Search

Performance Monitoring and Accountability 2020 (PMA2020) is a population-based and facility-based survey program conducted in 11 countries to track contraceptive use dynamics and the supply environment. Annual data collection provides trend data unavailable from any other source. Two-stage cluster sampling was used to select 58 enumeration areas in Kinshasa; data were collected in 2014, 2015 and 2016 from three to six service delivery points (SDPs) per EA. Of the 228–248 SDPs surveyed each year, only two-thirds reported to offer family planning (FP) services. Of those reporting to offer FP, one-fifth or more did not do so on the day of the survey. As of 2016, only one-half of SDPs offering FP had at least three methods available, a proxy for contraceptive choice; only one in five had at least five methods. Long-acting reversible contraceptives, including implants and IUDs, were less widely offered and more often stocked out than resupply methods, including condoms, pills and injectables. Contraceptive stockouts were rampant: in 2016, over a quarter of the SDPs experienced stockouts of all methods (except condoms) in the previous 3 months, and two of the three most widely used methods—implants and injectables—were also the most likely to be stocked out. The findings documented the inconsistency in pricing of methods across facilities; moreover, less than one quarter of SDPs posted prices. Patterns in the contraceptive supply environment remained relatively unchanged between 2014 and 2016. The PMA2020 SDP module provides timely, actionable information to the DRC government, FP implementing organizations and donors involved in FP service delivery in Kinshasa, DRC. Yet the value of this information will be determined by the ability of the local FP stakeholders to use it in bringing the needed improvements identified by this survey to the contraceptive supply environment.

Tertiary volcanic rocks in northwestern Firoozeh, Iran (the Meshkan triangular structural unit), constitute vast outcrops (up to 250 km2) of high-Mg basaltic andesites to dacites that are associated with high-Nb hawaiites and mugearites. Whole-rock 40Ar/39Ar ages show a restricted range of 24.1 ± 0.4-22.9 ± 0.5 Ma for the volcanic rocks. The initial ratios of 87Sr/86Sr and 143Nd/144Nd vary from 0.703800 to 0.704256 and 0.512681 to 0.512877, respectively, in the high-Mg basaltic andesites-dacites. High-Th contents (up to 11 ppm) and Sr/Y values (27-100) and the isotopic composition of the subalkaline high-Mg basaltic andesites-dacites indicate derivation from a mantle modified by slab and sediment partial melts. Evidence such as reverse zoning and resorbed textures and high Ni and Cr contents in the evolved samples indicate that magma mixing with mafic melts and concurrent fractional crystallization lead to the compositional evolution of this series. The high-Nb hawaiites and mugearites, by contrast, have a sodic alkaline affinity and are silica undersaturated; they are also enriched in Nb (up to 47 ppm) and a wide range of incompatible trace elements, including LILE, LREE, and HFSE. Geochemistry and Sr- Nd isotopic compositions of the high-Nb hawaiites and mugearites suggest derivation from a mantle source affected by lower degrees of slab melts. Post-orogenic slab break-off is suggested to have prompted the asthenospheric upwelling that triggered partial melting in mantle metasomatized by slab-derived melts.

