Search

Background: Prostate cancer is the most common cancer among men over seventy years. Prevalence of prostate cancer is reported diversely in PIRADS2,3 group in Multi-parametric MRI in previous studies and there is no similar examinations in Iran. The present study was investigated to prevalence of prostate cancer in these patients in Iranians for the first time, retrospectively. Materials and Methods: This cross-sectional study was performed in 2019 on 159 patients with suspected prostate cancer in Hazrat Rasoul Hospital. After obtaining informed consent, age and PSA levels, multi-parametric MRI results and MRI/TRUS Fusion Biopsy pathologic results was determined. Data analysis was performed using Statistical tests in SPSS 22 software. Results: The mean age of the patients was 61.96±8.49 years. The mean prostate volume of these patients was 59.57±31.09 with a range of (178-208). According to MRI results 61.6% had PI-RADS3, and 38.4% had PI-RADS2. There was no significant relationship between age, prostate volume, and PI-RADS (P>0.05). Prostate volume increased significantly with age. According to biopsy results, 23.3% had cancer and 76.7% had benign prostatic hyperplasia. The prevalence of cancer was 19.7% in PI-RADS2, and 25.5% in PI-RADS3. Conclusion: The prevalence of cancer in patients with PI-RADS2,3 lesions was 23.3%, which comprises a significant portion of patients. Biopsy in PI-RADS2,3 cases, considering the patient's condition, seems to lead to the diagnosis of a significant number of cancer cases.

Somayeh Sadeghi,1,2 Haleh Bakhshandeh,1 Reza Ahangari Cohan,1 Afshin Peirovi,1 Parastoo Ehsani,2 Dariush Norouzian1 1Department of Nano Biotechnology, New Technology Research Group, Pasteur Institute of Iran, Tehran, Iran; 2Department of Molecular Biology, Pasteur Institute of Iran, Tehran, IranCorrespondence: Parastoo EhsaniDepartment of Molecular Biology, Pasteur Institute of Iran, #69 Pasteur Avenue, Tehran 13164, IranTel + 98 21 64112219Fax + 98 21 64112803Email P_ehsani@pasteur.ac.irDariush NorouzianDepartment of Nano Biotechnology, New Technology Research Group, Pasteur Institute of Iran, #69 Pasteur Avenue, Tehran 13164, IranTel + 98 21 64112137Fax + 98 21 66465132Email dnsa@pasteur.ac.irPurpose: Staphylococcus aureus is the most common persistent pathogen in humans, so development of new formulations to combat pathogen invasion is quite necessary.Methods: In the current study, for the first time, the synergistic activity of recombinant lysostaphin and LL-37 peptide was studied against S. aureus. Moreover, different niosomal formulations of the peptide and protein were prepared and analyzed in terms of size, shape, zeta potential, and entrapment efficiency. Also, a long-term antibacterial activity of the best niosomal formulation and free forms was measured against S. aureus in vitro.Results: The optimal niosomal formulation was obtained by mixing the surfactants (span60 and tween60; 2:1 w/w), cholesterol, and dicetylphosphate at a ratio of 47:47:6, respectively. They showed uniform spherical shapes with the size of 565 and 325 nm for lysostaphin and LL-37, respectively. This formulation showed high entrapment efficiency for the peptide, protein, and a slow-release profile over time. Release kinetic was best fitted by Higuchi model indicating a diffusion-based release of the drugs. The lysostaphin/LL-37 niosomal formulation synergistically inhibited growth of S. aureus for up to 72 hours. However, the same amounts of free forms of both anti-microbial agents could not hold the anti-microbial effect and growth was seen in the following 72 hours. Cytotoxicity assay specified that lysostaphin/LL-37 niosomal combination had no deleterious effect on normal fibroblast cells at effective antimicrobial concentrations.Conclusion: This study indicated that the use of lysostaphin in combination with LL-37, either in niosomal or free forms, synergistically inhibited growth of S. aureus in vitro. In addition, niosomal preparation of antimicrobial agents could provide a long-term protection against bacterial infections.Keywords: LL-37, lysostaphin, sustained release, synergy, Staphylococcus aureus

Haleh Bakhshandeh1, Masoud Soleimani2, Saied Shah Hosseini3, Hassan Hashemi3, Iman Shabani4, Abbas Shafiee5, Amir Houshang Behesht Nejad6, Mohammad Erfan1, Rassoul Dinarvand7, Fatemeh Atyabi71Department of Pharmaceutics, School of Pharmacy, Shaheed Beheshti Medical University, Tehran, Iran; 2Hematology Department, Faculty of Medical Science, Tarbiat Modares University, Tehran, Iran; 3Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran; 4Nanotechnology and Tissue Engineering Department, Stem Cell Technology Research Center, Tehran, Iran; 5Stem Cell Biology Department, Stem Cell Technology Research Center, Tehran, Iran; 6Ophthalmology Department, Tehran University of Medical Sciences, Tehran, Iran; 7Nanotechnology Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, IranAbstract: The study aimed to fabricate and characterize a 2-part artificial cornea as a substitute for penetrating keratoplasty in patients with corneal blindness. The peripheral part of the artificial cornea consisted of plasma-treated electrospun poly (ε-caprolactone) (PCL) nanofibers, which were attached to a hydrogel disc of polyvinyl alcohol (PVA) as a central optical part. The physical properties of the prepared artificial cornea, including morphology, mechanical properties, light transmittance, and contact angle, were assessed. Cell attachment and proliferation studies were performed on rabbit limbal stem cells. The SEM image of the polymeric system showed that the peripheral part formed a highly porous scaffold that could facilitate tissue biointegration. Assessment of the mechanical properties of the peripheral nanofibrous part and the hydrogel optical part showed suitable elasticity. Young’s modulus values of the electrospun PCL skirt and PVA hydrogel core were 7.5 and 5.3 MPa, respectively, which is in line with the elasticity range of natural human cornea (0.3–7 MPa). The light transmittance of the central part was >85% when measured in the 400–800 nm wavelength range. The plasma-treated PCL nanofibrous scaffold promoted limbal stem cell adhesion and proliferation within 10 days. These results confirmed that the polymeric artificial cornea showed suitable physical properties and good biocompatibility and epithelialization ability.Keywords: two part artificial cornea, nanofibers, electrospun, poly (ε-caprolactone), polyvinyl alcohol hydrogel, limbal stem cells

