Publications by authors named "Jan D"

154 Publications

Assessing the Clinical Value of Performing CT Scan before Rhinoplasty Surgery.

Int J Otolaryngol 2020 18;2020:5929754. Epub 2020 Dec 18.

Department of Otolaryngology Head and Neck Surgery, Firoozgar Hospital, Iran University of Medical Science, Tehran, Iran.

Introduction: The endonasal mucosal or anatomic pathologies could lead to poor functional results and dissatisfaction after rhinoplasty. Although computed tomography (CT) scan has become an integral part of the diagnostic paradigm for patients with pathologies of the paranasal sinuses, the use of CT scan for preoperative evaluation of patients seeking rhinoplasty is up for debate. Our aim in this study was to compare the efficacy of CT scan in diagnosing nasal pathologies with other evaluating tools in patients undergoing rhinoplasty.

Design: In this randomized controlled trial study, 74 consecutive patients seeking cosmetic rhinoplasty referred to otorhinolaryngology clinic were randomly assigned into three groups based on the perioperative evaluation method: the CT group, the nasal endoscopy group, and the control group (anterior rhinoscopy only). Surgical planning was made according to perioperative findings, and the identified endonasal pathologies were corrected during the surgery. The functional and aesthetic outcomes of the rhinoplasty were assessed by Nasal Obstruction Symptom Evaluation (NOSE), Rhinoplasty Outcome Evaluation (ROE), and the Visual Analogue Scale (VAS) tools before surgery and at 12-month follow-up.

Results: All outcome measures improved significantly in either group toward one year after rhinoplasty (all with value <0.05). Subjects in the CT group demonstrated greater improvement in the NOSE, VAS, and ROE compared to other two groups (NOSE: value = 0.17; VAS: value = 0.024; ROE: value = 0.042).

Conclusions: According to our study, perioperative CT is associated with greater patients' satisfaction and quality of life after rhinoplasty compared to either nasal endoscopy or anterior rhinoscopy. A preoperative CT scan may improve the outcomes of rhinoplasty.
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http://dx.doi.org/10.1155/2020/5929754DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803282PMC
December 2020

Lipoma of the nasal septum: A case report.

Clin Case Rep 2020 Dec 16;8(12):3028-3031. Epub 2020 Sep 16.

ENT and Head & Neck Research Center The Five Senses Institute Iran University of Medical Sciences Tehran Iran.

Even routine diagnoses, such as septal deviation, which most people do not think need imaging, require careful examination because rare diagnoses such as lipoma may occur in the nose. Careful examination and imaging lead to the best treatment.
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http://dx.doi.org/10.1002/ccr3.3359DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752441PMC
December 2020

Rituximab in practice: Clinical evaluation of patients with pemphigus after rituximab administration.

Dermatol Ther 2021 Jan 15;34(1):e14633. Epub 2020 Dec 15.

Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Pemphigus Vulgaris (PV) is a rare autoimmune blistering disease, which mainly causes mucosal and/or cutaneous lesions. In June 2018, FDA approved Rituximab (RTX)-a B-cell depleting agent-for the management of patients with moderate-to-severe pemphigus. Although the majority of patients respond well to this drug, some do not reach complete remission with a single cycle of RTX. In this review, following an overview of RTX and its clinical outcomes, we have focused on the possible outcomes after RTX therapy in patients with PV. The response is defined into four main categories; complete responders, partial responders, nonresponders, and paradoxical reactions, based on three possibilities of reaching the consolidation phase after 3 months, reaching remission until 6 months, and the ability of corticosteroid tapering in 6 months after RTX administration. Concerning the safety of RTX, three categories of infusion reactions, short and long-term side effects are discussed. Additionally, we have suggested approaches for the evaluation of clinical and serological responses at different critical time-points, including 1, 2, 3, and 6 months after RTX administration. Finally, available markers to predict the response to RTX and research gaps in the field of RTX therapy have been summarized.
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http://dx.doi.org/10.1111/dth.14633DOI Listing
January 2021

"End to Side Technique": More organ preservation with less morbidity in patients with pyriform sinus apex SCC.

Am J Otolaryngol 2020 Jul - Aug;41(4):102505. Epub 2020 Apr 22.

ENT and Head & Neck Research Center, The Five Senses Institute, Iran University of Medical Science, Tehran, Iran; ENT and Head & Neck Research Center and Department, Five Senses Health Research institute, Hazrat Rasoul Akram Hospital, Tehran, Iran.

Introduction: Hypopharyngeal squamous cell carcinoma (SCC) is rare, but highly aggressive. Due to the advanced stage of this cancer at the time of diagnosis, radical surgery with reconstruction of pharynx is the standard care with high morbidity and mortality rate. A safer partial pharyngectomy could also be used for invasive hypopharyngeal cancer. In this study, we investigated the short and long-term outcomes in patients with SCC of the pyriform sinus apex undergoing standard partial pharyngectomy using a new suturing technique, called end to side technique.

Methods: This case series was performed on 8 patients with SCC of the pyriform sinus apex at the otorhinolaryngology clinic. All participants underwent standard partial pharyngectomy using "end to side technique". Post-operative evaluations included 6 and 12 months CT scan and 1-year barium swallow.

Results: Of 8 patients, 7 were male (87.5%) and 1 was female (12.5%) with a mean age of 60 years old. All patients were diagnosed at stage III of hypopharyngeal cancer and cervical lymph node involvement was reported in 3 patients (37.5%). Tumor margins were negative in all patients. Fistula was reported in 2 patients (25%) which was managed using conservative treatments.

Conclusions: According to our study, the standard partial pharyngectomy with end to side technique is a safe and feasible method for the surgical resection of the squamous cell carcinoma of the pyriform sinus apex with good short-term and long-term outcomes.
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http://dx.doi.org/10.1016/j.amjoto.2020.102505DOI Listing
August 2020

Latitudinal gradient in dairy production with the introduction of farming in Atlantic Europe.

Nat Commun 2020 04 27;11(1):2036. Epub 2020 Apr 27.