The south Ardestan region in the Urumieh-Dokhtar arc covers an area of about 250 km2 that is characterized by plutonic rocks with a compositional spectrum ranging from gabbro, gabbro-norite, gabbroic diorite, diorite, tonalite to granodiorite. Gabbroic rocks are mainly tholeiitic in character, whereas the diorites, tonalites and granodiorites show increasingly stronger calc-alkaline affinity. Gradual compositional variation and limited variation in radiogenic isotopic ratios indicate that these different rock types are petrogenetically related and most probably are derived from a common primitive source. U-Pb LA-ICP-MS dating of zircon from four granitoids yielded ages that range from 25 to 24 Ma. For tonalitic rocks, internal Rb-Sr isochron ages (biotite, feldspars) indicate cooling ages that lie in the range 20.4 +/- 0.1 to 22.1 +/- 0.5 Ma, slightly younger than the zircons’ ages. Their uniform initial Sr-Nd isotopic values imply that the major source component has probably been an asthenospheric mantle domain. This is further supported by the mantle-derived geochemical affinity of the plutonic rocks. A geodynamic model is presented in which the asthenospheric upwelling and partial melting in the south Ardestan has been triggered by Late Oligocene-Miocene rollback of the Neotethyan subducting slab. These melts were subsequently slightly modified through assimilation, fractional crystallization (AFC) en-route to the surface (A less than 6%). The trace element rich and high radiogenic Sr signature of some gabbros, this is the likely perturbation and then mobilization of Sr in the rock system during alteration. 43% fractional crystallization dominated by plagioclase and orthopyroxene is found responsible for magmatic evolution from gabbro to gabbroic diorite. Whereas, 44% fractional crystallization of a plagioclase-dominated mineral assemblage that also include clinopyroxene, titanomagnetite and orthopyroxene is found responsible for the evolutionary path from the gabbroic diorite to diorite. 22% fractional crystallization of amphibole and plagioclase is calculated as responsible for the differentiation path from diorite to tonalite. Assuming 6% crustal contamination effect inferred from isotopic trace elemental modelling by Cadomian crust, the major elemental crustal contamination effect on AFC product is found to be trivial. That is for K2O it is 10% and for other major elements less than 5%. M-REE abundances of the tonalites likely imply that a parental melts of these rocks have experienced significant amphibole differentiation due to a greater depth of magma chamber formation. We do not claim that our petrogenetic model for the south Ardestan plutonic rocks is representative for the whole UDMA. However, the new isotopic age and bulk rock data along with the mantle-dominated geochemical characteristics of the studied plutonic rocks open a new window for geodynamic interpretation and support a model suggesting that subduction still affected the UDMA in Miocene time.

Objectives: Three dimensional (3D) printing technology has many current and future applications in orthopaedics. The objectives of this article are to review published literature regarding applications of 3D technology in orthopaedic surgery with a focus on knee surgery. Methods: A narrative review of the applications of 3D printing technology in orthopaedic practice was achieved by a search of computerised databases, internet and reviewing references of identified publications. Results: There is current widespread use of 3D printing technology in orthopaedics. 3D technology can be used in education, preoperative planning and custom manufacturing. Custom manufacturing applications include surgical guides, prosthetics and implants. Many future applications exist including biological applications. 3D printed models of anatomy have assisted in the education of patients, students, trainees and surgeons. 3D printed models also assist with surgical planning of complex injuries or unusual anatomy. 3D printed surgical guides may simplify surgery, make surgery precise and reduce operative time. Computer models based on MRI or CT scans are utilised to plan surgery and placement of implants. Complex osteotomies can be performed using 3D printed surgical guides. This can be particularly useful around the knee. A 3D printed guide allows pre osteotomy drill holes for the plate fixation and provides an osteotomy guide to allow precise osteotomy. 3D printed surgical guides for knee replacement are widely available. 3D printing has allowed the emergence of custom implants. Custom implants that are patient specific have been particularly used for complex revision arthroplasty or for very difficult cases with altered anatomy. Future applications are likely to include biological 3D printing of cartilage and bone scaffolds. Conclusion: 3D printing in orthopaedic surgery has and will continue to change orthopaedic practice. Its role is to provide safe, reproducible, reliable models with reduced operative time and improves patient outcomes compared to traditional surgical techniques. Long term follow up of the techniques is still required.