Background: Brain type natriuretic peptide (BNP) is a cardiac hormone that is secreted mainly by the ventricles in response to volume expansion and pressure load. It can predict post-operative complications after heart surgery in adults. We sought to investigate the prognostic value of BNP in children after heart surgery.Methods: We measured the BNP serum levels in 96 children with congenital heart diseases before, immediately after, and 12 hours after open heart surgery. We studied the ability of the post-operative BNP serum level variations to predict mortality and morbidity in children.Results: In total, 96 patients, comprising 40 (41.7%) females and 56 (58.3%) males with a mean age of 4.1 years (range: 1 month to 17 years), with various congenital heart diseases were studied. The rise in the serum BNP level 12 hours post surgery was directly related to mortality before discharge from hospital (P value=0.004), congestive heart failure after surgery (P value<0.001) , patients' cyanosis (P value=0.045), duration of ICU stay (r=0.342, P value=0.004), and post-operative need for inotropic drugs (P value<0.001).Conclusion: The rise in the BNP serum level 12 hours after heart surgery is a good marker for predicting mortality, morbidity, and early diagnosis of heart failure in children. [ABSTRACT FROM AUTHOR]

Background/Objective: Multislice computed tomographic (MSCT) angiography is a rapid and minimally invasive method for the detection of intracranial aneurysms. The purpose of this study was to compare MSCT angiography with digital subtraction angiography (DSA) in the diagnosis of cerebral aneurysms. Patients and Methods: In this cross sectional study we evaluated 111 consecutive patients [42(37.8%) male and 69(62.2%) female], who were admitted under clinical symptoms and signs, suggestive of harboring an intracranial aneurysm by using a four detector MSCT angiography. Then we compared results of MSCT angiography with DSA results as a gold standard method. DSA was performed by bilateral selective common carotid artery injections and either unilateral or bilateral vertebral artery injections, as necessary. MSCT angiography images were interpreted by one radiologist and DSA was performed by another radiologist who was blinded to the interpretation of the MSCT angiograms. Results: The mean±SD age of the patients was 49.1±13.6 years (range: 12-84 years). We performed MSCT in 111 and DSA in 85 patients. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratio (LR) of MSCT angiography, when compared with DSA as the gold standard, were 100%, 90%, 87.5%, 100%, 10 and 0, respectively. Conclusion: MSCT angiography seems to be an accurate and non-invasive imaging modality in the diagnosis of intracranial aneurysms. [ABSTRACT FROM AUTHOR]

Abstract Objectives We sought to evaluate the geometric changes of the mitral leaflets, local and global LV remodeling in patients with left ventricular dysfunction and varying degrees of Functional mitral regurgitation (FMR). Background Functional mitral regurgitation (FMR) occurs as a consequence of systolic left ventricular (LV) dysfunction caused by ischemic or nonischemic cardiomyopathy. Mitral valve repair in ischemic MR is one of the most controversial topic in surgery and proper repairing requires an understanding of its mechanisms, as the exact mechanism of FMR are not well defined. Methods 136 consecutive patients mean age of 55 with systolic LV dysfunction and FMR underwent complete echocardiography and after assessing MR severity, LV volumes, Ejection Fraction, LV sphericity index, C-Septal distance, Mitral valve annulus, Interpapillary distance, Tenting distance and Tenting area were obtained. Results There was significant association between MR severity and echocardiogarphic indices (all p values < 0.001). Severe MR occurred more frequently in dilated cardiomyopathy (DCM) patients compared to ischemic patients, (p < 0.001). Based on the model, only Mitral valve tenting distance (TnD) (OR = 22.11, CI 95%: 14.18 – 36.86, p < 0.001) and Interpapillary muscle distance (IPMD), (OR = 6.53, CI 95%: 2.10 – 10.23, p = 0.001) had significant associations with MR severity. Mitral annular dimensions and area, C-septal distance and sphericity index, although greater in patients with severe regurgitation, did not significantly contribute to FMR severity. Conclusion Degree of LV enlargement and dysfunction were not primary determinants of FMR severity, therefore local LV remodeling and mitral valve apparatus deformation are the strongest predictors of functional MR severity.