BioArCh, Department of Archaeology, University of York, Wentworth Way, Heslington, York, YO10 5DD, UK.

The introduction of farming had far-reaching impacts on health, social structure and demography. Although the spread of domesticated plants and animals has been extensively tracked, it is unclear how these nascent economies developed within different environmental and cultural settings. Using molecular and isotopic analysis of lipids from pottery, here we investigate the foods prepared by the earliest farming communities of the European Atlantic seaboard. Surprisingly, we find an absence of aquatic foods, including in ceramics from coastal sites, except in the Western Baltic where this tradition continued from indigenous ceramic using hunter-gatherer-fishers. The frequency of dairy products in pottery increased as farming was progressively introduced along a northerly latitudinal gradient. This finding implies that early farming communities needed time to adapt their economic practices before expanding into more northerly areas. Latitudinal differences in the scale of dairy production might also have influenced the evolution of adult lactase persistence across Europe.
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http://dx.doi.org/10.1038/s41467-020-15907-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184739PMC
April 2020

"Modified tongue-in-groove": a new tip-plasty technique and comparison of its effect on correction of the nasolabial angle with the columellar strut technique.

Br J Oral Maxillofac Surg 2020 06 18;58(5):602-607. Epub 2020 Mar 18.

Department of Otolaryngology Head & Neck Surgery, Firoozgar Hospital, Iran University of Medical Science, Tehran, Iran; ENT and Head & Neck Research Center and Department, Five Senses Health Research institute, Hazrat Rasoul Akram Hospital, Tehran, Iran.

Ptosis of the nasal tip is one of the most challenging aspects of rhinoplasty, and the tongue-in-groove (TIG) and the columellar strut (CST) techniques are the two most common procedures used to improve it. The purpose of this study was to introduce a new modification of TIG, to evaluate the long term results of the modified TIG, and to compare its effect on correction of the nasolabial angle with that of the CST. Eighty patients with droopy nasal tips (all female, aged <40 years) were divided into two groups of 40 each according to the technique used for correction (modified TIG or CST). The nasolabial angle was recorded preoperatively, immediately postoperatively, and after one year. The mean was 90.80° in the modified TIG group and 94.87° in the CST preoperatively, which did not differ significantly (p=0.056). Immediately postoperatively, it was significantly higher in the CST group (116.92° compared with 107.10°, p=0.01), but at the one-year follow-up, the droop was similar in both groups (-7.35° in the modified TIG, and -7.48° in the CST group, respectively, p=0.942). Both techniques significantly increased the nasolabial angle postoperatively (p<0.001 in both cases). This study showed that the modified TIG is a reliable and effective technique for reconstructing and correcting a droopy nasal tip, and its long-term efficacy is comparable with that of CST.
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http://dx.doi.org/10.1016/j.bjoms.2020.03.005DOI Listing
June 2020

Monodisperse Al-Doped ZnO/Perovskite Nanocapsule.

ACS Appl Mater Interfaces 2020 Jan 20;12(1):1299-1305. Epub 2019 Dec 20.

Physics Division , Institute of Nuclear Energy Research , No. 1000, Wenhua Rd. , Jiaan Village, Longtan Township, Taoyaun County, Taiwan , Republic of China.

We developed monodisperse ZnO nanocapsules and atmospheric N plasma was used to develop a ZnO-organic nanocomposite. To test the seal of the ZnO nanocapsule, the halide perovskite CHNHPbBr was used as the filler. Al atoms were doped into ZnO nanorods to increase the conductivity of ZnO nanorods. A green emission peak located at 535 nm was observed in the nanocapsules with a 410 nm excitation because of the free-exciton recombination of CHNHPbBr. The Al-doped ZnO (AZO)/CHNHPbBr nanocapsules was further tested under using a three-electrode photoelectrochemistry cell. AZO/CHNHPbBr nanocapsule arrays yield an elevated photocurrent of approximately 0.2 mA/cm at 1 V versus Ag/AgCl under air mass 1.5 (AM 1.5), almost 1.5 times larger than that of the AZO nanorod arrays. The photo-current stability of AZO/CHNHPbBr nanocapsule arrays photoelectrode is better than that of AZO nanorod arrays under a repeated on/off light test. This confirmed that the AZO/CHNHPbBr nanocapsules had been successfully sealed and that the degradation of CHNHPbNBr was thus dramatically reduced. Our study yields a novel platform for nanoscale optical and optoelectronic devices or for delivery of highly toxic drugs.
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http://dx.doi.org/10.1021/acsami.9b16533DOI Listing
January 2020

Novel Non-Surgical Interventions for Benign Inflammatory Biliary Strictures in Infants: A Report of Two Cases and Review of Current Pediatric Literature.

Pediatr Gastroenterol Hepatol Nutr 2019 Nov 7;22(6):565-570. Epub 2019 Nov 7.

Division of Pediatric Gastroenterology and Nutrition, Children's Hospital at Montefiore, Bronx, NY, USA.

Benign biliary strictures are uncommon in children. Classically, these cases are managed surgically, however less invasive approaches with interventional radiology and or endoscopy may have similar results and improved safety profiles While benign biliary strictures have been described in literature on several occasions in young children, (most older than 1 year and once in an infant 3 months of age), all reported cases were managed surgically. We present two cases of benign biliary strictures in infants less than 6 months of age that were managed successfully with novel non-invasive procedures and a review of all current pediatric cases reported in the literature. Furthermore, we describe the use of a Rendezvous procedure, which has not been reported as a treatment approach for benign biliary strictures.
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http://dx.doi.org/10.5223/pghn.2019.22.6.565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6856500PMC
November 2019

Novel mutations in gene in infants with neonatal cholestasis.

Pediatr Rep 2019 Sep 30;11(3):8206. Epub 2019 Sep 30.

Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital at Montefiore, Bronx, NY.

