Clinical features of hepatopulmonary syndrome in cirrhotic patients

瞄准：评估频率，临床并且帕拉肝肺症候群(HPS ) 并且到的临床的特征在伊朗在病人在这症候群的诊断决定他们的预兆的价值。方法：54 个肝脏硬化症的病人经历了对比由二位心脏病专家检测肺内、心内的分流的提高的回响心动描记法。动脉的血氧， O (2 ) 坡度(A-a ) 和正统说法被气体(ABG ) 测试的动脉的血测量。为 HPS 的诊断标准积极的病人被定义为表明肺内的动脉的膨胀的临床的 HPS 盒子和那些，但是另外的标准(动脉的血血氧不足) 都没被定义为 lHPS 盒子。HPS 频率，敏感，积极、否定的预兆的价值临床并且帕拉临床的特征被学习。结果：十(18.5%) 并且七(13%) 盒子分别地有临床、无临床症状的 HPS。最普通的病原学是肝炎 B。呼吸困难(100%) 和青紫(90%) 是最流行的临床的特征。呼吸困难并且打分别地是最敏感、特定的临床的特征。没有重要关系被发现在之间 HPS 和脾大，腹水，浮肿，黄疸，尿少，和并行的静脉。HPS 在肝炎 B 是更流行的。PaO (2 )【 70 并且动脉牙槽的坡度在 HPS 病人有最高的敏感。正统说法特性是 100% 。结论：与 75% 的否定预兆的价值(NPV ) 与 75% 的积极预兆的价值(PPV ) 和呼吸困难打是在 HPS 的诊断的最好的临床的因素症候群。PaO (2 )【 70 并且 P (A-a ) O (2 )】 30 并且他们的和，是在 HPS 病人的最珍贵的否定、积极的预兆的价值。

Predictive value and main determinants of abnormal features of intraoperative cholangiography during cholecystectomy

BACKGROUND:The major issue with intraoperative cholangiography (IOC) is whether its diagnostic accuracy for common bile duct (CBD) stones matches that of other diagnostic procedures,and thus,whether it will become a routine diagnostic procedure.The current study aimed to address the main determinants of CBD stone diagnosis in IOC among an Iranian population.METHODS:In a retrospective review database-based study conducted in Taleghani Hospital in Tehran between 2006 and 2008,baseline data and perioperative information of 2060 patients (male to female ratio 542:1518,mean age 53.7 years) who were candidates for cholecystectomy and underwent concomitant IOC for confirming CBD stones were reviewed.The predictive power of this procedure for diagnosis of abnormal biliary ducts with the focus on biliary stones was determined.RESULTS:Overall mortality and morbidity following cholecystectomy in the study population were 0.6% and 2.6%,respectively.Both early mortality and morbidity due to cholecystectomy were higher in male than female.The prevalence of CBD stones in IOC was 3.4% (5.2% in male and 2.8% in female,P=0.008).Among those without gallstones,8.7% had CBD stones and only 3.1% had concomitant gallstones and CBD stones.The main predictors of stone appearance as an abnormal feature of IOC during cholecystectomy were:advanced age (OR=1.022,P=0.001),male gender (OR=1.498,P=0.050),history of abdominal surgery (OR=1.543,P=0.040) and preoperative endoscopic retrograde cholangiopancreatography (OR=5.400,P<0.001).CONCLUSIONS:IOC is a safe and accurate method for the assessment of bile duct anatomy and stones.Therefore,the routine use of IOC within cholecystectomy seems reasonable and is recommended.

Intra-familial prevalence of hepatitis B virologic markers in HBsAg positive family members in Nahavand, Iran