Background: Unilateral chronic thromboembolism pulmonary disease (CTEPD) is very rare. There is limited information on the safety and efficacy of pulmonary endarterectomy (PEA) in this population. This study investigated the effectiveness of PEA in this unique disease., Methods: This multicentre study included patients with unilateral CTEPD from three referral centres in the United States, Turkey, and Iran. The patients' demographic information, 6-minute walk test distance (6MWD), New York Heart Association (NYHA) functional class, and haemodynamics were evaluated., Result: Of the 1,031 patients who had undergone PEA, 39 patients (3.7%) had pure unilateral involvement, of whom 28 were female (71.8%). There was a significant improvement in the mean pulmonary artery pressure (mPAP, 26 mmHg vs 21 mmHg; p=0.011) and pulmonary vascular resistance (PVR, 202 vs 136 dynes∗sec 1 ∗cm -5 ; p=0.014). There was also a significant improvement in NYHA functional class (p<0.001) and 6MWD (360 vs 409 m; p<0.001). In the nine patients with normal haemodynamic parameters at rest, there was no significant change in median 6MWD (448.5 vs 449 m; p=0.208), mPAP (19 mmHg vs 16.5 mmHg; p=0.397), and PVR (129 vs 84.5 dynes∗sec 1 ∗cm -5 ; p=0.128). The most common postoperative complication was ipsilateral pleural effusion. One patient needed extracorporeal membrane oxygenation support. No patient died within the 1-year follow up., Conclusion: Pulmonary endarterectomy is a safe and effective procedure for improving the symptoms and haemodynamic parameters of patients with unilateral CTEPH. Symptomatic patients with unilateral chronic thromboembolic disease are suitable for PEA., Competing Interests: Conflicts of Interest The authors declare no conflict of interest regarding this study., (Copyright © 2024 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Background: Regarding adjustments to warfarin dosage, numerous studies have shown that computerized methods are superior to those based on personal experience., Objectives: To report the efficacy of a computer-based warfarin management system (WMS) in the Iranian population., Methods: By utilizing the existing dosing algorithms and obtaining expert opinions, we developed a computer-based WMS at a large tertiary cardiovascular center. The time in therapeutic range and the number of international normalized ratio (INR) tests of clinic patients were compared before and after the implementation of WMS., Results: Overall, 803 patients with 5407 INR tests were included in the before phase and 679 patients with 4189 INR tests in the after phase. The mean time in therapeutic range was 57.3% before and 59% after WMS implementation [mean difference, 1.64; 95% confidence interval (CI), -1.12-4.40]. In the before phase, the mean number of INR tests was 6.7, which dropped to 6.1 tests in the after phase (mean difference, -0.61; 95% CI, -0.97 to -0.24). Only 54.5% of the warfarin dosing prescriptions were consistent with the dosing recommendations of the WMS, and adherence to the WMS was poorest in the highest INR target range., Conclusions: For the first time in Iran, we demonstrated that a computerized system was as effective as a traditional experience-based method to monitor INR in VKA-anticoagulated patients. Furthermore, it could reduce both the number of INR tests and that of visits., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: The anticancer properties of recombinant α-luffin (LUF) are wellestablished. However, the cytotoxic effects of encapsulating LUF within niosomes on the SKBR3 breast cancer cell line have yet to be explored. Our study aimed to investigate whether this encapsulation strategy could improve cytotoxic effects., Methods: Alpha-luffin was expressed, purified, and refolded. Then, this protein was utilized to craft an optimal formulation, guided by experimental design. In this work, we have explored various physicochemical properties, including particle size, polydispersity index, zeta potential, morphology, entrapment efficiency, drug release and kinetics, storage stability, and FTIR spectroscopy. Additionally, we have assessed the cellular uptake and cytotoxic effect of the optimized niosome formulation on the SKBR3 breast cancer cell line., Results: The optimized niosome exhibited a mean diameter of 315±6.4 nm (DLS). Successful encapsulation of LUF into regularly shaped, spherical niosomes was achieved, with an encapsulation efficiency of 73.45±2.4%. Notably, Niosomal LUF (NLUF) exhibited significantly increased cytotoxicity against SKBR3 cells., Conclusion: These findings suggest that niosomes loaded with LUF hold promise as a potential treatment strategy for breast cancer., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background and Aims: Paravalvular leak (PVL) is a serious complication of prosthetic valve replacement. Both surgical and percutaneous closure techniques are used for PVL closure, but optimal strategies and comparative outcomes are uncertain. This study aimed to compare the efficacy and safety of percutaneous versus surgical PVL closure by analyzing changes in leak severity, functional status, echocardiographic parameters, and clinical outcomes., Methods: A total of 72 patients were included in this retrospective cross-sectional single-center study comparing percutaneous ( n  = 25) and surgical ( n  = 47) PVL closure from 2015 to 2022. Demographics, medical history, echocardiograms, laboratory data, complications, and mortality data were extracted from the records. Changes in leak severity, NYHA class, echocardiographic parameters, and clinical outcomes were compared between the percutaneous and surgical groups., Results: Both percutaneous and surgical PVL closure significantly reduced leak severity and improved NYHA class (both p  < 0.01), with no difference between the quantity of changes in each group. The 30-day mortality was 4% after percutaneous and 6.4% after surgical closure ( p  = 0.65). At 90 days, mortality was 24% percutaneous versus 17% surgical ( p  = 0.48). The length of stay in the hospital and post-procedural decrease in hemoglobin were considerably lower in the percutaneous group. The rate of complication rates was similar between the groups. Echocardiographic changes were also comparable., Conclusion: Percutaneous and surgical PVL closure had similar efficacy in reducing leaks and improving symptoms, with no significant difference in early outcomes. Both options should be considered viable for PVL repair after heart team evaluation., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Author(s). Health Science Reports published by Wiley Periodicals LLC.)

