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The widespread adoption of metformin as a primary therapeutic agent for type 2 diabetes has prompted inquiries into its potential impact on vitamin B 12 (cobalamin) levels and subsequent deficiency. This study aimed to elucidate this complex relationship and enhance the care provided to patients undergoing metformin treatment. A comprehensive search of meta-analyses , systematic reviews, randomised controlled trials and guidelines published between January 2010 and September 2021 was conducted. MeSH terms 'metformin' and 'vitamin B 12 ,' along with corresponding DeCS terms, guided the search. Varied recommendations from different scientific associations underscore the need for regular monitoring of vitamin B 12 levels in patients undergoing long-term metformin therapy. Different durations of metformin exposure, spanning from 6 weeks to 48 months, were associated with decreased vitamin B 12 concentrations. Observed decreases in B 12 concentrations ranged from 7.7 to 65.8 pmol/L, with percentage reductions ranging from 6.3 % to over 35 %. The evidence highlights a dosage-dependent correlation between higher metformin doses and an increased prevalence of B 12 deficiency. The results obtained highlight the association between metformin and B 12 deficiency. The prevalence of B 12 deficiency under metformin is of a greater magnitude than the one declared on the Summary of Product Characteristics approved by the medicine regulatory agencies. Thus, clinicians should be aware of this possible side effect when prescribing metformin, in order to prevent, monitor and treat if present.

In the context of uncertain economic environments urban agglomerations play a crucial role in economic development, reshaping industrial chains and fostering inter-city cooperation. This study employs the Global Production Network (GPN) theory to enhance our understanding of how cities integrate into regions, emphasizing the often-overlooked governmental influence in strategic coupling processes. In examining the evolution of China's smartphone industry within the Guangdong-Hong Kong-Macao Greater Bay Area (GBA) this research categorizes 19,599 smartphone companies into five distinct groups. Through analyzing their spatial distribution and geographical linkage the study identifies four strategic coupling modes based on the localization of assets, considering spatial influence and technological complexity along horizontal and vertical dimensions. Structural and institutional elements within these modes are also explored. The research uncovers unique integration patterns among nine cities in the GBA's mobile industry, revealing distinct spatial clusters rooted in technological, resource and innovation factors. Crucially, local policies play a pivotal role. Cities such as Shenzhen and Dongguan emerge as technology hubs, contrasting with Foshan and Zhongshan, which leverage resource advantages. The spatial impact, contingent on specific assets, underscores the necessity for nuanced top-down coupling methods in regional development. Moreover, the study emphasizes the significance of nurturing innovation links, not only between leading companies but also among midstream and downstream enterprises, enhancing cities' strategic coupling capabilities.

Background and Objective: Obesity has produced conflicting results on various indices of prostate cancer diagnosis. Since the effect of body mass index (BMI) on Gleason score and prostate specific antigen (PSA) as well as the overall classified risk of prostate cancer results is important, the present study was conducted to investigate the association of BMI and age with Gleason score and PSA in Patients with prostate cancer. Methods: In this cross-sectional study, 310 prostate cancer patients referred to the affiliated hospitals of Babol University of Medical Sciences from 2011 to 2021 were evaluated in terms of age, height, weight, PSA and Gleason score. Based on BMI, the patients were divided into three groups: obese (BMI≥30), overweight (BMI=25-30) and normal weight (BMI7) and were divided into three categories based on PSA: 4-10, 10-20 and more than 20. Then, the association of BMI and age with Gleason score and PSA was investigated. Findings: The mean BMI of the patients was 26.3±3.77 kg/m2. The mean PSA was 35.72±8.5 ng/dL and the mean Gleason score was 7.1±1.11. The mean Gleason score increased with increasing age (p

This study aimed to verify the effects of participation motivation in sports climbing on leisure satisfaction and physical self-efficacy. Structural equation modeling was used to analyze the causal relationships between participation motivation in sports climbing, leisure satisfaction, and physical self-efficacy, and to determine participation motivation. This study examined this causal relationship by verifying leisure satisfaction’s mediating effect on the relationship between participation motivation in sports climbing and physical self-efficacy. The participants of this study included 324 individuals over the age of 20 years with at least three months of sports climbing experience in the Seoul and Gyeonggi regions. The results indicated that among the subfactors of participation motivation in sports climbing, only skill acquisition and achievement positively affected leisure satisfaction, that leisure satisfaction positively affected physical self-efficacy, and that leisure satisfaction mediated the relationship between skill acquisition and achievement among the subfactors of participation motivation in sports climbing and physical self-efficacy. This study indicated that improved leisure satisfaction through sports climbing increases physical self-efficacy, including perceived improvement in physical abilities and confidence in interpersonal relationships. Accordingly, to expand and sustain participation, a systematic system for sports climbing instruction and educational programs is required to increase skill acquisition and a sense of accomplishment.

The industrial cooperation of Guangdong Hong Kong Macao Greater Bay Area (GBA) is one of the leading regional development strategies of this world-class urban agglomeration. This study constructed the industrial cooperation network based on the travel Origin-Destination (OD) connections among industrial parks. A multi-dimensional industrial cooperation and industrial development calculation index system were also set up to measure the nonlinear interaction relationship between them. The research found that an industrial collaboration network has been basically formed in the GBA, particularly presented by major cities. Some undeveloped cities may receive more benefits in the industrial collaboration network. The Covid-19 pandemic has had an impact in terms of within city connection instead of cross-city industrial cooperation. In addition, the degree of coupling between urban industrial coordination and urban industrial development has improved significantly over one decade and taking industrial collaboration as the input variables, industrial collaboration efficiently leads to industrial development outputs in almost every city in the GBA. Practically, decision makers should encourage and support intercity industrial collaboration, particularly between cities with closer geographic proximity, as it has been found to result in stronger cooperation and better economic enhancement. In addition, although industrial collaboration does not guarantee industrial development, when the collaboration systems and policies are enhanced, the synergy and coordination between them gradually improve. This highlights the potential benefits of continued investment in industrial collaboration for economic development.

