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The current study assesses the effects of platelet-rich plasma-fibrin glue (PRP-FG) dressing along with oral vitamin E and C on wound healing and biochemical markers in patients with non-healing diabetic foot ulcers (non-healing DFU).This randomized controlled trial was performed on 25 patients with non-healing DFU. Patients were treated with PRP-FG dressing plus oral vitamin E and C (intervention group) or PRP-FG dressing plus placebo (control group) for 8 weeks.Eight weeks after treatment, six wounds in the intervention group and two wounds in the control group were completely closed, and also wound size significantly reduced in both intervention and control groups (Our results showed that PRP-FG dressing along with oral vitamin E and C could be used to increase wound healing in patients with non-healing DFU by enhancing the wound healing process and reducing oxidative stress.This trial is registered at ClinicalTrials.gov (CT.gov identifier: NCT04315909).

International audience; Aims Hospitalization for acute heart failure (HF) is followed by a vulnerable time with increased risk of readmission or death, thus requiring particular attention after discharge. In this study, we examined the impact of intensive, early follow-up among patients at high readmission risk at discharge after treatment for acute HF. Methods and results Hospitalized acute HF patients were included with at least one of the following: previous acute HF < 6 months, systolic blood pressure = 180 mu mol/L, or B-type natriuretic peptide >= 350 pg/mL or N-terminal pro B-type natriuretic peptide >= 2200 pg/mL. Patients were randomized to either optimized care and education with serial consultations with HF specialist and dietician during the first 2-3 weeks, or to standard post-discharge care according to guidelines. The primary endpoint was all-cause death or first unplanned hospitalization during 6-month follow-up. Among 482 randomized patients (median age 77 and median left ventricular ejection fraction 35%), 224 were hospitalized or died. In the intensive group, loop diuretics (46%), beta-blockers (49%), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (39%) and mineralocorticoid receptor antagonists (47%) were titrated. No difference was observed between groups for the primary endpoint (hazard ratio 0.97; 95% confidence interval 0.74-1.26), nor for mortality at 6 or 12 months or unplanned HF rehospitalization. Additionally, no difference between groups according to age, previous HF and left ventricular ejection fraction was found. Conclusions In high-risk HF, intensive follow-up early post-discharge did not improve outcomes. This vulnerable post-discharge time requires further studies to clarify useful transitional care services.

Guillain-Barré syndrome (GBS) is an acute monophasic immune-mediated polyradiculoneuropathy. Here, we report a case of a young man with acute motor axonal neuropathy (AMAN) subtype of GBS having hepatitis A virus (HAV) infection. A 30-year-old man with icterus was referred to emergency center of Razi Hospital. He complained of flu-like symptoms 10 days before the onset of icterus. Also, he suffered from gradual fatigue and weakness with dark urine. He experienced neurological symptoms of muscle paralysis (ascending from the legs to hands). Neurological consultant suspected GBS at the first step based on clinical examinations. He was candidate for five sessions of plasmapheresis. The ultrasonography revealed liver span 166 mm, which was greater than the normal range, with normal parenchymal echo. The gallbladder wall was thicker than normal and gallstone with lesion was not seen in different conditions. He was discharged after total improvement of neurological symptoms and muscular power. In addition, the results of International normalized ratio (INR), partial thromboplastin time (PTT), prothrombin time (PT), alkaline phosphatase (ALK), alanine aminotransferase (ALT) , aspartate aminotransferase (AST), bilirubin total and direct (Bil T, D) tests were normal after 2-month follow-up. Although, acute viral infections such as hepatitis E virus (HEV) is common in patients with GBS; the possibility of HAV infection in patients with its risk factor should not be neglected.