Background: There is little information about the effect of single nucleotide polymorphisms (SNP) and nutritional status and weight loss after bariatric surgery. This study investigated the interactive effect of eight obesity-related SNPs and nutritional status on weight loss after Roux-en-Y gastric bypass (RYGB)., Method: This is a case-control study. After 1-year follow-up, the patients who underwent RYGB were dividing into two groups. The case group consisted of patients who lost more than 50% of their excess body weight (EBW%) 1 year after the surgery. The control group included patients who lost < 50% of EBW at same time frame. Then, the relationship between eight SNPs related to UCP2, FTO, LEPR, GHRL, and NPY genes with weight loss were checked., Results: In this study, 160 patients were recruited. The median of age for case and control group were 43 and 42 respectively. The presence of mutant variant NPYrs16147 had a significant relationship in terms of weight loss between the two groups (P > 0.05). In dominant model, two SNPs, UCP2 rs659366 and UCP2 rs660339, showed protective effect of the vitamin D deficiency., Conclusion: In conclusion, the presence mutant variant of NPYrs16147 is directly related to the incidence of weight loss greater than 50% of EBW. However, it is apparent individual behavioral, dietary, and other factors may have more influence on weight loss among patients underwent RYGB., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Childhood obesity has become a major non-communicable disease worldwide. It is associated with an increased risk of cardiometabolic factors, including diabetes and hypertension (HTN). The purpose of this study was to evaluate the association between obesity and HTN among Iranian children and adolescents. Cross-sectional data from the SHED LIGHT study performed in Tehran urban area were used in this report. The anthropometric values and blood pressure were analyzed. The obesity status was identified based on body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR). The blood pressure status was defined using percentiles for height, age, and sex. A total of 14,641 children with a mean age of 12.28 ± 3.1 years (6-18) were assessed, and 52.8% of them were boys. The prevalence of HTN was higher among obese compared to healthy weight subjects (p < 0.001). HTN had the strongest association with the central obesity by WC (odds ratio [OR] 4.098, 95% confidence interval [CI] 3.549-4.732), generalized obesity by BMI (OR 3.000, 95% CI 2.749-3.274), and central obesity by WHtR (OR 2.683, 95% CI 2.451-2.936). Moreover, parental university education, having studied in private schools, and the smaller number of household children increased the risk of obesity. The rate of HTN was high among children and adolescents with generalized and central obesities. HTN, elevated blood pressure, boy gender, and socioeconomic status were associated with obesity, emphasizing on the importance of screening and implementing lifestyle changes to decrease future risk of cardiovascular diseases., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background and Objective: The HEART pathway serves as a tool for predicting major adverse cardiac events (MACE) among patients presenting with acute chest pain, aiding in early discharge of low-risk patients and reducing unnecessary cardiac investigations. This study aimed to evaluate physician-nurse reliability of the HEART pathway. Moreover investigates the efficacy of HEART pathway to predict 3-month MACE in patients with acute chest pain., Method: We conducted a prospective study on 97 patients experiencing acute chest pain. A team of three professionals - a nurse, a cardiology resident, and a cardiology attending physician - performed risk stratification. We assessed inter-rater reliability among the raters as well as explored 3-month MACE outcomes., Result: Excellent pairwise agreements were found between the raters. Overall agreement among raters was excellent, with an ICC of 0.84 (95% CI: 0.73 - 0.97). The HEART pathway score exhibited strong predictive power (AUC: 0.85) for 3-month MACE. At a cut-off score of 4, sensitivity, specificity, and negative predictive values were 87.5%, 58.9%, and 95.8%, respectively., Conclusion: The HEART pathway score effectively predicts 3-month MACE in patients with acute non-traumatic chest pain. Moreover, the high agreement among the attending physician, the resident physician, and the nurse suggests that nurses could use this tool, potentially reducing the workload on physicians., Competing Interests: Conflict of interest: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: The Atrial Fibrillation Better Care (ABC) pathway is such an integrated care approach, recommended in guidelines. The aim of this service evaluation study was to evaluate the impact of implementing the ABC pathway in Iranian population., Methods: In this prospective longitudinal cohort study, consecutive patients with a diagnosis of AF were initially evaluated. Patients at baseline were evaluated in hence of adherence to ABC pathway strategy. After study enrolment, first and second follow-up service evaluations were conducted at 6 and 12 months, respectively., Results: The use of vitamin K antagonists (VKA) decreased from 25.1 % at enrolment to 13.8 % at follow-up; instead, non-VKA oral anticoagulants (NOAC) utilization increased from 40.0 % to 86.1 %, while antiplatelet treatment decreased from 34.9 % to 0 %. Use of antihypertensive drugs, ARBs, diuretics, and statins increased after implementation of the ABC pathway. Implementation of the ABC pathway approach led to a decrease in the occurrence of stroke/TIA (from 6.3 % to 2.2 %, p = 0.002), systemic thromboembolism (from 1.4 % to 0.0 %, p = 0.04), nose bleeds (from 0.8 % to 0.6 %, p = 0.04), skin bruising (from 1.2 % to 0.0 %, p = 0.002), and heart failure (from 7.7 % to 4.7 %, p = 0.04). The proportion of patients in EHRA Class I-II increased from 93.3 % at enrolment to 98.1 % at follow-up., Conclusion: In this first study from a Middle East population, compliance with ABC pathway strategy in the management of AF was associated with optimization of management and general improvements in patient outcomes during follow-up., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