One cause of neonatal cholestasis (NC) is paucity of intrahepatic bile ducts which can be associated with Alagille syndrome or non- syndromic. Alagille syndrome is caused by autosomal dominant mutations in the Notch signaling pathway ligand Jagged1 in 94% of patients and mutations in the receptor in <1% of patients. This is a retrospective case series studying infants with neonatal cholestasis found to have variants of unknown significance (VOUS) in . Sorting intolerant from tolerant (SIFT) and polymorphism phenotyping (PolyPhen) were utilized to predict a damaging effect. Five infants with NC without other features of Alagille syndrome were found to have one copy of a VOUS in , predicted to be damaging by SIFT and PolyPhen. Our cases support the notion that mutations may result in hypoplastic biliary system. Further characterization of these variants is important to assist with our clinical approach to NC.
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http://dx.doi.org/10.4081/pr.2019.8206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6778839PMC
September 2019

Assessing the socio-economic impact of climate change on wheat production in Khyber Pakhtunkhwa, Pakistan.

Environ Sci Pollut Res Int 2019 Mar 9;26(7):6576-6585. Epub 2019 Jan 9.

Institute of Agriculture and Resource Economics, University of Agriculture, Faisalabad, Pakistan.

This study involves the climate change impact assessment of wheat producers in Khyber Pakhtunkhwa, Pakistan. An extensive farm survey of 150 farms was designed. From study area, three districts, namely, Chitral, D.I. Khan, and Peshawar, were selected through multistage sampling process. Yield simulation from Crop model DSSAT (Decision Support System for Agro Technology Transfer) was used for socio-economic impact assessment. Future climate scenarios were generated by selecting five GCMs from latest CMIP5 family with two RCPs 4.5 and 8.5, at two carbon concentrations of 499 ppm and 571 ppm, respectively. Yield simulations were analyzed for each GCM. Results of crop model revealed that wheat yield will increase in district Chitral, while in D.I. Khan and Peshawar, yields would be reduced due to climate change. For socio-economic impact assessment, TOA-MD (Trade-Off Analysis for Multi-Dimensional Impact Assessment) version 6 was used. Climate change impacts on poverty, net farm returns, and per capita income were calculated for different scenarios. The analysis was carried out on per-farm basis. The economic model results revealed that climate change has negative impact on wheat producers in D.I. Khan and Peshawar while making wheat producers better off in Chitral. The number of losers ranged from 54 to 66.21% and 50 to 61.99% in D.I. Khan and Peshawar, respectively. Losers are the farmers who would be economically worse off under perturbed climate. With current climate, the observed poverty rate would be 34 to 49 in D.I. Khan while 21.26 to 34.03 in Peshawar. The study recommended need for adaptation strategies to overcome the vulnerabilities of climate change.
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http://dx.doi.org/10.1007/s11356-018-04109-7DOI Listing
March 2019

Indium-Zinc-Tin-Oxide Film Prepared by Reactive Magnetron Sputtering for Electrochromic Applications.

Materials (Basel) 2018 Nov 8;11(11). Epub 2018 Nov 8.

Division of Physics, Institute of Nuclear Energy Research, Taoyuan County 32546, Taiwan.

This paper reports on the fabrication of indium-zinc-tin-oxide (IZTO) transparent conductive film deposited by direct current (DC) reactive magnetron sputtering. The electrical, structural, and optical properties of IZTO film were investigated by Hall measurement, X-ray diffraction (XRD), and optical transmission spectroscopy with various sputtering powers. The IZTO film prepared used power at 100 W showed the lowest resistivity of 5.2 × 10 Ω cm. To accomplish rapid switching and high optical modulation, we have fabricated an electrochromic device (ECD) consisting of an working electrode (WO₃ electrode film deposited on IZTO/ITO/glass) and a counter-electrode (Pt mesh) in 0.2 M LiClO₄/PC liquid solution. The device demonstrated an optical contrast of 44% and switching times of 4.6 s and 8.1 s for the coloring and bleaching state, respectively, at the wavelength of 550 nm.
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http://dx.doi.org/10.3390/ma11112221DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6265803PMC
November 2018

Epidemiology of taeniosis/cysticercosis in Europe, a systematic review: eastern Europe.

Parasit Vectors 2018 Oct 30;11(1):569. Epub 2018 Oct 30.

Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium.

Background: Taenia solium and Taenia saginata are food-borne parasites of global importance. In eastern Europe only fragmented information is available on the epidemiology of these zoonotic parasites in humans and animal populations. In particular for T. solium, on-going transmission is suspected. The aim of this systematic review was to collect the available data and describe the current knowledge on the epidemiology of T. solium and T. saginata in eastern Europe.

Methods: Literature published in international databases from 1990 to 2017 was systematically reviewed. Furthermore, local sources and unpublished data from national databases were retrieved from local eastern European experts. The study area included 22 countries.

Results: Researchers from 18 out of the 22 countries provided data from local and unpublished sources, while no contacts could be established with researchers from Belarus, Kosovo, Malta and Ukraine. Taeniosis and human cysticercosis cases were reported in 14 and 15 out of the 22 countries, respectively. Estonia, the Former Yugoslav Republic of Macedonia, Lithuania, Moldova, Poland, Romania, Serbia, and Slovakia reported cases of porcine cysticercosis. Croatia, Czech Republic, Estonia, Former Yugoslav Republic of Macedonia, Moldova, Poland, Romania, Serbia, Slovakia, and Ukraine reported bovine cysticercosis.

Conclusions: There is indication that taeniosis and cysticercosis are present across eastern Europe but information on the occurrence of T. solium and T. saginata across the region remains incomplete. Available data are scarce and species identification is in most cases absent. Given the public health impact of T. solium and the potential economic and trade implications due to T. saginata, notification of taeniosis and human cysticercosis should be implemented and surveillance and notification systems in animals should be improved.
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http://dx.doi.org/10.1186/s13071-018-3153-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208121PMC
October 2018

Evaluation of factors affecting the efficacy of treatment against Fascioloides magna in wild red deer population.

Vet Ital 2018 Mar;54(1):33-39

University of Zagreb Veterinary Faculty, Heinzelova 55, 10000 Zagreb, Croatia.