Introduction Intensity Modulated Radiation Therapy (IMRT) has made a significant progress in radiation therapy centers in recent years. In this method, each radiation beam is divided into many subfields that create a field with a modulated intensity. Considering the complexity of this method, the quality control for IMRT is a topic of interest for researchers. This article is about the various steps of planning and quality control of Siemens linear accelerators for IMRT, using film dosimetry. This article in addition to review of the techniques, discusses the details of experiments and possible sources of errors which are not mentioned in the protocols and other references. Materials and Methods This project was carried out in Isfahan Milad hospital which has two Siemens ONCOR linear accelerators. Both accelerators are equipped with Multi-Leaf Collimators (MLC) which enables us to perform IMRT delivery in the step-and-shoot method. The quality control consists of various experiments related to the sections of radiation therapy. In these experiments, the accuracy of some components such as treatment planning system, imaging device (CT), MLC, control system of accelerator, and stability of the output are evaluated. The dose verification is performed using film dosimetry method. The films were KODAK-EDR2, which were calibrated before the experiments. One of the important steps is the comparison of the calculated dose with planning system and the measured dose in experiments. Results The results of the experiments in various steps have been acceptable according to the standard protocols. The calibration of MLC and evaluation of the leakage through the leaves of MLC was performed by using the film dosimetry and visual check. In comparison with calculated and measured dose, more that 80% of the points have to be in agreement within 3% of the value. In our experiments, between 85 and 90% of the points had such an agreement with IMRT delivery. Conclusion The EDR2 films are suitable for quality control of IMRT. According to complexity of the quality control for IMRT, the physicists of each center have to develop specific guidelines according to their equipments and limitations. An accurate treatment planning system with capability of inverse planning is an essential need for IMRT. The result of the planning system has to be compared with experiments in various situations.

International audience; BACKGROUND: Bone Morphogenetic Proteins (BMPs) belong to the transforming growth factor-β (TGF-β) superfamily, and play an important role in bone metabolism. Recombinant forms of BMP-2 and BMP-7 are the only BMPs used clinically. In this study the mature part of human bone morphogenetic protein-7 (BMP-7) was engineered through substitution of the BMP-7 N-terminal sequence by heparin-binding site of BMP-2. This targeted substitution was made to enhance the binding affinity of the novel protein to the extracellular matrix components such as heparin and heparan sulfate proteoglycans (HSPGs). METHODS: The engineered protein was expressed in Escherichia coli (E.coli). The PelB signal sequence was used to translocate soluble proteins into the periplasmic space of E.coli. The protein was purified from periplasmic extract using Ni-NTA chromatography and the SDS-PAGE and western blot analysis confirmed the successful expression of the novel protein. RESULTS: The novel hBMP-7 mutant was produced as approximately 16 kDa monomer. It was found that the heparin binding of this protein was approximately 50% more than that of the wild-type at a protein concentration of 500 ng/ml. CONCLUSION: The findings showed that the periplasmic expression may be suitable to produce complex proteins like BMPs.

Differentiating sepsis from other noninfectious causes of systemic inflammation is often difficult in the elderly. The aim of this study was to evaluate the ability of C-reactive protein (CRP), Erythrocyte Sedimentation Rate (ESR), procalcitonin (PCT), and Interleukin-6 (IL-6) to identify elderly patients with sepsis. In this single center prospective observational study, we included all consecutive elderly patients admitted with suspected sepsis and systemic inflammatory response syndrome (SIRS) in an emergency department. Blood samples for measuring CRP, PCT, IL-6, ESR and white blood cells (WBC) count were taken at first day of admission. Sensitivity, specificity, positive and negative predictive values were calculated for each inflammatory markers being studied. A total of 150 elderly patients aged 65 and older, 50 with sepsis and 50 with SIRS, and fifty individuals in a normal health status were included. CRP exhibited the greatest sensitivity (98%) and negative predictive value (98.6%) and performed best in differentiating patients with sepsis from those with SIRS. In a receiver operating characteristic curve analysis, IL-6 performed best in distinguishing between SIRS and the control group (AUC 0.75, 95% CI). On the other hand, both CRP and ESR appeared to be a more accurate diagnostic parameter for differentiating sepsis from SIRS among elderly patients.

