Effect of Interval between Neoadjuvant Chemotherapy and Radiation Therapy on Metastasis Risk for Inoperable Non-Metastatic Pancreatic Adenocarcinoma

PURPOSE/OBJECTIVE(S)

In inoperable pancreatic cancer patients requiring radiotherapy (RT) after neoadjuvant chemotherapy (CT), there can be delays in starting radiation due to multiple complications. However, pancreatic cancer can progress rapidly during short intervals without treatment. We hypothesize that longer intervals between neoadjuvant chemotherapy and radiation could expediate the development of metastatic disease.

MATERIALS/METHODS

We identified patients with inoperable non-metastatic borderline resectable or locally advanced pancreatic cancer treated with neoadjuvant CT followed by RT from 2011 to 2021 at a single institution. Patients who completed palliative RT as defined by a biologic effective dose (BED) of less than 50 Gy, or those who were lost to follow-up within 3 months after completing RT without documented disease progression were excluded. The interval between RT and CT was defined as the time between last date of CT administration and initiation of RT. The primary endpoint was metastasis-free survival (MFS) after RT completion. Differences in MFS between patients who started RT within or after 4, 6, and 8 weeks of completing CT were examined utilizing log rank analysis of MFS generated via the Kaplan-Meier method.

RESULTS

At a median follow-up of 5.45 months, twenty-three patients were included. Most patients were male (61%) with cT4 (61%), cN0 (83%) pancreatic adenocarcinoma. Almost all patients completed combination neoadjuvant CT (91%) followed by either intensity modulated RT to 50.4 Gy in 28 fractions with capecitabine (n = 9) or stereotactic body RT to 33-40 Gy in 5 fractions (n = 14). Eleven (48%) patients received adjuvant CT after radiation therapy. The median time between last CT and RT initiation was 34 days (range 13-142). The MFS of patients who initiated RT within 4 weeks of CT compared to after was higher but not significant (16.8 vs 9.9 months, p = 0.144). Those who received RT within 6 or 8 weeks of completing CT exhibited significantly longer MFS compared to later than 6 (16.0 vs 6.9 mo, p = 0.016) or 8 weeks (15.1 vs 2.1 mo, p = 0.004). There was no statistical correlation between MFS and other variables (CA 19-9 before radiation, T-stage, receipt of adjuvant CT, BED).

CONCLUSION

These results suggest that a longer interval between CT and RT is associated with the risk of developing metastatic disease sooner but requires validation in a prospective cohort. Root causes of delays in starting radiation (e.g., insurance authorization) should be investigated as well.

High incidence of type 1 diabetes, type 2 diabetes and gestational diabetes in Central Iran: A six years results from Semnan health cohort

Introduction

Diabetes incidence has increasingly risen in Iran and other low- and middle-income nations in recent decades. In the Semnan Greater Area of Iran, we evaluate the incidence of type 1 diabetes (T1D), type 2 diabetes (T2D), and gestational diabetes during 2015–2020 as well as their six-year trend.

Methods

This is a retrospective analysis of data (n = 820401) from the Integrated Health System (sib) in Semnan province during 2015–2020. All diabetes cases with diagnostic codes based on the International Classification of Diseases 10 (ICD-10) are listed by year. The Grid Search method was used to obtain the exact number and time of points when the incidence of diseases changes significantly (Joinpoints). Average Annual Percent Change-Annual Percentage Change (AAPC-APC) values and slop changes in the estimated regression line with 95% confidence interval were utilized based on diabetes types to determine Joinpoints. P-value < 0.05 is considered statistically significant.

Results

The proportions of diabetes types (T1D, T2D, and gestational diabetes) among 820401 diabetics were 4.18%, 94.84%, and 0.97%, respectively. APC value denotes that T1D has increased by 12.47% per year on average in this period (P-value < 0.01). The incidence of T2D and gestational diabetes has increased between 2015 and 2020 (APC = 15.02 and APC = 136.138, respectively; P-value < 0.1).

Conclusions

In summary, the incidence of diabetes in Semnan province is constantly increasing. T2D, meanwhile, has a higher proportion. Nevertheless, gestational diabetes had the highest increase annually. Well-designed surveys investigating the reasons for diabetes increment especially gestational ones and its burden are needed.