Deer fascioloidosis is a serious and potentially fatal disease caused by the non-native trematode Fascioloides magna. Infections of red deer with F. magna in Croatia have been reported for the first time in 2000 in the Baranja region. Subsequently, the disease spread throughout the Eastern parts of the country, involving all 3 deer species (red, roe, and fallow) and mouflons. Within the disease control programme (DCP), livers from all shot deer were thoroughly analysed and all detected trematodes and gross lesions were counted and categorized. Prevalence of positive animals, in this study for Spačva region, in the period ranging from 2007 to 2012 was 36.42% (46.39% when fawns are not considered). Epidemiological analysis was applied to evaluate risk factors and disease patterns at the population level with the aim to understand factors with negative influence on therapeutic effect. Each demographic variable was tested at the seasonal, individual and location level. Model for pathological lesions suggested that the likelihood of lesions was dependent on age (p = 0.003). We did not find any locality or sex related significant differences. Finally, environmental characteristics and migratory patterns were analysed using Geographic Information System (GIS) and showed that Spačva region represents an epidemiological unit for red deer fascioloidosis.
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http://dx.doi.org/10.12834/VetIt.970.5051.1DOI Listing
March 2018

Case Report: Oblique Fracture of the Ulnar Sesamoid Bone of the Metacarpophalangeal Joint, a Rare Pathology.

J Orthop Case Rep 2017 Mar-Apr;7(2):29-32

Department of Medicine, Catholic University of Leuven, KU Leuven, Belgium.

Introduction: Fractures of the sesamoid bones of the metacarpophalangeal joint (MCPJ) are a rare pathology in hand trauma. Only a few case reports and case series were found in literature. The diagnosis of an ulnar sesamoid bone fracture of the MCPJ is difficult and can pose a differential diagnostic problem with Stener lesions or ulnar collateral ligament (UCL) instability. This pathology is frequently missed with subsequent poor functional outcomes. Correct and early diagnosis is important as this will allow for correct treatment with full recovery of function without sequelae.

Case Presentation: We report a case of a 35-year-old male Caucasian patient after a thumb injury due to a fall with his mountain bike. X-ray showed a fracture of the ulnar sesamoid of the MCPJ of the pollex, which is rarely reported in this literature. Anamnesis, clinical examination, and X-ray evaluation contributed to our diagnosis. The ulnar sesamoid bone fracture of the MCPJ of the right pollex was initially treated conservatively with immobilization, rest and ice application. After 3-4 weeks, physiotherapy with thenar muscles exercises was started. 10 weeks after the injury, our patient reported a total recovery of function and pain-free thumb movement during daily activities.

Conclusion: Ulnar sesamoid fractures are rarely reported in current literature. This type of injury should be recognized as early as possible since it can be easily missed. Then a benign course can be expected after short immobilization of the MCPJ of the thumb during circa 2 weeks. UCL instability or a Stener lesion should be excluded at the emergency department by performing an ultrasound. With this case report, we underline the importance of early diagnosis and exclusion of an unstable Stener lesion.
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http://dx.doi.org/10.13107/jocr.2250-0685.736DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5553830PMC
August 2017

In vivo documentation of shape and position changes of MRI-visible mesh placed in rectovaginal septum.

J Mech Behav Biomed Mater 2017 11 5;75:379-389. Epub 2017 Aug 5.

Centre for Surgical Technologies, Faculty of Medicine, Belgium; Department of Development and Regeneration, Organ systems cluster, Faculty of Medicine, KU Leuven, Leuven, Belgium; Pelvic Floor Unit, University Hospitals KU Leuven, Leuven, Belgium. Electronic address:

Background And Objective: Large deformations in synthetic meshes used in pelvic organ prolapse surgery may lead to suboptimal support for the underlying tissue, graft-related complications as well as recurrence. Our aim was to quantify in vivo longitudinal changes in mesh shape and geometry in a large animal model. We compare two commonly used mesh shapes, armed and flat, that are differently affixed. The secondary outcomes were active and passive biomechanical properties.

Methods: A total of 18 animals were used. Six each were implanted with either an arm mesh, a flat mesh or underwent a sham surgery. PVDF meshes loaded with FeO were used to facilitate their visualization in vivo. MR images were taken at 2, 14 and 60 days after implantation and 3D models of the meshes were created at each time point. We calculate the Effective Surface Area (ESA), i.e. the support that the mesh provides to the underlying tissue using custom developed techniques. Longitudinal changes in the mesh shape were studied by comparing the respective 3D models using part comparison analyses. The root means square difference (RMSD) and the modified Hausdorff distance (MHD) were calculated to obtain an objective value for the part comparisons. Wall thickness maps were produced on 3D models. Mesh arm length and their ellipticity profiles were also evaluated. Active and passive biomechanical tests on vaginal tissue overlaying the mesh were conducted using a contractility assay and a uniaxial loading protocol.

Results: MR images of 5 animals in each group were used for longitudinal comparison. Compared to the initial implant size, there was an immediate drop in the ESA measurement at day 2 of almost 32.22 [7.06] % (median [IQR]) for flat meshes, and by 17.59 [6.50] % for arm meshes. After 14 days, the reduction in area was 41.84 [14.89] % and 27.18 [20.44] %, and at day 60 it was 36.61 [6.64] % and 26.43 [14.56] % for the flat and armed meshes respectively. The reduction in area in the two groups was different between the two groups only day 14 (p = 0.046). The ellipticity of the arms was 0.81 [0.08] (median [IQR]) and there was no significant change in the ellipticity profiles over time. The mesh arm length did not change significantly over time. The part comparison showed a maximum difference of 4.26 [3.29] mm in 3D models according to the MHD measure, which is clinically not relevant. Comparison of high thickness areas on the thickness maps correlated well with the areas of mesh folding in the arm mesh group observed during postmortem dissection. Thickness maps did not help us understand why the flat meshes had a reduction in support area. The comfort zone stiffness of the flat mesh and of the central part of the arm mesh were 2.4 fold and 4.5 times stiffer compared to sham groups, respectively. The arms were 36% stiffer than the central part of the mesh. The comfort zone length of the sham group was 46% longer than the flat mesh group (p = 0.027) and 59% longer than that of the central part of the arm mesh (p = 0.005). There was no significant difference in vaginal contractile forces generated in samples from the arm, flat mesh, and sham groups.

