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A severe complication associated with diabetes is diabetic foot ulcer (DFU). Most patients with DFU require amputation. Although treatment of non‐healing diabetic ulcers is challenging, the use of novel therapies can be effective. In this report, we present the case of a woman with type 2 diabetes with DFU‐related osteomyelitis, who was treated with a combination therapy of trichloroacetic acid, calcium alginate and foam dressings, human autologous fibroblast injection, and a fibroblast cell‐seeded collagen scaffold. The results showed the positive effects of combination therapy on DFU. In the initial treatment, the wound area was measured to be 14 × 7 cm2, with a depth of 4 cm. After 6 months, the wound was measured to be 1.5 cm2, showing a 90% reduction of the wound area. Overall, this combination therapy was highly effective in the treatment of DFU‐related osteomyelitis, and could markedly prevent amputation among DFU patients., Combination therapy using trichloroacetic acid, calcium alginate and foam dressing, human autologous fibroblast injection, and fibroblast cells seeded collagen scaffold is very effective for the treatment of a diabetic foot ulcer with osteomyelitis, and can markedly prevent amputation among diabetic foot ulcer patients.

Background Numerous therapeutic techniques for periorbital hyperpigmentation have been suggested. Aim In this comparative intrapatient study, the effectiveness of combination therapy included fractional Er: YAG laser and autologous platelet-rich plasma (PRP) compared to Er: YAG laser in periorbital hyperpigmentation treatment. Patients/methods Thirty-two patients were enrolled. The right periorbital sides of patients received combination of Er: YAG laser and autologous platelet-rich plasma (PRP) and the left side received Er: YAG laser (three sessions with 4 weeks' intervals). PRP was used in two ways included injection and topical. Patients were evaluated by biometric characteristics, patients, and physician assessments. Also, the patient's satisfaction was assessed and side effects were evaluated. Results The mexameter results showed that the melanin content in the right side of the periorbital of the patients was significantly decreased compared to left side. Also, significant increase was observed in the skin lightness of the right side in compare to left. The visioface results showed the decrease in the percent change of the color and wrinkle in both sides, but in the right side these changes were significantly more than left side. The patients and physician assessment confirmed the measured results. Conclusion Combination of Er: YAG laser and PRP is significantly effective for periorbital hyperpigmentation.

Treatment of the periorbital dark circles (PDCs) is a current challenge, with most treatment methods failing to yield promising results. The effectiveness of two common methods for periorbital dark circle treatment was compared in 28 patients with PDC. The patients were randomly divided into two groups of equal numbers: the first group received carboxy therapy, and the second group fractional 10,64 nm Q-switched Nd:YAG laser. In the carboxy therapy group, the treatment was performed six times, with 1-week intervals between sessions. In the group treated by Nd:YAG laser, the treatment was conducted in four sessions, with 1-month intervals between sessions. The results were evaluated through biometric evaluation, scoring on the visual analog scale (VAS) by both physicians and patients, and patients' satisfaction. Side effects of the treatments were also evaluated. The results showed that both carboxy therapy and Nd:YAG laser are effective in the treatment of periorbital dark circles, but carboxy therapy is significantly more effective. An increase in the skin lightness and a decrease in the melanin content of the periorbital skin was observed in the group receiving carboxy therapy, and these changes were more pronounced in this group compared to the group of Nd:YAG laser. In addition, side effects, such as erythema and post-inflammatory hyperpigmentation, were less in carboxy therapy than in Nd:YAG laser. Furthermore, the procedure was less expensive and easier to perform compared to Nd:YAG laser. Carboxy therapy is significantly more effective than Nd:YAG laser in PDC treatment.Trial registration: IRCT20080901001159N24.

Background The changes in morphology of hair follicle and aberrant cycling of hair follicle are the main reasons of the most common forms of hair loss (alopecia). However, existing alopecia treatments do not specifically target these processes. Aims Autologous whole fat injection suggests a paradigm shift that may offer alternative therapies that can be used to prevent hair loss. This study aimed to present clinical cases for the treatment of androgenetic alopecia by autologous whole fat injection in the scalp. Methods Nine patients with androgenetic alopecia (7 women and 2 men) were enrolled to our study. After lipoaspiration, autologous whole fat was injected into the patient's scalp. Hair regeneration was evaluated by three clinical tests: the pull test, hair quality, and hair density. Results For all patients, before and after treatment, the number (density) and diameter of hair were calculated using trichograms. The pull test was also performed. The pictures were obtained before after treatment. Conclusion Our results showed that whole fat injection enormously can increase the level of hair growth.

