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Hematopoietic stem cell transplantation (HSCT) with a non-total body irradiation (TBI) conditioning regimen has proven feasible for treating patients with acute lymphoblastic leukemia (ALL). However, it is commonly believed that for extramedullary involvement of ALL in sanctuary sites, such as the central nervous system (CNS), TBI shall not be abandoned. In this study, the outcomes of pediatric ALL patients with CNS involvement (CNS + ) and without CNS involvement (CNS - ) treated with TBI-free allogeneic HSCT were retrospectively compared. The patients received a TBI-free busulfan plus cyclophosphamide conditioning regimen. Comparing CNS + (n = 27) and CNS - (n = 134) patients, the 5-year probabilities of relapse (44.4% versus 41.8%; P = .799), disease-free survival (DFS; 48.1% versus 43.3%; P = .642) and overall survival (OS; 51.9% versus 47.0%; P = .646) were not significantly different. Although transplantation-related mortality (TRM) was higher in the CNS - patients, the difference between the 2 groups was not significant (3.7% versus 12.7%; P = .177). In multivariate analysis, there were no significant between-group differences in OS (P = .502), DFS (P = .424), relapse rate (P = .226), or TRM (P = .117). These findings suggest that HSCT using a non-TBI-containing conditioning regimen can lead to similar outcomes in pediatric ALL patients with and without CNS involvement. TBI-free allogeneic HSCT might be feasible and effective for CNS + ALL patients., (Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)

Char as a carbon-rich material, can be produced under pyrolytic conditions, wildfires or prescribed burn offs for fire management. The objective of this study was to elucidate mechanistic interactions of copper (Cu 2+ ) and nickel (Ni 2+ ) with different chars produced by pyrolysis (green waste, GW; blue-Mallee, BM) and forest fires (fresh-burnt by prescribed fire, FC; aged char produced by wild fire, AC). The pyrolytic chars were more effective sorbents of Cu 2+ (∼11 times) and Ni 2+ (∼5 times) compared with the forest fire chars. Both cross-polarization (CPMAS-NMR) and Bloch decay (BDMAS-NMR) 13 C NMR spectroscopies showed that forest fire chars have higher woody components (aromatic functional groups) and lower polar groups (e.g. O-alkyl C) compared with the pyrolytic chars. The polarity index was greater in the pyrolytic chars (0.99-1.34) than in the fire-generated chars (0.98-1.15), while aromaticity was lower in the former than in the latter. Fourier transform infrared (FTIR) and Raman spectroscopies indicated the binding of carbonate and phosphate with both Cu 2+ and Ni 2+ in all chars, but with a greater extent in pyrolytic than forest fire-generated chars. These findings have demonstrated the key role of char's oxygen-containing functional groups in determining their sorption capacity for the Cu 2+ and Ni 2+ in contaminated lands., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

We present a woman referred with underlying non-Hodgkin's lymphoma (NHL) masquerading clinically with Guillain-Barré syndrome (GBS) like syndrome. At first evaluation, chest CT-Scan along with brain and whole spine MRI were normal. Electrodiagnostic studies were in favor of acute generalized polyradiculoneuropathy. Laboratory evaluation revealed hypoglycorrhachia. She treated with plasmapheresis after two weeks; she was discharged from hospital, but neurological recovery was not complete. After 6 months, she came back with acute onset of weakness in lower limbs, back pain, fever and urinary incontinence. Pinprick and light touch complete sensory loss was found beneath umbilicus. Thoracic MRI with contrast revealed a dorsal epidural mass extending smoothly from T8 to T12 (10 cm) with spinal cord compression. She underwent urgent laminectomy for spinal cord decompression. Histological examination revealed small round cell tumor suggestive of malignant T-cell type lymphoma. In cases with Guillain-Barré syndrome presentation, systemic hematologic disorders such as non-Hodgkin's lymphoma should be considered as one of the differential diagnosis of underlying disease.