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The incidence of diabetes has been increasing in Iran and other low- and middle-income countries over the past decades.

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The incidence of diabetes in Semnan has been steadily increasing from 2015 through 2020. T2D, meanwhile, has a higher proportion.

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Although the trends in the incidence of T1D, T2D and gestational diabetes were increasing, gestational diabetes increased more than the other types.

First record of Brongersma's toad Barbarophryne brongersmai (Anura, Bufonidae) in the central High Atlas Mountains, Morocco

Brongersma’s toad Barbarophryne brongersmai is known in the southern Moroccan Atlantic coast, in the Anti–Atlas, in the arid plain of Marrakech, and in several localities in North–western Algeria. However, its distribution in Morocco is far from clear and its range is not well known. We report a new record of B. brongersmai in Morocco, in the region of the central High Atlas. The habitat type in this region is different from areas where the species has been observed previously. It consists of temporary ponds, located between rock outcrops and filled by stormy rains or snow during the winter. We recommend conducting surveys to collect additional information about this toad in other Moroccan regions, such as in the Middle Atlas where suitable conditions for this species may exist. Dataset published through Zenodo (Doi:

Motivations for alcohol consumption during the COVID-19 pandemic in Islamic Republic of Iran

Background: High alcohol consumption is an important public health problem, and understanding factors associated with such consumption is essential. Aims: This study aimed to assess individual and social factors associated with alcohol consumption during the coronavirus disease 2019 (COVID-19) pandemic in the Islamic Republic of Iran. Methods: In this qualitative study, purposive sampling was used to select study participants by sharing the survey link on the Telegram application channels with an Iranian audience during COVID-19. The study was conducted from March to June 2020 and reached all Iranian provinces. We used qualitative content analysis to investigate specific concepts in the responses. Results: Of the 116 participants who responded to the survey, 34 (29.3%) were females, and 82 (70.7%) were male. The mean age of the participants was 34.8 years (standard deviation 9.9; range 17–71 years). Most of the participants (75.9%) reported having consumed alcohol, and 56.9% reported having self-medicated for an illness without a doctor’s prescription before the COVID-19 pandemic. The most common reason given for alcohol consumption was to relieve stress during home quarantining (32.3%). Based on analysis of the responses, two themes emerged: coping motivations and coping skills, with five subthemes and 14 basic codes. Coping motivations were more powerful than coping skills in relation to high alcohol consumption. Conclusion: Poor coping skills and strong motivations, combined with misinformation on social media and the internet, appear to have led to new or higher alcohol consumption among survey respondents.

Transient osteoporosis of the hip: Physicians the occupation of at risk

Physicians are the occupation at risk for Transient Osteoporosis of the Hip. Therefore, sudden hip pain in them should be further evaluated with magnetic resonance imaging. Conservative treatment may help avoid further injury and speed up healing.

The Synergistic Combination of Cisplatin and Piperine Induces Apoptosis in MCF-7 Cell Line

Background

Piperine is a natural compound obtained from the Piper nigrum that exhibits anti-proliferative and anti-cancer activity in cancer cell lines. We analyzed the cytotoxic effect of piperine combined with cisplatin compound in the human MCF-7 breast cancer cell line and the underlying mechanism.

Methods

The present in vitro study was performed on MCF-7 cell line in Jahrom University of Medical Sciences between, Jahrom, Iran from 2016 to 2017. Cultured MCF-7 cells were seeded into four groups: a control group (untreated group), a group treated with cisplatin, a group treated with piperine and a group treated with cisplatin and piperine. Cell viability was analyzed using the MTT assay method. Flow c-ytometric analysis was investigated for apoptosis. The mRNA and protein expression of the apoptotic regulators p53, Bcl-2, Bax, caspase 3 and caspase 9 were detected by quantitative real-time polymerase chain reaction (qRT-PCR) and western blotting analysis.

Results

Piperine (20 and 30 μM) in combination with cisplatin (5, 10 and 15 μM) for 24 h synergistically inhibited cell viability of MCF-7 breast cancer cells more than piperine and cisplatin used alone. Synergistic anti-breast cancer activities cisplatin (5 μM) and piperine (20 μM) were via inducing apoptosis. Piperine (20 μM) and cisplatin (5 μM) for 24 h induce apoptosis strongly through reduction of Bcl-2 and increase of caspase 3, p53, caspase 9, and Bax.