Background Obstructive sleep apnea (OSA) is a common sleep disorder, which causes wide range of neurological and psychiatric symptoms. Several studies demonstrated structural and functional brain alterations using magnetic resonance imaging (MRI) techniques. Recently, diffusion-based brain MRI studies in patients with OSA showed changes in diffusion measures that represent various impairments of white matter (WM) integrity. The various finding may be due to diffusion indices employed for detection of neural impairment at the microstructural level, phase of the disease and the goals of studies. Objectives We aimed to identify a common abnormal WM pattern across the previous studies. Methods We reviewed related literature in EMBASE, Scopus and PubMed databases and identified 13 studies that meet our selection criteria. Results The current data pointed to WM integrity changes in corpus callosum, cingulate cortex, corticospinal tract, insular cortex, basal ganglia, and limbic sites. These regions mainly contribute in mood, autonomic and cardiovascular regulation. Conclusion Widespread use of diffusion magnetic resonance imaging (dMRI) parameters provides insight into the pathophysiology of OSA, stage of the disease and planning appropriate treatments in future.

Epidermolysis bullosa (EB) is a rare genetic disorder characterized by the formation of blisters and wounds in skin and mucous membranes; it is classified into four types and has various methods of treatment. Management of previous wounds and prevention of formation of new lesions are the most important strategies in the course of therapy to improve patient's quality of life; lack of wound management can lead to further complications such as infection. The current study investigated the therapeutic effects of allogeneic platelet gel (prepared from umbilical cord blood) in a group of children diagnosed with dystrophic epidermolysis bullosa (DEB) eligible for surgical correction of pseudosyndactyly in the hand. The post-surgical clinical outcome in this group was compared with the clinical outcomes of DEB patients receiving the standard treatment (paraffin gauze wound dressing and topical antibiotics) after corrective surgery. The current study results showed an increase in the rate of recovery and promotion of tissue granulation, complete wound healing, and a decrease in pain level and treatment period. The application of cord blood platelet gel topical dressing was not a conventional method of treatment in patients with DEB wounds and blisters. However, the current study results demonstrated that this gel dressing could effectively accelerate epithelialization and healing of the wounds, and decrease patients' pain and post-surgical recovery period, which altogether leads to improvements in patients' overall quality of life. This article is protected by copyright. All rights reserved.

Objectives Phosphate is essential for skeletal mineralization, which is regulated by parathyroid hormone, calcitriol and fibroblast growth factor 23 (FGF23). Serum phosphate is physiologically higher in younger children, but factors that contribute to this physiological state are poorly understood. This study aimed to evaluate phosphate and its regulators in children compared with adults. Materials and methods The participants were children aged 3–11 years and adults older than 20 years of age. Biochemical parameters including calcium, phosphorus, alkaline phosphatase, FGF23, and vitamin D were measured. Fractional excretion of phosphate was calculated, using serum and urine phosphate and creatinine. Results This cross-sectional study was conducted on 45 children (mean age: 9.0 ± 2.1) and 44 adults (mean age: 38.9 ± 11.1). The children had higher serum calcium, phosphate, alkaline phosphatase, and FGF23 (p β: 0.78, p 2: 0.59 for children, and β: 0.59, p 2: 0.45 for adults). Conclusion As far as we know, there is little information regarding the role of FGF23 in physiologic state. In this cross-sectional study no association was found between FGF23 and urinary phosphate excretion in growing children. Further studies with more detail are essential to evaluate phosphate homeostasis during childhood.

Background Fractional radiofrequency (RF) has been used for skin rejuvenation and tightening by dermatologists and cosmetic surgeons in recent years. Methods Twenty female patients (mean age of 51.9 years) with Fitzpatrick III to VI skin phototypes who desired to undergo skin lift/tightening received six sessions of fractional microneedle RF treatment and were assessed at baseline and then 3 months after the last session for biometric characteristics using a Colorimeter, Visioface 1000D, Tewameter, Cutometer, Mexameter, and Sebumeter and a skin ultrasound imaging system to evaluate the transepidermal water loss (TEWL), skin pores, color, melanin content, erythema, sebaceous content, and thickness and density of the epidermis and dermis. Patient satisfaction with visual analog scale (VAS) was also measured. Results The results showed that skin pores and spots decreased significantly. TEWL also decreased significantly (by 18.44%). Meanwhile, skin density increased significantly (R7, by 44.41%). The ultrasonographic assessments showed that both the density and thickness of the dermis and epidermis were increased. The changes in the other parameters were not significant. Conclusion FR increases the density and thickness of the dermis and thus also increases the collagen content and decreases skin pores and TEWL.

