Publications by authors named "Mohammad Behgam Shadmehr"

47 Publications

Prediction of Patient's Adherence to the Post-Intubation Tracheal Stenosis Follow-up Plan in Iran: Application of two Data Mining Techniques.

Tanaffos 2020 Dec;19(4):330-339

Department of Health information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.

Background: Timely diagnosis of post-intubation tracheal stenosis (PITS), which is one of the most serious complications of endotracheal intubation, may change its natural history. To prevent PITS, patients who are discharged from the intensive care unit (ICU) with more than 24 hours of intubation should be actively followed-up for three months after extubation. This study aimed to evaluate the abilities of artificial neural network (ANN) and decision tree (DT) methods in predicting the patients' adherence to the follow-up plan and revealing the knowledge behind PITS screening system development requirements.

Materials And Methods: In this cohort study, conducted in 14 ICUs during 12 months in ten cities of Iran, the data of 203 intubated ICU-discharged patients were collected. Ten influential factors were defined for adherences to the PITS follow-up (P<0.05). A feed-forward multilayer perceptron algorithm was applied using a training set (two-thirds of the entire data) to develop a model for predicting the patients' adherence to the follow-up plan three months after extubation. The same data were used to develop a C5.0 DT in MATLAB 2010a. The remaining one-third of data was used for model testing, based on the holdout method.

Results: The accuracy, sensitivity, and specificity of the developed ANN classifier were 83.30%, 72.70%, and 89.50%, respectively. The accuracy of the DT model with five nodes, 13 branches, and nine leaves (producing nine rules for active follow-up) was 75.36%.

Conclusion: The developed classifier might aid care providers to identify possible cases of non-adherence to the follow-up and care plans. Overall, active follow-up of these patients may prevent the adverse consequences of PITS after ICU discharge.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088141PMC
December 2020

Clinical Significance of Quantitative FDG PET/CT Parameters in Non-Small Cell Lung Cancer Patients.

Tanaffos 2020 Jul;19(3):186-194

Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: An initial evaluation of non-small cell lung cancer (NSCLC) patients with 18F- fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan can modify treatment planning. We investigated the clinical significance of FDG PET/CT quantitative parameters (QPs) in NSCLC patients.

Materials And Methods: We included 125 NSCLC patients for initial staging FDG PET/CT scan. The primary tumor (T), regional lymph node metastases (N), and distant metastases (M) were evaluated on FDG PET/CT images. QPs, including standard uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were calculated separately for each T, N, and M lesion and also for the whole body. Statistical analysis through SPSS version 22 was used to evaluate the clinical significance of PET/CT QPs concerning primary tumor pathology characteristics, initial tumor stage, and patient's prognosis.

Results: We followed the patients for 19.28 (±11.42) months. Considering primary tumor pathology, there was a significant difference in FDG PET/CT QPs, including primary tumor SUVmax (p=0.00), metastases SUVmax (p=0.014), whole-body MTV (p=0.045), and whole-body TLG (p=0.002). There was also a significant difference in QPs, including primary tumor SUVmax (p=0.00) and regional lymph node metastases SUVmax (p=0.048) when accounting for tumor initial stage. There was a significant prognostic value for the whole-body TLG (p=0.01) and a cut-off point of 568 was reached to differentiate better versus worse survival outcome.

Conclusion: We demonstrated a statistically significant difference in FDG PET/CT QPs when accounting for primary NSCLC pathology characteristics and initial stage, as well as patient's prognosis, and recommend incorporating QP values into clinical PET/CT reports.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008410PMC
July 2020

Investigation the Role of Autophagy in Non-Small Cell Lung Cancer.

Asian Pac J Cancer Prev 2021 Mar 1;22(3):947-955. Epub 2021 Mar 1.

Department of Genetics and Biotechnology, School of Biological Science, Varamin Pishva Branch, Islamic Azad University, Varamin, Iran.

Objective: Recent studies have shown the role of autophagy in different types of cancer including lung cancer. MicroRNAs are considered as key factors in regulation of autophagy related genes. miR-30d, miR-204-5p and miR-20a are regulatory markers which can suppress the expression of beclin1, LC3, bcl2 and ULK1 as their target genes and they lead to decrement of autophagy in human cancer cells. Moreover, epigenetic modifications DNA methylation has been indicated in regulation of autophagy in different stages of cancer.

Methods: In this study, the expression levels of miR-30d, miR-204-5p and miR-20a as well as their target genes were analyzed in 30 non-small cell lung cancers (NSCLCs) patients sample and adjacent normal tissues by real-time qPCR. In addition, DNA methylation of beclin1, LC3, bcl2 and ULK1 genes were assessed by MS-HRM method.

Results: MiR-30d (p value= 0.01) and miR-204-5p (P=0.048) significantly down-regulated in tumor samples compared to normal adjacent tissues, while there was no significant change in expression level of miR-20a. On the other hand, target genes expression level was significantly increased in NSCLC tissues, however methylation pattern of the target gene promoters, did not show any significant alteration.

Conclusion: These results indicate roles for miR-30d, miR-204-5p as tumor suppressor genes as well as target genes as oncogenes in NSCLC patients. Although these factors may have a significant role in NSCLC progression, further studies are necessary to investigate the implications of these findings for treatment of lung cancer. 
.
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http://dx.doi.org/10.31557/APJCP.2021.22.3.947DOI Listing
March 2021

Postintubation Multisegmental Tracheal Stenosis, a 24-Year Experience.

Ann Thorac Surg 2020 Nov 21. Epub 2020 Nov 21.

Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

Background: Management of Multisegmental Tracheal Stenosis (MSTS) is challenging. In this 24-year longitudinal single-center study, we present an algorithmic treatment approach.