With the exponential growth of the Internet of things (IoT) in remote sensing image applications, network resource orchestration and data privacy are significant aspects to handle in bigdata cellular networks. The image data sharing procedure toward central cloud servers in order to perform real-time classifications has leaked client personalization and heavily burdened the communication networks. Thus, the deployment of IoT image sensors in privacy-constrained sectors requires an optimized federated learning (FL) scheme to efficiently consider both aspects of securing data privacy and maximizing the model accuracy with sufficient communication and computation resources. In this article, an adaptive model communication scheme with virtual resource optimization for edge FL is proposed by converging a deep q-learning algorithm to enforce a self-learning agent interacting with network functions virtualization orchestrator and software-defined networking based architecture. The agent targets to optimize the resource control policy of virtual multi-access edge computing entities in virtualized infrastructure manager. The proposed scheme trains the learning model and weighs the optimal actions for particular network states by using an epsilon-greedy strategy. In the exploitation phase, the scheme considers multiple spatial-resolution sensing conditions and allocates computation offloading resources for global multiconvolutional neural networks model aggregation based on the congestion states. In the simulation results, the quality of service and global collaborative model performance metrics were evaluated in terms of delay, packet drop ratios, packet delivery ratios, loss values, and overall accuracy.

Federated learning (FL) is the up-to-date approach for privacy constraints Internet of Things (IoT) applications in next-generation mobile network (NGMN), $5^{\mathrm {th}}$ generation (5G), and $6^{\mathrm {th}}$ generation (6G), respectively. Due to 5G/6G is based on new radio (NR) technology, the multiple-input and multiple-output (MIMO) of radio services for heterogeneous IoT devices have been performed. The autonomous resource allocation and the intelligent quality of service class identity (IQCI) in mobile networks based on FL systems are obligated to meet the requirements of privacy constraints of IoT applications. In massive FL communications, the heterogeneous local devices propagate their local models and parameters over 5G/6G networks to the aggregation servers in edge cloud areas. Therefore, the assurance of network reliability is compulsory to facilitate end-to-end (E2E) reliability of FL communications and provide the satisfaction of model decisions. This paper proposed an intelligent lightweight scheme based on the reference software-defined networking (SDN) architecture to handle the massive FL communications between clients and aggregators to meet the mentioned perspectives. The handling method adjusts the model parameters and batches size of the individual client to reflect the apparent network conditions classified by the k-nearest neighbor (KNN) algorithm. The proposed system showed notable experimented metrics, including the E2E FL communication latency, throughput, system reliability, and model accuracy.

A variety of experimental tracer diffusivities of Mg and O in magnesium oxide available in the literature were first assessed. Atomic mobilities including bulk and short-circuit diffusion of Mg and O were then obtained by means of the CALPHAD (Calculation of Phase Diagram) approach. Afterwards, the diffusion-controlled kinetic model of oxidation in a gas-MgO-Mg environment was developed based on the moving boundary model and Fick's law, coupling with the modified thermodynamic description of MgO. A mathematical expression for parabolic rate constant kp of the oxide scale was derived for magnesia and correlated with the thermodynamic and diffusion kinetic information. The evaluated kp results were in line with the experimental data. Finally, the oxidation process of pure magnesium at 673 K was model-predicted, and the predicted evolution of the oxide thicknesses agreed very well with the experimental data. It was indicated that the grain boundaries diffusion of magnesium cations predominated the high temperature oxidation process.

Autores: Renato Dalle Vedove Silveira Cabral, Sophia Azevedo Maligeri, Edson Kazuo Saito e orientado por Patrícia Nunes Bezerra Pinheiro. Objetivos: Destacar a queda das doações de sangue durante a pandemia do SARS-COV-2, citar as iniciativas tomadas por serviços de saúde e analisar a eficácia destas. Material e métodos: Revisão de literatura com a utilização da plataforma Pubmed. Com os descritores “pandemic”AND “blood bank”, chega-se a 189 resultados. Aplicando filtros “texto completo grátis”e “2020 a 2021”encontra-se 131 resultados. Após a leitura dos resumos, 43 revelaram-se relevantes com o tema e destes, após a leitura completa, apenas 40. Resultados: À exceção do relato de dois artigos, a redução das doações no período foi severa para os bancos de sangue com relatos de estoques quase esgotados. As principais medidas de contingência adotadas foram: postergação de cirurgias eletivas, diminuição do uso de hemoderivados com descontinuação ou redução dos valores de hemoglobina e plaquetas para transfusão profilática, além da extensão do vencimento dos produtos. Para aumentar a segurança no momento das doações medidas como agendamento de horário, distanciamento físico entre as cadeiras, ambientes bem ventilados, uso de equipamentos de proteção individual pelos trabalhadores e testes rápidos de triagem para COVID-19 foram implementados. Discussão: Atualmente a tecnologia e a ciência caminham juntas em uma jornada de descobertas e conquistas. Todavia, ainda não é possível reproduzir sangue em laboratório, cabendo ao receptor apenas a esperança de doações. De acordo com a Organização Mundial da Saúde é recomendável que 5% da população seja doadora de sangue, no entanto, antes da pandemia o Brasil apresentava uma média baixa, de 2 a 2,5% de doadores e durante a pandemia da COVID-19 as doações diminuíram ainda mais. Diversos pacientes hematológicos e oncológicos necessitam de transfusões regulares para sobrevivência. Além disso, com o agravamento da pandemia, a demanda por transfusões devido às complicações da COVID-19 aumentou, enquanto o estoque de sangue sofreu o efeito contrário. A fim de controlar a disseminação da doença instaurou-se medidas restritivas. O altruísmo do ato de doar sangue perdeu forças em meio ao medo, ansiedade e individualismo que propagaram-se pela sociedade. Os bancos de sangue precisaram realizar campanhas de doações massivas com o intuito de sensibilizar a população, expuseram a carência do estoque e a segurança de seus estabelecimentos. Com novas abordagens, os doadores rotineiros voltaram a ativa, apesar da menor frequência, e novos doadores, os denominados “pandêmicos”, passaram a doar. Conclusão: Os bancos de sangue foram drasticamente afetados pela pandemia. Para a redução deste impacto as melhores medidas tomadas são: o uso da telemedicina para a entrevista de aptidão para doação, permanência dos bancos de sangue abertos em feriados, utilização de grandes espaços externos para campanhas de doações e o uso das redes sociais para a realização de marketing e engajamento social. Além das medidas já citadas, é importante ressaltar que brasileiros matriculados no ensino superior representam aproximadamente 18% da população, esta parcela deveria ser incentivada a realizar doações sanguíneas, com posterior validação como horas complementares.