We aimed to assess the diagnostic performance of Cardiac Magnetic Resonance (CMR) strain parameters in ACM patients to evaluate their diagnostic role. We systematically searched MEDLINE, EMBASE, Scopus, and Web of Science. Of the 146 records, 16 were included. All Right Ventricle (RV) global strains were significantly reduced in ACM patients compared to controls (Standardized Mean Difference (SMD)[95 % Confidence Interval (CI)]: Longitudinal 1.31[0.79,1.83]; Circumferential 0.88[0.34,1.42]; Radial -1.14[-1.78,-0.51]). Similarly, all Left Ventricle (LV) global strains were significantly impaired in ACM compared to healthy controls (SDM [95 %CI]: Longitudinal 0.88[0.48,12.28], Circumferential 0.97[0.72,1.22], Radial -1.24[-1.49,-1.00]). Regarding regional RV strains, longitudinal and circumferential strains were significantly reduced in basal and mid-wall regions, while they were comparable to controls in the apical regions. The RV radial strain was reduced only within the basal region in the ACM group compared to controls. ACM patients exhibited significant impairment of regional LV strains in all regions-basal, mid-wall, and apical-compared to control subjects. Ultimately, despite the limitations of CMR-FT in terms of reproducibility, it is superior to qualitative assessment in detecting wall motion abnormalities. Thus, integrating CMR-FT with ACM diagnostic criteria seems to enhance its diagnostic yield., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Published by Elsevier B.V.)

Background: Despite the fundamental progress in hematopoietic stem cell transplant, this treatment is also associated with complications. Graft-versus-host disease is a possible complication of HSCT. Bronchiolitis obliterans syndrome (BOS) is the pulmonary form of this syndrome. Due to the high morbidity and mortality rate of BOS, various studies have been conducted in the field of drug therapy for this syndrome, although no standard treatment has yet been proposed. According to the hypotheses about the similarities between BOS and chronic obstructive pulmonary disease, the idea of using tiotropium bromide as a bronchodilator has been proposed., Method/design: A randomized, double-blind, placebo-controlled, and crossover clinical trial is being conducted to evaluate the efficacy of tiotropium in patients with BOS. A total of 20 patients with BOS were randomly assigned (1:1) to receive a once-daily inhaled capsule of either tiotropium bromide (KP-Tiova Rotacaps 18 mcg, Cipla, India) or placebo for 1 month. Patients will receive tiotropium bromide or placebo Revolizer added to usual standard care. Measurements will include spirometry and a 6-min walking test., Ethics/dissemination: This study was approved by the Research Ethics Committees of Imam Khomeini Hospital Complex, Tehran University of Medical Science. Recruitment started in September 2022, with 20 patients randomized. The treatment follow-up of participants with tiotropium is currently ongoing and is due to finish in April 2024. The authors will disseminate the findings in peer-reviewed publications, conferences, and seminar presentations., Trial Registration: Iranian Registry of Clinical Trial (IRCT) IRCT20200415047080N3. Registered on 2022-07-12, 1401/04/21., (© 2024. The Author(s).)

Background: Evidence suggests patients undergoing Primary Percutaneous Coronary Intervention (PPCI) who have a prior history of Coronary Artery Bypass Grafting (CABG) are more likely to experience adverse cardiac events compared to patients without prior CABG. We aimed to study risk factors of one-year Major Adverse Cardiovascular Events (MACE) in patients undergoing PPCI with a prior history of CABG., Methods: Patients with a history of CABG undergoing PPCI on Saphenous Vein Graft (SVG) were contacted one year after PPCI. One-year follow-up sought MACE, death, and cardiovascular hospitalisation., Results: A total of 69 patients were included in this study of which 66 were followed-up. Within the one-year follow-up, 6 (8.7%) patients were hospitalised due to cardiovascular causes, and 20 (29%) developed MACE. Patients with prior PCI had a significantly higher one-year MACE rate compared to others. Among patients undergoing pre-dilation, patients who experienced MACE had a significantly higher pre-dilation diameter. Moreover, patients experiencing MACE had a significantly lower Ejection Fraction (EF). According to logistic regression models, prior PCI, pre-dilation, and EF were predictors of one-year MACE. Furthermore, The EF was an independent predictor of one-year MACE., Conclusion: Higher pre-dilation diameter might be associated with a higher one-year MACE rate in patients undergoing PPCI on SVG with a prior history of CABG. Additionally, EF was an independent predictor of one-year MACE.

Remarkable resistance of bacterial biofilms to high doses of antimicrobials and antibiotics is one of their main challenges. Encapsulation of proteolytic enzymes is one of the suggested strategies to tackle this problem. In this regard, the antibacterial and anti-biofilm activity of biocompatible hyaluronic acid- Lysine nanogels containing serratiopeptidase (SRP-loaded HA-Lys nanogel) was assessed against P. aeruginosa and S. aureus strains. SRP-loaded HA-Lys nanogel was prepared using dropping method and optimized by Box-Behnken experimental design. These formulations were studied for physical characterization, release profile, stability, bioactivity, and anti-biofilm effects. The particle size, polydispersity index (PDI), and surface charge were measured by Zetasizer Nano ZS. The average particle size and zeta potential of the optimum sample were 156 nm and -14.1 mV, respectively. SRP release showed an initial burst followed by sustained release and the highest release was around 77%. Enzyme biological activity data revealed the higher efficiency of free SRP compared to SRP-loaded HA-Lys nanogel. The time-kill assay showed that both forms of SRP-loaded HA-Lys nanogel and blank HA-Lys nanogel showed significant antimicrobial activity against examined bacteria in comparison to the free enzyme. The obtained results demonstrated improved anti-biofilm efficacy and down regulation of tested biofilm genes for both SRP-loaded HA-Lys nanogel 100% and blank HA-Lys nanogel 100% compared to SRP 100%., (© 2024. The Author(s).)