Background: Depression is a well-known complication of breast cancer, which is known to adversely affect quality of life, prognosis, and survival in breast cancer patients. Celecoxib, a nonsteroidal anti-inflammatory drug, which acts via the selective inhibition of cyclo-oxygenase (COX)-2, has been shown to have antidepressive effects., Objectives: Here, we aimed to compare the efficacy and safety of celecoxib, a selective inhibitor of COX-2, with diclofenac, a nonselective inhibitor of both COX-1 and COX-2 in reducing depressive symptoms and pain in breast cancer patients., Methods: A total of 52 outpatients with breast cancer with mild to moderate depression, who suffered from pain and needed analgesics, participated in the trial and underwent 6 weeks of treatment with either celecoxib (200 mg twice daily) or diclofenac (50 mg twice daily). Participants were investigated using the Hamilton Depression Rating Scale (HDRS). The primary outcome measure was to compare the antidepressant effects of celecoxib and diclofenac., Results: Repeated-measures analysis demonstrated significant effect for Time × Treatment interaction on the HDRS scores: F(1.76, 87.85) = 9.66; P < 0.001. By study conclusion, greater improvement was observed in the HDRS score of the celecoxib group compared with the diclofenac group (P = 0.002). No one experienced remission (HDRS ≤ 7) in either group. Frequencies of adverse events were not significantly different between groups., Conclusion: Celecoxib seems to possess superior antidepressive effects compared with diclofenac in breast cancer patients with mild to moderate depression., (© The Author(s) 2015.)

Background: Ketamine is used as a general anesthetic for short-term surgical procedures. The aim of this study is to compare the effect of intravenous (IV) ketamine and intramuscular (IM) ketamine in children admitted to the emergency department (ED)., Materials and Methods: This is a clinical trial on 60 patients who were randomly classified into two groups. The first group received IV ketamine (1 mg/kg) and the second received IM ketamine (4 mg/kg). Data were collected before, during, and after the procedure. Time to reach sedation, severity of the sedation, and complications of the drug until discharge were studied., Results: In this study, 60 patients were evaluated. The average length of the procedures was similar in both groups (P > 0.05). According to this study, sedation levels in the two groups in 5, 10, and 15 minutes did not show significant differences (P > 0.05), but there was a significant difference in sedation levels of patients in 30, 35, 40, and 45 minutes during sedation (P = 0.03, P = 0.04, P = 0.03 and P = 0.05). There was no significant difference in the incidence of complications between the two groups., Dicussion: There was no significant difference in complications and level of sedation in both groups, but sedation was longer in the IM group; so, IV ketamine is the desirable approach for orthopedic procedures in sedating children.

Background: Vancomycin is used abundantly in patients undergoing HSCT, especially during neutropenic fever. Despite its widespread use little is known about vancomycin pharmacokinetics in HSCT patients. We conducted this study to investigate vancomycin pharmacokinetic parameters in our HSCT patients and to evaluate current dosing regimen based on trough vancomycin concentrations measurement., Methods: Vancomycin serum concentration at steady-state was determined prospectively in 46 adult HSCT patients who received vancomycin as empirical treatment of neutropenic fever. Individual steady-steady pharmacokinetic parameters were also determined in 20 patients who had two vancomycin levels from an administered dose, assuming one-compartment model. Acute kidney injury was also evaluated in our patients during vancomycin therapy., Results: Mean (±SD) apparent volume of distribution (L/kg) and clearance (mL/min) were 0.6 (± 0.33) and 109.7 (± 57.5) respectively. With mean (±SD) total daily dose of vancomycin 31.9 (±10.5) mg/kg/day that was administered, more than 90% of measured vancomycin trough concentrations were outside the range of 15-20 mg/L and 54.3% of patients had trough concentrations below 10 mg/L. Of 46 patients, 21 patients (45.7%) developed acute kidney injury (AKI) during vancomycin therapy; among them 19 patients were receiving nephrotoxic drug(s) concomitantly., Conclusion: Current vancomycin dosage regimen could not lead to recommended therapeutic serum concentrations in our patients. Large variation in vancomycin pharmacokinetic parameters observed among patients of this study along with difference of vancomycin pharmacokinetics in our study and other similar studies further explain the need for therapeutic drug monitoring and individualization of vancomycin dosing.