Neuromyelitis Optica Spectrum Disorder (NMOSD) is an inflammatory demyelinating disease of the central nervous system (CNS) primarily affecting the optic nerves and spinal cord, but also involving other regions of the CNS including the area postrema, periaqueductal gray matter, and hypothalamus. Knowledge related to pediatric manifestations of NMOSD has grown in recent years, particularly in light of newer information regarding the importance of not only antibodies to aquaporin 4 (AQP4-IgG) but also myelin oligodendrocyte glycoprotein (MOG-IgG) in children manifesting clinically with this syndrome. In this review, we describe the current state of the knowledge related to clinical manifestations, diagnosis, and chronic therapies for children with NMOSD, with emphasis on literature that has been published in the last 5 years. Following the review, we propose recommendations for the assessment/follow up clinical care, and treatment of this population.

Background & aim: Hepatitis B risk factors are a main consideration among jobs related in healthcare. There is a high risk of hepatitis B infection in health care workers, compared to the general population due to higher exposure to patients infected with the virus. The aim of this study was to evaluate the immunity against hepatitis B virus and frequency of HBsAg positive cases among medical staffs of Shahid Beheshti hospital in Yasuj, Iran. Methods: The present cross-sectional, descriptive and analytical study was conducted by interviewing 270 personnel of Shahid Beheshti Hospital of Yasuj in 2016. After completing the questionnaire which included demographic and review vaccination records, 5 ml of blood was taken from the participants. Using an ELISA kit specific antibody levels against hepatitis B virus and HBsAg were measured. The data were analyzed by descriptive statistics and chi-square. Results: A total of 112 patients (41.5%) of the subjects were male and 158 (58.5%) were female. The results indicated that a number of seven subjects (6.2%) had no immunity against hepatitis B virus, 68 (25.1%) had border immunity and 195 (72.2%) had complete immunity. 9 patients (3/3 %) were infected with hepatitis B. Among these participants, 5 patients (55.6%) were female and 4 (44.4%) were male. None of them had any sign of obesity, smoking, high risk sexual behavior, blood transfusion and did not develop jaundice. Conclusion: The present study revealed that the frequency of HBsAg positive cases was in the expected range, and that the samples studied had a favorable safety level.

The study was conducted to investigate rumen impaction in goats slaughtered at Katsina Metropolitan Abattoir by administering 147 questionnaires and making weekly visits to the abattoir for information retrieval for eleven weeks. In addition, live-weights of sampled animals, weight of rumen contents and empty rumen were determined. The data indicated that 60% of the animal keepers allow their animals to scavenge on refuse and majority (93%) of the respondents observed some effects of rumen infection, which include death of the animals (34%). The result revealed that the problem was more common among the age range of 16 and 18 months of age and that sex also has effect on the rate of impaction occurring more in females. Types and quantity of non-degradable materials in the affected animals were identified and polythene materials occurred more. Frequency of non-degradable materials was also observed in goats. The study recommends cleanup of the environment in that, it will substantially reduce foreign bodies syndrome in goats, proper feeding, addition of mineral constituents in the diet, hence there is need for state legislature to enforce proper disposal of non-degradable synthetic polythene materials to make the environment safe for ruminants.

Background: Interferon regulatory factors (IRFs) can play a critical role in the regulation of many facets of innate and adaptive immune responses through transcriptional activation of type I interferons, other proinflammatory cytokines, and chemokines. However, their roles in transplantation immunity still remain to be elucidated. Objective: To evaluate the time course of mRNA expression of all 9 members of IRFs family of transcription factors during liver allograft acute rejection. Methods: Blood samples of 19 patients with autoimmune hepatitis receiving liver transplants were collected on days 1, 3, 5, and 7 post-transplantation. The patients were followed for 6 months after transplantation and divided into two groups of acute rejection (AR) (n=4) and non-acute rejection (non-AR) (n=15). Results: All of the studied transcription factors were down-regulated in AR-group on days 3, 5, and 7 post-transplantation compared to non-AR group. The mean±SEM IRF5 on day 7 post-transplantation was significantly (p=0.005) lower in AR-group than in non-AR group (0.7±0.21 vs. 1.91±0.27, respectively); expression of other IRFs family members was not significantly different between the two groups on days 3, 5, and 7 post-transplantation. Conclusion: IRF5 may have an important role during the acute rejection of liver transplants.