Coronary artery disease (CAD) is the major cause of mortality in the world. Premature development of CAD can be attributed to women under 55 and men under 45. Many genetic factors play a part in premature CAD. Among them, ANRIL, a long noncoding RNA is located at the 9p21 risk locus, and its expression seems to be correlated with CAD. In the current study, premature CAD and control blood samples, with and without Type 2 Diabetes (T2D), were genotyped for six SNPs at the 9p21 locus. Additionally, ANRIL serum expression was assessed in both groups using real-time PCR. It was performed using different primers targeting exons 1, 5-6, and 19. The χ 2 test for association, along with t-tests and ANOVA, was employed for statistical analysis. In this study, we did not find any significant correlation between premature coronary artery disease and rs10757274, rs2383206, rs2383207, rs496892, rs10757278 and rs10738605. However, a lower ANRIL expression was correlated with each SNP risk genotype. Despite the correlation between lower ANRIL expression and CAD, Type 2 diabetes was associated with higher ANRIL expression. Altogether, the correlation between ANRIL expression and the genotypes of the studied SNPs indicated that genetic variants, even those in intronic regions, affect long noncoding RNA expression levels. In conclusion, we recommend combining genetic variants with expression analysis when developing screening strategies for families with premature CAD. To prevent the devastating outcomes of CAD in young adults, it is crucial to discover noninvasive genetic-based screening tests., (© 2024. The Author(s).)

Background: Atrial fibrillation (AF) augments the risk of stroke by 4-5 times. Vitamin D is pivotal in numerous metabolic pathways. A handful of studies have explored the correlation between vitamin D deficiency (VDD) and AF outcomes. Hence, the authors sought to assess the relationship between VDD and AF outcomes., Methods: From December 2021 to February 2023, 190 patients with AF were incorporated into the authors' study. Given the seasonal fluctuation of vitamin D levels, these levels were examined from the start of December until the end of March., Results: The final analysis comprised 190 patients (55.8% male) with an average age of 46.22±15.03. Vitamin D deficiency, insufficiency, and sufficiency were noted in 77 (40.5%), 46 (24.2%), and 67 (35.3%) patients, respectively. Fatigue and syncope were significantly more prevalent in the VDD group than in other groups. Three-vessel disease was more frequent in the VDD group (p-value=0.04). Mortality was more prevalent in patients with VDD (6.31%) compared to the VDI (2.10%) and VDS (0.05%) groups (p = 0.03). Successful cardioversion was significantly more prevalent in the VDS group (p = 0.03)., Conclusion: A sufficient level of vitamin D was linked with a better response to cardioversion. However, low vitamin D levels are correlated with higher mortality in AF patients., Competing Interests: The authors declare that they have no conflict of interest.

Objective: To elucidate the value of gated SPECT-MPI using CT attenuation correction (AC) for prediction of pulmonary hypertension (PHT) in coronary patients by estimation of reliability of non-contrast CT in measurement of main pulmonary artery diameter (MPAd) as well as by assessment of potential predictive role of gated parameters as beneficial accessory findings., Background: Contrast-enhanced CT is known as an accurate tool for assessment of MPAd to predict PHT. [1] The low-dose non-contrast CT which is used for AC in MPI study, however, has an unclear value in precise vascular diameter measurement; it is also uncertain whether gated parameters could help to predict PHT., Methods and Patients: A total of 207 patients, who had a transthoracic echocardiography and MPI with an interval of maximum one month, underwent this retrospective study. PHT was defined as a RVSP ≥36 mmHg by echocardiography; peak tricuspid regurgitation velocity (PTRV) was also calculated to use as a criterion for PHT. Of all subjects, 120 had RVSP ≥ 36 and 87 showed RVSP < 36; there also were 191 and 16 patients with PTRV ≤ 3.4 m/s and >3.4 m/s, respectively. Comparison was made unconnectedly between each group regarding the echocardiography results with the MPI parameters, with and without CT-AC, including MPAd derived from CT as well as RV/LV uptake ratio, shape index and septal wall motion and thickening scores to define the best indicators of PHT., Results: There was a significant association between established benchmark of PHT in echocardiography (RVSP), with MPAd derived from non-contrast CT as well as with LV shape index from gated study and RV/LV uptake ratio acquired from non-AC SPECT-MPI. Also, stress and rest RV/LV uptake ratio, MPAd, LV end-systolic and LV end-diastolic shape indexes are significantly higher in patients with RVSP ≥ 36 mmHg compare to patients with RVSP < 36 mmHg., Conclusions: Gated-SPECT-MPI using CT-AC can predict PHT by reliable estimation of MPAd as well as by defining RV/LV uptake ratio and shape index, providing an added clinical value for this invaluable modality in cardiac patients., (Copyright © 2023 American Society of Nuclear Cardiology. Published by Elsevier Inc. All rights reserved.)