Methods: A retrospective analysis of 2167 patients with post-intubation tracheal stenosis indicated 83 (3.83%) patients with MSTS. Patients were assigned to four management groups according to the length, location, and severity of stenoses, tracheal infection/mucositis, laryngeal function, symptoms, general condition, and comorbid diseases. Type-1 (n=13): one-stage resection of both strictures, Type-2 (n=6): two-stage resection of both strictures, Type-3 (n=40): resection of one stricture and non-resectional management of the other one, Type-4 (n=24): non-resectional management of both strictures. Outcomes were categorized as Good, Acceptable, or Poor. Univariate analyses for factors predictive of recurrence and outcome were performed.

Results: Follow-ups were completed in 70 (84.34%) patients (median 22.5 months). Outcome was assessed as Good in 56 (82.35%), Acceptable in 10 (14.71%), Poor in 2 (2.94%), and mortality in 2 (2.94%) patients. The median length of airway resection was 46, 67.5, and 40 mm in Types 1-3, respectively. Only 11 (13.25%) patients had no history of tracheostomy or tracheal surgery. By univariate analysis, a shorter intubation period was associated with Good outcome (p=0.017). No factors predictive of recurrence or outcome were ascertained.

Conclusions: MSTS, generally caused by performing an inappropriate tracheostomy, is an iatrogenic disease that can be prevented. Although resection of both strictures may be feasible and is associated with Good results, in the majority of cases, a combination of surgical resection and non-resectional methods are sufficient to achieve Good results.
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http://dx.doi.org/10.1016/j.athoracsur.2020.10.026DOI Listing
November 2020

Idiopathic Subglottic Tracheal Stenosis in Identical Twin Sisters.

Iran J Otorhinolaryngol 2019 Jul;31(105):243-245

Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction: Idiopathic subglottic tracheal stenosis is a rare inflammatory disease of the trachea; most commonly affects females within the age range of 20-50 years. No etiologic factor has yet been identified for this rare tracheal disease and therefore it should be diagnosed after the exclusion of other inflammatory, traumatic, and autoimmune diseases of the trachea. The familial or genetic predisposition to this disease is still unknown although one published report in the literature showed some familial predisposition.

Case Report: A 41-year old woman presented with progressive dyspnea and stridor. The bronchoscopic evaluation revealed subglottic tracheal stenosis; however, there was no significant etiology of this disease after complete evaluations. Therefore, the idiopathic subglottic stenosis was the final diagnosis. After two years, her identical twin sister presented with the same signs and symptoms. There was also no etiology for her tracheal stenosis. The first patient was managed surgically through cricotracheal resection. However, the second sister didn't need surgical resection due to the mild to moderate tracheal stenosis.

Conclusion: The obtained results of our cases along with the previously reported family cases can potentiate the hypothesis that there is some genetic predisposition to the development of this disease.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6666938PMC
July 2019

Technical Details of Surgical Treatment of a Severely Displaced Sternal Fracture.

Tanaffos 2019 Apr;18(4):365-368

Tracheal Diseases Research Center (TDRC), National Research institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Sternal fracture is an uncommon injury, which is managed conservatively in most patients. In case of failure of non-surgical management or severely displaced fractures, open reduction and internal fixation should be considered. In this case report, we present the technical details of open reduction and internal fixation for a severely displaced sternal fracture in a bicyclist. The sternal fracture was successfully treated, and the patient benefited from the rapid control of symptoms, early mobilization, and good cosmetic outcome.

Conclusion: Open surgical treatment of a sternal fracture, when indicated, can be performed safely, with rapid control of symptoms, low risk of non-union, and good cosmetic outcome.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309882PMC
April 2019

Expression of long non-coding RNAs (lncRNAs) has been dysregulated in non-small cell lung cancer tissues.

BMC Cancer 2019 Mar 12;19(1):222. Epub 2019 Mar 12.

Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Non-small cell lung cancer (NSCLC) as the most frequent type of lung cancer is associated with extensive mortality. Researchers have studied the suitability of several molecules as biomarkers for early detection of this cancer. Long non-coding RNAs (lncRNAs) as the main regulators of gene expression have also been assessed in this regard.

Methods: In the present study, we compared expression level of Fas-antisense 1 (FAS-AS1), Growth Arrest Specific 5 (GAS5), PVT1, Nuclear Paraspeckle Assembly Transcript 1 (NEAT1), HOXA transcript antisense RNA myeloid-specific 1 (HOTAIRM1), taurine upregulated gene 1 (TUG1) and TNFα and hnRNPL related immunoregulatory LincRNA (THRIL) in 32 NSCLC samples and their corresponding adjacent non-cancerous tissues (ANCTs).

Results: NEAT1 has been significantly over-expressed in NSCLC tissues obtained from male subjects compared with the corresponding ANCTs (Relative expression (REx) = 3.022, P = 0.019) but not in female subjects (P = 0.975). FAS-AS1 was significantly down-regulated in NSCLC tissues obtained from both males and females subjects compared with the corresponding ANCTs (REx = - 4.12 and - 3.14, P = 0.015 and 0.033 respectively). TUG1, GAS5, THRIL and HOTAIRM1 were significantly down-regulated in tumoral tissues obtained from male subjects compared with the corresponding ANCTs.

Conclusions: The observed dysregulation of these lncRNAs in NSCLC tissues compared with the corresponding ANCTs warrants future studies to confirm the results of the current study in larger sample sizes to elaborate their role as cancer biomarkers.
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http://dx.doi.org/10.1186/s12885-019-5435-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6417110PMC
March 2019

The Development of a Four-Electrode Bio-Impedance Sensor for Identification and Localization of Deep Pulmonary Nodules.

Ann Biomed Eng 2018 Aug 23;46(8):1079-1090. Epub 2018 Apr 23.

