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OBJECTIVE Miscommunication and poor coordination among surgical teams are known causes of preventable medical harms and operating room inefficiencies and inhibit surgical training. Technology may help overcome these challenges. This study used the personal experience of one of the authors as a former Air Force F-15 pilot to design a combat aviation pre- and postoperative communication workflow in the neurosurgery department and tested its effect on safety, efficiency, and education. The authors hypothesized that the adoption of this workflow through a tailored technological platform will increase compliance and improve the chances of sustainability. METHODS Data were prospectively collected from neurosurgery cases before (January–May 2020) and after (June–October 2020) implementation of this workflow. Briefing and debriefing were executed using a custom mobile platform and were defined as nonmandatory for all participants. All faculty and residents who operated at NYU Langone Medical Center (Tisch campus) during the intervention period were enrolled on the platform. Primary outcomes were morbidity and mortality per the department’s criteria, and intraoperative last-minute requests as reported by operating room staff in a double-blinded fashion. Secondary outcomes were user responses on the subjective questionnaires. RESULTS Data were collected from 637 and 893 cases during the preintervention and intervention periods, respectively. The average briefing rates for residents and surgeons were 71% and 81%, respectively, and the average debriefing rates for residents and surgeons were 67% and 88%. There was no significant difference in preoperative risk score between the preintervention and intervention patient populations (p = 0.24). The rate of intraoperative last-minute requests significantly decreased from 16.6% (35/211) to 10.5% (35/334, p = 0.048). There was no significant change in morbidity and mortality between the preintervention and intervention periods. On subjective questionnaires there was a statistically significant improvement in safety, efficiency, and educational aspects of the cases during the intervention period. CONCLUSIONS Implementation of aviation-like structured team communication practices in the neurosurgery department through a technological platform improved education and communication between surgical teams and led to a reduction in last-minute surgical requests that could impact costs.

The pathogenesis of SARS-CoV-2 infection, causative pathogen of the known COVID-19 pandemic is not well clarified. In this regard oxidative stress is one of the topics that need to be investigated. Therefore, the present research was performed to explore the relationship between the oxidant/antioxidant system and COVID-19 exacerbation. Sera were collected from 120 patients with COVID-19 infection and 60 healthy volunteers as the control group. The patient group consisted of 60 cases with mild disease and 60 severely ill patients. Serum levels of total antioxidant capacity (TAC) and nitric oxide (NO) as well as serum activities of the two main antioxidant defense enzymes, superoxide dismutase (SOD) and catalase (CAT), were measured. TAC levels were considerably lower in patients compared with healthy individuals (p 0.05) and also between patients with mild and severe diseases (p 0.05). A rather decreasing trend was also found in NO concentration as well as SOD and CAT activity, though, the observed differences were not statistically significant (p 0.05). These findings suggest that COVID-19 patients may be susceptible to depleted total antioxidant capacity. Moreover, showing such variations in blood samples of infected individuals could be considered as a predictive marker of COVID-19 severity.

Statement of the Problem: A mineral trioxide aggregate (MTA) apical plug is commonly applied prior to endodontic treatment of open-apex teeth. However, difficult application and condensation of MTA in the apical region is a drawback of this technique. Purpose: This study aimed to compare the microleakage of MTA apical plug applied by the manual technique and indirect use of ultrasonic with different powers. Materials and Method: In this in vitro, experimental study, divergent open apices were created in 48 single-rooted, single-canal teeth using ProFile. The teeth were randomly divided into four experimental groups (n=10). All groups received 5-mm thick MTA apical plug at the apical region using one of the following methods. In group 1, MTA was manually condensed while in groups 2-4, indirect ultrasonic energy with minimum, medium, and maximum power levels was used for MTA plug condensation. After setting of MTA, the apical microleakage of the MTA plug was quantified using the fluid filtration method. Data were analyzed using the Mann-Whitney and Kruskal-Wallis tests (p< 0.05). Results: Significant differences were noted in microleakage of MTA plug between the manual group and ultrasonic groups with medium (p= 0.043) and maximum (p= 0.029) power levels. No significant difference was noted in microleakage of other groups (p> 0.05). Conclusion: Considering the current results, it seems that application of MTA with indirect ultrasonic energy at medium or high power level would decrease the microleakage of MTA plug in open-apex root canals.

Breast cancer is one of the main cancers that effect of the women’s health. This cancer is one of the most important health issues in the world and because of that, diagnosis in the beginning and appropriate cure is very effective in the recovery and survival of patients, so image processing as a decision-making tool can assist physicians in the early diagnosis of cancer. Image processing mechanisms are simple and non-invasive methods for identifying cancer cells that accelerate early detection and ultimately increase the chances of cancer patients surviving. In this study, a pipeline methodology is proposed for optimal diagnosis of the breast cancer area in the mammography images. Based on the proposed method, after image preprocessing and filtering for noise reduction, a simple and fast tumors mass segmentation based on Otsu threshold segmentation and mathematical morphology is proposed. Afterward, for simplifying the final diagnosis, a feature extraction based on 22 structural features is utilized. To reduce and pruning the useless features, an optimized feature selection based on a new developed design of Water Strider Algorithm (WSA), called Guided WSA (GWSA). Finally, the features injected to an optimized SVM classifier based on GWSA for optimal cancer diagnosis. Simulations of the suggested method are applied to the DDSM database. A comparison of the results with several latest approaches are performed to indicate the method higher effectiveness.