Background: Patients with hepatic diseases are treated with numerous drugs metabolized by cytochrome P450. Objective: To evaluate the frequencies of CYP2C19 variant alleles (*2, *3, and *17), genotypes, and phenotypes, and the relationship between the frequency of these alleles and the underlying hepatic diseases among patients with advanced liver diseases who were candidates for liver transplantation. Methods: The Study was conducted on 120 patients suffering from various hepatic disorders, candidates for liver transplantation, and 52 healthy volunteers. DNA was extracted from blood samples and analyzed by TaqMan SNP genotyping assay. The CYP2C19 genotypes were classified into poor, extensive, intermediate, and ultra-rapid metabolizer phenotypes. Results: Viral hepatitis was the most common cause of liver disease among studied patients. The frequencies of CYP2C19 alleles *1, *17, and *2 were 66.7% (160/240), 20.8% (50/240) and 12.5% (30/240), respectively. Allele CYP2C19*3 was not found in the studied population. The most prevalent genotypes were CYP2C19 *1/*1 (47.5%) and *1/*17 (24.2%). The predicted CYP2C19 phenotypes were extensive metabolizer (47.5%), heterozygote extensive metabolizer (45.9%), ultra-rapid metabolizer (5%), and poor metabolizer (1.6%). There was no significant difference between the frequencies of CYP2C19 genotypes between healthy people and patients. The distribution of CYP2C19 genotype frequencies was not significantly associated with the underlying disease conditions (p=0.472). Conclusion: The distribution of CYP2C19 genotype frequencies in Iranian healthy people and patients with various hepatic diseases was not significantly different. This may allow the physicians to predict a tailoring dose regimens based on the individual’s metabolic capacity, decrease the risk of harmful side effects of the drugs, and optimize the treatment.

Background: A Burn injury is a major health problem in the developing countries. Various treatments were applied for treatment of burn wounds by Iranian traditional medicine for thousands of years ago. Objective: The purpose of this study was to evaluate the natural products based on treatment of burn wounds by herbalists or herbal medicine vendors in the Mazandaran province. Methods: This research was a cross-sectional study and all herbalists or herbal medicine vendors were enrolled in this study. Snow ball sampling method was used with a questionnaire. Demographic data, methods of treatment for wounds, itching and pain were collected. The results were analysised. Results: In this study, 29 herbal and 4 animal based products were recommended by herbal medicine vendors for treatment of burn wounds. The results showed that 77 percent of respondents to treatment of burn wounds by natural products were recommended. Aloe Vera gel was the first choice for treatment of burn that was recommended by the herbalists. Conclusion: These results are interesting to find new drugs for treatment of burn wound healing with regards to Iranian traditional medicine. Since there are limited animal and clinical studies for approval of these natural products, future studies are needed for assessment of these traditional medicines for treatment of burn injuries.

Background: The aim of the present study was to survey birds' schistosomes in migratory birds (Anati­dae: Anas platyrhynchos) which are the source of the disease in Mazandaran Province, Northern Iran.Methods: A number of mallards were bought from the markets of hunted birds. The respiratory tracts (nasal mucosa) and intestinal blood vessels were studied for adult worms. The nasal mucosa was separated and observed by a microscope. In order to separate the visceral schistosomes, after separating intestine, vessel mesenteric was studied under the lamp light and then in saline. The para­site sample was collected for subsequent observation.Results: Fifteen (13.6%) cases out of 110 studied birds had nasal mucosa contaminated with Trichobilhar­zia sp. egg. Besides that, two birds had adult worms schistosome visceral i.e. Bilharziella sp.Conclusion: The elements that cause cercarial dermatitis in aforementioned region are Trichobilharzia sp. and Bilharziella sp. parasites. Thus, it is necessary for the authorities of health, environmental and agricultural organization of the province to cooperate in order to control this disease.

A successful liver transplantation team consists of several specialists to work closely together. The histopathologist (anatomical pathologist) is one of the key players in this multidisciplinary team. This role starts with the pre-transplantation evaluation of the recipient’s liver by diagnosis or confirming the underlying liver disease and continues with the evaluation of the explanted recipient’s liver for any further information about the underlying liver disease including malignancies such as hepatocellular carcinoma, cholangiocarcinoma, or any other incidental findings. The evaluation of the new donor liver begins with determining the suitability of the donor liver for transplantation during or before the operation and continues throughout the entire posttransplantation period by evaluating not only the allograft diseases but also evaluating other tissues for infections, malignancies, etc. It is worthy to note that in many of the above-mentioned situations, histopathology is the gold-standard diagnostic test. In this review, we present on various tasks of a histopathologist according to the current literature and our own experience in the largest liver transplantation center in Iran.

Background: Interleukin-28 (IL-28B) rs12979860 C/T polymorphism is a known predictor of sustained virological response after antiviral treatment in hepatitis C. IL-28B affects the innate immune system as well as intrahepatic expression level of interferon-stimulated genes. Objective: To investigate the effect of recipient IL-28B polymorphism on occurrence of acute rejection after liver transplantation. Methods: 140 liver allograft recipients were selected. Acute rejection episodes were recorded in 39 patients (AR group); the remaining had normal graft function (non-AR group). 70 normal subjects were also studied as the control group. The IL-28B rs12979860 was genotyped through PCR-RFLP method. Results: No significant difference was found between AR and non-AR groups in terms of genotype and allele frequency. However, the CC genotype was significantly (p

AbstractBackground: Solid organ transplantation is the only definitive treatment available for patients with endstage organ failure. Organs procured from brain-death donors are the main source of transplants. Following brain death, a burst of inflammatory reaction develops; it is characterized by increased plasma levels of cytokines. This inflammatory reaction has been associated with increased early allograft dysfunction.Objective: In this study, we test if the increased inflammatory response in brain-death donors is associated with more recipient complications.Methods: We prospectively recruited 38 consecutive brain-death donors admitted to the intensive care units (ICUs) of Shiraz University of Medical Sciences. Following the declaration of brain death, the demographics data on donor and recipient characteristics and cause of brain death were recorded. The post-liver transplant complications in recipients were stratified according to the Clavien classification. Plasma levels of cytokines IL-6, IL-2, and TNF-α were measured using enzyme linked immunosorbent assay (ELISA) kits, in all donors before organ procurement. Results: The mean (range) age of donors was 44 (16–74) years. Trauma due to car accident was the most common cause of brain death (79%). The post-liver transplant complications occurred in 19 (50%) recipients. The mean±SD plasma TNF-α concentration was significantly (p

AbstractA 55-year-old man with hepatitis B and hepatocellular carcinoma was treated with liver transplantation without veno-venous bypass. During the procedure his arterial blood pressure remained at 55/30 mm Hg and did not respond to increasing doses of norepinephrine. Vasoplegia was managed aggressively with the intravenous infusion of high doses of epinephrine.