Department of Thoracic Surgery, Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Identifying and localizing of deep pulmonary nodules are among the main challenges that thoracic surgeons face during operations, particularly in thoracoscopic procedures. To facilitate this, we have tried to introduce a non-invasive and safe method by measuring the lung electrical bio-impedance spectrum with a four-electrode array sensor. To study the feasibility of this method, since any change in the depth or diameter of the nodule in the lung tissue is not practical, we used the finite element modeling of the lung tissue and pulmonary nodule to allow changes in the depth and diameter of the nodule, as well as the distance in between the injection electrodes. Accordingly, a bio-impedance sensor was designed and fabricated. By measuring the electrical impedance spectrum of pulmonary tissues in four different specimens with a frequency band of 50 kHz to 5 MHz, 4 pulmonary nodules at four different depths were identified. The obtained bio-impedance spectrum from the lung surface showed that the magnitude and phase of electrical bio-impedance of the tumoral tissue at each frequency is smaller than that of the healthy tissue. In addition, the frequency characteristic varies in the Nyquist curves for tumoral and healthy lung tissues.
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http://dx.doi.org/10.1007/s10439-018-2032-8DOI Listing
August 2018

Identification of Pulmonary Nodules by Sweeping the Surface of the Lung with an Electrical Bioimpedance Probe: A Feasibility Study.

J Invest Surg 2019 Nov 19;32(7):614-623. Epub 2018 Mar 19.

Department of Thoracic Surgery, Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences , Tehran , Iran.

: Identifying and localizing the invisible and nonpalpable pulmonary nodules are among the main challenges surgeons face during open and thoracoscopic surgeries. This study explores the feasibility of utilizing a simple and safe electrical bioimpedance probe in locating the pulmonary nodules by sweeping the surface of the lung tissue. : A probe was designed with four spherical electrodes that were used for recording the bioimpedance spectrum of the lung tissue in a frequency range of 50 kHz to 5 MHz. In each of the 10 resected surgical specimens, the bioimpedance of normal lung tissue as well as the tumoral lung tissue were recorded and compared with each other. : By drawing the Nyquist curves, it was determined that the amplitude of the electrical impedance measured by moving the probe from the healthy point to the region of the pulmonary nodule decreases and the frequency characteristics of the bioimpedance spectrum increases. : This method could be potentially beneficial in the localization of invisible and even nonpalpable in-depth pulmonary nodules in thoracic surgeries.
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http://dx.doi.org/10.1080/08941939.2018.1446106DOI Listing
November 2019

Obstructive Tracheal Pseudomembrane.

Arch Iran Med 2017 Nov 1;20(11):714-715. Epub 2017 Nov 1.

1 Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Obstructive tracheal pseudomembrane is a rare complication of endotracheal intubation, which could cause fatal airway obstruction following extubation. Hereby, we reported a patient who had only undergone a short course of intubation for a laparoscopic cholecystectomy and developed progressive respiratory distress after extubation.
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November 2017

Investigation of the Mechanical Properties of the Human Tracheal Cartilage.

Tanaffos 2017 ;16(2):107-114

Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: The tracheal cartilage plays an important role in maintaining the mechanical stability of the trachea, as it keeps the trachea open and prevents its collapse under the negative pressures of the respiratory cycle. This study aimed to evaluate and compare the mechanical properties of cartilage specimens from the cranial and caudal regions of the human trachea and compare the results with respect to age and sex of the subjects.

Materials And Methods: After obtaining human trachea samples from brain-dead, organ-donating patients and storing them in appropriate conditions, the prepared cartilage samples from the cranial and caudal regions of the trachea were subjected to uniaxial tension and stress relaxation experiments to obtain the corresponding Young's modulus and relaxation percentage values, respectively. The results were compared in terms of the position (cranial or caudal) in the trachea, and age and sex of the patients.

Results: Based on the results, no statistically significant effect of the position in the trachea on the Young's modulus of the human tracheal cartilage samples was observed, despite the generally stiffer behavior of cartilage samples from the cranial region compared to those from the caudal region of the trachea. For both the cranial and caudal regions, no significant effect of sex on the stiffness of the tracheal cartilage was observed; further, the cartilage samples of the human trachea (from both cranial and caudal regions) of the old subjects were significantly stiffer than those of the young subjects. Based on the stress relaxation data, no significant effect of age, sex, or position on the relaxation percentage was observed.

Conclusion: The tracheal cartilage samples of the old patients are significantly stiffer than those of the young patients. Sex and position in the trachea (cranial vs caudal) do not significantly influence the mechanical properties of the human tracheal cartilage samples. The results of this study can be useful in designing tracheal tissue-engineered scaffolds, which should be mechanically compatible with the native trachea.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749323PMC
January 2017

Identifying and Localizing of the In-depth Pulmonary Nodules Using Electrical Bio-Impedance.

J Invest Surg 2019 Apr 18;32(3):208-217. Epub 2017 Dec 18.

b Department of Thoracic Surgery , Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences , Tehran , Iran.

Intraoperative localization of small and in-depth pulmonary nodules particularly during video-assisted thoracoscopic surgery (VATS), is one of the main challenges for Thoracic surgeons. Failure to determine the location of nodules may lead to a large incision in the normal lung tissue or the conversion of the minimally invasive surgery to an open thoracotomy. The aim of this study is to evaluate the use of electrical bio-impedance measurement to precisely determine the position of in-depth pulmonary nodules and tumors, which are not visible during thoracoscopic surgeries or even are not palpable during open thoracic surgeries. With this regard, a suitable bio-impedance sensor similar to a biopsy forceps has been designed in order to measure the lung tissue bio-impedance. Using the available data on the electrical properties recorded from lung tissue during inhalation and exhalation, combined with the tumor modeling in COMSOL software, the effect of different parameters including the size and depth of tumor and the relative difference of electrical properties between healthy and tumoral tissue has been assessed. Furthermore, the geometric characteristics of the proposed sensor are considered. The results generally verify that larger size of nodules results in an easier distinguishing process. Additionally, it is worthy to note that applying a larger geometrically sensor is essential to detect the small and in-depth nodules.
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http://dx.doi.org/10.1080/08941939.2017.1394403DOI Listing
April 2019

An Overview of Tracheal Stenosis Research Trends and Hot Topics.

