period of 1 week. Efficacy was assessed by using the International Index of Erectile Function (IIEF) before and 1 week after treatment. Baseline demographic and clinical features were similar in both the groups. There was a weak correlation between ED and duration of undergoing dialysis (P = 0.073). There was significant relationship between sildenafil usage and improvement in erectile function (P < 0.0001). Placebo improved significantly the erectile function (P = 0.016), perhaps by psychological way. However, sildenafil had a more significant effect than placebo in increasing IIEF score among HD patients (P = 0.00 compared to 0.016). Sildenafil is effective and safe for treating ED among HD patients.

Post-transplantation Diabetes Mellitus (PTDM) is a serious complication after organ transplantation, which could lead to cardiovascular morbidity and mortality. The rate of PTDM increased in recent years, probably due to new immunosuppressive drugs such as Tacrolimus. In this study, we retrospectively evaluated the frequency of PTDM and related risk factors in 644 non diabetic patients who underwent renal transplantation. Data was analyzed by chi-square and Fisher′s exact test in SPSS software ver11.5. Among 644 patients PTDM developed in 10.2% similar to literature. PTDM was significantly correlated to age (P value = 0.000), positive familial history (P= 0.003) and HBV infection (P= 0.046). In conclusion, PTDM is not uncommon in Iranian patients and a positive family history of diabetes, HBV infection and older age increases the likelihood to develop PTDM.

There is little data about the pattern of disease progression in kidney transplant recipients with chronic allograft dysfunction (CAD). Extrapolating the current classification of chronic kidney disease for CAD, we studied the pattern of progression of CAD in 5 stages among our kidney transplant recipients.We performed a retrospective cohort study on 214 kidney transplant recipients with CAD. The selection criteria were a functioning kidney allograft for at least 1 year after transplantation and a progressive decline in allograft function. An event history analysis in survival data was carried out based on the stages of CAD at baseline and the end of the study.At the beginning of the study, 54.7% of the patients had CAD stage 1; 37.9%, stage 2, and 7.5%, stage 3. At the end of study, 10.3% were in stage 2; 39.7%, stage 3; 23.4%, stage 4; and 26.6%, stage 5. Patients with CAD stage 5 were 17.1% of those in stage 1, 32.1% of those in stage 2, and 67.7% of those in stage 3 at baseline. There was a significant correlation between stage of CAD at the beginning of the study and the stage of CAD at the end (r = 0.465, P.001).Because the decline in kidney allograft function was relatively faster in advanced stages of CAD, strategies to increase allograft survival by improving the baseline level of allograft function can be more effective than strategies to slow down progression of advanced stages of CAD.

Several years after the initial usage of continuous ambulatory peritoneal dialysis (CAPD), the percentage of patients using this continues to be very low constituting about 15% of all patients with end-stage renal disease (ESRD). In this study, we attempt to define the impact of an educational program for improving the use of CAPD. This is a quasi-experimental study (before-after) conducted with educational materials including workshop, teaching by booklet and showing educational films, performed in Urmia, Iran. We designed a questionnaire for data col-lection and enrolled 160 patients with an aim-based sampling method. We used descriptive sta-tistics and Friedman test for analysis in SPSS software version 11.5. The overall patients′ infor-mation about CAPD defined by total scoring was as follows: 75% had little information; 19% had moderate information and 6% of patients were well informed. All the information levels increased after intervention. Our study suggests that the poor utilization of CAPD is due to relative un-awareness about PD and/or lack of adequate facilities.

Viral infections are a real threat in kidney transplant recipients because of their immunocompromised condition. This study aimed to evaluate herpes simplex virus-2 (HSV-2) seropositivity among kidney transplant recipients.Serum samples of 91 kidney transplant recipients from Urmia, Iran, were examined serologically for antibodies against HSV-2 using an enzyme-linked immunosorbent assay.The mean time from transplantation at HSV-2 testing was 5.04 +/- 4.45 years. The anti-HSV-2 immunoglobulin G antibody was positive in 5.4% of the kidney transplant recipients. Seropositive patients did not present any clinical manifestations of genital herpes infection. There was no association between HSV-2 seropositivity and age, gender, history of hemodialysis and transplantation, blood transfusion, or immunosuppressive regimen.Seroprevalence of HSV-2 is not high among our kidney transplant recipients. However, it remains a source of concern, considering the compromised immune system in this specific population.

INTRODUCTION. Screening programs for chronic kidney disease (CKD) are deemed to be cost effective only when they are limited to high-risk groups. We screened a sample of high-risk population of Urima, Iran. MATERIALS AND METHODS. As a pilot study for a national project, we enrolled 905 participants who had at least one risk factor for CKD (including hypertension, diabetes mellitus, or a family history of CKD). The study population was selected from among patients with Dm or hypertension and family members of those with CKD in Urima urban area and 2 randomly selected neighbor rural areas. Urine dipstick tests were done and blood sample was obtained to detect proteinuria and measure serum creatinine concentration, respectively. RESULTS. A total of 607 participants (67.1%) were enrolled from rural areas and 298 (32.9%) from the urban area. The mean serum creatinine level was 1.27 ± 0.60 mg/dL. A high serum creatinine level was demonstrated in 343 participants (37.9%), and 212 (23.4%) were demonstrated to have proteinuria. There was a significant correlation between serum creatinine level and urinary protein excretion (P = .001). There were no significant differences between rural and urban subgroups in terms of proteinuria (P = .42) and serum creatinine level (P = .08). CONCLUSIONS. The prevalence of a high creatinine level (37.9%) is so high in the high-risk population of Urmia. Our most important goal of implementing this preliminary study was to assess probable limitations and problems of performing an extensive national screening program for CKD in the future.