Background: Acute rejection is the main problem in liver transplantation that occurs in the first days or months of transplantation. It includes histological and cellular rejection. Acute histological rejection is confirmed by biopsy. Glutathione S-transferase family is the most important genes in phase II detoxification working in xenobiotic and drug metabolism. GSTO2 is one of the members of this family. GSTO2 (N142D) polymorphism may influence metabolism of immunosuppressive drugs. Objective: To determine if GSTO2 polymorphism has association with acute liver rejection. Methods: The present study included 120 patients with histological-proven acute liver rejection and 182 patients without acute rejection. Both groups were matched for sex and age. To determine variants of GSTO2, we used polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results: There was a significant association between the GSTO2 genotype and acute liver rejection (NN: OR: 3.642, 95% CI: 1.179–5.444) and (ND: OR: 2.533, 95% CI: 1.672–8.149) compared to those with DD geneotype. Conclusion: Recipients with either NN or ND genotype for GSTO2 are more likely to develop acute liver rejection compared to those with DD genotype.

Background: Myocardial performance index (MPI) or Tei index is a Doppler-derived index of combined systolic and diastolic myocardial function, calculated as the sum of isovolumetric relaxation time (IRT) and isovolumetric contraction time (ICT) divided by the ejection time (ET). Objective: To evaluate the right and left ventricular systolic and diastolic function using MPI in children before and after liver transplantation. Methods: A cross-sectional study was conducted on 30 children with liver cirrhosis before liver transplantation, 30 age-matched comparison group at least 6 months after liver transplantation, and 30 agedmatched children without history of heart disease in Nemazi Liver Transplant Center, Shiraz, Iran, from April 2012 to April 2014. Echocardiographic evaluation was carried out with a GE Vivid 3 echocardiographic machine, using a 3-MHz probe with tissue Doppler imaging (TDI) software using conventional and TDI method. Results: The mean±SD left ventricle Tei index in patients was 0.33±0.02 before liver transplantation, 0.34±0.02 after liver transplantation, and 0.33±003 in the comparison group (p=0.36). The mean±SD right ventricular Tei index was 0.35±0.04 in patients before transplantation, 0.36±0.46 after liver transplantation, and 0.28±0.04 in the comparison group (p

Background: Metabolic syndrome (MetSx) is common among liver transplant recipients. It contributes to morbidity and mortality. Objective: To determine the prevalence of MetSx in patients undergoing liver transplantation (LTx) in Iran. Methods: 202 liver transplant recipients of both sexes completed this study. Relevant information including age, sex, the underlying disease, systolic and diastolic blood pressure, waist circumference, fasting serum levels of blood sugar (FBS), triglyceride (TG), and HDL-cholesterol were measured. The prevalence of MetSx was evaluated at 1, 3, 6, 9, and 12 months after LTx. Results: The prevalence of MetSx was 36.6% after 1 month that decreased to 28.2% after 12 months of follow-up. The lowest prevalence of MetSx (27.7%) was observed 9 months after LTx. Our data showed a decrease in TG and an increase in HDL-C level and no significant changes in blood pressure, waist circumference and FBS during the study period. Conclusion: The prevalence of MetSx after LTx is high when compared to the normal population. It seems that a change in diet after transplantation may affect the prevalence of MetSx.

Background: Malaria is one of the most important parasitic diseases in tropical and temperate regions. The aim of this study was to determine the trend of malaria in Mazandaran Province, northern Iran during 1997-2012. Methods: This retrospective study was conducted from 1997 to 2012. The population's study was individuals who registered at health centers of Mazandaran Province. Peripheral blood smear were prepared for each case, stained with Giemsa and examined by light microscope. In addition to demographic data, other parameters including Slide Positive Rate (SPR), Annual Parasite Incidence (API) and Annual Blood Examination Rate (ABER) were analyzed. Results: In total, 844 cases of malaria were reported. Plasmodium vivax was predominant species with 821 cases (97.4%). The number of malaria cases increased from 1997 to 2005 and then decreased to 3 cases in 2011. Some cities had not reported any cases during last three years. The highest infection rate, 163(20.07%), was seen in 2001-02. The SPR had the highest value (0.54%) in 2004-05. The maxi­mum API and ABER were ob­served in 2001-02 and 1997-98. 641(75.9%) of cases were imported from hyperendemic areas such as Afghanis­tan and South-eastern Iran and 94 (11.1%) malaria pa­tients were recorded as introduced cases. The highest infection rate of malaria (21.3%) was seen in Babolsar. Conclusion: Extensive malaria control should be continued to Mazandaran to become malaria-free region and in prevention of re-introduction stage.

Background: Objective: To evaluate the en bloc anastomosis technique for unilateral dual kidney transplantation (DKT). Methods: From May to October 2011, 5 patients (4 women and 1 man) with mean age of 31.8 years underwent unilateral DKT with this technique in which distal end of the aorta and proximal end of inferior vena cava (IVC) were closed with running sutures. Then, proximal end of the aorta and distal end of the IVC were anastomosed to internal (or external) iliac artery and external iliac vein, respectively.Results: Post-operative course was uneventful. No vascular and urologic complications developed; all patient had acceptable serum creatinine at discharge time and up of 2–6 months of post-operation follow up.Conclusion: Unilateral DKT is a safe method for performing DKT. The proposed en bloc anastomosis can improve the outcome of the graft by reducing the cold ischemia and the operation time.