Conclusions: This is a first longitudinal study observing deformations in vaginally implanted synthetic meshes in a large animal model. A novel methodology is presented to calculate the area of the vaginal tissue effectively supported by the mesh implant. Immediately post-operatively, a reduction in 32% and 17% was noted, which remained stable over the 60 following days of observation. We use thickness maps to analyze the cause of this dramatic immediate reduction. In the armed mesh we found it to be mesh folding at the interface between the arms and central part. For the flat mesh we suggest that pore aggregation during suturing.
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http://dx.doi.org/10.1016/j.jmbbm.2017.08.005DOI Listing
November 2017

Surgical Site Infections Following Pediatric Ambulatory Surgery: An Epidemiologic Analysis.

Infect Control Hosp Epidemiol 2016 08 28;37(8):931-8. Epub 2016 Apr 28.

1Department of Pediatrics,Children's Hospital at Montefiore and the Albert Einstein College of Medicine,Bronx,New York.

OBJECTIVE To identify surgical site infection (SSI) rates following pediatric ambulatory surgery, SSI outcomes and risk factors, and sensitivity and specificity of SSI administrative billing codes. DESIGN Retrospective chart review of pediatric ambulatory surgeries with International Classification of Disease, Ninth Revision (ICD-9) codes for SSI, and a systematic random sampling of 5% of surgeries without SSI ICD-9 codes, all adjudicated for SSI on the basis of an ambulatory-adapted National Healthcare Safety Network definition. SETTING Urban pediatric tertiary care center April 1, 2009-March 31, 2014. METHODS SSI rates and sensitivity and specificity of ICD-9 codes were estimated using sampling design, and risk factors were analyzed in case-rest of cohort, and case-control, designs. RESULTS In 15,448 pediatric ambulatory surgeries, 34 patients had ICD-9 codes for SSI and 25 met the adapted National Healthcare Safety Network criteria. One additional SSI was identified with systematic random sampling. The SSI rate following pediatric ambulatory surgery was 2.9 per 1,000 surgeries (95% CI, 1.2-6.9). Otolaryngology surgeries demonstrated significantly lower SSI rates compared with endocrine (P=.001), integumentary (P=.001), male genital (P<.0001), and respiratory (P=.01) surgeries. Almost half of patients with an SSI were admitted, 88% received antibiotics, and 15% returned to the operating room. No risk factors were associated with SSI. The sensitivity of ICD-9 codes for SSI following ambulatory surgery was 55.31% (95% CI, 12.69%-91.33%) and specificity was 99.94% (99.89%-99.97%). CONCLUSIONS SSI following pediatric ambulatory surgery occurs at an appreciable rate and conveys morbidity on children. Infect Control Hosp Epidemiol 2016;37:931-938.
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http://dx.doi.org/10.1017/ice.2016.98DOI Listing
August 2016

When things go wrong: Cysticercus longicollis in an adult wild red fox (Vulpes vulpes).

Parasitol Res 2016 Mar 9;115(3):1345-8. Epub 2016 Jan 9.

Department of Parasitology and Parasitic Diseases with Clinic, University of Zagreb Faculty of Veterinary Medicine, Heinzelova 55, 10000, Zagreb, Croatia.

First case of Cysticercus longicollis, larval stage of Taenia crassiceps, was diagnosed in a wild adult male red fox (Vulpes vulpes). The fox was killed by dogs at Nature Park Medvednica and presented to the University of Zagreb Faculty of Veterinary Medicine with history of being unable to run away and having skin lesions on legs that resembled to those of mange. Necropsy revealed whitish fluctuant mass full of cysticercus-like structures, surrounded by fibrous capsule and placed between the leg muscles, and numerous of spherical cysts in the subcutis and in the peritoneal cavity. Cysticerci were identified as C. longicollis based on their size, number and size of the rostellar hooks, mode of proliferation and DNA analysis. To our knowledge, this is the first case of T. crassiceps cysticercosis in a wild carnivore.
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http://dx.doi.org/10.1007/s00436-015-4894-0DOI Listing
March 2016

Volvulus of the entire small bowel with normal bowel fixation simulating malrotation and midgut volvulus.

Pediatr Radiol 2015 Dec 26;45(13):1953-6. Epub 2015 Jul 26.

Department of Radiology, University of Chicago Medical Center, Chicago, IL, USA.

Background: Midgut volvulus is a complication of malrotation of bowel and mesenteric malfixation. In contrast, primary volvulus of the small bowel is a distinctly different and rare entity characterized by torsion of the entire small bowel with normal mesenteric fixation.

Objective: To present the clinical and imaging findings in four infants with primary small bowel volvulus and normal bowel fixation in order to improve awareness of this entity among clinicians and radiologists and to discuss the potential etiologies of this entity to distinguish it from other causes of small bowel volvulus.

Materials And Methods: A retrospective review of imaging studies (two ultrasounds and four upper gastrointestinal series) in four infants (three full-term and one premature) from three institutions with surgically proven volvulus of the entire small bowel and normal bowel fixation were reviewed by three board-certified pediatric radiologists and correlated with clinical and surgical reports when available.

Results: The infants presented during the first week to 6 months of life and were acutely ill. The upper gastrointestinal series showed complete duodenal obstruction with beaking in one and partial duodenal obstruction in three. All studies were interpreted as highly suspicious for malrotation and midgut volvulus. Emergent laparotomy demonstrated primary small bowel volvulus with normal mesenteric fixation in all infants. The base of the small bowel mesentery was described by the operating surgeon as smaller than normal in one infant (case 3). There was no mesenteric defect or other abnormality predisposing to volvulus in the other three. In both infants who had abdominal US, a retroperitoneal position of the third portion of the duodenum was demonstrated. All infants survived. One infant required resection of the necrotic small bowel and currently has short gut syndrome, one has malabsorption and two were lost to follow-up.

