Introduction of a handmade vacuum-assisted sponge drain for the treatment of anastomotic leakage after low anterior rectal resection

Keshvari, Amir,Badripour, Abolfazl,Keramati, Mohammad Reza,Kazemeini, Alireza,Behboudi, Behnam,Fazeli, Mohammad Sadegh,Rahimpour, Ehsan,Ghaffari, Parisa,Tafti, Seyed Mohsen Ahmadi 대한대장항문학회 2022 Annals of Coloproctolgy Vol.38 No.3

Purpose: Anastomotic leakage, a known major postoperative complication, potentially leads to readmission, reoperation, and increased mortality rates in patients, such as rectal cancer patients following a low anterior resection (LAR). Currently, vacuum-assisted closure, as featured by B-Braun (B-Braun Medical B.V.), is already being used for the treatment of gastrointestinal leakages and fistulas. The main aim of this study was to introduce a novel method for creating a vacuum-assisted drain for the treatment of anastomotic leakage after LAR. Methods: All 10 patients, who underwent LAR surgery from 2018 to 2019, were diagnosed with anastomotic leakage and had received neoadjuvant chemotherapy prior to surgery. Therefore, patients were treated with a handmade vacuum-assisted drain and were revisited every 5 to 7 days for further evaluations and drain replacement until leakage resolution. Physical features of cavity, time of diagnose, and duration of treatment were analyzed correspondingly. The handmade vacuum-assisted sponge drain was prepared for each patient in each session of follow-up. Results: Eight out of 10 patients experienced complete closure of the defect. The mean delay time from the day of operation to the diagnosis of anastomotic leakage was 61.0±80.4 days while the mean time for leakage closure was 117.6±68.3 days. Eventually, 7 cases underwent ileostomy reversal with no complications during a 3-month follow-up. Conclusion: In this study, we evaluated the healing process of anastomotic leakage after the usage of a handmade vacuum-assisted sponge drain in a case series method. In our trial, we provided an innovative cost-benefit method easily applicable in the operating room.

The effect of collagen/polycaprolactone fibrous scaffold decorated with graphene nanoplatelet and low-frequency electromagnetic field on neuronal gene expression by stem cells

Moraveji, Marzie,Keshvari, Hamid,Karkhaneh, Akbar,Bonakdar, Shahin,Hadi, Amin,Haghighipour, Nooshin Techno-Press 2021 Advances in nano research Vol.10 No.6

This study aimed to develop a collagen/polycaprolactone (CP) fibrous scaffold decorated with Graphene (Gr) nanoplatelets (Gr-CP). In previous studies, accessibility of cells to the surface of Gr nanoplatelet was missed. Nanofibers were prepared by electrospinning which sprayed Gr nanoplatelets (1 wt.%) to synthesize the Gr-CP scaffold. Fourier transform infrared spectroscopy (FTIR) was utilized for investigation of chemical structure. Tensile tests were performed to study the influence of Gr on the mechanical properties of scaffolds. Cell differentiation was analyzed based on MAP2 and TUJ1 expression levels using real-time PCR technique in 6 groups. The variables examined in this experiment was the neural differentiating chemical medium, low-frequency electromagnetic field (LFEMF; 50Hz, 1mT) and Gr. Based on the results, Young's modulus, tensile strength and work of fracture ratio of the Gr-CP were 1.68, 2.41 and 1.42 times higher than those of the CP scaffold, respectively. MTT assay outcomes were indicative of scaffold cytocompatibility. The group treated with all three factors exhibited the highest MAP2 expression level compared to other groups. Based on the obtained results, exposing stem cells to the combined treatment of Gr and LFEMF can be used as a promising method to induce neuronal differentiation.