Leishmaniasis is a major tropical disease. There is no effective vaccine against leishmaniasis and chemotherapy is still the most effective treatment for the disease. However, most of the common drugs have many disadvantages such as toxicity and high cost. Most important of all is the development of resistance against these drugs. Many studies have tried to provide new pharmaceutical agents and formulations in various ways to overcome these problems. In recent years, medical plants have been widely considered for leishmaniasis treatment. Besides, various drug delivery strategies have been studied for the treatment of leishmaniasis in order to increase activity and reduce the side effects of the drugs. Accordingly, nanotechnology will play an important role in the preparation of new pharmaceutical formulations. In this review, we focused on various therapeutic approaches for leishmaniasis.

BACKGROUND Androgenetic alopecia (AGA) is widely characterized as the main reason of hair loss which most of the time it has been reported in adults regarding dermatological consultation. Also, it is broadly believed that the progressive miniaturization of hair follicles could be usually different at the age of onset. AIMS Over the last decade, detecting and understanding newer genetic basis in AGA lead to provide better therapeutic approaches. We have highlighted on an evidence-based method to treat AGA whose incidence is increasing significantly in our country. PATIENTS/METHODS In this study, 9 adults with AGA including 5 women and 4 men, age range of 25-55 years, were treated with a combination of minoxidil (20%) by micro-needling and carboxytherapy mediated by needling. All cases had a normal physical development. Hair numbers (density) and diameter were calculated using trichograms before and after treatment. Hair growth was assessed by the pull test as well. RESULTS Our results showed that combination of high concentration of minoxidil and carboxygas extremely can increase the level of hair growth. CONCLUSION Our treatment effects on the terminal follicles using needling make sticky follicles become progressively smaller as a result of mechanical forces.

Macular amyloidosis (MA) is a common form of primary localized cutaneous amyloidosis, characterized by the eruption of brown pigments of the skin with a rippled pattern. MA can be of cosmetic concern for patients, and its treatment is challenging. In this study, we aimed to find new effective approaches for MA treatment. A total of 39 patients with the clinical diagnosis of MA were treated with two types of laser therapy, and the effectiveness of each approach was examined. Fractional Q-switched 10.64 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser therapy was compared with a combination of fractional Q-switched 10.64 nm Nd:YAG laser and long-pulsed fractional erbium:YAG laser therapy. Melanin biometric measurements were performed using a Mexameter, objective image-based evaluation was carried out, and the itching score and patient satisfaction were examined. Mexameter-based analysis showed that both types of laser therapy were effective in the treatment of MA, causing a significant decrease in the amount of melanin in the treated areas (P

Finding new therapies for male and female pattern hair loss treatment remains as great interest. The autologous fat grafting technique is a new method, and clinical experience was increased over the past 10-15 years. Adipose tissue is a biologically active and important tissue and can help drive the complex hair growth cycle. Surgeons have previously reported that autologous fat not only have a positive affect for reconstructive volume and esthetics after transplant but can also have positive skin and hair changes post-transplantation. In this study, lipoaspiration of adipose was performed by cannula and scalp injection was done. In this case report, the authors report that scalp injection of adipose tissue has a positive effect on a patient with alopecia after trauma. The findings suggest adipose tissue can be a promising alternative method to treating men and women alopecia.

OF TRIAL DESIGN Treatment of depressed acne scars requires multiple modalities. Although needle subcision is a valuable method, it exhibits mild to moderate efficacy in treatment of deep acne scars owing to the high recurrence rate and other side effects. A total of 100 patients with rolling acne scars were randomly treated using the standard technique of 18 gauge cannula and 27 gauge needle subcision in two parallel groups, and the effect of cannula subcision instead of needle subcision was evaluated in the treatment of rolling acne scars. METHODS A total of 100 patients were randomly treated using the standard technique of 18 gauge cannula and 27 gauge needle subcision. The outcomes of these procedures were assessed by three blinded dermatologists and by patients' satisfaction. RESULTS Subcision using the cannula showed good and very good improvement in about 83% of patients (n = 50, P