Arch Iran Med 2017 Sep;20(9):598-607

Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Tracheal stenosis remains a challenge in the thoracic surgery field. Recognizing the hot topics and major concepts in this area would help the health policy makers to determine their own priorities and design the effective research plans. The present study analyzed and mapped the topics and trends of tracheal stenosis studies over time as well as authors' and countries' contributions.

Materials And Methods: Search results were obtained employing Bibexcel. To determine cold and hot topics, co-occurrence analysis was applied using three international databases 'Web of Science', 'PubMed' and 'Scopus'. Appropriately, different categories in the articles such as keywords, authors, and countries were explored via VOSviewer and NetDraw. Afterward, the trends of research topics were depicted in four time-intervals from 1945 to 2015 by ten co-occurrence terms.

Results: The majority of articles were limited to case series and retrospective studies. The studies had been conducted less frequently on prevention, risk factors and incidence determination but extensively on treatment and procedures. Based on the articles indexed in WOS, 45 countries and 8,260 authors have contributed to scientific progress in this field. The highest degree of cooperation occurred between the USA and England with 15 common papers.

Conclusions: Most of the published literature in tracheal stenosis research field was about surgical and non-surgical treatments. Conducting the screening and prevention studies would diminish the burden of this disease on the health system as well as the patients and their families' well-being.
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http://dx.doi.org/0172009/AIM.008DOI Listing
September 2017

In-vivo characterization of a 3D hybrid scaffold based on PCL/decellularized aorta for tracheal tissue engineering.

Mater Sci Eng C Mater Biol Appl 2017 Dec 4;81:74-83. Epub 2017 May 4.

Faculty of Biomedical Engineering, AmirKabir University of Technology, Iran.

Introduction: As common treatments for long tracheal stenosis are associated with several limitations, tracheal tissue engineering is considered as an alternative treatment.

Aim Of Study: This study aimed at preparing a hybrid scaffold, based on biologic and synthetic materials for tracheal tissue engineering.

Materials And Methods: Three electrospun polycaprolactone (PCL) scaffolds, namely E1 (pure PCL), E2 (collagen-coated PCL) and E3 (PCL blended with collagen) were prepared. Allogeneic aorta was harvested and decellularized. A biodegradable PCL stent was fabricated and inserted into the aorta to prevent its collapse.

Result: Scaffold characterization results revealed that the 2-h swelling ratio of E2 was significantly higher than those of E1 and E3. In the first 3months, E2 and E3 exhibited almost equal degradabilities (significantly higher than that of E1). Moreover, tensile strengths of all samples were comparable with those of human trachea. Using rabbit's adipose-derived mesenchymal stem cells (AMSCs) and primary chondrocytes, E3 exhibited the highest levels of GAG release within 21days as well as collagen II and aggrecan expression. Fot the next step, AMSC-chondrocyte co-culture seeded scaffold was sutured to the acellular aorta, implanted into rabbits' muscle, and finally harvested after 4weeks of follow up.

Conclusion: Harvested structures were totally viable due to the angiogenesis created by the muscle. H&E and alcian blue staining results revealed the presence of chondrocytes in the structure and GAG in the produced extracellular matrix. Since tracheal replacement using biologic and synthetic scaffolds usually results in tracheal collapse or granulation formation, a hybrid construct may provide the required rigidity and biocompatibility for the substitute.
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http://dx.doi.org/10.1016/j.msec.2017.04.150DOI Listing
December 2017

Colopharyngoplasty in Patients with Severe Pharyngoesophageal Corrosive Injury: A Complicated but Worthwhile Procedure to Restore GI Tract Continuity, A Case Series.

Tanaffos 2017 ;16(1):68-75

Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Pharyngoesophageal strictures (PES) after corrosive injury impose a problematic condition for both physicians and patients in terms of their management and patients' quality of life. Colopharyngoplasty is a complex procedure, which is used to restore swallowing in these severely disabled patients. We describe our experience in treating nine patients with severe PES after corrosive injuries in a referral center.

Materials And Methods: A retrospective analysis of our database from 2009 to 2014 showed nine patients (seven men; age range: 18 to 47 years) with severe PES who underwent colopharyngoplasty ∼6 months (range: 4-10) after caustic material ingestion. All patients had a feeding jejunostomy tube before reconstruction. Esophagectomy with or without gastrectomy was performed in all patients, except for one; thereafter, an isoperistaltic segment of the left colon was pulled up, and a pharyngocolic anastomosis was performed. Eight patients had a tracheostomy created either before reconstruction due to respiratory symptoms or at the time of definitive surgery to prevent aspiration in the early post-operative period.

Results: Almost all survivors had a satisfactory swallowing at the end of the follow-up (range: 4-60 months). The jejunostomy tube could be removed in all of the patients after a median of 5 months. One patient died of sepsis due to graft necrosis in the immediate post-operative period. Another patient died 5 months after the first surgery following a revision surgery for intractable dysphagia. At the end of the follow-up, only one patient tolerated tracheostomy tube decannulation. Two patients required laryngotracheal dissociation because of massive aspiration and recurrent episodes of pneumonia. Five patients still had a tracheostomy because of an severely destroyed larynx (two patients) and aspiration (three patients).

Conclusion: Colopharyngoplasty is considered a complicated but trustworthy procedure to restore gastrointestinal tract continuity after severe corrosive injury. Undeniably, laryngeal involvement adversely affects the functional outcome. The post-operative course is frequently protracted, accompanied with several problems. Aspiration is nearly the most problematic event in the early post-operative period, which mandates a multidisciplinary approach to manage it.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473385PMC
January 2017

Item Selection and Content Validity of the Risk Factors of Post-Intubation Tracheal Stenosis Observation Questionnaire for ICU-Admitted Patients.