Using Taguchi design of experiments for the optimization of electrospun thermoplastic polyurethane scaffolds

Nezadi, Maryam,Keshvari, Hamid,Yousefzadeh, Maryam Techno-Press 2021 Advances in nano research Vol.10 No.1

Electrospinning is a cost-effective and versatile method for producing submicron fibers. Although this method is relatively simple, at the theoretical level the interactions between process parameters and their influence on the fiber morphology are not yet fully understood. In this paper, the aim was finding optimal electrospinning parameters in order to obtain the smallest fiber diameter by using Taguchi's methodology. The nanofibers produced by electrospinning a solution of Thermoplastic Polyurethane (TPU) in Dimethylformamide (DMF). Polymer concentration and process parameters were considered as the effective factors. Taguchi's L9 orthogonal design (4 parameters, 3 levels) was applied to the experiential design. Optimal electrospinning conditions were determined using the signal-to-noise (S/N) ratio with Minitab 17 software. The morphology of the nanofibers was studied by a Scanning Electron Microscope (SEM). Thereafter, a tensile tester machine was used to assess mechanical properties of nanofibrous scaffolds. The analysis of DoE experiments showed that TPU concentration was the most significant parameter. An optimum combination to reach smallest diameters was yielded at 12 wt% polymer concentration, 16 kV of the supply voltage, 0.1 ml/h feed rate and 15 cm tip-to-distance. An empirical model was extracted and verified using confirmation test. The average diameter of nanofibers at the optimum conditions was in the range of 242.10 to 257.92 nm at a confidence level 95% which was in close agreement with the predicted value by the Taguchi technique. Also, the mechanical properties increased with decreasing fibers diameter. This study demonstrated Taguchi method was successfully applied to the optimization of electrospinning conditions for TPU nanofibers and the presented scaffold can mimic the structure of Extracellular Matrix (ECM).

Delorme’s Procedure: An Effective Treatment for a Full-Thickness Rectal Prolapse in Young Patients

Mohammad Sadegh Fazeli,Ali Reza Kazemeini,Amir Keshvari,Mohammad Reza Keramati 대한대장항문학회 2013 Annals of Coloproctolgy Vol.29 No.2

Purpose: Delorme’s procedure is infrequently applied in young adults because of its assumed higher recurrence rate. The aim of this prospective study was to assess the efficacy of the Delorme’s technique in younger adults. Methods: Fifty-two consecutive patients were entered in our study. We followed patients for at least 30 months. Their complaints and clinical exam results were noted. Results: Our study included 52 patients (mean age, 38.44 years; standard deviation, 13.7 years). Of the included patients, 41(78.8%) were younger than 50 years of age, and 11 (21.1%) were older than 50 years of age. No postoperative mortalities or major complications were noted. Minor complications were seen in 5 patients (9.6%) after surgery. The mean hospital stay was 2.5 days. In the younger group (age ≤50 years), fecal incontinence was improved in 92.3% (12 out of 13 with previous incontinence) of the patients, and recurrence was seen in 9.75% (4 patients). In the older group (age >50 years), fecal incontinence was improved in 20% (1 out of 5 with previous incontinence) of the patients, and recurrence was seen in 18.2% (2patients). In 50% of the patients with a previous recurrence (3 out of 6 patients) following Delorme’s procedure as a secondary procedure, recurrence was observed. Conclusion: Delorme’s procedure, especially in younger patients, is a relatively safe and effective treatment and should not be restricted to older frail patients. This procedure may not be suitable for recurrent cases.

Lipid Profiles and Hepatitis C Viral Markers in HCV-Infected Thalassemic Patients

( Seyed Moayed Alavian ),( Seyyed Mohammad Miri ),( Seyed Vahid Tabatabaei ),( Maryam Keshvari ),( Bita Behnava ),( Pegah Karimi Elizee ),( Nastaran Mahboobi ),( Kamran Bagheri Lankarani ) 대한소화기기능성질환·운동학회 2011 Gut and Liver Vol.5 No.3

Background/Aims: The distribution of blood lipids, glucose and their determinants in thalassemic patients with chronic hepatitis C virus (HCV) infection has rarely been investigated. Thus, we aimed to investigate the relationship between both liver histologic findings and viral markers and serum lipids in thalassemic patients chronically infected with HCV. Methods: We enrolled 280 polytransfused thalassemic patients with chronic hepatitis C. HCV viral load was determined using the Amplicor test. Genotyping was performed using genotype specific primers. Fasting serum lipid, glucose, ferritin and liver function enzyme concentrations were measured. A modified Knodell scoring system was used to stage liver fibrosis and to grade necroinflammatory activity. Perls` staining was used to assess hepatic siderosis. Results: Just one subject had total cholesterol >200 mg/dL, and 7% had triglycerides >150 mg/dL. The mean high-density lipoprotein cholesterol (HDL-C) and glucose levels were 37 and 104 (97-111) mg/dL, respectively. Viral markers, liver histological findings and aminotransferase activity were not associated with serum lipid levels. Serum triglycerides, total cholesterol and ferritin were independent risk factors for impaired glucose tolerance or diabetes in these patients. Conclusions: The majority of the patients had blood lipid levels (with the exception of HDL) within the defined normal range; viral and liver histological factors do not appear to play a significant role in changing the levels of serum lipids or glucose in these patients. (Gut Liver 2011;5:348-355)