Conclusion: Primary small bowel volvulus with normal fixation is indistinguishable from malrotation with midgut volvulus in the acutely ill infant or child. Radiographic diagnosis can be difficult in patients with intermittent or incomplete small bowel volvulus without malrotation. In these patients, neither an upper gastrointestinal series demonstrating a normal position of the duodenojejunal junction nor the sonographic demonstration of a retromesenteric third portion of the duodenum excludes the diagnosis. In young infants, the clinical and imaging findings may mimic necrotizing enterocolitis. Sonography may be useful to evaluate the bowel for signs of bowel wall compromise or a whirlpool sign.
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http://dx.doi.org/10.1007/s00247-015-3430-9DOI Listing
December 2015

Students' concerns about the pre-internship objective structured clinical examination in medical education.

Educ Health (Abingdon) 2014 May-Aug;27(2):188-92

Department of Emergency Medicine, Imam Khomeini Hospital; Clinical Skills Development Center, Medical Faculty, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: Despite several studies on implementation, reliability and validity of the Objective Structured Clinical Examination (OSCE), the perceptions of examinees toward this evaluation tool remain unclear. The aim of the current study was to assess students' perceptions of the OSCE.

Methods: All students in their final year of studies, who participated in the pre-internship OSCE in September 2010, were included in the study. A 16-item questionnaire was designed to assess: Characteristics of respondents; organization, content and structure of the OSCE; and perceptions of validity, reliability and rating of the OSCE with respect to other assessment methods. Questionnaires were administered immediately after all students had finished the OSCE and before leaving the examination venue.

Results: Response rate was 86.2%, with 77% of the students indicating the OSCE as a useful learning experience. A majority of the students (62%) agreed that a wide range of clinical skills was covered in this exam. However, 66% had concerns about the wide coverage of knowledge assessed. A total of 81% of students did not prefer the OSCE to multiple choice question exams and 88% found the OSCE intimidating and more stressful than other forms of assessment.

Discussion: Our study demonstrates that although the majority of students believe in the reliability and validity of the OSCE, they have concerns about it and report poor acceptance of the OSCE. Further studies are necessary to assess the important concerns of the students and the effectiveness of interventions in improving the acceptability of the OSCE.
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http://dx.doi.org/10.4103/1357-6283.143787DOI Listing
August 2015

Outcomes after early splenectomy for hematological disorders.

J Laparoendosc Adv Surg Tech A 2014 Dec;24(12):897-900

1 Division of General Surgery, Department of Surgery, Montefiore Medical Center , Bronx, New York.

Purpose: Acute splenic sequestration crisis is a devastating complication of sickle cell disease that can require prophylactic splenectomy. Historically, splenectomy before 5 years of age was avoided because of fear of overwhelming postsplenectomy sepsis. Recently, splenectomy has been performed as early as 2 years of age, but the safety of this approach is unknown. This study compared outcomes of splenectomy performed in patients under 5 years of age with those 5 years of age and older.

Materials And Methods: A retrospective chart review of patients registered in a children's hospital hematology database was performed to examine intraoperative and postoperative outcomes after splenectomy. Statistical data analysis included Fisher's exact tests for categorical variables and the nonparametric median test for continuous variables.

Results: From 1997 to 2012, 30 sickle cell patients underwent splenectomy. At surgery, 18 of the 30 patients were under 5 years of age (Group 1), and 12 patients were 5 years of age or older (Group 2). Almost all procedures were laparoscopic. Both group had similar operative times, rates of conversion, and frequencies of complications. Both groups had similar lengths of follow-up (median, 62 months for Group 1 versus 63 months for Group 2). No portal vein thromboses or postsplenectomy sepsis events occurred in either group.

Conclusions: In this study, there was no evidence that the incidence of complications was higher after splenectomy at a younger age. A large, multicenter study is needed to further evaluate the safety of this practice.
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http://dx.doi.org/10.1089/lap.2014.0280DOI Listing
December 2014

Assessment and outcome of children with intestinal failure referred for intestinal transplantation.

Clin Nutr 2015 Jun 30;34(3):428-35. Epub 2014 Apr 30.

Department of Pediatric Gastroenterology, Hepatology and Nutrition, Reference Center for Rare Digestive Diseases, Intestinal Rehabilitation Center, Hôpital Necker-Enfants Malades, University of Paris-Descartes, 149 rue de Sèvres, 75015 Paris, France. Electronic address:

Background & Aims: Chronic intestinal failure (CIF) requires long term parenteral nutrition (PN) and, in some patients, intestinal transplantation (ITx). Indications and timing for ITx remain poorly defined. In the present study we aimed to analyze causes and outcome of children with CIF.

Methods: 118 consecutive patients referred to our institution were assessed by a multidisciplinary team and four different categories were defined retrospectively based on their clinical course: Group 1: patients with reversible intestinal failure; group 2: patients unsuitable for ITx, group 3: patients listed for ITx; group 4: patients stable under PN. Analysis involved comparison between groups for nutritional status, central venous catheter (CVC) related complications, liver disease, and outcome after transplantation by using non parametric tests, Mann-Whitney tests, Kruskal-Wallis, Wilcoxon signed rank tests and chi square distribution for percentage.