Background: Immune cells and their cytokine production affect in the outcomes of many malignancies. Two subsets of cluster of differentiation 4 T cells (TCD4+) are categorized as T helper 1 (TH1) and 2 (TH2) which differ in their cytokine profile. TH1/TH2 cell balance could shift toward TH2-type responsiveness in many malignancies. Regulatory T cells (Treg) are a new group of T cells which are indicated to adjust other immune cells including T helper cells. Forkhead box protein 3 (Foxp3) is a lineage-determining transcription factor for Treg. Several subsets of Foxp3 and Treg have been identified. CD4+Foxp3+Treg and CD8+Foxp3+Treg are the main cell population in circulation and were the subject of evaluation in this study. Methods: Peripheral blood mononuclear cells (PBMC) were obtained from 48 patients with breast cancer and 21 healthy controls. Monoclonal antibodies including anti-CD4, anti-CD8 and anti-Foxp3 were used and specific staining process was performed. Flow cytometry was applied for evaluation and assessment of the markers. Findings: The percentage of CD4+Foxp3+Treg was 1.75 ± 0.74 in breast cancer group and 1.25 ± 0.30 in the control group (P = 0.004). The corresponding values for CD8+Foxp3+ Treg were 0.71 ± 0.17 and 0.63 ± 0.16 (P = 0.080). The mean of white blood cell (WBC) count and lymphocyte population in the breast cancer group were lower than the control group but the differences were not statistically significant. Conclusion: According to our findings, altered frequency of Treg might be involved in the prognosis of breast cancer. This may be a contributory factor in the susceptibility to breast cancer. Therefore, targeting Treg can be a novel therapeutic approach in this disease. Keywords: Breast cancer, Regulatory T cells, Foxp3, CD4, CD8, T cells

Background: Breast cancer, as the most common cancer among women, is the main cause of death in women aged 45 to 55. Therefore, different novel screening methods and technologies to diagnose and treat the disease in its early stages are of high importance for health systems. The present study aimed to investigate the epidemiological trend, and clinical and treatment indices of breast cancer by collecting available information from Seyed-Al-Shohada Hospital, in Isfahan during 1981-2006. Methods: All available data at Oncology Center of Isfahan Province, related to 1981-2006 were encoded and analyzed. Age groups of the patients, along with all cases of cancer recorded by Statistical Center of Iran, were calculated. After age specific rating (ASR), the resulted indices were evaluated. The frequency of clinical indices, such as tumor, metastasis, chemotherapy, and breast conserving surgery, as well as the frequency of age groups among patients, and the ASR pattern were calculated. Correlational tests and mean comparison were used to analyze the data. Results: Among 4652 breast cancer patients, 98.6% were female and 1.35% were male. Total ASR for breast cancer was calculated as 13 in 1996, 14.1 in 2001, and 18.21 in 2006 in the province of Isfahan. The values were then compared with the rate in the country (25.6) during 2006. The age of patients was 48.79 ± 11 years with 34.65% aging 40-50, and 26.7% aging less than 40 years. The ASR was estimated as approximately 57 in every 100,000 for age groups of 41-50, 51-60, and 61-70. Categorization of patients based on frequency among different age groups and frequency based on ASR did not result in an identical pattern. The relative frequency of tumor sizes obtained from the patients were T1 = 7.6%, T2 = 61.2%, T3 = 27.2% and T4 = 3.8%. In addition, an increasing trend of chemotherapy was observed during the studied period with 71.2% of the patients receiving the treatment. The tendency to perform breast conserving surgery is growing recently and 8.9% of the cases undergone the surgery during 2002-2006. Conclusion: The increasing trend of ASR may indicate improved screening methods, staff training development, and modern disease detection equipments. The data proves that compared with most western countries, Iran is in a low risk region. However, changing people's lifestyle and increasing trend in breast cancer incidence would be a matter of caution for the health system.