Background People with acne scar suffer from destruction to the surface of the skin. Treating acne scars is a challenge that might need several methods. Aims Subsection is a method that has been informed to be a useful method in treating rolling acne scars. While Subcision is a valued procedure, its effect is mild to moderate due to its high reappearance rate, and patients' dissatisfaction with some of the side effects such as inflammation after procedure. Patients/methods In this pilot study, 9 rolling acne scar patients underwent Subcision with the Endolift (200-nm fiber) and followed up for 3 months. Outcomes were evaluated by 3 dermatologists (Blind). Also, the patients' satisfaction was assessed to compare with dermatologist's opinions. Results Our results indicated that Subcision with the Endolift displayed good and very good improvement in about 90% of patient with a good and very good satisfaction in the patients. Photographic data evaluation indicated 100% improvement in scar depth, topography, and total acne scar appearance. The average numbers of lesions before the treatment were 25.5 ± 12.1, and after treatment, it was reduced to 11.4 ± 2.1 (P Conclusion Subcision with the Endolift seems to be a safe and effective method for acne scar treatment. It is done with a single perforation on each side (instead of several perforations), which reduces the pain and scar risk in the patients. Also, Endolift-based Subcision needs fewer surgical sessions and less recovery time with less inflammation and erythema.

Background Cervical cancer is the second most common cancer and the fifth deadliest cancer among women in Iran. Educational interventions based on the proper behavior promoting models can lead to early diagnosis of cervical cancer.This study aimed to investigate the effects of educational intervention on performing Pap smear tests based on the Theory of Planned Behavior among women living in Fasa, Iran. Methods A cross-sectional study was conducted on 700 participants. Thereafter, the educational intervention based on the results of cross-sectional study was conducted in a workshop form for 50 women as the intervention group and 50 women as the control group. Afterward, the data were entered into the SPSS statistical software and then analyzed via logistic regressions analysis, paired t test, independent t test, chi-square test, and McNemar test. Result According to the results, 45.7% of the patients had a history of performing a Pap smear test, and 20.7% of them regularly performed this test. The knowledge, attitude, subjective norms, and perceived behavioral control were the predictors of intention and behavior of Pap smear test among the women (P p = 0.41) and performance of the Pap smear test (p = 0.583). The number of the participants undergone the Pap smear test has increased from 10 to 26 in the intervention group by passing 3 months from the intervention. The results of McNemar test indicated that this difference was statistically significant. Conclusion The results indicated an increase in the women’s performance of the Pap smear screening test by appropriate planning, provision of educational packages based on the women’s needs, and using effective subjective norms. Trial Registration: Current Controlled Trials IRCT20160830029608N3:12/31/2018. “Retrospectively registered”.

Purpose This RCT study investigates the effects of a self-management program on clinical status indexes of COPD patients. Design In this study, 50 COPD patients referred to the respiratory clinic participated. Methods Patients were randomly assigned to control and intervention groups. The control group received standard care, and the intervention group received standard care plus the self-management program. Patients were assessed by spirometry, Modified Borg scale, and 6-minute walking test at the baseline and the end of 12-weeks. Paired t-test, independent t-test, and chi-square were used to analyze variables. Findings No significant difference was noted in the spirometry indexes mean in the two groups; however, significant differences were noted in dyspnea and exercise tolerance at the end. Conclusion/clinical relevance Using the 5A model can lead to increased exercise tolerance and decreased dyspnea in COPD patients. Therefore, this self-management program is recommended as an effective way to improve their functional status.

Background The role of quantitative apparent diffusion coefficient (ADC) maps in differentiating adnexal masses is unresolved. Purpose/Hypothesis To propose an objective diagnostic method devised based on spatial features for predicting benignity/malignancy of adnexal masses in ADC maps. Study Type Prospective. Population In all, 70 women with sonographically indeterminate and histopathologically confirmed adnexal masses (38 benign, 3 borderline, and 29 malignant) were considered for this study. Field Strength/Sequence Conventional and diffusion-weighted magnetic resonance (MR) images (b-values = 50, 400, 1000 s/mm2) were acquired on a 3T scanner. Assessment For each patient, two radiologists in consensus manually delineated lesion borders in whole ADC map volumes, which were consequently analyzed using spatial models (first-order histogram [FOH], gray-level co-occurrence matrix [GLCM], run-length matrix [RLM], and Gabor filters). Two independent radiologists were asked to identify the attributed (benign/malignant) classes of adnexal masses based on morphological features on conventional MRI. Statistical Tests Leave-one-out cross-validated feature selection followed by cross-validated classification were applied to the feature space to choose the spatial models that best discriminate benign from malignant adnexal lesions. Two schemes of feature selection/classification were evaluated: 1) including all benign and malignant masses, and 2) scheme 1 after excluding endometrioma, hemorrhagic cysts, and teratoma (14 benign, 29 malignant masses). The constructed feature subspaces for benign/malignant lesion differentiation were tested for classification of benign/borderline/malignant and also borderline/malignant adnexal lesions. Results The selected feature subspace consisting of RLM features differentiated benign from malignant adnexal masses with a classification accuracy of ∼92%. The same model discriminated benign, borderline, and malignant lesions with 87% and borderline from malignant with 100% accuracy. Qualitative assessment of the radiologists based on conventional MRI features reached an accuracy of 80%. Data Conclusion The spatial quantification methodology proposed in this study, which works based on cellular distributions within ADC maps of adnexal masses, may provide a helpful computer-aided strategy for objective characterization of adnexal masses. Level of Evidence: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017.