Background: End-stage liver diseases are common in Iran. The only therapeutic option for these patients is liver transplantation.Objective: To present our 2-year experience of liver transplantations in Afzalipoor Hospital, Kerman, southeastern Iran.Methods: From November 2009 to September 2011, 12 patients underwent orthotopic liver transplantation in our center. Their data including demographics, indications for transplantation, MELD scores, post-operative complications and their management were collected.Results: Patients (7 women and 5 men) aged between 14 and 55 years. Indications for the transplantation included HBV infection (n=5), cryptogenic cirrhosis (n=2), Wilson’s disease, alcoholism (n=1), HCV infection (n=1), Budd-Chiari syndrome (n=1), and autoimmune hepatitis (n=1). MELD score of patients ranged from 16 to 30. All patients received tacrolimus, mycophenolate mofetile and corticosteroid, postoperatively. 2 patients died of pulmonary and intra-abdominal infections with resultant to multiple organ failure. Nonfunctioning of transplanted liver and ongoing bleeding resulted in death in another patients. 9 patients are well doing and have excellent liver functions.Conclusion: We had relatively successful results in our experience of orthotopic liver transplantation. Vicinity of our center to Shiraz Transplant Center would be an important factor in this success.

Background: Pathogenesis of neonatal hepatitis relates to various underlying causes including viral infections. Both hepatotropic and non-hepatotropic viruses may induce liver failures in infants before birth, during delivery, or shortly after birth.Objectives: The tissue impact of HCMV, HSV, HBV, HCV, and rotavirus and adenovirus infections was evaluated in studied infants with neonatal hepatitis.Methods: The history of viral infections was analyzed in paraffin-embedded biopsy and autopsy tissues of 22 infants with neonatal hepatitis between years 1996 and 2007, retrospectively. The tissue molecular presentation of HBV, HCV, HCMV, HSV, adenovirus, and rotavirus was evaluated by different qualitative simple and nested PCR and RT-PCR protocols. Immunohistochemistry (IHC) method was used for studying the antigenic prevalence of HSV-1, 2; HBV, HCMV and adenovirus infections. Also the laboratory liver indices of all patients with neonatal hepatitis were analyzed.Results: The HBV and HSV genomes were detected in 3 (14%) of 22 infants. The rotavirus and HCV-RNA and also the HCMV-DNA were detected separately in 1 (4%) of 26 paraffin-embedded autopsy and biopsy tissues. The HBV and HSV-1 specific antigens were separately diagnosed in 1 (4%) of 26 neonatal samples by IHC protocols. Also the HSV-2 antigen was seen in 5 (23%) of 22 liver autopsy and biopsy specimens. Co-infections with HCMV, HSV, HBV, HCV, and rotavirus were detected in these infants with hepatitis.Conclusion: Diagnosis of single and mixed molecular and antigenic traces of HCMV, HSV, HBV, HCV and rotavirus underlines the etiologic role of these viruses in clinical pathogenesis of neonatal hepatitis.

Background and Objectives: 25-50 percent of all patients who are visited by GPs, have complains that are not medically explained. Their management is a challenge for GPs. In homeopathy (a method of alternative medicine) these symptoms are important for selection of remedies and in an effort to treat them. This study aimed at describing this existing situation by investigating the frequency of such complaints in the patients under study. Methods: This study is a cross-sectional study conducted in Isfahan in 2008 on 240 Patients who were visited in some of the clinics affiliated to Isfahan university of medical sciences. The patients were selected by convenient method. Data were gathered by the questionnaire and analyzed via SPSS 13.5 software using Chi-Square test. Results: Out of 240 patients, 150 were women (%65.4) and 90 were men(34.6%). 75.4 percent were 20-40 years old. 1.7 percent had no symptoms, 31.3 had 1-5 symptoms and 40.8 percent had 6-10 symptoms. The females had more symptoms than males. Symptoms of mind, GI, sleep and miscellaneous ones were 81.3, 80.4, 72.1 and 87.1 percent, respectively. The most frequent symptoms in each group were intrusive thought, salivation in sleep, waking frequently and dyspnea wearing tight collared clothes. Only 10.97 percent of patient referred to the physicians for these symptoms. Conclusion : The symptoms registered in homeopathy references have notable prevalence in the society but most of people with such symptoms will not go to a doctor for examination and treatment Therefore, it is very important to carry out more research regarding these symptoms. General population should receive more information and physicians, in turn, should use appropriate methods of therapy for treating these patients.

Background: Nitric oxide (NO) is a major mediator in vascular biology, regulating regional blood flow. NOand the enzymes required for its production contribute to ischemia-reperfusion injury. The T-786C functionalpolymorphism in the promoter region substantially reduces promoter activity of the endothelialnitric oxide synthase (eNOS) gene and compromises endothelial NO synthesis.Objective: To examine the association between T-786C (rs 2070744) single nucleotide polymorphism(SNP) in eNOS gene and the development of acute rejection in renal transplant patients.Methods: 60 renal transplant recipients (30 with episodes of acute rejection (ARs) and 30 without rejection(non-ARs)), between June 2008 and March 2010, were included in this study. The polymorphism wasdetermined by PCR-restriction fragment-length polymorphism analysis.Results: The distribution of the genotypes were TT/TC/CC 60%, 33.4%, 6.6%, and 43%, 46.7%, 13.3% inARs and non-ARs, respectively (p=0.28). The frequency of T-allele was 76.7% and 66.3%; and for C-allelewas 66.6% and 33.3% in ARs and non-ARs, respectively (p=0.09). There were no significant associationsbetween these polymorphisms and acute and chronic kidney allograft rejection.Conclusion: We could not detect any significant association between polymorphism in T-786C of eNOS geneand the development of acute rejection.