AIM: To determine the prevalence of hepatitis B in Nahavand and evaluate the HBsAg positive prevalence in families with a member who was confirmed to have HBV infection.METHODS: This study was performed in two phases. In the first phase, 1 824 subjects in Nahavand city were selected. The interviewers visited the houses of chosen families to fill the questionnaire and take the blood samples.All subjects signed an informed consent before interviews and blood sampling. The samples were evaluated for HBV virologic markers. In the second phase, 115 HBsAg-positive cases were enrolled and evaluated for HBV virologic markers.RESULTS: The prevalence of positive HBsAg in Nahavand was 2.3%. The most frequent relatives of index cases were sons and daughters (32.2% and 23.5% respectively).Twelve (11%) of all family members were HBsAg positive.Fifty (56.2%) were isolated HBsAb positive and only one person (2.5%) was isolated HBcAb positive. The higher rates of HBsAg marker were detected in the brothers (1-25%) and fathers (1-12.5%). The infection rate in husbands and wives of index cases was 10%. Only two (16.7%) of all HBsAg-positive participants reported previous HBV vaccination.CONCLUSION: The prevalence of intra-familial HBV infection is lower in Nahavand of Iran compared to other studies.More attention should be paid to HBV vaccination and risk-lowering activities.

Frequent loss of heterozygosity at 8p22 chromosomal region in diffuse type of gastric cancer

AIM: To study the loss of heterozygosity (LOH) at 8p21-23 locus in diffuse gastric cancer.METHODS: To evaluate the involvement of this region in gastric cancer, we used eight microsatellite markers covering two Mb of mentioned region, to perform a high-resolution analysis of allele loss in 42 cases of late diffuse gastric adenocarcinoma.RESULTS: Six of these STS makers: D8S1149, D8S1645, D8S1643, D8S1508, D8S1591, and D8S1145 showed 36%, 28%, 37%, 41%, 44% and 53% LOH, respectively.CONCLUSION: A critical region of loss, close to the NAT2 locus and relatively far from FEZ1 gene currently postulated as tumor suppressor gene in this region.

Diversity of Helicobacter pylori genotypes in Iranian patients with different gastroduodenal disorders

AIM:To investigate the diversity of Helicobacter pylori(H.pylori)genotypes and correlations with disease outcomes in an Iranian population with different gastroduodenal disorders.METHODS:Isolates of H.pylori from patients with different gastroduodenal disorders were analyzed after culture and identification by phenotypic and genotypic methods.Genomic DNA was extracted with the QIAamp DNA mini kit(Qiagen,Germany).After DNA extraction,genotyping was done for cagA,vacA(s and m regions),iceA(iceA1,iceA2)and babA with specific primers for each allele using polymerase chain reaction(PCR).All patients’pathologic and clinical data and their relation with known genotypes were analyzed by using SPSS version 19.0 software.2test and Fisher’s exact test were used to assess relationships between categorical variables.The level of statistical significance was set at P<0.05.RESULTS:A total of 71 isolates from 177 patients with different gastroduodenal disorders were obtained.Based on analysis of the cagA gene(positive or negative),vacA s-region(s1or s2),vacA m-region(m1or m2),iceA allelic type(iceA1and iceA2)and babA gene(positive or negative),twenty different genotypic combinations were recognized.The prevalence of cagA,vacA s1,vacA s2,vacA m1,vacA m2,iceA1,iceA2,iceA1+iceA2and babA were 62%,78.9%,19.7%,21.1%,78.9%,15.5%,22.5%,40.8%and 95.8%,respectively.Interestingly,evaluation of PCR results for cagA in 6 patients showed simultaneous existence of cagA variants according to their size diversities that proposed mixed infection in these patients.The most prevalent genotype in cagA-positive isolates was cagA+/vacAs1m2/iceA1+A2/babA+and in cagA-negative isolates was cagA-/vacAs1m2/iceA-/babA+.There were no relationships between the studied genes and histo-pathological findings(H.pylori density,neutrophil activity,lymphoid aggregation in lamina propria and glandular atrophy).The strains which carry cagA,vacAs1/m1,iceA2and babA genes showed significant associations with severe active chronic gastritis(P=0.011,0.025,0.020 and 0.031,respectively).The vacAs1genotype had significant correlation with the presence of the cagA gene(P=0.013).Also,babA genotype showed associations with cagA(P=0.024).In the combined genotypes,only cagA+/vacAs1m1/iceA2/babA+genotype showed correlation with severe active chronic gastritis(P=0.025).CONCLUSION:This genotyping panel can be a useful tool for detection of virulent H.pylori isolates and can provide valuable guidance for prediction of the clinical outcomes.