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemiology implicates airborne transmission; aerosol infectiousness and impacts of masks and variants on aerosol shedding are not well understood. Methods We recruited coronavirus disease 2019 (COVID-19) cases to give blood, saliva, mid-turbinate and fomite (phone) swabs, and 30-minute breath samples while vocalizing into a Gesundheit-II, with and without masks at up to 2 visits 2 days apart. We quantified and sequenced viral RNA, cultured virus, and assayed serum samples for anti-spike and anti-receptor binding domain antibodies. Results We enrolled 49 seronegative cases (mean days post onset 3.8 ± 2.1), May 2020 through April 2021. We detected SARS-CoV-2 RNA in 36% of fine (≤5 µm), 26% of coarse (>5 µm) aerosols, and 52% of fomite samples overall and in all samples from 4 alpha variant cases. Masks reduced viral RNA by 48% (95% confidence interval [CI], 3 to 72%) in fine and by 77% (95% CI, 51 to 89%) in coarse aerosols; cloth and surgical masks were not significantly different. The alpha variant was associated with a 43-fold (95% CI, 6.6- to 280-fold) increase in fine aerosol viral RNA, compared with earlier viruses, that remained a significant 18-fold (95% CI, 3.4- to 92-fold) increase adjusting for viral RNA in saliva, swabs, and other potential confounders. Two fine aerosol samples, collected while participants wore masks, were culture-positive. Conclusions SARS-CoV-2 is evolving toward more efficient aerosol generation and loose-fitting masks provide significant but only modest source control. Therefore, until vaccination rates are very high, continued layered controls and tight-fitting masks and respirators will be necessary.

In recent years, increasing attention has been paid to the novel drug delivery systems to reduce the dose of the drug and avoid side effects. Metronidazole has been used for many years in the treatment of anaerobic bacterial and protozoal infections. Nanolactoferrin, a newly developed antibacterial agent originated from lactoferrin, is applied both as an active therapeutic and a drug nanocarrier. The present study describes the development and characterization of metronidazole-loaded lactoferrin nanoparticles (nano-MTZ) as well as reports their antitrichomonal activity on Trichomonas gallinae, the protozoal causative agent of pigeon trichomoniasis. The activity of the nano-MTZ is compared with the regular metronidazole formulation (MTZ) under in vitro and in vivo conditions. Additionally, cytotoxicity of the nano-MTZ to fibroblast cell line and possible hepatotoxicity in treated pigeons were evaluated. Nano-MTZ was prepared based on the thermal treatment method and the average size and surface charge of the dispersion were 30.6 nm and - 44.6 mv, respectively. No significant cytotoxicity was noted for the nano-MTZ in comparison to the MTZ. Loading efficiency in nano-MTZ was calculated as 55%. In vitro susceptibility results demonstrated 24 h 90% lethal concentration values of 4.23 and 6.64 µg/mL for MTZ and nano-MTZ, respectively. Oral treatment of the pigeons experimentally infected with T. gallinae resulted in the earlier eradication of the infection in the nano-MTZ-treated pigeons. No adverse effects on the liver function have been observed for the nano-MTZ. These findings suggest that nanolactoferrin is a promising platform for the development of novel MTZ formulations with improved antitrichomonal activity.

Objectives The goal of endodontic therapy is to prevent apical periodontitis. This is achieved by biomechanical preparation, microbial control using endodontic irrigants, and complete obturation of the canal space. In order to prevent possible post‐obturation complications and for an added antimicrobial effect, substantivity is a desired characteristic of endodontic irrigants. Currently the most commonly used endodontic irrigant that produces an antibacterial substantivity effect is chlorohexidine (CHX). Silver diamine fluoride (SDF) is a topically applied agent for managing dental caries and has shown to stop caries lesion progression. The objective of this study was to compare the antimicrobial substantivity effect of 3.8% SDF against other commonly used endodontic irrigants such as 2% CHX and 6.25% Sodium hypochlorite (NaOCl). Material and methods Using a diffusion disc assay we determined the antimicrobial activities of 38%, 3.8%, 0.38%, and 0.038% of SDF against the bacterium Enterococcus faecalis OG1RF. Subsequently, we compared the levels of colonization of E. faecalis by scanning electron microscopy (SEM) at 1.5‐ and 3‐week time intervals on dentin pretreated with 3.8% SDF, 6.25% NaOCl, 2% CHX or sterile phosphate buffered saline (PBS). Results The diffusion disc assay demonstrated that 38% and 3.8% of SDF inhibited the growth of E. faecalis. Moreover, the substantivity of 3.8% SDF (p

Fascioliasis is an important parasitic disease which affects productivity of ruminants, and imposes significant economic losses. Benzimidazoles are effective in the treatment of fascioliasis; however, there are several reports on benzimidazoles resistant flukes. Combinational therapy is an approach to delay the emergence of resistant flukes. The present study aimed to compare the efficacy of triclabendazole (TBZ) and combination of triclabendazole and levamisole (TBZ + LVM) in the treatment of sheep naturally infected with Fasciola sp. For this purpose, 40 ewes infected with Fasciola sp. in three groups received TBZ, and TBZ + LVM, or remained untreated as CON. Fecal egg count (FEC), fecal egg count reduction (FECR), liver enzymes activity, albumin, globulin, and total protein levels were measured on day 0, 7, 14, and 28 post treatments. Obtained results showed that treatment with TBZ and TBZ + LVM resulted in significant reduction in FEC (P