Background: Platelet transfusion is required in the acute phase of some thrombocytopenic disorders in order to prevent potentially dangerous hemorrhages.The purpose of this study was to assess the increase in platelet count following a slow platelet transfusion., Methods: Patients suffering from thrombocytopenia due to various underlying diseases were enrolled in the prospective pilot feasibility trial and were randomly divided into two groups. Standard platelet transfusion was administered in one group, while slow transfusion was used in the other. The platelet count was examined at 1 hour, 24 hours, and 1 week following the transfusions., Results: Although the platelet count was higher following 1 hour after transfusion via the standard method, the count tended to be higher 1 week after the transfusion in the slow transfusion group. This difference, however, only turned out to be statistically significant amongst females., Conclusion: A therapy of slow platelet transfusion might be more effective for the prevention of platelet loss. Further studies will be required to strengthen this hypothesis.

Background: Over the centuries, opium has been the most frequent substance abused in the Middle East. There are many controversial aspects about the effects of opioids on the atherosclerosis process, which is still unclear., Methods: All patients who were candidates for coronary artery bypass graft in Tehran Heart Center were registered and evaluated for risk factors such as diabetes mellitus, hypertension, smoking status and duration, opium abuse, involved coronary arteries and left main branch lesion > 50%, carotid stenosis > or = 70%., Results: A total of 1,339 patients were enrolled in the study, of whom 400 (29.9%) were female and the other 939 (70.1%) male. Female patients were omitted from analysis due to the low numbers of female opium addicts. Our study revealed that in the addicted population, the risk of diabetes and hypertension was lower than in the non-addicted group (p < 0.05 for each variable) and fasting blood sugar tended to be less in addicted ones, but the number of involved coronary arteries, left main stenosis > 50% and extent of carotid stenosis was not significantly different between the two groups., Conclusions: Our investigations demonstrate that opium is not cardioprotective, as has been claimed by some previous studies, and does not even decelerate atherosclerosis of carotid arteries in opium-addicted patients, but more evidence is still needed to completely prove the case.

Background: To evaluate the prevalence of abdominal aortic aneurysm in Iranian candidates for coronary artery bypass graft surgery and its associated factors., Methods: Totally, 2843 consecutive candidates for coronary artery bypass graft surgery underwent ultrasonography of abdominal aorta. The relation between abdominal aortic aneurysm with gender, age, smoking, dyslipidemia, hypertension, diabetes, and carotid and coronary stenosis was evaluated., Results: The prevalence of abdominal aortic aneurysm was 2.7% and 0.7% in men and women subgroups, respectively. The prevalence was 3.8% in men older than 65 years. The largest diameter of abdominal aortic aneurysm was 61.7 mm. Only two men had aneurysm larger than 55 mm, which led to changing their surgery schedule to stenting. Gender, age, smoking, smoking more than 40 years, diabetes , hypertension, and significant carotid stenosis were associated factors of abdominal aortic aneurysm., Conclusion: Compared with the results sited in Western studies, the prevalence of abdominal aortic aneurysm is lower in Iran (P<0.0001). Its associated factors in our study were similar to previously published studies. Significant carotid stenosis, a factor not reported previously, was an associated factor in our study. Because of the low prevalence of abdominal aortic aneurysm in our population, screening the candidates for coronary artery bypass graft surgery is not recommended.

Background: The incidence of stroke is 2.1-5.2% in bypass surgery patients with a mortality of 0-38%. This study was designed to evaluate the incidence of significant carotid artery stenosis and its related risk factors in candidates for coronary artery bypass graft (CABG) surgery., Methods: One thousand forty five consecutive candidates for CABG underwent carotid artery Doppler examination in a prospective study. The relation of age, sex, smoking and diabetes history, as well as lipid profile with carotid stenosis, was evaluated., Results: In 1045 CABG candidates with a mean age of 60 years, prevalence of significant carotid stenosis (>60%) was 6.9%. In the patients aged 65 years and older, the rate of significant stenosis was 12.5%. Age >50 years, female gender, hypercholesterolemia and diabetes mellitus are independent risk factors for significant carotid stenosis., Conclusions: Significant carotid stenosis has an earlier appearance in our study. Cost-effectiveness studies are recommended for revising the previous screening protocols.