Conclusion

Piperine in combination with cisplatin could trigger p53-mediated apoptosis more effective than cisplatin alone in MCF-7 breast cancer cells, reducing the toxic dose of cisplatin used in cancer chemotherapy.

Effect of Phytoestrogen on Depression and Anxiety in Menopausal Women: A Systematic Review

Objectives

In this systematic review, the effectiveness of herbal medicines in improving depression and anxiety in menopausal women was assessed.

Methods

Three following databases were individually searched: MEDLINE (1966-March 2017), SCOPUS (1990-March 2017), and the Cochrane Library (Cochrane Central Register of Controlled Trials; 2017).

Results

A total of 9 trials were included in this systematic review. Overall, soy was found to have a beneficial effect. Also, fennel had a significant positive effect on menopausal women with depression and anxiety disorder, but not on healthy women. Red clover showed varying effects ranging from significant to non-significant on depression and anxiety. Moreover, kava was found to have a significant beneficial effect on depression and anxiety at dose of 200 mg/days.

Conclusions

Our study demonstrated that herbal medicines could improve anxiety and depression in among menopausal women. However, the beneficial effect still remains indefinite due to the poor methodology.

Isotropic Design of Spatial Parallel Manipulators

In this paper, we study the isotropic design of two types of spatial parallel manipulators: a three-degrees-of-freedom manipulator and the Stewart—Gough platform. The isotropic conditions for Jacobian matrices, which relate the input joint velocity and output Cartesian velocity, are determined separately using a pure symbolic method. Thereafter, upon determining the isotropic conditions for both manipulators, the variation of the kinematic condition index is studied with respect to the motion of the moving platform to show how far the manipulator is from being isotropic. Finally, the isotropic conditions are obtained numerically for both manipulators.

Functional contribution of T1 to the brachial plexus in infants

To determine the contribution of the T1 root to movements of the upper limb in infancy, 40 infants presenting with obstetrical brachial plexus palsy who underwent resection and reconstruction of all brachial plexus roots with the exception of the T1 root were assessed in the early postoperative period. The movements of the limb were recorded using the Hospital for Sick Children active movement scale and demonstrated considerable variability. All movements of the upper limb were observed in this group with the exception of external rotation of the shoulder and elbow flexion. Classical accounts of the function of T1 have limited its activity to the small muscles of the hand and were based on anatomical dissection, brachial plexus injuries and electrical stimulation. By contrast, this study isolated the physiological activity of T1 and analysed the functional contribution of this root to arm movement. We show a greater than generally recognized contribution of T1 to the function of the upper limb in infants.

The first successful lower extremity transplantation: 6-year follow-up and implications for cortical plasticity

Vascularized composite allotransplantation as a viable reconstructive option is gaining recognition and new cases are being reported with increasing frequency including hand, face and laryngeal transplantation. However, only one successful complete lower limb transplantation has been reported to date, in which a functioning limb from one ischiopagus twin with a lethal cardiac anomaly was transplanted to the other. Six years later, the patient is mobilizing well and engaging in sporting activities with her peers in a mainstream school. Clinical evaluation of motor and sensory modalities demonstrated a good functional result. Quality of life was assessed using the short form-36 health survey and lower extremity functional scale disclosing a high level of social and physical capacity. Functional magnetic resonance imaging was performed and showed cortical integration of the limb; the implications of cortical plasticity and vascularized composite allotransplantation for the correction of congenital limb anomalies are presented.

Ulnar nerve palsy after open carpal tunnel decompression: Case report and review of the literature

open carpal tunnel release is the commonest surgical treatment of median nerve compression at the wrist. although successful in most cases, there are well described complications. we report a case of laceration of the deep motor branch of the ulnar nerve at the level of the hook of hamate following a complicated carpal tunnel decompression. good surgical technique and knowledge of wrist anatomy are essential for performing this apparently simple procedure safely.

Ulnar nerve palsy after open carpal tunnel decompression: Case report and review of the literature

Open carpal tunnel release is the commonest surgical treatment of median nerve compression at the wrist. Although successful in most cases, there are well described complications. We report a case of laceration of the deep motor branch of the ulnar nerve at the level of the hook of hamate following a complicated carpal tunnel decompression. Good surgical technique and knowledge of wrist anatomy are essential for performing this apparently simple procedure safely.