Aim: Bacterial micro leakage at implant-abutment interface under functional loading is an important factor, may lead to crestal bone loss and affect the long term success of dental implants. Due to the limited studies about the implant systems with a connection of Slip joint design, this study aimed to evaluate the effect of dynamic loading on bacterial leakage at the implant-abutment interface with slip joint connection. Settings and Design: In vitro- comparative study. Materials and Methods: A total of 20 implants and abutments with slip joint connections (Tapered Screw-Vent, 3.7 mm ×10 mm, Zimmer Dental, USA) was examined and depends on using functional loading were divided into two groups; loaded and unloaded. Initially, 10 μl of Brain Heart Infusion (BHI) culture broth was pipetted to the internal lumen of each implant, then the abutments were tightened to the fixtures and crowns were cemented. In the unloaded group, samples were immersed in E-Coli suspension for 5 days. In the loaded group, samples were immersed in microbial suspension under 500000 cycles using a cyclic load device. Following disconnection of fixtures and abutments, microbial samples were taken from the internal lumen of implants and colonies were counted. Data were analyzed using. Statistical Analysis Used: Mann-Whitney statistical test, SPSS version 24. Results: The mean rate of micro leakage in unloaded and loaded groups was 4000 CFU/ml and 27000 ± 31640 CFU/ml respectively. Bacterial colonies grew in 10% of unloaded samples and 50% of loaded samples. This difference was statistically significant. (P < 0.05) Conclusions: Microbial micro leakage at the implant-abutment interface with slip joint design increased significantly after functional loading.

Objective The production of β-lactamase enzymes such as AmpC β-lactamases and extended-spectrum β-lactamases (ESBLs) is among the main mechanisms for resistance to expanded-spectrum cephalosporins. The present study was conducted to investigate the prevalence and molecular epidemiology of plasmid-mediated AmpC beta (β)-lactamase in ESBL co-producing Escherichia coli (E. coli) and Klebsiella spp. (Klebsiella pneumoniae and Klebsiella oxytoca) clinical isolates in the northeast of Iran. Methods A total of 602 E. coli and Klebsiella spp. clinical isolates were collected from three hospitals in Mashhad (northeast of Iran). A combination disk test (CDT) was performed for the phenotypic detection of ESBLs. Screening for the detection of AmpC β-lactamases was performed by a susceptibility test to a cefoxitin disc among ESBL producing isolates. A confirmatory test for AmpC β-lactamases was performed using the Mast® D68C test. Identification of plasmid-mediated AmpC cluster genes was done by multiplex polymerase chain reaction (PCR). Results Among 336 ESBL-producing strains, 230 (68.4%) isolates were resistant to cefoxitin. Results of the Mast® D68C test showed that 30% (69/230) of cefoxitin-resistant isolates simultaneously exhibited ESBL and AmpC activity and 22% (51/230) of isolates probably showed multi-drug resistant (MDR) phenotype. Results of multiplex PCR among ESBL-positive isolates showed that, 16.7% (56/336) of isolates were positive for plasmid-borneampC cluster genes, and CMY (38%) was the most frequent genotype of plasmid mediated AmpC. Conclusion Findings of the study revealed that an increase in the prevalence of ESBL and AmpC co-producer in E. coli and Klebsiella spp. strains may become an important public health issue. Therefore, there is a vital need for surveillance of spread of these clinical isolates.

Background Intestinal parasitic infections (IPIs) are confirmed as major public health problems, worldwide. Northern Iran is highly endemic area for such infections. This research aimed to study on the prevalence of IPIs among people referred to the health care centers in Mazandaran Province, Northern Iran. Methods In this descriptive cross-sectional survey, 984 stool samples were collected during 2015–2016. Fresh stool samples were collected from all individuals and examined by direct slide smear, formalin-ether concentration, trichrome and modified Ziehl-Neelsen staining techniques. The results were analyzed using SPSS version 16 and Chi-square test. Results Out of 984 participants, the overall prevalence of IPIs was 12.1% (95 CI, 11.4–12.7; 119/984). The prevalence of protozoa and helminthes infections were 7.9% (95 CI, 7.4–8.3; 109/984) and 5.3% (95 CI, 4.9%–5.5%; 69/984), respectively. The most prevalent protozoan IPs were include Giardia lamblia (3.3%), Entamoeba coli (2%), Blastocystis hominis (1.3%), Entamoeba histolytica/dispar (1.1%), Entamoeba hartmanni (1.1%) and Cryptosporidium spp. (0.6%). Also major helminthic infections were include Trichostrongylus spp. (2.6%), Hookworms (1.7%), Strongyloides stercoralis (1.1%), Hymenolepis nana (0.6%) and Dicrocoelium dendriticum (0.6%). The results of the univariate analysis revealed that residence (rural being [P = 0.017]) and occupation (farmers [0.033]) were statistically significant risk factor for IPIs. Conclusion In conclusion, we have found, despite persistent improvement in sanitary conditions over the recent years in northern part of Iran, IPIs are still among the main public health problems in this area. Moreover, helminths infection in our study were considerable. Thus, effective control programs are essential to reduce the incidence of IPIs.

According to the last information of IUCN Red List, Eurasian lynx has been endangered since 2010. The population of this animal is heavily affected by infectious parasites. Two adult Eurasian lynx (one male and one female) were illegally hunted and found dead in Parvar National Park, Semnan Province, Iran. After the autopsy, the tissue and parasite samples were collected from gastrointestinal tract and transferred to 70% alcohol. Samples were recovered and identified as Joyeuxiella spp. Sonsino, 1889. Tissue samples were taken from the place of sticking of parasites on the intestinal wall, for histopathological examination, and were transferred to 10% buffered formalin. Following routine processes and H&E staining, the slides were examined microscopically. Main histopathological observations were epithelial hyperplasia and destruction, inflammatory cell infiltration in mucosa and submucosa of jejunum. To the best of the author’s knowledge, this is the first report and histopathological study of Joyeuxiella spp. in the world in Eurasian lynx.