Introduction Tuberculosis (TB) is one of the endemic diseases with a challenging diagnosis in the absence of pulmonary disease. On the other hand, rheumatoid arthritis (RA) is a systemic autoimmune disease with extra-articular manifestations that occur at any age after onset, such as nodules, Sjogren's syndrome, anemia of chronic disease, and pulmonary manifestations, which are more frequently seen in patients with severe, active disease. Here we present a case of RA with intestinal TB. Case report A 55-year-old woman with a 30-year history of RA using prednisolone and hydroxychloroquine presented with a nonpositional hypogastric pain and a weight loss of 20 kg over 7 months. No history of biological therapy was recorded. Colonoscopy revealed an ulcerated mass that was suspicious for malignancy. The pathobiological assessments confirmed ulceration and granulation tissue formation, foci of necrotizing granulomatous inflammation in lamina propria with adjacent mild crypt regenerative changes. Also, Ziehl-Neelsen staining for acid-fast bacilli in the granulomas was positive though the polymerase chain reaction assay did not detect the Mycobacterium tuberculosis. Anti-TB medication for 2 weeks eliminated the symptoms. Conclusions Intestinal TB in patients with vague abdominal symptoms and relevant physical findings such as pain and palpable mass should be considered to prevent late or misdiagnosis.

Introduction. Solid pseudopapillary neoplasm (SPN) is a rare and indolent pancreatic tumor with low malignant potential which frequently occurs in reproductive-age females. Complete resection is almost always the curative option. Case Presentation. We present a 20-year-old woman with acute epigastric pain and vomiting in multiple episodes. Abdominal ultrasound showed a hypoechoic lesion with the probable source in the pancreas. Following that, CT scans and Endoscopic Ultrasound (EUS) manifested a 9 × 7.5 cm -sized hypodense mass with heterogeneous well-defined margins in the pancreas suggesting the diagnosis of SPN. Whipple’s procedure was performed. Histopathological examination and immunohistochemistry confirmed SPN without evidence of malignancy. Discussion. SPN is known as a tumor with a favorable prognosis and a long survival rate after complete resection. However, some literature focused on minimally invasive surgery as an alternative surgical approach.

Precise product distribution data is very important for kinetic modeling of chemical reactions and chemical reactor design. In this work, H-ZSM-5 catalyst was hydrothermally synthesized and characterization tests including XRD, XRF, BET, and NH3-TPD revealed its physicochemical properties. Then, methanol conversion into hydrocarbons over ZSM-5 was investigated with WHSV of 4 h−1 at reaction temperature 410°C. Product distribution result indicated that C3-C5+ and C2=-C4= were the major products in gaseous phase, and in liquid phase xylenes, three methyl benzene and C10+ aromatics were the main components. It was also observed that the synthesized ZSM-5 had good performance in the methanol to hydrocarbons process and gave rise to highest activity (100%) during 10 h of operation approximately.

Background: Diffuse large B-cell lymphoma (DLBCL) is the most common form of non-Hodgkins lymphoma (NHL), accounting for approximately 25% of NHL cases. The aim of this study was to evaluate the association between the BCL6 and MUM1 gene expression and patient prognosis and stage. Materials and Methods: After ethical approval, in a cross-sectional study, tissue samples of 80 patients with diffuse large B-cell lymphoma were analyzed for BCL6 and MUM1 gene expression. Immunohistochemical staining was performed with division into categories of 0-5%, 5-25%, 26-50%, 51-75% and more than 75%. Other clinical and histological information such as lymph node involvement, T-stage, B symptoms and patient outcome were also recorded. Data were analyzed with SPSS version 16 and a P-value less than 0.05 was considered significant. Results: The patient mean age was 46.9±10.5 years (47.6±10.7 and 46.1±9.6 for males and females, respectively). A significant association was seen between lymphoma stage and BCL6 (p=0.045) but not MUM1 expression (p=0.09). However, the latter was associated with mortality (p=0.006) as was also the BCL6 level (p=0.006). Conclusions: : Overexpression of MUM1 and BCL6 is associated with poor prognosis in patients with diffuse large B-cell lymphoma.