Background Neglected parasitic diseases (NTDs) like cutaneous leishmaniasis (CL) have caused high mortality and morbidity rate in developing countries. This disease is considered as one of the six major tropical diseases, and has a great importance in HIV infected individuals as an opportunistic infection in those areas that both infections are endemic. This study evaluated the therapeutic effects of the Urtica dioica L (U. dioica) aqueous extract as an anti-leishmanial herbal drug in-vitro and in-vivo, and in addition to that, evaluated two vital immune system cytokines including gamma interferon (IFN-γ) and interleukin-4 (IL-4) plus nitric oxide (NO) and arginase activity against Leishmania major (L. major) infected mice. Methodology/Principal findings In-vitro anti-leishmanial activity of U. dioica aqueous extract was determined using MTT method and also Parasite Rescue Transformation Assay. Also, the footpad lesion size and parasite load in BALB/c mice infected with L. major were quantified for in-vivo assessment. Furthermore, for evaluating the immune responses, the levels of IFN-γ, IL-4, NO and arginase were measured in the BALB/c mice. These results indicated that U. dioica extract significantly reduced the L. major promastigotes viability. According to the in-vitro cytotoxicity assay of the extract on Leishmania parasites (CC50) and infected macrophages (EC50), the extract had no toxicity to the macrophages, however it efficiently killed the L. major amastigotes. In addition, the lesion size, parasite load, IL-4, and ARG were decreased in the treated infected mice, however IFN-γ and NO were significantly increased. Conclusions/Significance This study established satisfactory results in Leishmania parasite clearing both in-vivo and in-vitro. Therefore, U. dioica extract can be considered as an effective and harmless herbal compound for killing the parasite without toxicity to the host macrophages. Furthermore, it also can treat the CL by switching the mouse immune response towards a cell-mediated response (Th1); hence, it may be identified as a perfect therapeutic herbal drug for CL treatment., Author summary Nowadays, neglected tropical diseases (NTDs) like leishmaniasis have increased the mortality and morbidity rate in developing countries, especially in tropical regions, and is considered as responsible for more than 20 million deaths per year. Although, cutaneous leishmaniasis (CL) is rapidly spreading in all over the world, but this disease controlling has remained insufficient because of low-cost treatment and the lack of an effective vaccine. Therefore, new treatment approaches for leishmaniasis are immediately required. Up to now, application of natural herbal products has been considered as one of the major effective ways in treating the protozoan parasitic infections like CL. In this study, we evaluated the therapeutic effects of the Urtica dioica L (U. dioica) aqueous extract as an anti-leishmanial herbal drug in-vitro and in-vivo, and also quantified the immune cytokines IFN-γ, IL-4 against CL caused by Leishmania major (L. major). The in-vitro activity of U. dioica aqueous extract on L. major was determined using MTT method and Parasite Rescue Transformation Assay. Moreover, the footpad lesion size was assessed and parasite load in the mice infected with L. major was quantified for in-vivo. In order to evaluate the immune responses, IFN-γ, IL-4, NO and arginase were measured in the Leishmania infected mice. Accordingly, U. dioica is one of the effective herbal plant in L. major parasite clearing without any harmful toxicity to the murine cells, and can strongly cure the zoonotic CL.

Summary Leishmaniasis caused by protozoan parasites of the genus Leishmania. Intracellular infections treatment such as leishmaniasis is frequently hampered by limited access of drugs to infected cells. Moreover, most of the current drugs are confined to some toxic compounds, and there are increasing incidences of development of drug resistance. Hence, production of a new antileishmanial compound is crucial. Paromomycin sulphate (PM) is a promising antileishmanial drug. One strategy to improve drug effectiveness is to use appropriate delivery systems. Solid lipid nanoparticle (SLN) is as an excellent substitute delivery system to other colloidal carrier. In the present study, PM was loaded in solid lipid nanoparticles (PM-SLN) and the in vivo efficacy was studied against Leishmania (L.) major-infected BALB/c mice. For this reason, the footpad swelling was measured and real-time PCR was performed to quantify the parasite load after infectious challenge. The level of cytokines including interleukin-4 (IL-4) and gamma interferon (IFN-γ) and nitric oxide was evaluated. Altogether, this study showed that the PM-SLN formulation is a safe compound and SLN in PM-SLN compound is effective for treatment of leishmaniasis by improving the effectiveness of PM in killing the parasite and switching towards Th1 response.