Short-course versus long-course neoadjuvant chemoradiotherapy in patients with rectal cancer: preliminary results of a randomized controlled trial

Mahdi Aghili,Nastaran Khalili,Neda Khalili,Mohammad Babaei,Farshid Farhan,Peiman Haddad,Samaneh Salarvand,Amir Keshvari,Mohammad Sadegh Fazeli,Negin Mohammadi,Reza Ghalehtaki 대한방사선종양학회 2020 Radiation Oncology Journal Vol.38 No.2

Purpose: Colorectal cancer is becoming an increasing concern in the middle-aged population of Iran. This study aimed to compare the preliminary results of short-course and long-course neoadjuvant chemoradiotherapy treatment for rectal cancer patients. Materials and Methods: In this clinical trial we recruited patients with rectal adenocarcinoma located from 5 cm to 15 cm above the anal verge. Patients in group I (short-course) received three-dimensional conformational radiotherapy with a dose of 25 Gy/5 fractions in 1 week plus concurrent XELOX regimen (capecitabine 625 mg/㎡ from day 1-5 twice daily and oxaliplatin 50 mg/㎡ on day 1 once daily). Patients in group II (long-course) received a total dose of 50-50.4 Gy/25-28 fractions for 5 to 5.5 weeks plus capecitabine 825 mg/m2 twice daily. Both groups underwent consolidation chemotherapy followed by delayed surgery at least 8 weeks after radiotherapy completion. The pathological response was assessed with tumor regression grade. Results: In this preliminary report on complications and pathological response, 66 patients were randomized into two study groups. Mean duration of radiotherapy in the group II (long-course) was 5 ± 1 days (range, 5 to 8 days) and 38 ± 6 days (range, 30 to 58 days). The median follow-up was 18 months. Pathological complete response was achieved in 32.3% and 23.1% of patients in the short-course and long-course groups, respectively (p = 0.558). Overall, acute grade 3 or higher treatment-related toxicities occurred in 24.2% and 22.2% of patients in group I and II, respectively (p = 0.551). No acute grade 4 or 5 adverse events were observed in either group except one grade 4 hematologic toxicity that was seen in group II. Within one month of surgery, no significant difference was seen regarding grade ≥3 postoperative complications (p = 0.333). Conclusion: For patients with rectal cancer located at least 5 cm above the anal verge, short-course radiotherapy with concurrent and consolidation chemotherapy and delayed surgery is not different in terms of acute toxicity, postoperative morbidity, complete resection, and pathological response compared to long-course chemoradiotherapy.

Preoperative short course radiotherapy with concurrent and consolidation chemotherapies followed by delayed surgery in locally advanced rectal cancer: preliminary results

Mahdi Aghili,Sarvazad Sotoudeh,Reza Ghalehtaki,Mohammad Babaei,Borna Farazmand,Mohammad-Sadegh Fazeli,Amir Keshvari,Peiman Haddad,Farshid Farhan 대한방사선종양학회 2018 Radiation Oncology Journal Vol.36 No.1