Dorsal dimelia in patau syndrome: a case report

We present a case of a child with Patau syndrome that exhibits features consistent with congenital palmar nail syndrome. The literature is reviewed and evidence presented to demonstrate that this is a defect in the dorso-ventral patterning of the limb and thus a form of dorsal dimelia. In order to differentiate this from other instances of ectopic nail tissue we suggest congenital palmar nail syndrome should be more specifically defined as duplicated nails, absent flexion creases, non-glabrous skin on the palmar surface, reduced movement at the interphalangeal joints and hypoplastic terminal phalanges.

Characteristics and survival rate of elderly patients with colorectal cancer detected by immunochemical occult blood screening

BACKGROUND/AIMS

A comparative study was carried out to clarify the clinicopathological features and survival rate of elderly patients with colorectal cancer diagnosed by immunochemical fecal occult blood screening.

METHODOLOGY

The study subjects included 208 patients with colorectal cancer, who were divided into 2 groups based on their ages: 52 patients aged 75 years and over (older group) and 156 patients aged 50-74 years (younger group). The 2 groups were compared in terms of their individual factors, including site, size, Dukes' classification, histo-pathological type of their cancer lesions and 5-year survival rate.

RESULTS

There was a significant difference in prevalence of tumor sites between the older and younger groups (P < 0.05). Particularly, the frequency of right colon cancers was higher in the older group (34.6%) than in the younger group (20.5%), but there were no differences found in any other factors such as size, Dukes' classification, and histopathological type. Survival rate was almost the same between the 2 groups.

CONCLUSIONS

These results suggest that elderly patients are susceptible to right colon cancer but there is no difference in the clinicopathological characteristics and 5-year survival rate between older and younger patients with colorectal cancer detected by immunochemical fecal occult blood test. The older as well as younger people should be encouraged to attend the screening program for colorectal cancer by immunochemical fecal occult blood test.

A comparative study of immunochemical fecal tests for detection of colorectal adenomatous polyps

BACKGROUND/AIMS

This study was conducted to assess the diagnostic validity of new different immunochemical fecal occult blood tests for colorectal adenomatous polyps, including reversed passive hemagglutination test (Immudia-HemSp), combination monoclonal antibody guaiac test (Monohaem), latex agglutination inhibition test (Iatro Hemcheck), and latex agglutination tests (LA Hemochaser, OC-Hemodia).

METHODOLOGY

Two hundred and fifty patients with colorectal adenomatous polyps 1.0 cm or larger in diameter and the same number of healthy controls served as subjects for the study. Each subject received a set of 5 immunochemical tests within 3 consecutive days, and sensitivities and specificities of these tests were evaluated.

RESULTS

Mean sensitivity and specificity in a set of 5 immunochemical tests were 47.6% and 95.8%, respectively. Sensitivities and specificities of 5 different immunochemical tests were calculated as 47.6% and 96.8% for Immudia-Hem Sp, 46.8% and 95.2% for Monohem, 46.4% and 95.2% for Iatro Hemchek, 48.0% and 96.4% for LA Hemochaser, and 49.2% and 95.6% for OC-Hemodia, respectively, showing no significant difference in sensitivity and specificity among the 5 tests.

CONCLUSIONS

These findings suggest that there is no difference in the degree of accuracy for colorectal adenomatous polyps among several types of immunochemical fecal occult blood test.

Quantitative determination of some thiazole cephalosporins through complexation with palladium (II) chloride

A simple and sensitive spectrophotometric method has been developed for the determination of five cephalosporins namely cefpodoxime (CFPD), ceftizoxime (CTIZ), ceftazidime (CZD), ceftriaxone (CTRX), and cefixime (CXIM). This method is based on the formation of yellow to yellowish brown complex between palladium (II) chloride and the investigated cephalosporins in the presence of sodium lauryl sulphate (SLS) as surfactant. The reaction conditions were studied and optimized. The procedure was validated. For each drug, the composition of this complex as well as its stability constant were also investigated. The proposed method was used for the determination of the above-mentioned drugs in their commercial preparations. The results were compared statistically with either official or published methods and showed no significant difference between the two methods.