BackgroundSARS-CoV-2 epidemiology implicates airborne transmission; aerosol infectiousness and impacts of masks and variants on aerosol shedding are not well understood.MethodsWe recruited COVID-19 cases to give blood, saliva, mid-turbinate and fomite (phone) swabs, and 30-minute breath samples while vocalizing into a Gesundheit-II, with and without masks at up to two visits two days apart. We quantified and sequenced viral RNA, cultured virus, and assayed sera for anti-spike and anti-receptor binding domain antibodies.ResultsWe enrolled 49 seronegative cases (mean days post onset 3.8 ±2.1), May 2020 through April 2021. We detected SARS-CoV-2 RNA in 45% of fine (≤5 µm), 31% of coarse (>5 µm) aerosols, and 65% of fomite samples overall and in all samples from four alpha-variant cases. Masks reduced viral RNA by 48% (95% confidence interval [CI], 3 to 72%) in fine and by 77% (95% CI, 51 to 89%) in coarse aerosols; cloth and surgical masks were not significantly different. The alpha variant was associated with a 43-fold (95% CI, 6.6 to 280-fold) increase in fine aerosol viral RNA, compared with earlier viruses, that remained a significant 18-fold (95% CI, 3.4 to 92-fold) increase adjusting for viral RNA in saliva, swabs, and other potential confounders. Two fine aerosol samples, collected while participants wore masks, were culture-positive.ConclusionSARS-CoV-2 is evolving toward more efficient aerosol generation and loose-fitting masks provide significant but only modest source control. Therefore, until vaccination rates are very high, continued layered controls and tight-fitting masks and respirators will be necessary.Key PointsCases exhale infectious viral aerosolsSARS-CoV-2 evolution favors more efficient aerosol generation.Loose-fitting masks moderately reduce viral RNA aerosol.Ventilation, filtration, UV air sanitation, and tight-fitting masks are needed to protect vulnerable people in public-facing jobs and indoor spaces.

Objective: We propose a novel method to obtainmap patient-specific blood velocity profiles (obtained from imaging data such as 2D flow MRI or 3D colour Doppler ultrasound) and map them to geometric vascular models suitable to perform CFD simulations of haemodynamics. We describe the implementation and utilisation of the method within an open-source computational hemodynamics simulation software (CRIMSON). Methods: tThe proposed method establishes point-wise correspondences between the contour of a fixed geometric model and time-varying contours containing the velocity image data, from which a continuous, smooth and cyclic deformation field is calculated. Our methodology is validated using synthetic data, and demonstrated using two different in-vivo aortic velocity datasets: a healthy subject with normal tricuspid valve and a patient with bicuspid aortic valve. Results: We compare the performance of our method with results obtained with the state-of-the-art Schwarz-Christoffel method, in terms of preservation of velocities and execution time. Our method is as accurate as the Schwarz-Christoffel method, while being over 8 times faster. The proposed method can preserve either the flow rate or the velocity field through the surface, and can cope with inconsistencies in motion and contour shape. Conclusions: Our results show that the method is as accurate as the Schwarz-Christoffel method in terms of maintaining the velocity distributions, while being more computationally efficient.Our mapping method can accurately preserve either the flow rate or the velocity field through the surface, and can cope with inconsistencies in motion and contour shape. Significance: The proposed method and its integration into the CRIMSON software enable a streamlined approach towards incorporating more patient-specific data in blood flow simulations.

Background: Systolic aortic root expansion is reported to facilitate valve opening, but the precise dynamics remain unknown. A sonometric study with a high data sampling rate (200 to 800 Hz) was conducted in an acute ovine model to better understand the timing, mechanisms, and shape of aortic valve opening and closure. Methods: Eighteen piezoelectric crystals were implanted in 8 sheep at each annular base, commissures, sinus of Valsalva, sinotubular junction, nodulus of Arantius, and ascending aorta (AA). Geometric changes were time related to pressures and flows. Results: The aortic root was hemodynamically divided into left ventricular (LV) and aortic compartments situated, respectively, below and above the leaflets. During isovolumetric contraction (IVC), aortic root expansion started in the LV compartment, most likely due to volume redistribution in the LV outflow tract below the leaflets. This expansion initiated leaflet separation prior to ejection (2.1%±0.5% of total opening area). Aortic compartment expansion was delayed toward the end of IVC, likely related to volume redistribution above the leaflets due to accelerating aortic backflow toward the aortic valve and coronary flow reduction due to myocardial contraction. Maximum valve opening during the first third of ejection acquired a truncated cone shape [leaflet free edge area smaller than annular base area (−41.5%±5.5%)]. The distal orifice became clover shaped because the leaflet free edge area is larger than the commissural area by 16.3%±2.0%. Conclusions: Aortic valve opening is initiated prior to ejection related to delicate balance between LV, aortic root, and coronary dynamics. It is clover shaped at maximum opening in systole. A better understanding of these mechanisms should stimulate more physiological surgical approaches of valve repair and replacement.

The bicuspid aortic valve (BAV) is the most common congenital cardiovascular anomaly and may present with differing phenotypes including almost constant annular dilation. We have developed a standardized approach to BAV repair with a systematic adjunct of aortic annuloplasty according to the three phenotypes of the proximal aorta, which include a dilated aortic root, dilated ascending aorta and normal root and ascending aorta. In our cohort of 191 patients, freedom from AV-related re-intervention was 98% for remodeling with annuloplasty (n=100) and 100% for tubular aortic replacement with annuloplasty (n=31) at 8 years. In an isolated aortic insufficiency (AI) group, freedom from AV-related re-intervention varied from 72.4% with a single subvalvular annuloplasty ring (n=31) compared to 100% at 6 years when a double sub- and supra-valvular (STJ) annuloplasty ring was performed (n=29). Restoration of the annulus: sinotubular junction (STJ) ratio is a key factor to ensure longevity of the bicuspid valve repair and freedom from re-intervention.

