New Concept in Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)

The world-wide impact of traumatic injury and associated hemorrhage on human health and well-being is significant. Methods to manage bleeding from sites within the torso, referred to as non-compressible torso hemorrhage (NCTH), remain largely limited to the use of conventional operative techniques. The overall mortality rate of patients with NCTH is approximately 50%. Studies from the wars in Afghanistan and Iraq have suggested that up to 80% of potentially survivable patients die as a result of uncontrolled exsanguinating hemorrhage. The commercially available resuscitative endovascular balloon occlusion of the aorta (REBOA) is a percutaneous device for the rapid control of torso hemorrhage in trauma. A compliant balloon is inserted via the femoral artery and inflated in the thoracic or abdominal aorta, providing inflow control of the abdomen, pelvis, or groin/lower extremities. Recent studies indicate that REBOA carries an inherent risk of aortic injury due to over-inflation and possible risk of aortic or iliac artery rupture. A new approach isto resolve the issue of balloon sizing and over-inflation. We propose a novel concept to be used in trauma facility for arterial occlusion to eliminate arterial injury and the risk of vascular rupture through real time balloon diameter profile measurements to ensure proper inflation. The proposed concept, called Smart Resuscitative Endovascular Balloon Occlusion (SREBO) will be novel in the following aspects: 1) It will have electrical conductance-based navigation technology to target the desired site of balloon deployment in the aorta, 2) The balloon can determine the time of proper inflation using electrical conductance catheter technology. This technology would eliminate the risk of arterial rupture and simplify the procedure in the trauma facility or medical clinics without significant training. The results can be displayed on a handheld device. This novel device has the potential to save civilians in trauma or soldiers injured on the battlefield.     

Susceptibility assessment of bell pepper genotypes to crown and root rot disease

Bell Pepper (Capsicum annuum) is one of the important vegetable crops with valuable food sources, which is used almost around the world. Crown and root rot disease caused by Phytophthora capsici is one of the most important diseases of bell pepper in Iran. The present study was conducted to evaluate the susceptibility of different varieties of bell pepper to crown and root rot disease under glasshouse condition. Fourteen commonly planted genotypes of bell pepper in Iran were evaluated for their susceptibility to infection with the pathogen. For this purpose, disease severity of the chosen genotypes in different growth stages was evaluated. The results indicated that the bell pepper genotypes respond differently to pathogenicity tests. Based on cluster analyses confirmed by the results of SAS analyses, bell pepper cultivars were categorised in five distinct groups.     

Evaluation of DNA/DNA and prime-boost vaccination using LPG3 against Leishmania major infection in susceptible BALB/c mice and its antigenic properties in human leishmaniasis

One of the main issues in vaccine development is implementation of new adjuvants to improve the antigen presentation and eliciting the protective immune response. Heat shock protein (HSP) molecules are known as natural adjuvants. They can stimulate the innate and adaptive immune response against infectious diseases and cancer. Lipophosphoglycan 3 (LPG3), the Leishmania homologous with GRP94 (glucose regulated protein 94), a member of HSP90 family, is involved in assembly of LPG as the most abundant macromolecule on the surface of Leishmania promastigotes. In the present study as a primary step, we tested LPG3 as a vaccine candidate in two regimens, DNA/DNA and prime-boost (DNA/Protein), against Leishmania major infection in BALB/c mice model. Our results showed that LPG3 and its fragment (rNT-LPG3) are highly immunogenic in BALB/c mice and can stimulate the production of both IgG1 and IgG2a. In prime-boost immunization strategy, the level of antibody response was higher compared with DNA/DNA immunization. The levels of IFN-γ in the supernatant of splenocytes from mice immunized with DNA/DNA and prime-boost regimens were significantly higher when compared to control groups. In fact, immunization with prime-boost vaccination has higher ratio of IFN-γ/IL-5, suggesting a shift towards a Th1 response.In addition, sera reactivity against LPG3 in visceral leishmaniasis (VL) patients was significantly higher in comparison with cutaneous leishmaniasis (CL) patients. Therefore, we recommend further investigations on the usage of LPG3 co-delivery with candidate antigens for vaccine development against leishmaniasis.     