Tanaffos 2017 ;16(1):22-33

Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Laryngotracheal stenosis as a late complication of prolonged endotracheal intubation is a life-threatening event. In order to determine the related risk factors for this complication, which may vary among different countries, designing a valid questionnaire is necessary. The aim of this study was to select the items and evaluate the face and content validities of a questionnaire developed for assessment of risk factors of post-intubation tracheal stenosis (PITS) in patients admitted in the intensive care unit.

Materials And Methods: A mixed method study design was used in four steps in 2015, i.e., 1) a literature review, 2) focus groups with five experts in the field, 3) consultations with intensive care unit (ICU) specialists and thoracic surgeons, and 4) evaluation of content and face validity with 15 experts in a scientific panel using two self-administered questionnaires. Content validity index (CVI) was computed for individual items as well as the overall scale.

Results: We extracted the items from different sources of information. An initial version of the 52-item questionnaire was developed and classified into four domains including patient characteristics, intubation features, equipment-drugs, and complications. The items with an excellent modified kappa were included in the questionnaire. Five questions received more criticism instead of support and were removed (Item-CVI<0.55, fair modified kappa). The ones with an Item-CVI > 0.60 and a good modified kappa were revised, merged, or retained. The new 43-item questionnaire found a scale-level CVI, averaging (Scale-CVI/Ave) of 0.91.

Conclusion: The PITS risk factors questionnaire was developed and validated through item selection, expert opinions, and content validity index.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473379PMC
January 2017

Surgical Antibiotic Prophylaxis: A Descriptive Study among Thoracic Surgeons.

Tanaffos 2016 ;15(3):154-159

Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Surgical site infections (SSIs) are common complications following surgeries and increase mortality, morbidity and healthcare costs. The use of antimicrobial prophylaxis is an effective measure to prevent development of SSIs. This study aimed to evaluate the current use of prophylactic antibiotics in thoracic surgeries in Iran.

Materials And Methods: A descriptive study was conducted among thoracic surgeons in order to assess their knowledge, attitude and practice (KAP) about surgical antibiotic prophylaxis (SAP). A four-section multiple-choice questionnaire was designed and hand-delivered to registered thoracic surgeons. The surgeons' answers were considered correct when they were in accordance to the American Society of Health-System Pharmacist (ASHP) guidelines.

Results: Seventy thoracic surgeons were requested to participate in this study and their response rate was 71.4%. Thirty-five (70%) surgeons had good knowledge about appropriate SAP. However, less than half of the respondents were aware of appropriate SAP in case of Ig E-mediated reaction to penicillin and risk of Gram-negative infections. The surgeon's attitude score about the need for local and national guidelines for SAP was 78% and 90%, respectively. Accordance of the physician's practice with ASHP guidelines regarding timing of the first dosage of SAP was acceptable while correct administration of an intraoperative dose was 40% in agreement with the guideline.

Conclusion: Although thoracic surgeons had a good attitude towards antibiotic prophylaxis guidelines, their knowledge and practice should be improved for proper administration of SAP.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5304959PMC
January 2016

Incidence Rate of Post-Intubation Tracheal Stenosis in Patients Admitted to Five Intensive Care Units in Iran.

Iran Red Crescent Med J 2016 Sep 2;18(9):e37574. Epub 2016 Aug 2.

Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.

Background: Tracheal stenosis is one of the worst complications associated with endotracheal intubation and it is the most common reason for reconstructive airway surgeries. Due to various local risk factors, the incidence rate of tracheal stenosis may vary in different countries. In order to estimate the incidence rate of post-intubation tracheal stenosis (PITS) in patients admitted to an intensive care unit (ICU), a follow-up study was planned. As there was no similar methodological model in the literature, a feasibility step was also designed to examine the whole project and to enhance the follow-up rate.

Objectives: To estimate the PITS incidence rate in patients admitted to ICUs, as well as to evaluate the feasibility of the study.

Methods: This prospective cohort study was conducted in five hospitals in two provinces (Tehran and Arak) of Iran from November 2011 to March 2013. All patients admitted to ICUs who underwent more than 24 hours of endotracheal intubation were included. Upon their discharge from the ICUs, the patients received oral and written educational materials intended to ensure a more successful follow-up. The patients were asked to come back for follow-up three months after their extubation, or sooner in case of any symptoms developing. Those with dyspnea or stridor underwent a bronchoscopy. The asymptomatic patients were given a spirometry and then they underwent a bronchoscopy if the flow-volume loop suggested airway stenosis.

Results: Some seventy-three patients (70% men) were included in the study. Multiple trauma secondary to motor vehicle accidents (52%) was the most common cause of intubation. Follow-ups were completed in only 14 (19.2%, CI = 0.109 - 0.300) patients. One patient (7%, CI = 0.007 - 0.288) developed symptomatic tracheal stenosis that was confirmed by bronchoscopy. The barriers to a successful follow-up were assessed on three levels: ineffective oral education upon discharge, improper usage of educational materials, and difficulties to attending follow-up visits. There were also some important obstacles in terms of human, time, material, and cost resources, as well as data management.

Conclusions: To enhance the follow-up rate, three strategies were proposed: patient-focused strategies such as emphasizing patient education upon discharge and providing rewards; structural-focused strategies such as scheduling home visits and uploading questionnaires onto the research center's website; and provider-focused strategies such as selecting coordinators with good communication skills. All necessary resources should also be re-arranged for a multicenter national study.
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http://dx.doi.org/10.5812/ircmj.37574DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5253460PMC
September 2016

Fabrication of Chitosan Silk-based Tracheal Scaffold Using Freeze-Casting Method

Iran Biomed J 2017 07 9;21(4):228-39. Epub 2017 May 9.

Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran.

Background: Since the treatments of long tracheal lesions are associated with some limitations, tissue engineered trachea is considered as an alternative option. This study aimed at preparing a composite scaffold, based on natural and synthetic materials for tracheal tissue engineering.