Staphylococcus aureus and coagulase-negative Staphylococcus (CoNS) are frequently found in nosocomial environments as the main pathogen in several infections. In 1961, reports of nosocomial S. aureus resistant to methicillin, the drug of choice against penicillin-resistant strains, required new alternatives and vancomycin started being used to treat infections caused by methicillin-resistant S. aureus (MRSA). Community-acquired methicillin-resistant S. aureus (CA-MRSA) was first reported in 1990 affecting patients without risk factors for infection with MRSA of hospital origin. MRSA of community origin harbor the genes responsible for the synthesis of Panton-Valentine leukocidin (PVL), a toxin associated with skin and soft tissue infections and that carries the staphylococcal cassette chromosome mec (SCCmec) type IV. CA-MRSA emergence has caused great impact on the worldwide medical community since the presence of this pathogen in patients without risk factors represents a high risk to public health.

Context: Osteoporosis is a skeletal disorder characterized by low bone mass and microarchitectural deterioration of bone tissue. It may affect the craniomaxillofacial complex and result in less bone-implant contact. Aims: The objective of this study was to measure the endosseous integration of titanium implants using the removal torque test in low-mineral density experimental animal models. Materials and Methods: Thirty female New Zealand white rabbits were divided into two groups: control (n=14), sham-operated; and test (n=16), ovariectomized. All animals received 2.2 mm Χ 4.0 mm titanium implants in the right tibia, 120 days after ovariectomy or sham surgery. Animals were killed at 7 and 14 weeks of postimplant insertion, when implants were removed by reverse torque rotation using a digital torque meter. Statistical analysis used was Student′s t-test. Results and Conclusion: At the 7-week period, the mean torque values for the control and test groups were 11.6 Ncm and 10.4 Ncm, respectively, with no statistical significance. Implant removal torque analysis showed statistically lower values (P < 0.05) for the test group at the 14-week period (control=16.7 Ncm and test=9.7 Ncm). The results of this study indicate that hormonal privacy compromise implants biomechanical performance.

Background and Objectives The aim of this study was to investigate the effect of isolated soy protein on prevention of rheumatoid arthritis in collagen-induced rats. Methods A total of 24 female Sprague-Dawley rats (body weights: 180-200g) were randomly divided into four equal groups including normal; control of rheumatoid arthritis; rheumatoid arthritis + isolated soy protein (7g/kg); rheumatoid arthritis + dexamethasone (1mg/kg). Experimentally rheumatoid arthritis in rats was induced by subcutaneous injection of collagen ΙΙ emolsified in Incomplete Frund ’ s Adjuvant in days 1 and 7. Treatments were gavaged to animals for 30 days, once a day. The severity of rheumatoid arthritis symptoms in paws were daily measured in double blind format by standard method. The statistical comparison between the experimental groups was performed by Independent -samples t- test and One-Way ANOVA using SPSS software. Results The clinical symptoms of rheumatoid arthritis started from day 17.4±2.4, 20±4 and 14.1±1.9 in isolated soy protein, dexamethasone and control groups, respectively (P

"nPrior to the Islamic Revolution, there was hardly a health care "system" in Iran. Preventive health care was very limited, and a fairly decent curative care could only be found in Tehran and, to a lesser extent, in a few large cities where a great major­ity of the 12-14 thousand Iranian physicians were practicing. In 1985, according to the law, all health-related schools and institutions were taken away from the Ministry of Higher Education and were integrated into the Ministry of Health, form­ing the Ministry of Health and Medical Education. In 1994 provincial health organizations and the universities of medical sciences were integrated, and universities of medical sciences and health services were established. Since then, the chan­cellors of these universities are not only responsible for education and research, but also for the health care of their entire province. As a result of the integration, research has become more public health oriented and medical education more com­munity oriented. The integration has also led to an improvement in the health situation of the country; particularly in the villages, remote areas and less developed provinces.

Liver is an exclusive anatomical and immunological organ that displays a considerable tolerance effect. Liver allograft acceptance is shown to occur spontaneously within different species. Although in human transplant patients tolerance is rarely seen, the severity level and cellular mechanisms of transplant rejection vary. Non-paranchymal liver cells, including Kupffer cells, liver sinusoidal endothelial cells, hepatic stellate cells, and resident dendritic cells may participate in liver tolerogenicity. The mentioned cells secret anti-inflammatory cytokines such as TGF-β and IL-10 and express negative co-stimulatory molecules like PD-L1 to mediate immunosuppression. Other mechanisms such as microchimerism, soluble major histocompatibility complex and regulatory T cells may take part in tolerance induction. Understanding the mechanisms involved in liver transplant rejection/tolerance helps us to improve therapeutic options to induce hepatic tolerance.

OBJECTIVE: To analyse trends in reported invasive Haemophilus influenzae disease in South Africa within the first five years of introduction of conjugate Haemophilus influenzae type b (Hib) vaccine in the routine child immunization schedule. METHODS: We used national laboratory-based surveillance data to identify cases of invasive H. influenzae disease between July 1999 and June 2004, and submitted isolates for serotyping and antimicrobial susceptibility testing. FINDINGS: The absolute number of Hib cases (reported to the national surveillance system) among children below one year of age decreased by 65%, from 55 cases in 1999-2000 to 19 cases in 2003-04. Enhanced surveillance initiated in 2003, identified human immunodeficiency virus (HIV)-infection and incomplete vaccination as contributing factors for Hib transmission. The total number of laboratory-confirmed cases of H. influenzae remained unchanged because non-type b disease was being increasingly reported to the surveillance system concomitant with system enhancements. Children with non-typable disease were more likely to be HIV-positive (32 of 34, 94%) than children with Hib disease (10 of 14, 71%), P = 0.051. Recent Hib isolates were more likely to be multidrug resistant (2% in 1999-2000 versus 19% in 2003-04, P = 0.001). CONCLUSION: Data from a newly established national laboratory-based surveillance system showed a decrease in Hib disease burden among South African children following conjugate vaccine introduction and identified cases of non-typable disease associated with HIV infection.