Prevalence of putative virulence markers in Campylobacter jejuni and Campylobacter coli isolated from hospitalized children, raw chicken, and raw beef in Tehran, Iran

The incidence of the virulence-associated genes cdtA, cdtB, cdtC, cadF, dnaJ, racR, and pldA has been investigated in Campylobacter jejuni and Campylobacter coli collected from raw chicken and beef from retailers in Tehran, Iran, and from hospitalized children (age, ≤14 years) suffering from diarrhea. Campylobacter spp. were collectively identified by morphological and biochemical methods. Campylobacter jejuni and C. coli were discriminated from other Campylobacter spp. by amplification of a specific conserved fragment of the 16S rRNA gene. The distinction between C. jejuni and C. coli was subsequently made by molecular determination of the presence of the hipO gene in C. jejuni or the ask gene in C. coli. Fragments of the studied virulence-associated genes, cdtA, cdtB, cdtC, cadF, racR, dnaJ, and pldA, were amplified by PCR and subjected to horizontal gel electrophoresis. A total of 71 isolates of C. jejuni and 24 isolates of C. coli from meat were analyzed, while the numbers of isolates from the hospitalized children were 28 and 9, respectively. The unequal distribution of C. jejuni and C. coli in the samples has also been reported in other studies. Statistical analyses by the use of the two-tailed Fisher's exact test of the occurrence of the virulence genes in the isolates of different origins showed that the occurrence of the dnaJ gene was consistently significantly higher in all C. jejuni isolates than in C. coli. The occurrence of the other virulence markers did not differ significantly between species in the majority of the isolates. The PCR results also showed that the occurrence of the virulence markers in the analyzed isolates was much lower than in other studies, which may be caused by a divergent genomic pool of our isolates in comparison with others.     

Human Neutrophil Peptide-1 (HNP-1): A New Anti-Leishmanial Drug Candidate

The toxicity of available drugs for treatment of leishmaniasis, coupled with emerging drug resistance, make it urgent to find new therapies. Antimicrobial peptides (AMPs) have a strong broad-spectrum antimicrobial activity with distinctive modes of action and are considered as promising therapeutic agents. The defensins, members of the large family of AMPs, are immunomodulatory molecules and important components of innate immune system. Human neutrophil peptide-1 (HNP-1), which is produced by neutrophils, is one of the most potent defensins. In this study, we described anti-parasitic activity of recombinant HNP-1 (rHNP-1) against Leishmania major promastigotes and amastigotes. Furthermore, we evaluated the immunomodulatory effect of rHNP-1 on parasite-infected neutrophils and how neutrophil apoptosis was affected. Our result showed that neutrophils isolated from healthy individuals were significantly delayed in the onset of apoptosis following rHNP-1 treatment. Moreover, there was a noteworthy increase in dying cells in rHNP-1- and/or CpG–treated neutrophils in comparison with untreated cells. There is a considerable increase in TNF-α production from rHNP-1-treated neutrophils and decreased level of TGF-β concentration, a response that should potentiate the immune system against parasite invasion. In addition, by using real-time polymerase chain reaction (real-time PCR), we showed that in vitro infectivity of Leishmania into neutrophils is significantly reduced following rHNP-1 treatment compared to untreated cells.     

Effect of Topical Tranexamic Acid on Bleeding and Quality of Surgical Field during Functional Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis: A Triple Blind Randomized Clinical Trial

Background

The effect of tranexamic acid (TXA) on bleeding and improvement of surgical field during functional endoscopic sinus surgery (FESS) is not clear yet. This study was conducted to answer this question.

Methods

This trial was conducted on 60 patients with chronic sinusitis at Beasat Hospital, Hamadan, Iran, from April to November 2013. Thirty patients in the intervention group received three pledgets soaked with TXA 5% and phenylephrine 0.5% for 10 minutes in each nasal cavity before surgery. Thirty patients in the control group received phenylephrine 0.5% with the same way. The amount of bleeding and the quality of surgical field were evaluated at 15, 30, and 45 minutes after the start of surgery using Boezaart grading.

Results

The quality of the surgical field in the intervention group compared to the control group was significantly better in the first quarter (P = 0.002) and the second quarter (P = 0.003) but not in the third quarter (P = 0.163). Furthermore, the amount of bleeding was much less during all periods in the intervention group than in the control group (P = 0.001).

Conclusion

Topical TXA can efficiently reduce bleeding and improve the surgical field in FESS in patients with rhinosinusitis. Based on these findings, topical TXA may be a useful method for providing a suitable surgical field during the first 30 minutes after use.

Trial Registration

Iranian Registry of Clinical Trials IRCT201212139014N15     

Inhibition of mesothelin as a novel strategy for targeting cancer cells

Mesothelin, a differentiation antigen present in a series of malignancies such as mesothelioma, ovarian, lung and pancreatic cancer, has been studied as a marker for diagnosis and a target for immunotherapy. We, however, were interested in evaluating the effects of direct targeting of Mesothelin on the viability of cancer cells as the first step towards developing a novel therapeutic strategy. We report here that gene specific silencing for Mesothelin by distinct methods (siRNA and microRNA) decreased viability of cancer cells from different origins such as mesothelioma (H2373), ovarian cancer (Skov3 and Ovcar-5) and pancreatic cancer (Miapaca2 and Panc-1). Additionally, the invasiveness of cancer cells was also significantly decreased upon such treatment. We then investigated pro-oncogenic signaling characteristics of cells upon mesothelin-silencing which revealed a significant decrease in phospho-ERK1 and PI3K/AKT activity. The molecular mechanism of reduced invasiveness was connected to the reduced expression of β-Catenin, an important marker of EMT (epithelial-mesenchymal transition). Ero1, a protein involved in clearing unfolded proteins and a member of the ER-Stress (endoplasmic reticulum-stress) pathway was also markedly reduced. Furthermore, Mesothelin silencing caused a significant increase in fraction of cancer cells in S-phase. In next step, treatment of ovarian cancer cells (OVca429) with a lentivirus expressing anti-mesothelin microRNA resulted in significant loss of viability, invasiveness, and morphological alterations. Therefore, we propose the inhibition of Mesothelin as a potential novel strategy for targeting human malignancies.     