This is the first study aiming to determine the therapeutic effects of the Sambucus ebulus aquatic extract as an antileishmanial herbal drug and evaluate the immune responses in Leishmania major major infected BALB/c mice. The antileishmanial activity of S ebulus aquatic extract was evaluated using MTT test as well as parasite rescue and transformation assay. Footpad swelling and parasite load of infected mice were measured by several techniques. The immune responses were evaluated by measuring the levels of IFN-γ, IL-4, nitric oxide and arginase. The results indicated that S. ebulus can significantly decrease L. major promastigotes and amastigotes viability, but it was not toxic to macrophages. The lesion size, parasite burden and the level of ARG decreased in the treated infected mice, while the IFN-γ-to-IL-4 ratio and the level of NO increased significantly. Altogether, the S. ebulus extract is an effective compound for killing Leishmania parasite without excessive toxicity to the host cells and can cure the CL by switching the host immune responses towards Th1 response. Thus, it may be a perfect therapeutic option for CL treatment.

Background: Adjuvant radiation therapy (RT) improves the prognosis of breast cancer (BC); nevertheless, causes post-RT complications. One of the most life-threatening complications of RT in BC patients is atherosclerotic coronary artery disease (CAD). Compared with old two-dimensional RT (2D-RT), newer three-dimensional conformal radiotherapy (3D-CRT) protects normal tissues including the heart from irradiation. Early detection of plaques using coronary artery calcium score (CACS) could improve the post-RT BC survivors’ outcomes. Objectives: This study assessed CACS in BC patients who underwent 3D-CRT to find whether there is any significant difference between their CACS and those of non-BC patients. Patients and Methods: CACS of fifty BC patients with different intervals from RT - case - and fifty women with no history of BC or RT - control - using 64-slice ECG-gated CT scan were assessed as Agatston score (AS). The risk factors of CAD, the Framingham’s 10-year risk score, and the age-matched CACS percentiles were evaluated. Results: No AS difference between the case and control was found. No correlation between AS and RT-to-follow-up time interval, laterality of BC, Framingham’s 10-year risk score or traditional CAD risk factors were detected. Increase in CACS related to the senile atherosclerotic process was shown (P < 0.001). Conclusion: No significant difference in CACS was found in BC patients treated by 3D-CRT in comparison with those of non-BC individuals or BC patients who treated by 2D-RT. This finding may be the result of either the non-calcified nature of radiation-induced CAD plaques or reduced cardiac radiation in 3D-CRT, leading to myocardial microvascular disease rather than senile calcified atherosclerotic plaques. CACS may not be an appropriate screening test to detect early CAD in these patients.

Objectives Family caregivers face numerous challenges in taking care of their family members with epilepsy. The empowerment of this group of people, who can be described as forgotten patients, should always be considered through supportive interventions; therefore, this study investigated the effect of a family-centered intervention program on stress, anxiety, and depression among family caregivers of patients with epilepsy. Methods In 2017, a trial was conducted in Iran among subjects selected by the convenience sampling method and randomly assigned to two groups: intervention and control. After five sessions per week over a four-week period, the intervention- and control-group data were collected using the Depression Anxiety Stress Scale (DASS) in three stages: before, immediately after, and two months after the intervention. Data were analyzed with Statistical Package for the Social Sciences (SPSS) software using descriptive and analytical statistics, an independent t-test, and repeated measures Analysis of variance (ANOVA). Results In this study, the family caregivers included 61.3% women and 38.7% men, with a mean age of 37.5 years. The findings showed no significant differences in the mean scores of stress (p = 0.93), anxiety (p = 0.91), and depression (p = 0.56) before the interventional program between the intervention and control groups, but these differences were statistically significant in the mean score of stress (p = 0.003) in the immediately after the interventional program, whereas the mean scores of depression were not decreased significantly (p = 0.3). Two months after the interventional program the mean scores of stress (p = 0.001) and anxiety (p = 0.001) were significantly decreased in the intervention group, but the mean score of depression was not decreased significantly (p = 0.09). Conclusion The results suggested that a family-centered intervention program reduced the stress, anxiety, and depression of caregivers because of feasibility, simplicity, and utility of intervention. This program was focused on psychological issues of caregivers, and an emphasis on their empowerment helped them in managing their problems in the caregiving situation and achieved greater psychological potency in the caring process.