Background: Breast cancer is one of the most important causes of death in women. One of the various gene expression involved in breast cancer is human epidermal growth factor receptor 2 (HER2/neu) gene expression increases. Factors of dietary affect on regulation of hormone secretion and the rate of breast cancer. One of these factors is amount and type of fats in diet. Gamma-linolenic acid (GLA) and Docosah-exaenoic acid (DHA) are members of poly unsaturated fatty acids. In this study, effects of dietary GLA and DHA alone or together with paclitaxel on treatment of mice mammary carcinoma has been evaluated.Methods: Thirty female balb/c mice were divided in six groups randomly. Carcinoma-tous mass induced by tumor implantation method. Spontaneous breast adenocarcinoma of mice were used as tumor stock. The tumors of these mice were removed aseptically, dissected into 0.5 cm3 pieces. These pieces were transplanted subcutaneously into their right flank. GLA and DHA added to the mice diet two week prior to tumor implanta-tion. At the end of intervention, tumors were removed and HER2 gene expression was measured. The weight of animal and tumor volume measured weekly.Results: It was not significant change in the weight of animals that consumed DHA and DHA with taxol. Tumor volume in those groups that received corn oil with taxol (P

Considerable debate persists regarding the petrogenesis of high-alumina basalts (HAB) which are purported to occur exclusively in subduction zones. Major and trace element, mineral chemistry, whole-rock Sr-Nd-Hf-isotopes and zircon U-Pb age data are reported for the Cenozoic Eshtehard HABs, in order to constrain the nature of mantle beneath the central Urumieh-Dokhtar magmatic arc, and further investigate the mechanism of HABs generation. Eshtehard HABs, chemically akin to those from continental arcs, include basaltic, basaltic andesite, andesitic and dacitic rocks. U-Pb geochronology of zircon yield ages of 47.2 ± 0.6 Ma, 43.9 ± 0.3, and 40.9 ± 0.5 to 39.4 ± 0.9 for basaltic, andesitic and dacitic samples, respectively. Basaltic andesitic dikes intruded into dacitic hosts yield age of ca. 20–18 Ma. eHf(t) values for Eocene zircons display a range variable from −6.4 to +6.5. Miocene zircons have higher eHf(t), ranging between −1.8 and +10.7. The studied rocks are characterized by enrichment in incompatible trace elements and have relatively homogeneous Sr-Nd isotopes. Integrated studies indicate that Eshtehard HABs were derived from the hydrated, dominantly depleted shallow asthenospheric mantle wedge (and possibly also in the lower lithosphere) overlying subducted oceanic lithosphere. Traversing lithospheric mantle and Cadomian crust, and assimilating crustal material while fractionating plagioclase, high-Ca pyroxene, magnetite, and amphibole, the primary melt formed Eshtehard high-alumina, low-Mg# basalts. We hypothesize that ponding of hydrous magma at the base of the crust allowed for further crustal assimilation and fractionation of Ca-pyroxene and magnetite without plagioclase and zircon nucleation; then, ascending magmas through the crust led to crystallization of plagioclase and eventually zircon. We suggest comparatively high water content (rather than high crystallization pressure), up to 4% sediment melt and less than 10% of continental crust materials were involved, as subordinate components, in the petrogenesis of Eshtehard HABs.

The Avaj Oligocene volcanic – plutonic complex is part of extensive Cenozoic magmatic activity within the Urumieh-Dokhtar magmatic arc of Iran. We use whole rock geochemistry, mineral compositions and crystal size distributions (CSD) in a suite of co-genetic basalt, basaltic andesite and gabbro to determine their petrogenesis. Ca-rich cores in plagioclase (An79-86) overlap empirically modelled compositions, indicating equilibrium crystallization from melts represented by the whole-rock compositions. Clinopyroxene compositions (Mg# 74–80) are compatible with mildly fractionated mantle-derived magmas in an arc setting. Mineral-melt equilibrium is inferred from high Al contents and close correspondence between the measured DiHd and predicted KdFe–Mg (0.23–0.32) in clinopyroxenes, and Kd(Plg/melt)(An–Ab) values of plagioclase cores (0.11–0.15). Clinopyroxene-melt thermometers indicate crystallization at 1119–1173 °C for volcanic and 1099–1134 °C for plutonic rocks. Plagioclase crystal core saturation temperatures range from 1088–1162 °C (volcanic) and 1121–1163 °C (plutonic); these values overlap calculated mineral-melt equilibrium temperatures. Plagioclase CSDs are nearly straight for both volcanic and plutonic samples, with higher nucleation density and steeper slopes for the plutonic samples. Major element variations suggest the Avaj rocks represent co-genetic magmas related by fractional crystallization of the observed mineral phases. We suggest minor crustal assimilation occurred during ascent from a deeper reservoir to a shallower one; CSD data indicate longer magma residence time for plagioclase in the plutonic samples (∼117 years) compared to the residence time of basaltic samples (∼13 years).