Methods: Nine chitosan silk-based scaffolds were fabricated using three freezing rates (0.5, 1, and 2°C/min) and glutaraldehyde (GA) concentrations (0, 0.4, and 0.8 wt%). Samples were characterized, and scaffolds having mechanical properties compatible with those of human trachea and proper biodegradability were selected for chondrocyte cell seeding and subsequent biological assessments.

Results: The pore sizes were highly influenced by the freezing rate and varied from 135.3×372.1 to 37.8×83.4 µm. Swelling and biodegradability behaviors were more affected by GA rather than freezing rate. Tensile strength raised from 120 kPa to 350 kPa by an increment of freezing rate and GA concentration. In addition, marked stiffening was demonstrated by increasing elastic modulus from 1.5 MPa to 12.2 MPa. Samples having 1 and 2°C/min of freezing rate and 0.8 wt% GA concentration made a non-toxic, porous structure with tensile strength and elastic modulus in the range of human trachea, facilitating the chondrocyte proliferation. The results of 21-day cell culture indicated that glycosaminoglycans content was significantly higher for the rate of 2°C/min (12.04 µg/min) rather than the other (9.6 µg/min).

Conclusion: A homogenous porous structure was created by freeze drying. This allows the fabrication of a chitosan silk scaffold cross-linked by GA for cartilage tissue regeneration with application in tracheal regeneration.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5459938PMC
http://dx.doi.org/10.18869/acadpub.ibj.21.4.228DOI Listing
July 2017

An Investigation of Topics and Trends of Tracheal Replacement Studies Using Co-Occurrence Analysis.

Tissue Eng Part B Rev 2017 04 22;23(2):118-127. Epub 2016 Nov 22.

1 Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences , Tehran, Iran .

This study evaluated tracheal regeneration studies using scientometric and co-occurrence analysis to identify the most important topics and assess their trends over time. To provide the adequate search options, PubMed, Scopus, and Web of Science (WOS) were used to cover various categories such as keywords, countries, organizations, and authors. Search results were obtained by employing Bibexcel. Co-occurrence analysis was applied to evaluate the publications. Finally, scientific maps, author's network, and country contributions were depicted using VOSviewer and NetDraw. Furthermore, the first 25 countries and 130 of the most productive authors were determined. Regarding the trend analysis, 10 co-occurrence terms out of highly frequent words were examined at 5-year intervals. Our findings indicated that the field of trachea regeneration has tested different approaches over the time. In total, 65 countries have contributed to scientific progress both in experimental and clinical fields. Special keywords such as tissue engineering and different types of stem cells have been increasingly used since 1995. Studies have addressed topics such as angiogenesis, decellularization methods, extracellular matrix, and mechanical properties since 2011. These findings will offer evidence-based information about the current status and trends of tracheal replacement research topics over time, as well as countries' contributions.
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http://dx.doi.org/10.1089/ten.TEB.2016.0254DOI Listing
April 2017

The Role of Systemic Steroids in Postintubation Tracheal Stenosis: A Randomized Clinical Trial.

Ann Thorac Surg 2017 Jan 29;103(1):246-253. Epub 2016 Jul 29.

Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

Background: Most patients with postintubation tracheal stenosis are not ideal candidates for airway resection at presentation and their airways must be temporarily kept open by repeated bronchoscopic dilation (RBD). Meanwhile, some sufficiently recover by RBD without further airway resection requirement. We hypothesized whether systemic corticosteroids could lengthen RBD intervals, decrease the number of patients who eventually need airway resection, and shorten the required length of airway resection.

Methods: Between February 2009 and November 2012, a randomized double-blind clinical trial with a 1:1 ratio (corticosteroids group [group C], prednisolone 15 mg/day; placebo group [group P]) was conducted on 120 patients without tracheostomy or T tube and in no ideal situation for airway resection at presentation, whose precipitating injury had occurred recently. All underwent RBD until they became asymptomatic or prepared for airway resection. Asymptomatic patients received the capsules (prednisolone or placebo) for 6 months; others discontinued them before surgery. Those requiring RBD at short intervals underwent tracheostomy or T tube placement and were then excluded. Follow-up terminated 6 months after airway resection or capsule discontinuation.

Results: There were 105 patients (72 male; 50 in group C), aged 15 to 64 years, who completed their follow-up. There was no significant difference between the two groups in age, sex, history of tracheostomy, intubation cause and duration, time interval between intubation and initial bronchoscopy, length of stenosis, and subglottic involvement. Our study showed a trend for RBD with longer intervals (22 days), and fewer operations, 17% (28 of 50 versus 40 of 55) in group C, although statistically insignificant. Furthermore, the required airway resection length became significantly shorter (5.3 mm) in group C.

Conclusions: Early low-dose systemic corticosteroids can be beneficial in postintubation tracheal stenosis management.
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http://dx.doi.org/10.1016/j.athoracsur.2016.05.063DOI Listing
January 2017

Abberent expression of oncogenic and tumor-suppressive microRNAs and their target genes in human adenocarcinoma alveolar basal epithelial cells.

J Cancer Res Ther 2016 Jan-Mar;12(1):395-400

Department of Molecular Medicine, Biotechnology Research Center, Pasture Institute of Iran, Tehran, Iran.

Context: Lung cancer is one of the most serious types of cancer that often diagnosed at advanced stage. MicroRNAs (miRNAs) are small non-coding molecules which silence gene expression of target gene (s) at posttranscriptional level. They are key regulators of cell cycle, apoptosis, anti-cancer drug responsiveness and metastasis.

Aims: Identification of the differential expression level of miR-15a/16, miR-21, miR-34a, miR-126, miR-128 and miR-210 in A549 cell line versus normal tissues and their correlation with selected corresponding target genes.