Purpose: This study aimed to assess complications and outcomes of a new approach, that is, combining short course radiotherapy (SRT), concurrent and consolidative chemotherapies, and delayed surgery. Materials and Methods: In this single arm phase II prospective clinical trial, patients with T3-4 or N+ M0 rectal adenocarcinoma were enrolled. Patients who received induction chemotherapy or previous pelvic radiotherapy were excluded. Study protocol consisted of three-dimensional conformal SRT (25 Gy in 5 fractions in 1 week) with concurrent and consolidation chemotherapies including capecitabine and oxaliplatin. Total mesorectal excision was done at least 8 weeks after the last fraction of radiotherapy. Primary outcome was complete pathologic response and secondary outcomes were treatment related complications. Results: Thirty-three patients completed the planned preoperative chemoradiation and 26 of them underwent surgery (24 low anterior resection and 2 abdominoperineal resection). Acute proctitis grades 2 and 3 were seen in 11 (33.3%) and 7 (21.2%) patients, respectively. There were no grades 3 and 4 subacute hematologic and non-hematologic (genitourinary and peripheral neuropathy) toxicities and perioperative morbidities such as anastomose leakage. Grade 2 or higher late toxicities were observed among 29.6% of the patients. Complete pathologic response was achieved in 8 (30.8%) patients who underwent surgery. The 3-year overall survival and local control rates were 65% and 94%, respectively. Conclusion: This study showed that SRT combined with concurrent and consolidation chemotherapies followed by delayed surgery is not only feasible and tolerable without significant toxicity but also, associated with promising complete pathologic response rates.

Preoperative short course radiotherapy with concurrent and consolidation chemotherapies followed by delayed surgery in locally advanced rectal cancer: preliminary results

Aghili, Mahdi,Sotoudeh, Sarvazad,Ghalehtaki, Reza,Babaei, Mohammad,Farazmand, Borna,Fazeli, Mohammad-Sadegh,Keshvari, Amir,Haddad, Peiman,Farhan, Farshid The Korean Society for Radiation Oncology 2018 Radiation Oncology Journal Vol.36 No.1

Purpose: This study aimed to assess complications and outcomes of a new approach, that is, combining short course radiotherapy (SRT), concurrent and consolidative chemotherapies, and delayed surgery. Materials and Methods: In this single arm phase II prospective clinical trial, patients with T3-4 or N+ M0 rectal adenocarcinoma were enrolled. Patients who received induction chemotherapy or previous pelvic radiotherapy were excluded. Study protocol consisted of three-dimensional conformal SRT (25 Gy in 5 fractions in 1 week) with concurrent and consolidation chemotherapies including capecitabine and oxaliplatin. Total mesorectal excision was done at least 8 weeks after the last fraction of radiotherapy. Primary outcome was complete pathologic response and secondary outcomes were treatment related complications. Results: Thirty-three patients completed the planned preoperative chemoradiation and 26 of them underwent surgery (24 low anterior resection and 2 abdominoperineal resection). Acute proctitis grades 2 and 3 were seen in 11 (33.3%) and 7 (21.2%) patients, respectively. There were no grades 3 and 4 subacute hematologic and non-hematologic (genitourinary and peripheral neuropathy) toxicities and perioperative morbidities such as anastomose leakage. Grade 2 or higher late toxicities were observed among 29.6% of the patients. Complete pathologic response was achieved in 8 (30.8%) patients who underwent surgery. The 3-year overall survival and local control rates were 65% and 94%, respectively. Conclusion: This study showed that SRT combined with concurrent and consolidation chemotherapies followed by delayed surgery is not only feasible and tolerable without significant toxicity but also, associated with promising complete pathologic response rates.

Comparisons of computed mobile phone induced SAR in the SAM phantom to that in anatomically correct models of the human head

Beard, B.B.,Kainz, W.,Onishi, T.,Iyama, T.,Watanabe, S.,Fujiwara, O.,Wang, Jianqing,Bit-Babik, G.,Faraone, A.,Wiart, J.,Christ, A.,Kuster, N.,Lee, Ae-Kyoung,Kroeze, H.,Siegbahn, M.,Keshvari, J.,Abrish [Institute of Electrical and Electronics Engineers 2006 IEEE transactions on electromagnetic compatibility Vol.48 No.2

The specific absorption rates (SAR) determined computationally in the specific anthropomorphic mannequin (SAM) and anatomically correct models of the human head when exposed to a mobile phone model are compared as part of a study organized by IEEE Standards Coordinating Committee 34, Sub-Committee 2, and Working Group 2, and carried out by an international task force comprising 14 government, academic, and industrial research institutions. The detailed study protocol defined the computational head and mobile phone models. The participants used different finite-difference time-domain software and independently positioned the mobile phone and head models in accordance with the protocol. The results show that when the pinna SAR is calculated separately from the head SAR, SAM produced a higher SAR in the head than the anatomically correct head models. Also the larger (adult) head produced a statistically significant higher peak SAR for both the 1- and 10-g averages than did the smaller (child) head for all conditions of frequency and position.