The growing expertise in valve sparing root replacement over the years (1) has paved the way for developing isolated aortic valve (AV) leaflet repair as an alternative to replacement, especially when a standardized systematic approach in term of annulus and sinotubular junction (STJ) stabilization is utilized. Since 2003, we have developed a standardized systematic approach for AV repair which incorporates leaflet repair and the stabilization of annulus and STJ with double sub and supra (STJ) valvular external ring annuloplasties (Figure 1). Open in a separate window Figure 1 Double sub and supra valvular ring annuloplasty for isolated AI repair (drawing with kind permission of Dr Pavel Zacek).

Introduction: Quality is defined based on the recipient's request. Students are the main members of the higher educational system. The aim of this study was to investigate the items related to the quality of services from the students’ point. Methods: This cross-sectional study was carried out in six faculties of Mashhad University of Medical Sciences in 2015-2016. Five hundred and seven undergraduate students were enrolled by multi-stage random sampling method. The standard SERVQUAL questionnaire with 27 pairs of questions which evaluate the quality of educational servies, was distributed. SPSS version 24 was used for data analysis. Results: Overall, 303 individuals (60%) were female and another 60% were in basic science period. There was a negative gap in all items in all the faculties. The item related to "the appealing appearance of the employees" had the smallest gap (from -0.6 to -0.1). The greatest gaps were related to the following items: in the medical(-1.7±0.1) and health (-1.8±0.2) faculties, "preparing students for future jobs by providing necessary theoretical and practical trainings"; in the faculty of dentistry(-2.0±0.1), "staff flexibility in specific conditions"; in the faculties of pharmacy(-1.5±0.1) and nursing(-1.2±0.1) "room and environmental facilities"; in the faculty of paramedicine(-1.5±0.1), "possibility for students to comment on educational programs" and "appropriate time for conducting classes". Conclusion: Items with highest gaps were not similar among different faculties. Focusing on the identified items with the greatest negative gaps is highly recommended. &nbsp

Aortic valve surgery in non-elderly patients represents a very challenging patient population. The younger the patient is at the point of aortic valve intervention, the longer their anticipated life expectancy will be, with longer exposure to valve-related complications and risk for re-operation. Although the latest international guidelines recommend aortic valve repair in patients with aortic valve insufficiency, what we see in the real world is that the vast majority of these aortic valves are replaced. However, current prosthetic valves has now been shown to lead to significant loss of life expectancy for non-elderly patients up to 50% for patients in their 40s undergoing mechanical aortic valve replacement. Bioprostheses carry an even worse long-term survival, with higher rates of re-intervention. The promise of trans-catheter valve-in-valve technology is accentuating the trend of bioprosthetic implantation in younger patients, without yet the appropriate evidence. In contrast, aortic valve repair has shown excellent outcomes in terms of quality of life, freedom from re-operation and freedom from major adverse valve-related events with similar life expectancy to general population as it is also found for the Ross procedure, the only available living valve substitute. We are at a time when the paradigm of aortic valve surgery needs to change for the better. To better serve our patients, we must acquire high quality real-world evidence from multiple centers globally - this is the vision of the AVIATOR registry and our common responsibility.

Background The JC polyomavirus has been blamed to contribute in colorectal cancer (CRC), however, the topic is still controversial. Varying detection rate of JCPyV genome has been reported mainly due to technical reasons. Here, we provide summative data on the topic, with emphasize on technical issues. Methods Formalin-fixed paraffin-embedded tissue samples from 50 patients with CRC, consisting of tumoral and non-cancerous marginal tissue (totally 100 samples) were included in the study. After DNA extraction, specific JCPyV T-Ag sequences were targeted using Real-time PCR. To unwind the supercoiled JCPyV genome, pretreatment with topoisomerase I, was applied. Immunohistochemical (IHC) staining was performed using an anti-T-Ag monoclonal antibody. Results In the first attempts, no samples were found to be positive in Real-time PCR assays. However, JCPyV sequences were found in 60% of CRC tissues and 38% of non-cancerous colorectal mucosa after application of pre-treatment step with topoisomerase I enzyme (P = 0.028). T-Ag protein was found in the nuclear compartment of the stained cells in IHC assays. Conclusions The presence of JCPyV in CRC tissues, as well as T-Ag localization in the nucleolus, where its oncogenic effect takes place, may provide supporting evidence for JCPyV involvement in CRC development. The study highlights the importance of using topoisomerase I to enhance JCPyV genome detection. Also, colorectal tissue is one of the permissive human tissue for JC resistance after preliminary infection.

Designing a novel platform capable of providing a proper tissue regeneration environment is a key factor in tissue engineering. Herein, a green composite based on gelatin/agarose/zeolite with pomegranate peel extract was fabricated as an innovative platform for tissue engineering. Gelatin/agarose was loaded with pomegranate peel extract-loaded zeolite to evaluate its swelling behavior, porosity, release rate, and cell viability performance. The composite characteristics were evaluated using XRD and DSC. The hydrogel performance can be adjusted for the desired aim by zeolite content manipulation, such as controlled release. It was shown that the green nanocomposite exhibited proper cellular activity along with a controlled release rate. Moreover, the hydrogel composite’s swelling ratio was decreased by adding zeolite. This study suggested a fully natural composite as a potential biomaterial for tissue engineering, which opens new ways to design versatile hydrogels for the regeneration of damaged tissues. The hydrogel performance can be adjusted specifically by zeolite content manipulation for controlled release.