Cardiovascular effects of black tea and nicotine alone or in combination against experimental induced heart injury

The present study was designed to elucidate the outcome of subchronic co-administration of black tea and nicotine on cardiovascular performance and whether these substances could modulate the isoproterenol-induced cardiac injury. Animal groups were control, black tea, nicotine and black tea plus nicotine. Test groups received nicotine (2 mg/kg s.c.) and black tea brewed (p.o.) each alone and in combination for 4 weeks. On the 28th day, myocardial damage was induced by isoproterenol (50 mg/kg i.p.), and blood samples were taken. On day 29, after hemodynamic parameters recording, hearts were removed for histopathological evaluation. Tea or nicotine consumption had no significant effects on hemodynamic indices of animals without heart damage. When the cardiac injury was induced, tea consumption maintained the maximum dp/dt, and nicotine significantly decreased the pressure–rate product. Moreover, severity of heart lesions was lower in the presence of nicotine or black tea. Concomitant use of these materials did not show extra effects on mentioned parameters more than the effect of each of them alone. The results suggest that subchronic administration of black tea or nicotine for a period of 4 weeks may have a mild cardioprotective effect, while concomitant use of these materials cannot intensify this beneficial effect.     

Mixing characteristics and liquid circulation in a new multi-environment bioreactor

The theoretical and experimental aspects of the hydrodynamics and mixing in a new multi-environment bioreactor that uses the air-lift design were investigated. This study focused on the mixing characteristics, residence time distribution, liquid circulation between three zones of aerobic, microaerophilic and anoxic, and liquid displacement in the bioreactor at influent flow rates of 720–1,450 L/day and air flow rates of 15–45 L/min. The theoretical analysis of liquid displacement led to the estimation of the specific rate of liquid discharge from the bioreactor at any given influent flow rate, and the number of liquid circulations between various bioreactor zones before the discharge of a given quantity of wastewater. The ratio of mean residence time to the overall hydraulic retention time (t _m/HRT) decreased with the increase of air flow rate at any given influent flow rate, and approached unity at higher air flow rates. Mixing was characterized in terms of the axial dispersion coefficient and Bodenstein number, demonstrating a linear relationship with the superficial gas velocity. A correlation was developed between the Bodenstein number and the Froude number. The study of liquid circulation between the zones showed that less than 1.5 % of the circulating liquid escapes circulation at each cycle and flows towards the outer clarifier, while the percentage of escaped liquid decreases with increasing air flow rate at a given influent flow rate. The specific rate of liquid discharge from the bioreactor increased from 0.19 to 0.69 h^?1 with the increase of air and influent flow rates from 15 to 45 L/min and 500 to 1,450 L/day, respectively. Under the examined operating conditions, mixed liquor circulates between 364 and 1,698 times between the aerobic, microaerophilic and anoxic zones before 99 % of its original volume is replaced by the influent wastewater.     

The host environment regulates the function of CD8+ graft-versus-host-reactive effector cells

We have examined how the host environment influences the graft-vs-leukemia (GVL) response following transfer of donor T cells to allogeneic chimeras. Donor T cells induce significant GVL when administered in large numbers to established mixed chimeras (MC). However, when using limiting numbers of T cells, we found that late transfer to MC induced less GVL than did early transfer to freshly irradiated allogeneic recipients. Late donor T cell transfer to MC was associated with marked accumulation of anti-host CD8 cells within the spleen, but delayed kinetics of differentiation, reduced expression of effector molecules including IFN-gamma, impaired cytotoxicity, and higher rates of sustained apoptosis. Furthermore, in contrast to the spleen, we observed a significant delay in donor CD8 cell recruitment to the bone marrow, a key location for hematopoietic tumors. Increasing the numbers of T cells transferred to MC led to the enhancement of CTL activity and detectable increases in absolute numbers of IFN-gamma(+) cells without inducing graft-vs-host disease (GVHD). TLR-induced systemic inflammation accelerated differentiation of functional CTL in MC but was associated with severe GVHD. In the absence of inflammation, both recipient T and non-T cell populations impeded the full development of GVHD-inducing effector function. We conclude that per-cell deficits in the function of donor CD8 cells activated in MC may be overcome by transferring larger numbers of T cells without inducing GVHD.