Results: 118 children (72 boys) with a median age of 15 months at referral (2 months-16 years) were assessed. Etiology of IF was short bowel syndrome [n = 47], intractable diarrhea of infancy [n = 37], total intestinal aganglionosis [n = 18], and chronic intestinal pseudoobstruction [n = 17]. Most patients (89.8%) were totally PN dependent, with 48 children (40.7%) on home-PN prior to admission. Nutritional status was poor with a median body weight at -1.5 z-score (ranges: -5 to +2.5) and median length at -2.0 z-score (ranges: -5.5 to +2.3). The mean number of CVC inserted per patient was 5.2 (range 1-20) and the mean number of CRS per patient was 5.5 (median: 5; range 0-12) Fifty-five patients (46.6%) had thrombosis of ≥2 main venous axis. At admission 34.7% of patients had elevated bilirubin (≥50 μmol/l), and 19.5% had platelets <100,000/ml, and 15% had both. Liver biopsy performed in 79 children was normal (n = 4), or showed F1 or F2 fibrosis (n = 29), bridging fibrosis F3 (n = 20), or cirrhosis (n = 26). Group 1 included 10 children finally weaned from PN (7-years survival: 100%). Group 2 included 12 children with severe liver disease and associated disorders unsuitable for transplantation (7-years survival: 16.6%). Group 3 included 66 patients (56%) who were listed for small bowel or liver-small bowel transplantation, 62/66 have been transplanted (7 years survival: 74.6%). Factors influencing outcome after liver-ITx were body weight (p < .004), length (p < .001), pre-Tx bilirubin plasma level (p < .001) and thrombosis (p < .01) for isolated ITx, Group 4 included 30 children (25.4%) with irreversible IF considered as potential candidates for isolated ITx. Four children were lost from follow up and 3 died within 2 years (survival 88.5%). Among potential candidates, the following parameters improved significantly during the first 12 months of follow up: Body weight (p.0001), length (p < .0001) and bilirubin (p < .0001).

Conclusions: many patients had a poor nutritional status with severe complications especially liver disease. PN related complications were the most relevant indication for ITx, but also a negative predictor for outcome. Early patient referral for Tx-assessment might help to identify and separate children with irreversible IF from children with transient IF or uncomplicated long-term PN, allowing to adapt a patient-based treatment strategy including or not ITx.
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http://dx.doi.org/10.1016/j.clnu.2014.04.015DOI Listing
June 2015

Electrochromic and optical properties of tungsten oxide films deposited with DC sputtering by introducing hydrogen.

Appl Opt 2014 Feb;53(4):A321-9

Research was undertaken to investigate the electrochromic and optical properties of tungsten oxide (WO3) films deposited by introducing hydrogen with a direct current (DC) and pulsed DC sputtering. The results show that WO3 films have optimum electrochromic properties at a hydrogen flow of 4 and 3 sccm for DC and pulsed DC, respectively. In the Raman spectra, the peak intensity increased with the increase of hydrogen flow at both 770  cm1 and 950  cm(-1) peaks, which resulted in bonds of W(6+)-O and W(6+)=O, respectively. Simultaneously, the transmittance (ΔT550  nm) variations were 65.6% and 64.4%, and the average transmittance (ΔT400-500  nm) variations were 56.7% and 56.4% for DC and pulsed DC, respectively. The bleached/colored ability of the cyclic voltammograms (CVs) was DC>pulsed DC, and the resistances of AC impedance were pulsed DC>DC.
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http://dx.doi.org/10.1364/AO.53.00A321DOI Listing
February 2014

Pyogenic Liver Abscess Masquerading as a Hepatic Neoplasm.

J Pediatr Gastroenterol Nutr 2015 Jul;61(1):e2-3

*Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Columbia University Medical Center, New York †Montefiore Medical Center, Bronx, NY.

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http://dx.doi.org/10.1097/MPG.0000000000000254DOI Listing
July 2015

Medical students' health-related quality of life: roles of social and behavioural factors.

Med Educ 2013 Oct;47(10):1001-12

Students' Scientific Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran.

Objectives: The long and demanding course of medical education may be accompanied by distress with serious consequences. This study was conducted to assess the multidimensional health-related quality of life (HR-QoL) in medical students in different stages of medical education and its associations with behavioural and social factors.

Methods: A cross-sectional study was conducted in medical students at three medical schools at, respectively, Tehran University of Medical Sciences, Aja University of Medical Sciences and Baghiyatalah Medical School, in November and December 2011 using stratified sampling. Data were obtained on participants' characteristics, including gender, current education stage, living situation, smoking status, physical activity, and membership of associations or teams. Health-related QoL was measured using the Persian version of the 36-item Short Form Health Survey (SF-36), which generates a physical component score (PCS) and a mental component score (MCS). Logistic regression was applied to measure the adjusted associations between variables.

Results: Of the 1350 students invited, 1086 individuals completed the survey to give a response rate of 80.4%. Logistic regression showed male gender (odds ratio [OR] = 2.88, p < 0.001), living with family versus in a dormitory (OR = 2.72, p < 0.001) and participation in daily physical activity (OR = 16.96, p < 0.001) to be significantly associated with a higher PCS. Being in an internship versus in the basic sciences stage of medical education showed a significant association with a lower PCS (OR = 0.12, p < 0.001). Similarly, male gender (OR = 1.67, p < 0.05), living with family rather than in a dormitory (OR = 16.91, p < 0.001), daily physical activity (OR = 25.36, p < 0.001), and membership of associations or teams (OR = 3.67, p < 0.001) were associated with a higher MCS. Likewise, studying in internship rather than in the basic sciences stage was accompanied by a lower MCS (OR = 0.12, p < 0.001).

Conclusions: This large, multi-institution study, despite its limitations, indicates that medical students in internships show lower scores in all domains of QoL. Social engagement is an important associate of higher HR-QoL. Further studies should address the efficacy of interventions, such as self-awareness programmes and initiatives to encourage students to be more physically and socially active, in improving students' health.
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http://dx.doi.org/10.1111/medu.12247DOI Listing
October 2013

Results of combined radiotherapy and hormonal treatment of prostate cancer patients with initial PSA value >40 ng/ml.

Rep Pract Oncol Radiother 2012 9;17(2):79-84. Epub 2012 Feb 9.

Institute of Radiation Oncology, Faculty Hospital Na Bulovce and 1 Faculty of Medicine, Charles University, Budínova 2, Prague 8, 18000, Czech Republic.

Aim: To evaluate the outcome of prostate cancer patients with initial PSA value >40 ng/ml.