Holistic approach to health education on AIDS

OBJECTIVE

To identify a method for health education using the example of an educational seminar on AIDS prevention and control at Hebei Medical University in China, 1994.

METHODS

Our goal is the theoretical formulation of a unified community approach for problem solving through the combination of the self regulative approach and the case analytical approach. "Quality improvement", "essential quality" and "human ecosystems" provide the basic ideas for better understanding the integration of culture, science and technology within the "cultural norm".

RESULTS

The present seminar was successfully organized for Chinese medical students based on the theme of "living with AIDS". Through this program, we identified that self regulative and case analytical approach were major issues for holistic approach to health education. We also identified that a community approach provides the scientific basis for health education in the community.

CONCLUSIONS

The present paper generates a healthcare paradigm for surveillance in health/medical education. Through a better understanding of community approach, we related "community care" (emphasizing self, mutual, professional and institutional care) to the "practical norm"; and "preventive epidemiology" (emphasizing the unification of quality and quantity, as well as systems and population) to the "research norm".

Examination of genotype and phenotype relationships in 14 patients with apparent mineralocorticoid excess

Apparent mineralocorticoid excess (AME) is a genetic disorder causing pre- and postnatal growth failure, juvenile hypertension, hypokalemic metabolic alkalosis, and hyporeninemic hypoaldosteronism due to a deficiency of 11 beta-hydroxysteroid dehydrogenase type 2 enzyme activity (11 beta HSD2). The 11 beta HSD2 enzyme is responsible for the conversion of cortisol to the inactive metabolite cortisone and therefore protects the mineralocorticoid receptors from cortisol intoxication. Several homozygous mutations are associated with this potentially fatal disease. We have examined the phenotype, biochemical features, and genotype of 14 patients with AME. All of the patients had characteristic signs of a severe 11 beta HSD2 defect. Birth weights were significantly lower than those of their unaffected sibs. The patients were short, underweight, and hypertensive for age. Variable damage of one or more organs (kidneys, retina, heart, and central nervous system) was found in all of the patients except one. The follow-up studies of end-organ damage after 2-13 yr of treatment in six patients demonstrated significant improvement in all patients. The urinary metabolites of cortisol demonstrated an abnormal ratio with predominance of cortisol metabolites, i.e. tetrahydrocortisol plus 5 alpha-tetrahydrocortisol/tetrahydrocortisone was 6.7-33, whereas the normal ratio is 1.0. Infusion of [11-3H]cortisol resulted in little release of tritiated water, indicating the failure of the conversion of cortisol to cortisone. Thirteen mutations in the HSD11B2 gene have been previously published, and we report three new genetic mutations in two patients, one of whom was previously unreported. All of the patients had homozygous defects except one, who was a compound heterozygote. Our first case had one of the most severe mutations, resulting in the truncation of the enzyme 11 beta HSD2, and died at the age of 16 yr while receiving treatment. Three patients with identical homozygous mutations from different families had varying degrees of severity of clinical and biochemical features. Due to the small number of patients with identical mutations, it is difficult to correlate genotype with phenotype. In some cases, early and vigilant treatment of AME patients may prevent or improve the morbidity and mortality of end-organ damage such as renal or cardiovascular damage and retinopathy. The outcome of treatment in more patients may establish the efficacy of treatment.

Effect of cutting, phosphorus and potassium fertilization on guar plant (Cyamoposis tetragonoloba) in newly reclaimed soil in Egypt

A two year experiment was carried out in newly reclaimed soils (sandy soils) to investigate the effect of cutting and phosphorus and potassium fertilization on the growth, yield, seed mucilage content and seed protein content of guar plant. The results revealed that different cutting treatments significantly decreased the plant weight, seed yield, seed mucilage content and seed protein content. Phosphorus fertilization up to 350 kg super-phosphate (15% P2O5)/feddan* significantly increased plant weight, seed yield, seed mucilage content and seed protein content. Fertilization with 150 kg potassium sulfate (48% K2O)/feddan was quite capable to meet guar plant potassium demands in this kind of soil. Without cutting plants, fertilization with 350 kg super-phosphate and 150 kg potassium sulfate/feddan resulted in the highest seed yield, seed muculage content and seed protein content.