Background: The aim of the current study is to assess the prevalence of different categories of thyroid dysfunction and their associated risk factors among the modern urban population of Tehran, the capital of Iran., Methods: The present investigation is a sub-study of the HAMRAH study, a population-based prospective study designed to assess the prevalence of traditional cardiovascular risk factors and their changes through a 10-year follow-up. 2228 (61% female) adults aged between 30 and 75 years old and with no overt cardiovascular diseases were selected through a multistage cluster randomized sampling. Blood levels of thyroid-stimulating hormone (TSH), thyroxin (T4), and triiodothyronine (T3) were measured with the aim of assessing the prevalence of abnormal thyroid function status among the modern urban Iranian population, and in order to report the total prevalence of participants with clinical hypo- or hyperthyroidism, the number of individuals taking thyroid-related drugs were added to the ones with overt thyroid dysfunction. A subgroup analysis was also performed to determine the associated risk factors of thyroid dysfunction., Results: The prevalence of thyroid dysfunction among the total population was 7% (95%CI: 5.9 - 8%) and 0.4% (95% CI: 0.1 - 0.6%) for subclinical and overt hypothyroidism, and 1.6% (95% CI: 1 - 2%) and 0.2% (95% CI: 0 - 0.3%) for subclinical and overt hyperthyroidism, respectively. Clinical thyroid dysfunction was detected in 10.3% of the study population (9.4% had clinical hypo- and 0.9% had clinical hyperthyroidism). In the subgroup analysis, thyroid dysfunction was significantly more prevalent among the female participants (P-value = 0.029)., Conclusions: In the current study, the prevalence of different categories of abnormal thyroid status, and also the rate of clinical hypo- and hyperthyroidism was assessed using the data collected from the first phase of the HAMRAH Study. In this study, we detected a higher prevalence of clinical and subclinical hypothyroidism among the Iranian population compared to the previous studies., (© 2023. The Author(s).)

This study aimed to present a novel three-dimensional nanocomposite scaffold using poly-ε-caprolactone (PCL), containing transforming growth factor-beta 1 (TGF-β1)-loaded chitosan-dextran nanoparticles and poly-l-lactic acid (PLLA), to make use of nanofibers and nanoparticles simultaneously. The electrospinning method fabricated a bead-free semi-aligned nanofiber composed of PLLA, PCL, and chitosan-dextran nanoparticles containing TGF-β1. A biomimetic scaffold was constructed with the desired mechanical properties, high hydrophilicity, and high porosity. Transmission electron microscopy findings showed a linear arrangement of nanoparticles along the core of fibers. Based on the results, burst release was not observed. The maximum release was achieved within 4 days, and sustained release was up to 21 days. The qRT-PCR results indicated an increase in the expression of aggrecan and collagen type Ι genes compared to the tissue culture polystyrene group. The results indicated the importance of topography and the sustained release of TGF-β1 from bifunctional scaffolds in directing the stem cell fate in cartilage tissue engineering., (© 2023 Wiley Periodicals LLC.)

Objectives: Chronic venous disease (CVD) of the lower extremities is one of the common venous diseases in different populations, with a wide range of clinical manifestations and undetermined exact prevalence owing to different population characteristics and measurement methods. This study aimed to estimate the prevalence of CVD among the modern Iranian urban population and determine its associated risk factors., Methods: The Heart Assessment and Monitoring in Rajaie Hospital study, a longitudinal population-based cohort, aims to investigate the baseline prevalence and the 10-year incidence of cardiovascular diseases and associated risk factors in the adult population aged 30 to 75 years with no overt cardiovascular diseases in Tehran. Two instructed interventional cardiologists performed CVD evaluation using the Clinical-Etiology-Anatomy-Pathophysiology classification. CVD was graded as C1 to C6, and chronic venous insufficiency (CVI) as C3 to C6. A multivariable regression model was used to analyze the association between CVD and prespecified covariates of age, sex, body mass index (≥30 kg/m 2 ), smoking, hypertension, diabetes mellitus, physical activity, dyslipidemia, and delivery method., Results: CVD prevalence among 1176 participants was 36.5% (95% confidence interval [CI], 33.8-39.3) and was higher in women than men (44.2% vs 23.5%). CVI prevalence was only 0.7% (95% CI, 0.3-1.3). Multivariable analysis showed that advanced age (odds ratio [OR], 1.06; 95% CI, 1.04-1.08), female sex (OR, 2.98; 95% CI, 2.14-4.14), and body mass index of ≥30 (OR, 1.36; 95% CI, 1.03-1.81) were independently associated with CVD. Physical activity (OR, 0.77; 95% CI, 0.58-1.02) was nearly protective, whereas other factors, including traditional cardiovascular risk factors, had no meaningful association with CVD., Conclusions: Our findings showed that CVD was prevalent in the modern Iranian urban population. However, considering the very low prevalence of the higher stages of the disease, the benefit of mass screening is debatable, and better risk discriminators should be investigated., (Copyright © 2023 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Considering the anti-viral effects of Spirulina platensis (Sp), this study investigated the impact of Sp on impaired blood biomarkers of patients hospitalized in the intensive care unit (ICU) with COVID-19. Therefore, 104 patients (aged 48-66; 61.5% male) were randomly assigned to the Sp (daily consumption of 5 g) or placebo group for 2 weeks. Linear regression analysis was employed to assess the differences in blood test results between the control and intervention groups among patients with COVID-19. Our results showed significant differences in certain hematological tests, including a higher level of hematocrit (HCT) and a lower platelet count (PLT) in the intervention group ( p  < 0.05). The percentage of lymphocytes (Lym%) in serology testing was significantly different between the control and intervention groups ( p =  0.03). In terms of biochemical test analyses, Sp supplementation was associated with reduced levels of both blood urea nitrogen (BUN) and lactate dehydrogenase (LDH) ( p =  0.01). Furthermore, on day 14, the intervention group displayed significantly higher medians of serum protein, albumin, and zinc compared to the control group ( p <  0.05). Additionally, patients supplemented with Sp had a lower BUN-albumin ratio (BAR) ( p =  0.01). No immunological and hormonal differences were observed between groups following 2 weeks. Our analysis indicates that Sp supplementation may be effective in regulating some blood test abnormalities associated with COVID-19. This study was registered at ISRCTN as IRCT20200720048139N1., Competing Interests: The authors of the manuscript declared that they have no conflict of interest.