Gingival enlargement is one of the most cumbersome complications of cyclosporine A. It affects patient's life style by impairing the appearance and function of masticatory tract. This study was conducted on a sample of Iranian kidney transplant recipients to determine the frequency and risk factors of cyclosporine-induced gingival enlargement.A total of 200 kidney transplant recipients (mean age, 39.7 +/- 13.2 years) were enrolled in this study. All of the participants were receiving cyclosporine for at least 12 months prior to the study. Factors including age, gender, cyclosporine dose, serum concentration of cyclosporine, duration of immunosuppressive administration, plaque, and gingival indexes were evaluated.Seventy kidney transplant recipients (35%) showed various degrees of gingival enlargement. Serum cyclosporine concentration and the intensity of gingival enlargement (McGraw index) had a significant correlation (r = 0.35, P.001). Multiple regression analysis revealed an independent association between gingival enlargement and either serum concentrations of cyclosporine and plaque index (P.05). The other variables failed to show a significant relationship with gingival enlargement.The prevalence of cyclosporine-induced gingival enlargement in our patients seems to be almost greater than the prevalence reported in previous studies. There was a significant relationship between cyclosporine immunosuppressive treatment and gingival overgrowth in Iranian kidney transplant recipients.

Full activation of T cells requires 2 distinct but synergistic signals. The first is the T-cell antigen receptor, which is antigen specific, and the second is activation of co-stimulatory signals. Active vitamin D (1, 25-dihydroxyvitamin D3) decreases T-cell activation and proliferation, inhibits differentiation and maturation of dendritic cells, and induces tolerogenic dendritic cells. These immunoregulatory effects may be due, at least in part, to changes in cytokine secretion and expression of co-stimulatory molecules. The use of active vitamin D has been reported to improve allograft survival, decelerate loss of allograft function, and prevent acute rejection. This study was conducted to assess the effect of active vitamin D on the expression of co-stimulatory molecules and HLA-DR in renal transplant recipients.In this prospective study, we enrolled 24 renal transplant recipients who had undergone a transplant 6 to 18 months earlier, had stable allograft function, and were without episodes of allograft dysfunction or febrile illness in the previous 2 months. Participants were administered oral calcitriol 0.5 micrograms daily for 4 weeks. Expression of HLA-DR, CD28, CD86, and CD40 in peripheral blood leukocytes was assessed by flow cytometry before and after calcitriol administration.Compared to baseline levels, expression of HLA-DR decreased by 16.8%; expression of CD28, by 30%; of CD40, by 31.2%; and of CD86, by 36.7%.In renal transplant recipients, decreased expression of co-stimulatory and HLA-DR molecules occurred after treatment with active vitamin D. Such changes may be involved in increasing allograft survival.

Autosomal dominant polycystic kidney disease is associated with cysts in many organs including the liver, pancreas, lungs, spleen, ovaries, testes, thyroid, and uterus. However, there is no report, to our knowledge, of cystic changes of the breast along with this disease. We describe 3 members of a family with multiple bilateral breast cysts in association with autosomal dominant polycystic kidney disease.

Oxidative stress due to overproduction of reactive oxygen species and impairment in antioxidant defense mechanisms have been suggested as possible factors contributing to the pathogenesis of atherosclerosis in patients with end-stage renal disease. We compared glutathione levels, glutathione peroxidase and glutathione reductase activities, and total antioxidant capacity between patients on hemodialysis and peritoneal dialysis and healthy individuals.Thirty patients receiving regular hemodialysis and 12 on continuous ambulatory peritoneal dialysis were recruited as well as 25 healthy volunteers. Diabetes mellitus, recent febrile or infectious episodes, and hospitalization during the past month were the exclusion criteria. Erythrocyte glutathione level, plasma activities of glutathione peroxidase and glutathione reductase, total antioxidant capacity were determined and compared between the three studied groups.Glutathione levels and glutathione peroxidase activity were markedly lower in the patient groups than in the controls. Conversely, higher activity of glutathione reductase and total antioxidant capacity were noted in the patients than in the controls. There were no significant differences between antioxidant markers of the patients on hemodialysis and peritoneal dialysis. Strong positive correlation were observed between total antioxidant capacity and uric acid in the patients (r = 0.59, P = .045 and r = 0.63, P = .03, respectively).Although total antioxidant capacity of plasma is increased in patient on dialysis, depletion of glutathione as a key antioxidant component and disturbances in its related enzymes show oxidative stress. This condition may increase the risk of developing cardiovascular disease in patients with end-stage renal disease.