We use the mineralogy, trace element compositions and elemental mass balance of volcanic materials collected from propylitic, potassic and phyllic alteration facies in the Eshtehard area of Iran to document the nature and effects of hydrothermal alteration. Incompatible element abundances in hydrothermally–altered samples show transformations that include: (i) depletion of alkalis and alkaline earth elements (i.e., Ba, Sr), (ii) variable behavior of first series transition elements (depletion in Cr, Co and Ni; enrichment in Zn and Cu), and (iii) depletion of HREE, Hf and Th relative to U and LREE. In detail, potassic (associated with a major addition of Cu) and phyllic zones are characterized by enrichment of SiO2 and MgO whereas propylitization depleted SiO2 and MnO, enriched MgO and Fe2O3, and increased LOI. Whole rock geochemistry along hydrothermal facies revealed consistent negative Ce and Eu anomalies, indicating that reducing conditions persisted during hydrothermal processes. Substantial changes in isovalent elements ratios (i.e., K/Ba, K/Rb, Y/Ho, Sr/Eu, Zr/Hf and Eu/Eu*) along the facies illustrate non–charge and radius control behavior are construed as lanthanide tetrad–effect phenomena. The co–occurrence of zigzag patterns (i.e., M and W–shapes) is evidence for partial or incomplete tetrad effect reaction between REE3+ and F-and Cl-rich fluids in hydrothermal systems. Low T4 tetrad–effect values overall suggest rock–fluid interaction involving rather low temperature hydrothermal solutions. Mass (ΔM) and volume (ΔV) were slightly depleted in the propylitic (−3.80% and −5.66%) potassic (−3.48% and −5.66%), and phyllic (−2.52% and −2.91%) zones with isocon slopes of 1.06, 1.06 and 1.03, respectively. We envisage a secondary phenomenon in open system conditions which accompanied fluid–rock interaction as the plausible cause of slight REE tetrad effect observed in the hydrothermally altered samples. Fluid inclusions studies yield homogenization temperatures of 275–596 °C and salinity ranging from 34 to 39 wt% NaCl equivalent suggesting boiling during mineralization in the Eshtehard area. The calculated δ18O and δD of the fluids range between 5.3 and 7.1 and −75 to −62 per mil, respectively. On this basis, we suggest that the ore-forming fluids had a magmatic source and underwent boiling and/or exchange with hydrous minerals.

The south Ardestan plutonic rocks constitute major outcrops in the central part of Iran’s Cenozoic magmatic belt and encompass a wide compositional spectrum from gabbro to granodiorite. U–Pb laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) dating of zircon three granodiorites yielded ages of 24.6 ± 0.1, 24.6 ± 0.1, and 24.5 ± 0.1 Ma. For tonalitic rocks, internal Rb–Sr isochron ages (biotite, feldspars) indicate cooling ages of 20.4 ± 0.1, 20.5 ± 0.1, and 22.3 ± 0.1 Ma, which are slightly younger than the zircons’ ages. The limited variations in their Sr–Nd isotope ratios indicate derivation from an asthenospheric mantle source. A geodynamic model is presented in which late Oligocene–Miocene rollback of the Neotethyan subducting slab triggered asthenospheric upwelling and partial melting in the south Ardestan. These melts were subsequently modified through fractional crystallization and minor crustal contamination en-route to the surface. Plagioclase + orthopyroxene-dominated fractional crystallization accounts for differentiation of gabbro to gabbroic diorite, whereas fractionation of clinopyroxene, titanomagnetite, and orthopyroxene led to differentiation of gabbroic diorite to diorite. Amphibole fractionation at deeper levels led to the development of tonalites.