Background Mucormycosis (zygomycosis) is an invasive fungal infection that carries a high risk of morbidity and mortality. Uncontrolled diabetes mellitus and other immunocompromising conditions are risk factors for mucormycosis development. We here describe the differences in characteristics and outcomes of mucormycosis among solid organ transplant, hematological malignancy, and diabetes mellitus groups at our institution. Methods We conducted a retrospective chart review over the period of 2009-2020, with identifying patients using the International Classification of Diseases, Ninth and Tenth Revisions. Clinical, laboratory, and outcome data were collected. Results There were 28 patients identified: 7 solid organ transplant, 3 hematological malignancy, and 18 diabetes mellitus patients were included in the study. Three solid organ transplant patients experienced an episode of rejection, and another 3 had cytomegalovirus infection prior to presenting with mucormycosis. Four of seven solid organ transplant patients had a history of diabetes mellitus, but the median hemoglobin A1C was lower than in the diabetes mellitus group (6.3 vs 11.5; P = .006). The mortality rate difference between solid organ transplant and diabetes mellitus was not statistically significant: 2/7 (28.57%) vs 5/18 (27.78%); P = .66. Patients with bilateral disease (pulmonary or sinus) had significantly higher mortality (80% vs 13%, P = .008). There was no difference in mortality outcomes among the different types of antifungal therapies administered. Conclusion A multispecialty approach is imperative in mucormycosis therapy. While the underlying risk factors were different, the outcomes were comparable for the solid organ transplant and diabetes mellitus groups. Future larger and longitudinal studies are recommended.

Standardization of aortic valve repair techniques with use of a calibrated annuloplasty have led to improved long-term outcomes in dystrophic aortic insufficiency. It can also improve dissemination of techniques and rates of aortic valve repair. Dystrophic aortic insufficiency can be found in three aortic phenotypes: dilated aortic root, dilated ascending aorta and isolated aortic insufficiency. The aortic annulus is invariably dilated above 25 mm in the vast majority of cases of aortic insufficiency, regardless of whether the aorta is dilated or not. A dilated annulus is a risk factor for late failure of aortic valve repair if not addressed at the time of surgery. We perform a calibrated annuloplasty at both sub- and supra-valvular levels in order to restore the ratio of sinotubular junction and annulus. Current evidence shows aortic valve repair reduces valve-related mortality compared to prosthetic valve replacement, with an improved quality of life.

Dystrophic aortic insufficiency accounts for the majority of Western cases of aortic insufficiency and can be divided into the three phenotypes of isolated aortic insufficiency, dilated aortic root, and dilated ascending aorta. Each of these phenotypes is associated with a dilated annulus and/or sinotubular junction. Recent international guidelines recommend reimplantation or remodeling with aortic annuloplasty for valve-sparing root replacement, as well as consideration of aortic valve repair in cases of aortic insufficiency. A dilated aortic annulus is a major risk factor for failure of aortic valve repair procedures, indicating the need to address the annulus at the time of aortic valve or root repair. Calibrated annuloplasty should be performed at sub- and supravalular levels in order to restore the ratio of the sinotubular junction and annulus and be adapted according to the phenotype of the root and ascending aorta. Standardization of aortic valve repair techniques with use of a calibrated annuloplasty will improve dissemination of techniques and rate of aortic valve repair. Current medical evidence shows that aortic valve repair is safe, produces better quality of life, and reduces valve-related mortality compared to prosthetic valve replacement.

Autoimmune diseases are considered as one of the most important disorders of the immune system, in which the prolonged and chronic processes eliminate self-tolerance to the auto-antigens. The prevalence of autoimmune diseases has been increasing worldwide in the recent years. According to the literature, biological processes such as the host genome, epigenetic events, environmental condition, drug consumption, and infectious agents are the most important risk factors that make the host susceptible to the development of autoimmune diseases. In the recent years, the role of Helicobacter pylori in the induction of autoimmune diseases has attracted extensive attention. Via molecular mimicry, epitope spreading, bystander activation, polyclonal activation, dysregulation in immune response, and highly immune-dominant virulence, such as cagA, H. pylori causes tissue damage, polarity, and proliferation of the host cells leading to the modulation of host immune responses. Moreover, given the large population worldwide infected with H. pylori, it seems likely that the bacterium may develop into autoimmune diseases through dysregulation of the immune response. The frequency and relationship between H. pylori infection and systemic lupus erythematosus, rheumatoid arthritis, autoimmune atrophy gastritis, and autoimmune pancreatitis were evaluated using the data from 43 studies involving 5052 patients. According to statistical analysis it is probable that infection with more virulent strains of H. pylori (such as H. pylori cagA positive) can increase the risk of autoimmune diseases. In addition, it was shown that infection with H. pylori can prevent the development of atrophic gastritis by stimulating inflammation in the gastric antrum. However, future studies should confirm the validity of this study.

Mycobacterium arupense is among the opportunist pathogens of atypical mycobacteria emergence (atypical mycobacteria) that is one of the isolated and reported environmental and clinical specimens. Numerous cases of osteo-articular infections of this bacterium are reported nowadays, while the pulmonary infection is rare. We identified Mycobacterium arupense in non-healing wound infection of an elderly woman with history of diabetes mellitus. She has negative tests for HIV, HBV and HCV, but was positive for HTLV-1. The patient was referred according to mild-fever, non-healing, destructive, and swelled lesion on her left foot. The mycobacterial wounds infection was suspected due to her non-conclusive previous treatment. The pathology, acid-fast staining, conventional and 16S rRNA sequencing confirmed the micro-organism to be M. arupense . Finally, the patient recovered following two-week consumption of clarithromycin, ethambutol and rifabutin. The results of this study provide evidence on the potential pathogenicity, clinical outcomes and treatment of infections caused by this bacterium.