Materials And Methods: A549 cell line was cultured in F-12K medium and miRNA was extracted from normal tissues (2-3 cm adjacent to tumor tissue) and A549 cell line. cDNA was synthesized with specific stem-loop primers for each miRNA, while OligodT primer was used for target genes cDNA synthesis. Real-time quantitative polymerase chain reaction. (RT-qPCR) was used to analyze the expression pattern of miRNAs and target genes in A549 and normal non-small cell lung carcinoma. (NSCLC) tissues.

Results: miR-15a/16, miR-34a, miR-126 and miR-128 were down-regulated significantly. (>2-fold change), while miR-21 and miR.210 were up-regulated in A549. Bcl-2 as miR-34a target gene was down-regulated while Hif-1α and Akt-3 were up-regulated that might be miR-210 and miR-34a target genes, respectively.

Conclusion: The significant differential expression level of these miRNAs made them as candidate biomarkers in NSCLC tumor tissues of patients. Perhaps Bcl-2 down-regulation and Akt-3 up-regulation can be linked with survival signals in A549 cell line. We can conclude that Bcl-2 and Akt-3 might be therapeutic targets to inhibit cell proliferation in NSCLC.
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http://dx.doi.org/10.4103/0973-1482.148673DOI Listing
December 2016

Overexpression of the non-coding SOX2OT variants 4 and 7 in lung tumors suggests an oncogenic role in lung cancer.

Tumour Biol 2016 Aug 4;37(8):10329-38. Epub 2016 Feb 4.

Department of Molecular Genetics, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran.

Despite the advances in cancer therapy, lung cancer still remains the most leading cause of cancer death worldwide. The long non-coding RNAs (lncRNAs) are recently introduced as novel regulators of human cancers. SOX2 overlapping transcript (SOX2OT) is a cancer-associated lncRNA gene that encodes different alternatively spliced transcripts. Here, we investigated the alterations in the preferential expression of different SOX2OTs in twenty non-small cell lung cancer (NSCLC) patients by real-time quantitative reverse transcription PCR (qRT-PCR) method. We observed preferential expression of SOX2OT4 and SOX2OT7 in lung tumor tissues. The quantitative gene expression analysis revealed that >30 % of NSCLC tumors express SOX2OT4 (mean = 7.6 times) and SOX2OT7 (mean = 5.9 times) more than normal tissues, with higher expression in squamous cell carcinoma. Further, we observed overexpression of pluripotency-associated transcription factor, SOX2 in 47 % of our samples concordant with SOX2OT (R = 0.62, P value <0.05). Overexpression of OCT4A gene was also observed in 36.8 % of tumor tissues. Then, we investigated the effects of SOX2OT suppression in lung adenocarcinoma cell line, by means of RNAi. Cell characteristics of colony formation, apoptosis, 2-D mobility, and cell cycle progression were measured in control and treated A549 cells. The SOX2OT knockdown significantly reduced the colony formation ability of cancer cells; however, no alterations in the rate of apoptosis were detected. On the other hand, SOX2OT-suppressed cells had elevated accumulation in G2/M phase of cell cycle and exhibited limited mobility. Altogether, our findings support a potential oncogenic role for SOX2OT in non-small cell lung cancer tumor genesis and SOX2OT seems a promising therapeutic candidate for NSCLC.
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http://dx.doi.org/10.1007/s13277-016-4901-9DOI Listing
August 2016

Identification of new SOX2OT transcript variants highly expressed in human cancer cell lines and down regulated in stem cell differentiation.

Mol Biol Rep 2016 Feb 24;43(2):65-72. Epub 2015 Dec 24.

Department of Molecular Genetics, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran.

Long non-coding RNAs are manifested as a new paradigm of molecular effectors in a wide range of human diseases. Human SOX2 overlapping transcript (SOX2OT) gene can generate six lncRNA transcript variants which are functionally assumed to be correlated with cellular differentiation and carcinogenesis. However, the circumstances determining expressional and functional differences between SOX2OT transcript variants remain to be explored. Here, we studied the expression of all SOX2OT transcript variants specifically in five human cancer cell lines by real-time RT-PCR. Changes of the new SOX2OT transcript variants expression were measured during the NT2 teratocarcinoma cell line neuronal-like differentiation and were compared to pluripotency regulators, SOX2 and OCT4A gene expressions. Surprisingly, we identified two new SOX2OT transcripts, named SOX2OT-7, SOX2OT-8 which lack exon 8. We discovered that beside active proximal and distal SOX2OT promoters, different cancer cell lines express high levels of some SOX2OT transcript variants differentially by alternative splicing. Significantly, both SOX2OT-7 and SOX2OT-8 are highly expressed in human cancer cell lines coinciding with SOX2, one of the pluripotency regulators. Our results revealed that SOX2OT-7 is almost the most abundant form of SOX2OT transcript variants in the examined cancer cell lines particularly in NT2 teratocarcinoma cell line where its expression falls upon neuronal-like differentiation similar to SOX2 and OCT4A. We suggest that at least some of SOX2OT transcripts are significantly associated with cancer and stem cell related pathways.
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http://dx.doi.org/10.1007/s11033-015-3939-xDOI Listing
February 2016

Lymphangiomatosis: The Cause of Refractory Pleural Effusion in a Patient with Lupus Erythematosus.

Tanaffos 2015 ;14(2):153-5

Tracheal Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Mediastinal cavernous lymphangioma is a rare mediastinal lesion and its association with lupus erythematosus has not yet been reported in the literature. We present a 25 year-old female with lupus erythematosus who had bilateral massive refractory and recurrent pleural effusion as well as ascites for a long period of time. During surgery, a huge multicystic lesion with a thick wall, covering the entire parietal and visceral pleura was found, which was subsequently proven to be a cystic cavernous lymphangioma.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4629431PMC
November 2015

Gorham's Disease With Chest Wall Involvement: A Case Report and a Review of the Literature.

Iran Red Crescent Med J 2014 Nov 17;16(11):e12180. Epub 2014 Nov 17.

Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.