O objetivo deste trabalho foi avaliar o efeito do preparo e não preparo do solo, de doses de N aplicadas em cobertura e da irrigação na produtividade do feijoeiro cv. IAC Carioca Eté. O delineamento experimental foi o de blocos casualizados em esquema fatorial com quatro repetições. Os tratamentos constituíram-se da combinação de três lâminas de água, com preparo do solo com arado de aiveca, com grade pesada e sem preparo (plantio direto) e com 0, 30, 60, 90 e 120 kg ha-1 de N aplicados em cobertura aos 15 dias após a emergência das plantas. A irrigação foi realizada com um sistema fixo de irrigação convencional por aspersão e no manejo de água foram utilizados diferentes coeficientes de cultura (Kc) distribuídos em períodos compreendidos entre a emergência e a colheita. A menor lâmina de água propiciou produtividade de grãos semelhante à das outras lâminas, mas com menor custo. O preparo do solo com arado de aiveca não diferenciou do preparo com grade aradora e proporcionou maior produtividade de grãos em relação ao plantio direto. A adubação nitrogenada não afetou a produtividade de grãos.

OBJETIVO: avaliar a ingestão diária de cálcio e estabelecer sua correlação com a densidade óssea de pacientes com anorexia nervos. PACIENTES E MÉTODOS: quatorze mulheres com anorexia nervosa registraram, em diário alimentar padronizado, sua ingestão em 24 horas e foram submetidas ao exame de densitometria óssea. A análise estatística foi feita pelos testes do c² e correlação de Pearson, adotando-se como significância estatística p

São relatados quatro casos de cistos perineurais sacrais, conhecidos por cistos de Tarlov, e é feita revisão da literatura. A partir de amostra de 88 pacientes com queixas de radiculopatia em membros inferiores, e/ ou dor lombar ou sacral que foram submetidos à ressonância magnética de coluna lombossacra quatro (4.5%) tiveram o diagnóstico de cisto de Tarlov. O diagnóstico foi feito através de ressonância magnética de coluna vertebral lombossacra. Os quatro casos foram submetidos a laminectomia sacral. Todos evoluíram assintomáticos sem défices motores ou sensitivos. Os cistos de Tarlov podem apresentar manifestações clínicas semelhantes às provocadas por hérnia discal lombossacra embora, nem sempre sejam citados nos diagnósticos diferenciais. O tratamento clínico é basicamente fisioterápico. O tratamento cirúrgico visa sanar o efeito compressivo em estruturas ósseas e/ ou nervosas através de punção do cisto ou retirada dele através de laminectomia sacral.

Com a documentação de Bertha e Adolpho Lutz, depositada no Arquivo do Museu Nacional, os autores reconstroem o esforço realizado pela filha para preservar a memória do pai depois de sua morte em 6 de outubro de 1940. Seus projetos incluíam a construção de um museu para abrigar as coleções de Adolpho Lutz, assim como a publicação de toda sua obra e de uma biografia. Pioneira do movimento feminista no Brasil e pesquisadora do Museu Nacional do Rio de Janeiro, Bertha foi sempre fiel auxiliar do pai, tomando como diretriz de sua própria vida profissional uma das linhas de pesquisa iniciada por ele. Por mais de trinta anos, dedicou-se à missão de imortalizar o nome do pai, acionando com este fim políticos e cientistas brasileiros e estrangeiros. Os resultados ficaram bem aquém do esperado, tendo Bertha Lutz registrado em testamento o desejo de que a obra e biografia de Adolpho Lutz fossem concretizados pelos pósteros.

The synthetic potential of multifunctional allylic azides and imines in attempted intramolecular cyclizations to nitrogen-containing heterocycles was investigated. Tandem Staudinger/aza-Wittig reaction of (E)-3-aryl-2-(azidomethyl)propenoates with triphenylphosphine and aldehydes yielded N-allylic imines in good yield. The (E)-stereochemistry of C=C and C=N bonds was assigned based on NOESY experiments. AlCl3 mediated formation of 3-carbomethoxyquinoline from methyl (E)-2-(azidomethyl)-3-phenylpropenoate is also described.

Caroli disease is a rare congenital disorder characterized by multifocal, segmental dilatation of intrahepatic bile ducts. Patients with Caroli disease who have recurrent bouts of biliary infection, particularly those who also have complications related to portal hypertension may require liver transplantation. In liver transplant ward of Shiraz University of Medical Science we had 4 patients with Caroli disease who were transplanted. Herein, we describe the demographic characteristics and post-transplant course of the patients. These patients presented with liver failure, recurrent cholangitis and portal hypertension sequelae unresponsive to medical treatment. The mean age of patients was 24.5 (range: 18–36) years, the mean MELD score was 17.5 (range: 11–23), three patients were female; one was male. All of the patients had good post-transplantation course except for one patient who developed post-operative biliary stricture for whom biliary reconstruction was done.

Background: New-onset diabetes after transplantation (NODAT) is a serious complication in transplant recipients. Transcription factor-7-like 2 (TCF7L2) is a Wnt signaling-associated transcription factor that plays an important role in β-cell proliferation and insulin secretion. The association between TCF7L2 SNP rs7903146 and NODAT was documented in renal transplant patients. Objective: To determine the association between TCF7L2 rs7903146 variants and the risk of NODAT after liver transplantation. Methods: This study was conducted on 140 liver transplant recipients who had received tacrolimusbased immunosuppressive drugs. The patients were divided into NODAT (n=70) and non-NODAT (n=70) groups and were genotyped using PCR-RFLP. In addition, 100 normal subjects were considered as the comparison group. Results: There was a significant difference (p