The pharmacokinetic parameters of levamisole were determined in the Caspian salmon after intramuscular (IM), oral by gavage, and oral by feed administrations. Eighty-one healthy fish in three different groups received levamisole at the dose of 25 mg/fish by each route. Blood samples were collected at time points of 0, 0.5, 1, 2, 4, 6, 12, 14, and 24 hr after administrations. Plasma levamisole concentrations were measured by a validated high-performance liquid chromatography (HPLC) assay and were analyzed using a noncompartmental approach. The mean terminal half-life was 4.56, 3.95, and 2.91 hr for IM, gavage and feed routes, respectively. The peak plasma concentration for IM, gavage, and feed routes of levamisole were 35.53, 4.63, and 8.36 µg/ml, respectively, at the time of 0.25 for IM, and 1 hr for gavage and feed. The relative bioavailability for gavage and feed routes was 54.80 and 69.30. The similar bioavailability for gavage and feed might be indicative of similar efficacy for these routes of administrations. Further studies are warranted to evaluate the absolute oral bioavailability and the effective dose in Caspian salmon.

Introduction. Dental caries is the most common oral health disease of school-aged children around the world. In this study, we aimed to assess the prevalence and associated factors of dental caries in primary schoolchildren in Yasuj township, Iran. Methods. In this cross-sectional study, a total of 460 children aged 7–12 years were investigated. Dental examination was performed at school according to the World Health Organization criteria. Sociodemographic data were collected using a structured questionnaire, and caries statuses of children’s teeth were recorded through a dental chart. Data were analyzed using summary statistics, chi-square test, and logistic regression model with odds ratio. Results. The prevalence of dental caries in primary, permanent, and whole dentition among children was 75.3%, 41.1%, and 89.8%, respectively. Among all considered factors, the caries presence in primary teeth was inversely (p<0.001) and in permanent teeth was positively (p<0.001) associated with the children’s age. Moreover, the odds of decaying permanent teeth were significantly higher in girls, in rural children, and in children whose fathers were not an employee compared to their counterparts (p=0.04, p<0.001, and p=0.02, respectively). Conclusions. The prevalence of dental caries among the studied primary schoolchildren in mixed dentition was high and associated with their sociodemographic factors. Providing and implementing preventive, therapeutic, and informative programs for controlling dental caries at individual, family, and school levels are necessary for local health policymakers.

Background Recent guidelines support more aggressive surgery for aneurysms of the ascending aorta and root in patients with bicuspid aortic valve. However, the fate of the arch after surgery of the root and ascending aorta is unknown. We set out to assess outcomes following root and ascending aortic surgery and subsequent growth of the arch. Methods Between 2005 and 2016, 536 consecutive patients underwent surgery for aneurysm of the root and ascending aorta; 168 had bicuspid aortic valve. Patients with dissection were excluded. Arch diameter was measured before and after surgery, at 6 months and then annually. Results Of 168 patients, 127 (75.6%) had aortic root replacement and 41 (24.4%) had ascending replacement. Mean age was 57 ± 12.8 years, 82.7% were men, and 5 operations were performed during pregnancy. There was 1 (0.6%) hospital death. One (0.6%) patient had a stroke and 1 (0.6%) had resternotomy for bleeding. Median intensive care unit and hospital stays were 1 and 6 days, respectively. Follow-up was complete for 94% at a median of 5.9 years (range, 1 to 139 months). Aortic arch diameter was 2.9 cm preoperatively and 3.0 cm at follow-up. There was 97% freedom from reoperation and none of the patients required surgery on the arch. Conclusions Prophylactic arch replacement during aortic root and ascending aortic surgery in patients with bicuspid aortic valve is not supported. Our data do not support long-term surveillance of the rest of the aorta in this population.

Background: Globally, Acinetobacter spp., most commonly, Acinetobacter baumannii, are one of the most common Gram-negative nosocomial infections, especially in Intensive Care units (ICUs) and burn wards. Because of the pathogens’ ability to survive for a long time, the eradication of the pathogen from these wards remains a great concern. Simultaneously, the remarkable increase in antibacterial resistance among A. baumannii strains in recent years has raised a great deal of concern. Objectives: The study assessed the prevalence and antibacterial resistance pattern of A. baumannii in the only academic-affiliated burn center in northeastern Iran. Methods: In this cross-sectional study, 5,080 samples from patients admitted to two burnt wards and one burn ICU were included in 2012-2014. The samples were from different sources including wound tissue, blood, bronchial secretion, and urine. The antibacterial resistance pattern was determined using relevant antibiotics based on the Clinical and Laboratory Standards Institut (CLSI) instructions. Results: Acinetobacter spp. were found in 39 of the acquired cultures (1,985 out of 5,080) and 51.9 of bacterial positive cultures (1985 out of 3823). The resistance rate of Acinetobacter spp. against antibiotics varied from 0.9 for colistin to 100 for piperacillin-tazobactam. All Acinetobacter spp. were multidrug-resistant (MDR) due to considerable resistance to fluoroquinolones (95), cephalosporins (93-98), penicillins (97), carbapenems (94-95), and beta-lactamase inhibitors (87-100). Conclusions: Given that infections are a major cause of mortality in burn wards, the high prevalence of MDR isolates of Acinetobacter spp. in this burn center suggests that local antibiotic prescription policies should be revised and infection control strategies should be improved. Also, antibiotic cycling and restrict infection control strategies should be implemented in high-risk wards such as burn units. © 2019, Author(s).