Helicobacter pylori infection and expression of DNA mismatch repair proteins

瞄准：为了决定 DNA (MMR ) 蛋白质的表示，包括 hMLH1 和 hMSH2，在在病人与或没有 Helicobacter 的胃的上皮细胞， pylori (H pylori ) 感染了胃炎。方法：五十个 H pylori 积极的病人和 50 H pylori 否定的病人在学习被注册。在有非溃疡消化不良的病人的内视镜检查法期间，二窦和二语料库活体检视为组织学的检查(Giemsa 污点) 并且为免疫被拿 hMLH1 和 hMSH2 的组织化学的染色。结果：为染色的 hMLH1 表明了确实的上皮的房间原子核的百分比是 84.14 +/-7.32% 在 H pylori 否定的病人，当它是 73.34 +/- 时 10.10% 在 H pylori 积极的病人(P 【 0.0001 ) 。没有有效差量关于为染色的 hMSH2 表明了确实的上皮的房间原子核的百分比在二个组之间被看见(81.16 +/-8.32% 在 pylori 否定的 H 对 78.24 +/-8.71% 在 H pylori 积极的病人；P = 0.09 ) 。结论：这研究显示 H pylori 可能通过它影响 DNA MMR 系统的能力部分地至少支持胃的癌的开发。

Polyp detection rate and pathological features in patients undergoing a comprehensive colonoscopy screening

AIM To identify the prevalence, and clinical and pathologic characteristic of colonic polyps among Iranian patients undergoing a comprehensive colonoscopy, and determine the polyp detection rate(PDR) and adenoma detection rate(ADR).METHODS In this cross-sectional study, demographics and epidemiologic characteristics of 531 persons who underwent colonoscopies between 2014 and 2015 at Mehrad gastrointestinal clinic were determined. Demographics, indication for colonoscopy, colonoscopy findings, number of polyps, and histopathological characteristics of the polyps were examined for each person.RESULTS Our sample included 295(55.6%) women and 236(44.4%) men, with a mean age of 50.25 ± 14.89 years. Overall PDR was 23.5%(125/531). ADR and colorectal cancer detection rate in this study were 12.8% and 1.5%, respectively. Polyps were detected more significantly frequently in men than in women(52.8% vs 47.2%, P < 0.05). Polyps can be seen in most patients after the age of 50. The average age of patients with cancer was significantly higher than that of patients with polyps(61.3 years vs 56.4 years, P < 0.05). The majority of the polyps were adenomatous. More than 50% of the polyps were found in the rectosigmoid part of the colon.CONCLUSION The prevalence of polyps and adenomas in this study is less than that reported in the Western populations. In our patients, distal colon is more susceptible to developing polyps and cancer than proximal colon.

Colorectal 癌症屏蔽: 在伊朗的行动的时间

Colorectal cancer(CRC) is now the third most common cause of cancer-related deaths in the world.According to the Iranian Annual National Cancer Registration Report,CRC is the third most common cancer in Iranian women and fifth in men.The incidence of CRC has increased during the last 25 years.CRC screening is an efficient way to reduce the burden of CRC through detection of precursor lesions of cancer or early stage cancer.Iran may benefit even more from screening programs.According to recent studies,the prevalence of colorectal adenoma in first degree relatives of patients diagnosed with CRC is significantly higher than in the average risk population.So,appropriate screening strategies,especially in relatives of patients,should be considered as the first step of CRC screening in Iran.

Bayesian adjustment for over-estimation and under-estimation of gastric cancer incidence across Iranian provinces

AIM To correct the misclassification in registered gastric cancer incidence across Iranian provinces in cancer registry data. METHODS Gastric cancer data is extracted from Iranian annual of national cancer registration report 2008. A Bayesian method with beta prior is implemented to estimate the rate of misclassification in registering patient'spermanent residence in neighboring province. Each time two neighboring provinces with lower and higher than 100% expected coverage of cancer cases are selected to be entered in the model. The expected coverage of cancerous patient is reported by medical university of each province. It is assumed that some cancer cases from a province with a lower than 100% expected coverage are registered in their neighboring province with more than 100% expected coverage. RESULTS The condition was true for 21 provinces from a total of 30 provinces of Iran. It was estimated that 43% of gastric cancer cases of North and South Khorasan provinces in north-east of Iran was registered in Razavi Khorasan as the neighboring facilitate province; also 72% misclassification was estimated between Sistan and balochestan province and Razavi Khorasan. The misclassification rate was estimated to be 36% between West Azerbaijan province and East Azerbaijan province, 21% between Ardebil province and East Azerbaijan, 63% between Hormozgan province and Fars province, 8% between Chaharmahal and bakhtyari province and Isfahan province, 8% between Kogiloye and boyerahmad province and Isfahan, 43% Golestan province and Mazandaran province, 54% between Bushehr province and Khozestan province, 26% between Ilam province and Khuzestan province, 32% between Qazvin province and Tehran province(capital of Iran), 43% between Markazi province and Tehran, and 37% between Qom province and Tehran. CONCLUSION Policy makers should consider the regional misclassification in the time of programming for cancer control, prevention and resource allocation.