Background: The outcome of prostate cancer patients with very high initial PSA value is not known and patients are frequently treated with palliative intent. We analyzed the outcome of radical combined hormonal treatment and radiotherapy in prostate cancer patients with initial PSA value >40 ng/ml.

Methods: Between January 2003 and December 2007 we treated, with curative intent, 56 patients with non-metastatic prostate cancer and initial PSA value >40 ng/ml. The treatment consisted of two months of neoadjuvant hormonal treatment (LHRH analog), radical radiotherapy (68-78 Gy, conformal technique) and an optional two-year adjuvant hormonal treatment.

Results: The median time of follow up was 61 months. 5-Year overall survival was 90%. 5-Year biochemical disease free survival was 62%. T stage, Gleason score, PSA value, and radiotherapy dose did not significantly influence the outcome. Late genitourinal and gastrointestinal toxicity was acceptable.

Conclusion: Radical treatment in combination with hormonal treatment and radiotherapy can be recommended for this subgroup of prostate cancer patients with good performance status and life expectancy.
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http://dx.doi.org/10.1016/j.rpor.2012.01.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3863225PMC
December 2013

Transparent conductive oxide layer with monolayer closed-pack Al-doped ZnO spheres and their application to a-Si thin-film solar cells.

Opt Lett 2011 Sep;36(18):3678-80

Department of Photonics, Feng-Chia University, Taichung, Taiwan.

We report a new (to the best of our knowledge) transparent conductive oxide (TCO) layer with a monolayer of closed-pack Al-doped ZnO (AZO) spheres partly embedded in an AZO thin film. The average transmittance and haze ratio in the wavelength range of 380-800 nm achieves 65% and 55%, respectively, when AZO spheres with a diameter of 500 nm are embedded in a thickness of 240 nm AZO thin films. The a-Si thin-film solar cell with a regular p-i-n TCO structure is demonstrated. Under air mass 1.5 global illumination, conversion efficiencies of 5.6%, a fill factor of 0.55, V(oc) of 0.81 V, and a J(sc) of 2.44 mA/cm² are obtained. The Letter helps us to open up potential applications of a new TCO in advanced solar cells and light-emitting diodes.
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http://dx.doi.org/10.1364/OL.36.003678DOI Listing
September 2011

Renal transplantation in familial dysautonomia: report of two cases and review of the literature.

Clin J Am Soc Nephrol 2010 Sep 17;5(9):1676-80. Epub 2010 Jun 17.

Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.

Background And Objectives: Chronic kidney disease (CKD) is an increasingly recognized complication of familial dysautonomia (FD), a neurodevelopmental disorder with protean systemic manifestations that are the result of sensory and autonomic dysfunction. Progressive renal dysfunction occurs due to chronic volume depletion and cardiovascular lability with supine hypertension and orthostatic hypotension. By age 25, nearly one-half of all patients with FD will have reached stage 3 CKD. Furthermore, dialysis for ESRD in FD patients is associated with multiple complications and poor outcomes.

Design, Settings, Participants, & Measurements: We report two patients with FD who developed ESRD at ages 27 and 16, respectively, and underwent renal transplantation. Transplant was performed after 3 months on intermittent hemodialysis (HD) in the first case and after 1 month on twice-weekly continuous veno-venous hemodialysis (CVVHD) in the second case.

Results: Both patients tolerated surgery well and have maintained good graft function at 20 and 24 months posttransplantation, respectively. Symptomatic and functional improvements have included lower supine BP and increased sensitivity to antihypertensive agents.

Conclusions: As general supportive care improves the lifespan of FD patients, issues related to the management of ESRD will become more important. Renal transplantation provides a viable alternative to dialysis for FD patients with ESRD.
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http://dx.doi.org/10.2215/CJN.01750210DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2974411PMC
September 2010

Genitourinary involvement in epidermolysis bullosa: clinical presentations and therapeutic challenges.

BJU Int 2010 Dec;106(11):1763-6

Paediatric Urology Research Center, Department of Urology, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: To present our experience of children with epidermolysis bullosa (EB; a rare bullous disorder of the skin) with genitourinary involvement.

Patients And Methods: The medical records of eight children diagnosed with EB (six junctional and two dystrophic type) with genitourinary involvement were reviewed retrospectively. The data collected included age, clinical presentation, ultrasonographic findings, voiding cystourethrography, urodynamic and uroflowmetry studies, and the treatment challenges. The outcomes of the interventions were evaluated every 6 months.

Results: The mean age was 2.3 years (range 1 day to 7 years). The most common clinical presentations were urinary retention and voiding difficulty. Meatomy was performed in two of three boys followed by diminution of urological complaints. In children with vesico-ureteric reflux, subureteric injections of bulking agent and ureteric stenting were satisfactory. Detrusor instability and bladder compliance improved after α-blocker therapy. The mean (range) follow-up was 62.6 (11-120) months except for two who died in early infancy.

Conclusions: Considering the potential urological involvement in every child with EB it is essential to provide patients with early appropriate treatment. Management of urological problems should preferably be in a way to entail minimal interventions and if required be performed using small sized instruments. Medical therapy seems promising for voiding dysfunction in this subset of patients.
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http://dx.doi.org/10.1111/j.1464-410X.2010.09399.xDOI Listing
December 2010

Haze ratio enhancement using a closely packed ZnO monolayer structure.

Opt Express 2010 Jan;18(2):662-9

Department of photonics, Feng-Chia University, Taichung, Taiwan.

A ZnO thin-film that comprised a ZnO monolayer close-packed structure embedded in ZnO sol-gel was fabricated. The structure contained ZnO spheres of various sizes. At normal incidence, the mean optical transmittance of the thin-film was 60% in the visible region when the structure contained spheres with a diameter of 300 nm. An average haze ratio of 80% was obtained from the thin-film when the structure was formed using 500 nm-diameter spheres. The thin-film exhibits broad-band transparency and a high haze ratio. It can be used as a light-trapping structure in an ultrathin solar cell.
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http://dx.doi.org/10.1364/OE.18.000662DOI Listing
January 2010