Purpose Extended-spectrum beta-lactamases (ESBLs) and carbapenemase enzymes are the most common and significant mechanisms for bacterial resistance to extended-spectrum cephalosporins and carbapenems, respectively. The present study was conducted to investigate the prevalence and molecular epidemiology of ESBL coding genes and carbapenem-resistant genes among clinical isolates of Enterobacter, Serratia, and Hafnia species in Northeast Iran. Methods A total of 143 clinical samples suspected as Enterobacter species were collected from three hospitals in Mashhad (northeast of Iran) during November–January 2018–2020. Bacterial identification was done using VITEK 2 system. Antimicrobial susceptibility was determined by the Kirby–Bauer disk diffusion test. Molecular epidemiology of ESBLs and carbapenemase coding genes were assessed by PCR. Results Results of VITEK 2 system showed that Serratia marcescens was the predominant isolate (n = 37, 25.87%) followed by Enterobacter cloacae (n = 30, 20.97%), Cronobacter sakazakii (n = 26, 18.18%), and Hafnia alvei (n = 16, 11.19%). The evaluation of antimicrobial susceptibility showed high resistance rates to trimethoprim/sulfamethoxazole, ampicillin-sulbactam, and ceftriaxone (59.44%, 55.24%, and 48.25%, respectively). Phenotypic ESBLs were positively detected in 52 isolates [36.4%]. Moreover, eight isolates (5.59%) were resistant to carbapenems. The frequency of the genes blaTEM, blaSHV, blaCTX-M15, was 71.15%, 23.08%, and 80.77%, respectively, in the 52 ESBL-producing isolates, while the frequency of the blaNDM gene was 25% (2/8) in carbapenem resistant-isolates. Conclusions A Highly frequency distribution of ESBL producer clinical bacterial species such as Serratia, and Enterobacter may be has been acquired by horizontal gene transfer phenomenon from other bacteria and this issue become an important public health issue.

The castor bean tick, Ixodes ricinus, is a species of medical and veterinary importance. The use of synthetic acaricides for tick control has led to development of resistance, residues in the environment and animal products, and public health concerns. In this regard, plant essential oils and their main constituents represent an appealing alternative strategy to combat ticks. The phenols thymol and carvacrol and the alcohol linalool are monoterpenoids occurring in essential oils of several aromatic and medicinal plants, such as thyme, oregano, savory, lavender and coriander. Recent studies have shown toxicity of these monoterpenoids against selected mosquito vectors and other arthropod pests. However, information on their bioactivity on I. ricinus is not available. On this basis, here we evaluated the ovicidal, larvicidal and repellency effects of these compounds against I. ricinus. Concentrations of 0.25, 0.5, 1, 2 and 5% were sprayed on the egg masses, then hatching rates were noted. Larvicidal assays were conducted on unengorged larvae, following the larval packet technique. The repellency was determined by measuring the vertical migration behavior of ticks in laboratory conditions. Carvacrol and thymol at all concentrations tested led to a significant hatching decrease, showing an efficacy higher than permethrin, whereas linalool did not cause any significant effect. In the larvae treated with carvacrol and thymol (1, 2 and 5%), mortality rates reached 100% after 24h, showing a larvicidal efficacy higher than permethrin, whereas no effect was seen in the larval groups treated with linalool. Carvacrol and thymol at all concentrations tested showed >90% repellency on I. ricinus. Linalool was scarcely effective (50.24% repellency) only at the concentration of 5%. Overall, based on these results, the phenols carvacrol and thymol can be considered as candidate ingredients for the development of novel acaricidal formulations to control the populations of I. ricinus and the spread of related tick-borne diseases.

Background and Objectives: Due to adverse effects of pentavalent antimonial treatment of visceral leishmaniasis using herbal medicines has received a lot of attention. In this study, we evaluated inhibitory activity of Pelargonium roseum essential oil on growth of Leishmania infantum promastigotes, and compared it with that of Glucantime. Methods: Inhibitory effects of different concentrations (1, 2.5, 5, 10, 25, 50 and 100 µL/ml) of P. roseum essential oil on the growth of L. infantum promastigotes were studied by MTT assay after 24 and 48 hours. All the data were analyzed by one-way analysis of variance. The effect of the essential oil was later compared with that of standard dose of Glucantime. Results: After 24 hours, different concentrations of the essential oil had no significant inhibitory effect on promastigotes of L. infantum. After 48 hours, all concentrations except for 1µL/ml showed significant anti-leishmanial activity. In addition, the lowest concentration that had significant inhibitory effect on L. infantum promastigote was 5 µL/ml. Conclusion: The essential oil of P. roseum has favorable inhibitory activity on the growth of L. infantum promastigotes after 48 hours. This indicates the therapeutic potential of this plant for treatment of leishmaniasis. Keywords: Leishmania infantum, Pelargonium, Promastigote, Meglumine antimoniate.

There is no data concerning the status of Linguatula serrata (L. serrata) infection in ruminants in Mazandaran Province, northern Iran. Therefore, the present study was aimed to investigate the prevalence and pathologic features of linguatulosis, among slaughtered ruminants in several abattoirs in Mazandaran Province. The infection rate of L. serrata in mesenteric lymph nodes of sheep, goats, and cattle were grossly and microscopically examined. Overall, of 6249 goats, sheep, and cattle examined, 16.8% of goats, 6.8% of sheep, and 6.9% of cattle were found to be infected with L. serrata nymphs. In general, the prevalence rate of L. serrata infection was 9.1% in these animals. The prevalence of L.serrata infection in goats was significantly (p