In this work, an adaptive neuro-fuzzy inference system (ANFIS) and a couple of fuzzy logic approach and genetic algorithms are utilized to serve robust inverse-based approaches for determination/prediction of the clathrate hydrate formation pressure of carbon dioxide in the presence of 1,4-dioxine, which is a most-widely implemented water “soluble” organic promoter. The gained outcomes prove the reliability and accuracy of the suggested ANFIS approach with the mean square error of 0.0034 and squared correlation coefficients of 0.9969. Thanks to the results generated by the aforementioned intelligent approaches, the models proposed in the current research contribute to high accuracy for the estimations of the phase equilibria clathrate hydrates of carbon dioxide +1,4-dioxane.

Objective Our objective was to evaluate whether ECG gated multidetector-row computed tomographic (MDCT) imaging could detect the abnormalities of prosthetic heart valves. Methods We reviewed the image sequences of 35 patients who underwent a MDCT and a echocardiography (TTE) with a total of 46 prosthetic valves (PV) in different position: 27 bileaflet PV, 2 tilting disc, 2 caged ball PV, and 15 biological PV. According to TTE data, 21 were abnormal and 25 normal. MDCT data were retrospectively reconstructed and analyzed using reformatting in anatomically adapted planes. Results The abnormalities on CT were following: 12 obstructions, 14 dehiscences and 1 vegetation. MDCT identified obstruction with a sensitivity of 100% and specificity of 84%. The causes for obstruction were subprosthetic tissue (pannus) (n=3), thrombus (n=2), leaflets calcifications (n=4), periprostetic and annulus calcifications (n=6). A good correlation was found between the mean prosthetic gradient on TTE and difference of angles for bileaflet PV on MDCT (r=0,7, p=0,0005). 4 patients with PV obstruction were re-operated and the MDCT imaging was confirmed by surgery. MDCT identified dehiscence of PV with a sensitivity of 100% and specificity of 84%. MDCT detect the false aneurysms (n=4) and sequels of ancient abscess (n=6). 5 patients were re-operated and the MDCT imaging of dehiscence was confirmed by surgery. In 6 cases, MDCT showed abnormalities that were not seen during TTE: 3 dehiscences of PV and 3 opening dysfunction of PV without significant obstruction (1 pannus, 1 calcification of prosthetic annulus and 1 asymmetry of opening. The Bjork PV cannot be exanimated on MDCT because of numerous artifacts. Conclusion This experience demonstrates that MDCT have additional value because it can show perivalvular structures as well as cardiac and mediastinal abnormalities and can identify causes of PV dysfunction that constitute indications for surgery, but could be are missed at TTE.

Summary Aim To evaluate the evolution of surgical management in a large population of patients with Marfan syndrome. Methods This is a retrospective study of patients fulfilling the Ghent criteria for Marfan syndrome, who visited the Centre de reference national pour le syndrome de Marfan et apparentes and underwent a surgical event before or during follow-up in the centre. Results One thousand and ninety-seven patients with Marfan syndrome, according to international criteria, came to the clinic between 1996 and 2010. Aortic surgery was performed in 249 patients (22.7%; 20 children and 229 adults), including the Bentall procedure in 140 patients (56%) and valve-sparing surgery in 88 patients (35%); a supracoronary graft was performed in 19 patients (7.6%), usually for aortic dissection. During the past 20 years, the predominant reason for aortic surgery has switched from aortic dissection to aortic dilatation, while age at surgery has tended to increase (from 32.4 ± 11.9 years to 35.2 ± 12.4 years; P = 0.075). Mitral valve surgery was performed in 61 patients (5.6%; six children and 55 adults), including 37 valvuloplasties (60.6%) and 18 mitral valve replacements (29.5%). No significant difference was observed when comparing mitral valve surgery before and after 2000. Conclusion Surgery performed in patients with Marfan syndrome has switched from emergency surgery for aortic dissection to elective surgery for aortic dilatation; this is associated with surgery performed at an older age despite the indication for surgery having decreased from 60 mm to 50 mm. No significant evolution was observed for mitral valve surgery.