Introduction: Gorham's disease is a rare disorder characterized by osteolysis and abnormal vascular growth within bones. Diagnosis of Gorham's disease is often delayed and for accurate and early diagnosis high clinical suspicion is crucial. No specific treatment is available. Management options include surgery, radiation therapy and medical therapy. We aimed to present the first case of Gorham's disease with chest wall involvement in Iran. By review of the literature we discussed important issues of this rare disease including clinical findings, diagnosis and treatment options.

Case Presentation: We present a 48-year-old man with a history of dyspnea following a blunt chest trauma who was admitted to our clinic several times due to reaccumulation of pleural fluid and chylothorax. Gorham's disease was finally established according to clinical manifestations and radiological findings including massive osteolysis in his left ribs and also histological examination.

Discussion: According to review of the literature and considering all treatment modalities the patients was successfully treated with a combination of radiotherapy, pamidronate and thalidomide. We suggest that this disease should be considered among differential diagnoses of patients with chest pain, pleural effusion and/or chylothorax with an unknown reason and more importantly history of chest trauma. In suspected cases, it is essential to examine biopsy specimens of the bone adjacent to the inflammated tissues in order to confirm diagnosis.
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http://dx.doi.org/10.5812/ircmj.12180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4329932PMC
November 2014

Hemoptysis as a complication of capitonnage for management of pulmonary hydatid cyst.

Tanaffos 2014 ;13(3):46-8

Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

The surgical approach to hydatid cyst of the lung is based on complete removal of the parasite, and management of the residual pericyst cavity. For the latter, capitonnage is a recognized method, by which the walls of the evacuated pericyst cavity are approximated with multiple sutures. Capitonnage without suturing and ligation of bronchial openings individually may lead to postoperative air leakage with resultant pneumothorax or pneumatocele. The pulmonary parenchyma may also become distorted. Herein, we report another complication of capitonnage: presence of large amounts of unabsorbed suture material acting as foreign body within the residual pericyst cavity, leading to chronic infection and hemoptysis.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338052PMC
February 2015

Application of intra-aortic balloon pump in resection and anastomosis of trachea.

Tanaffos 2014 ;13(1):48-51

Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

The intra-aortic balloon pump (IABP) is a mechanical device used to assist cardiac circulatory function in patients suffering from cardiogenic shock, congestive heart failure, refractory angina and complications of myocardial infarction. While using IABP in cardiac surgery is well established, there are few studies on the utility of IABP support in high-risk cardiac patients undergoing non-cardiac surgery. Major non-cardiac surgeries are associated with high rates of cardiac complications in patients with advanced coronary disease. Recent case studies have reported favorable outcomes with the use of IABP support in non-cardiac surgery in patients with severe cardiac compromise. Using IABP may reduce cardiac complications by providing hemodynamic stability. Here, we present five cases of IABP use in high-risk cardiac patients undergoing resection and anastomosis of the trachea. IABP was inserted prior to induction of anesthesia in four of the cases, while IABP insertion was withheld in one case. In the four cases where IABP support was utilized, the IABP was removed between 6-48 hours postoperatively with no complications. The patient who did not undergo IABP insertion died on the 8th postoperative day due to uncontrollable pulmonary edema and progressive myocardial infarction. We also review the literature and discuss the role of IABP use in non-cardiac surgery.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153278PMC
September 2014

A comparative study on tobacco cessation methods: a quantitative systematic review.

Int J Prev Med 2014 Jun;5(6):673-8

Department Telemedicine Research Center, National Research Institute of TB and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: During recent years, there have been many advances in different types of pharmacological and non-pharmacological tobacco control treatments. In this study, we aimed to identify the most effective smoking cessation methods used in quit based upon a review of the literature.

Methods: We did a search of PubMed, limited to English publications from 2000 to 2012. Two trained reviewers independently assessed titles, abstracts and full texts of articles after a pilot inter-rater reliability assessment which was conducted by the author (GH). The total number of papers and their conclusions including recommendation of that method (positive) or not supporting (negative) was computed for each method. The number of negative papers was subtracted from the number of positive ones for each method. In cases of inconsistency between the two reviewers, these were adjudicated by author.

Results: Of the 932 articles that were critically assessed, 780 studies supported quit smoking methods. In 90 studies, the methods were not supported or rejected and in 62 cases the methods were not supported. Nicotine replacement therapy (NRT), Champix and Zyban with 352, 117 and 71 studies respectively were the most supported methods and e-cigarettes and non-Nicotine medications with one case were the least supported methods. Finally, NRT with 39 and Champix and education with 36 scores were the most supported methods.

Conclusions: Results of this review indicate that the scientific papers in the most recent decade recommend the use of NRT and Champix in combination with educational interventions. Additional research is needed to compare qualitative and quantitative studies for smoking cessation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4085918PMC
June 2014

Two thymus-related autoimmune disorders: a case report and review of the literature.

Onco Targets Ther 2014 10;7:633-6. Epub 2014 May 10.

Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Thymoma is the most common tumor in the anterior mediastinum. A 56-year-old man presented unremitting and periodic chronic diarrhea of 9 weeks duration, and clinical examination revealed a huge nonhomogeneous mass lesion in the right lung and leukocytosis. He was treated with CHOP regimen (cyclophosphamide 1,200 mg/m(2), doxorubicin 50 mg/m(2), vincristine 1.5 mg/m(2), and prednisolone 75 mg/m(2) × 5 days) based on lung mass computed tomography-guided biopsy, but he was reevaluated because neither symptom improved. Surprisingly, celiac disease was documented with increased titer of immunoglobulin antibodies to gliadin and tissue transglutaminase. Lung mass rebiopsy and thymectomy demonstrated thymoma. After surgery, the patient showed aplastic anemia that responded well to cyclosporine. At 2-year follow-up, the patient's hematologic status and diarrhea were completely recovered and no symptom and/or sign of thymoma recurrence was seen.
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http://dx.doi.org/10.2147/OTT.S58194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025932PMC
May 2014