Today, enzymatic treatment is a progressive field in combating biofilm producing pathogens. In this regard, serratiopeptidase, a medicinally important metalloprotease, has been recently highlighted as an enzyme with proved anti-biofilm activity. In the present study, in order to increase the long-lasting effects of the enzyme, serratiopeptidase and the novel engineered forms with enhanced anti-biofilm activity were immobilized on the surface of cellulose nanofibers (CNFs) as a natural polymer with eminent properties. For this, recombinant serratiopeptidases including the native and previously designed enzymes were produced, purified and conjugated to the CNF by chemical and physical methods. Immobilization was confirmed using different scanning and microscopic methods. The enzyme activity was assessed using casein hydrolysis test. Enzyme release analysis was performed using dialysis tube method. Anti-biofilm activity of free and immobilized enzymes has been examined on Staphylococcus aureus and Pseudomonas aeruginosa strains. Finally, cytotoxicity of enzyme-conjugated CNFs was performed by MTT assay. The casein hydrolysis results confirmed fixation of all recombinant enzymes on CNFs by chemical method; however, inadequate fixation of these enzymes was found using cold atmospheric plasma (CAP). The AFM, FTIR, and SEM analysis confirmed appropriate conjugation of enzymes on the surface of CNFs. Immobilization of enzymes on CNFs improved the anti-biofilm activity of serratiopeptidase enzymes. Interestingly, the novel engineered serratiopeptidase (T344 [8-339ss]) exhibited the highest anti-biofilm activity in both conjugated and non-conjugated forms. In conclusion, incorporation of serratiopeptidases into CNFs improves their anti-biofilm activities without baring any cytotoxicity. KEY POINTS: • Enzymes were successfully immobilized on cellulose nanofibers using chemical method. • Immobilization of enzymes on CNFs improved their anti-biofilm activity. • T344 [8-339ss] exhibited the highest anti-biofilm activity in both conjugated and non-conjugated forms., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: While most of the evidence in CTO interventions emerge from Western and Japanese studies, few data have been published up today from the Middle East. Objective of this study was to evaluate technical success rates and clinical outcomes of an Iranian population undergoing CTO PCI in a tertiary referral hospital. Moreover, we sought to evaluate the efficacy of our CTO teaching program., Methods: This is a retrospective single-center cohort study including 790 patients who underwent CTO PCI performed by operators with different volumes of CTOs PCI performed per year. According to PCI result, all patients have been divided into successful (n = 555, 70.3 %) and unsuccessful (n = 235, 29.7 %) groups. Study endpoints were Major Adverse Cardiovascular Events and Health Status Improvement evaluated using the Seattle Angina Questionnaire at one year., Results: A global success rate of 70 % for antegrade and 80 % for retrograde approach was shown despite the lack of some CTO-dedicated devices. During the enrollment period, the success rate increased significantly among operators with a lower number of CTO procedures per year. One-year MACE rate was similar in both successful and unsuccessful groups (13.5 % in successful and 10.6 % in unsuccessful group, p = 0.173). One year patients' health status improved significantly only in successful group., Conclusions: No significant differences of in-hospital and one-year MACE were found between the successful and unsuccessful groups. Angina symptoms and quality of life significantly improved after successful CTO PCI. The RAIAN registry confirmed the importance of operator expertise for CTO PCI success., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Cardiological Society of India. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved.)

Background: Little evidence is available on post-pulmonary embolism impairment (PPEI), a recently defined complication of pulmonary embolism (PE) encompassing dysfunctional clinical and imaging parameters. In the present study, we sought to evaluate its frequency with a focus on the main components., Methods: In this prospective registry, we included patients with a confirmed diagnosis of acute PE and focused on those with initial right ventricular (RV) dysfunction. Their baseline, pre-discharge, and 6 month follow-up clinical and imaging characteristics were recorded. The main study outcomes were incomplete RV functional recovery, exercise capacity limitations (based on the 6 minute walk test), and their combination, which defines PPEI, within six months of acute PE., Results: Of 170 consecutive patients with a confirmed diagnosis of acute PE, 123 accepted to participate in the follow-up study, of whom 87 had initial RV dysfunction. The 6 month rates of incomplete RV functional recovery, signs of an intermediate-to-high echocardiographic probability of PH, and exercise limitations were observed in 58.6, 32.1, and 45.9%, respectively. A total of 22 (25.2%; 95% CI 15.5-34.4%) patients had PPEI. The RV/LV ratio and the fractional area change on discharge after acute PE were more often impaired among patients with incomplete RV recovery, exercise limitations, and a high probability of PH at 6 months. In contrast, an initial impaired RV diastolic function indices appeared to characterize patients with a limited exercise capacity at 6 months., Discussion: PPEI affects one fourth of patients surviving acute PE with half of them presenting with RV dysfunction or exercise limitations.