Inflammatory bowel disease (IBD) as a chronic recurrent disorder is characterized by mucosal immune response dysregulation, which is more prevalent in the youth. Adipose-derived mesenchymal stem cells (ADMSCs) are the multipotent cells that can be effective in immune response regulation via cell-cell interaction and their secretions. In this study, the effects of ADMSCs and mesenchymal stem cell-conditioned medium (MSC-CM) were evaluated on dextran sulfate sodium (DSS)-induced colitis in mice. Chronic colitis was induced in female C57BL/6 mice using 2% DSS in drinking water for three cycles; there were 4 days of DSS-water administration that was followed by 7 days of DSS-free water, in a cycle. ADMSCs, 106 cells per mouse, were injected intraperitoneally (IP), whereas the MSC-CM injection was also performed six times from the last day of DSS in Cycle 1. Clinical symptoms were recorded daily. The colon pathological changes, cytokine levels, and regulatory T (Treg) cell percentages were then analyzed. After receiving ADMSCs and MSC-CM in colitis mice, the clinical symptoms and disease activity index were improved and the survival rate was increased. The histopathological examination also showed tissue healing in comparison with the nontreated group. In addition, the increased level of transforming growth factor beta, increased percentage of Treg cells, increased level of interleukin (IL)-10, and decreased level of IL-17 were observed after the treatment. This study showed the regulatory effects of ADMSCs and MSC-CM on inflammatory responses. Therefore, the use of ADMSCs and MSC-CM can be introduced as a new and effective therapeutic approach for patients with colitis.

Cells mobilized from the bone marrow can contribute to endothelial regeneration and repair. Nevertheless, cardiovascular diseases are associated with diminished numbers and function of these cells, attenuating their healing potential. Gene transfer of endothelial nitric oxide synthase (eNOS) can restore the activity of circulating cells. Furthermore, estrogen accelerates the reendothelialization capacity of early outgrowth cells (EOCs). We hypothesized that overexpressing eNOS alone or in combination with estrogen stimulation in EOCs would potentiate the beneficial effects of these cells in regulating smooth muscle cell (SMC) function. Native human EOCs did not have any effect on human coronary artery SMC (hCASMC) proliferation or migration. Transfecting EOCs with a human eNOS plasmid and/or stimulating with 17β-estradiol (E2) increased NO production 3-fold and enhanced EOC survival. Moreover, in co-culture studies, eNOS overexpressing or E2-stimulated EOCs reduced hCASMC migration (by 23% and 56% respectively), vs. control EOCs. These effects do not implicate ERK1/2 or focal adhesion kinases. Nevertheless, NOS-EOCs had no effect on hCASMC proliferation. These results suggest that overexpressing or activating eNOS in EOCs increases their survival and enhances their capacity to regulate SMC migration through paracrine effects. These data elucidate how eNOS overexpression or activation in EOCs can prevent vascular remodeling.