Bayesian adjustment of gastric cancer mortality rate in the presence of misclassification

AIM To correct for misclassification error in registering causes of death in Iran death registry using Bayesian method.METHODS National death statistic from 2006 to 2010 for gastric cancer which reported annually by the Ministry of Health and Medical Education included in this study. To correct the rate of gastric cancer mortality with reassigning the deaths due to gastric cancer that registered as cancer without detail, a Bayesian method was implemented with Poisson count regression and beta prior for misclassified parameter, assuming 20% misclassification in registering causes of death in Iran.RESULTS Registered mortality due to gastric cancer from 2006 to 2010 was considered in this study. According to the Bayesian re-estimate, about 3%-7% of deaths due to gastric cancer have registered as cancer without mentioning details. It makes an undercount of gastric cancer mortality in Iranian population. The number and age standardized rate of gastric cancer death is estimated to be 5805(10.17 per 100000 populations), 5862(10.51 per 100000 populations), 5731(10.23 per 100000 populations), 5946(10.44 per 100000 populations), and 6002(10.35 per 100000 populations), respectively for years 2006 to 2010.CONCLUSION There is an undercount in gastric cancer mortality in Iranian registered data that researchers and authorities should notice that in sequential estimations and policy making.

Trend of hepatocellular carcinoma incidence after Bayesian correction for misclassified data in Iranian provinces

AIM To study the trend of hepatocellular carcinoma incidence after correcting the misclassification in registering cancer incidence across Iranian provinces in cancer registry data.METHODS Incidence data of hepatocellular carcinoma were extracted from Iranian annual of national cancer registration reports 2004 to 2008.A Bayesian method was implemented to estimate the rate of misclassification in registering cancer incidence in neighboring province.Abeta prior is considered for misclassification parameter.Each time two neighboring provinces were selected to be entered in the Bayesian model based on their expected coverage of cancer cases which is reported by medical university of the province.It is assumed that some cancer cases from a province that has an expected coverage of cancer cases lower than 100% are registered in their neighboring facilitate province with more than 100% expected coverage.RESULTS There is an increase in the rate of hepatocellular carcinoma in Iran.Among total of 30 provinces of Iran,21 provinces were selected to be entered to the Bayesian model for correcting the existed misclassification.Provinces with more medical facilities of Iran are Tehran(capital of the country),Razavi Khorasan in north-east of Iran,East Azerbaijan in north-west of the country,Isfahan in central part and near to Tehran,Khozestan and Fars in south and Mazandaran in north of the Iran,had an expected coverage more than their expectation.Those provinces had significantly higher rates of hepatocellular carcinoma than their neighboring provinces.In years 2004 to 2008,it was estimated to be on average 34% misclassification between North Khorasan province and Razavi Khorasan,43% between South Khorasan province and Razavi Khorasan,47% between Sistan and balochestan province and Razavi Khorasan,23% between West Azerbaijan province and East Azerbaijan province,25% between Ardebil province and East Azerbaijan province,41% between Hormozgan province and Fars province,22% between Chaharmahal and bakhtyari province and Isfahan province,22% between Kogiloye and boyerahmad province and Isfahan,22% between Golestan province and Mazandaran province,43% between Bushehr province and Khozestan province,41% between Ilam province and Khuzestan province,42% between Qazvin province and Tehran province,44% between Markazi province and Tehran,and 30% between Qom province and Tehran.CONCLUSION Accounting and correcting the regional misclassification is necessary for identifying high risk areas and planning for reducing the cancer incidence.