Proliferation of Leishmania (L.) parasites depends on polyamine availability, which can be generated by the L-arginine catabolism and the enzymatic activity of arginase (ARG) of the parasites and of the mammalian hosts. In the present study, we characterized and compared the arginase (arg) genes from pathogenic L. major and L. tropica and from non-pathogenic L. tarentolae. We quantified the level of the ARG activity in promastigotes and macrophages infected with pathogenic L. major and L. tropica and non-pathogenic L. tarentolae amastigotes. The ARG's amino acid sequences of the pathogenic and non-pathogenic Leishmania demonstrated virtually 98.6% and 88% identities with the reference L. major Friedlin ARG. Higher ARG activity was observed in all pathogenic promastigotes as compared to non-pathogenic L. tarentolae. In vitro infection of human macrophage cell line (THP1) with pathogenic and non-pathogenic Leishmania spp. resulted in increased ARG activities in the infected macrophages. The ARG activities present in vivo were assessed in susceptible BALB/c and resistant C57BL/6 mice infected with L. major, L. tropica and L. tarentolae. We demonstrated that during the development of the infection, ARG is induced in both strains of mice infected with pathogenic Leishmania. However, in L. major infected BALB/c mice, the induction of ARG and parasite load increased simultaneously according to the time course of infection, whereas in C57BL/6 mice, the enzyme is upregulated solely during the period of footpad swelling. In L. tropica infected mice, the footpads' swellings were slow to develop and demonstrated minimal cutaneous pathology and ARG activity. In contrast, ARG activity was undetectable in mice inoculated with the non-pathogenic L. tarentolae. Our data suggest that infection by Leishmania parasites can increase ARG activity of the host and provides essential polyamines for parasite salvage and its replication. Moreover, the ARG of Leishmania is vital for parasite proliferation and required for infection in mice. ARG activity can be used as one of the main marker of the disease severity., Author summary Over the past decades, there has been a significant improvement in the understanding of immune responses against infection with pathogenic Leishmania spp. and the pathogenesis of cutaneous leishmaniasis (CL) in the mouse models. Leishmania parasites infect macrophages that can be activated via two major pathways resulting in classical and alternative activated macrophages which metabolize L-arginine differentially. Classically activated macrophages upregulate the enzyme inducible NO synthase (iNOS) and alternatively activated macrophages upregulate the arginase (ARG). ARG hydrolyzes the conversion of its substrate (L-arginine) to L-ornithine and urea. L-ornithine is a key intermediate substrate for the biosynthesis of polyamines, which are crucial nutrients for cellular processes such as growth, differentiation and proliferation of host cells and Leishmania parasites. Leishmania parasites may partly activate ARGs and inactivate the NO production by the host cells and enhance parasite survival via depletion of the iNOS substrate (L-arginine) and reduce NO levels. In this study, we tested the activity of this enzyme in the promastigote forms of the pathogenic L. major and L. tropica, and non-pathogenic L. tarentolae in vitro and assessed the differences between the levels of ARG activity in THP1 cells infected with different Leishmania spp. Moreover, we investigated the relationship between excessive ARG activity and lesion development in susceptible BALB/c and resistant C57BL/6 mice infected with virulent L. major, L. tropica and non-virulent L. tarentolae parasites and its impact on parasite burden during the development of infection. Our results show that ARG is highly upregulated in all pathogenic promastigotes as compared to non-pathogenic L. tarentolae and had a negative correlation between production of ARG and NO. We showed that during the development of the infection in susceptible BALB/c and resistant C57BL/6 mice, ARG is induced in both strains of mice infected with pathogenic Leishmania but not in non-pathogenic counterparts. These results suggest that ARG activity of Leishmania is essential for parasite survival in vitro and in vivo that directly regulates its growth and replication inside the host cells; therefore, it can be used as a significant marker of disease severity in CL and possible tools for drug designing.

Context Leishmaniasis is one of the most common parasitic diseases. Many medicinal plants have been utilized for the treatment of leishmaniasis. Evidence Acquisition Recent clinical trials have proven the efficacy of a number of herbal drugs. Synthetic agents and current drugs on the market have some disadvantages, such as side effects, high cost, and painful injections. Given the efficiency of herbal drugs, they can be a source of natural and harmless compounds for Leishmania treatment. Results Several researches have shown a wide range of plant extract exhibiting remarkable anti-leishmanial activity in vitro and in vivo. Conclusions Attempts for discovery of an effective strategy for leishmaniasis treatment with nominal side effects are being continued and herbal drugs are receiving much interest. More clinical studies should be done to investigate the efficacy and safety of herbal drugs for the production of effective and safe drugs for leishmaniasis treatment. This may also provide new hope for leishmaniasis treatment.

Surface plasmon resonance effect of gold nanostructures makes them good candidates for photothermal therapy (PTT) application. Herein, gold-ferrite nanocomposite (GFNC) was synthesized and characterized as a photothermal agent in PTT. The aim of this study was to investigate the effect of GFNC upon laser irradiation on treatment of cancer in mice bearing melanoma cancer. Thirty mice received 1.5 × 10(6) B16/F10 cells subcutaneously. After 1 week, the mice bearing solid tumor were divided into four groups: control group (without any treatment), laser group (received laser irradiation without GFNC injection), GFNC group (only received intratumorally GFNC), and GFNC + laser group (received intratumorally GFNC upon laser irradiation). In GFNC + laser group, 200 μL of fluid, 1.3 × 10(-7) mol L(-1) gold nanoparticles, was injected intratumorally and immediately the site of tumor was exposed to continuous wave diode laser beam (808 nm, 1.6 W cm(-2)) for 15 min. All mice but four were euthanized 24 h after treatment to compare the necrotic surface area histologically by using measuring graticule. Statistical analyses revealed significant differences in necrosis extent for GFNC + laser group, compared to other groups. Four subjects (control group and GFNC + laser group, two mice each) were kept for longitudinal study. Histological analyses and tumor volume measurements of the four subjects indicated that tumor in GFNC + laser group was controlled appropriately. It was concluded that combining an 808-nm laser at a power density of 1.6 W cm(-2) with GFNC has a destruction effect in melanoma cancer cells in an animal model.