Diffuse large B cell lymphoma (DLBCL) is the most common histologic subtype of non-Hodgkin lymphoma (NHL) accounting for approximately 30 percent of all NHL cases, involving both nodal and extra-nodal sites. Apart from distinct morphological and clinicopathological subtypes, DLBCL can be dived into molecular subtypes, Germimal Centre Subtype (GCB) and Activated B-Cell (ABC) based on gene expression profiling. IPI (International Prognostication Index) and its variants are used to prognosticate the patients. Limited stage DLBCL is primarily treated with combined modality therapy consisting of abbreviated systemic chemotherapy (three cycles), and involved field radiation therapy, whereas advanced stage disease is treated with full course of chemotherapy with recommendation of addition of novel agents ( Bortezomib, Ibrutinib, Lenalidomide) in ABC type DLBCL.

Background: Describing the personality traits of medical health students is an essential for understanding their motivation and learning styles and can help plan theoretical and clinical training in this field. Given the dearth of research in this area, the present study was conducted to examine and describe personality traits and spiritual intelligence in medical sciences students and to determine the relationship between these two variables. Methods: This descriptive, analytical, cross-sectional study was conducted with 240 medical and dental students at Babol University of Medical Sciences selected through simple random sampling. The students completed a demographic questionnaire, the NEO Five-Factor Inventory and the Integrated Spiritual Intelligence Scale developed by Amram and Dryer. Results: The spiritual intelligence score was higher among dental students than medical students (220.12 ± 78.63 vs. 191.08 ± 65.79) and was higher among women than men (229.27 ± 83.25 vs. 191.89 ± 78.63). The results of the multivariate regression analysis revealed extraversion (β = 0.330) was positively associated with spiritual intelligence. Openness to experience (β = −0.581), agreeableness (β = −0.433), and conscientiousness (β = −0.415) were negatively associated with spiritual intelligence. However, neuroticism was not associated with spiritual intelligence. Conclusions: Some personality traits were associated with spiritual intelligence in Iranian medical and dental students. These findings suggest that improving the spiritual intelligence of medical and dental students requires further attention to personality traits in this group of students.

A clear quantitative relationship between the dose of total body ionizing radiation and mortality in humans is not known because of lack of human data that would enable us to determine the lethal dose for 50% of cases (LD₅₀) in total body irradiation on earth or in probable future interplanetary travels. Analysis of human data has been primarily from radiation accidents, radiotherapy, and the atomic bomb victims. The author published the general mathematical formula that predicts mortality probability as a function of dose rate and duration of exposure to acute ionizing radiation in humans on the basis of data presented by Cerveny et al., employing the author's mathematical probacent model. Further, the author applied the general formula to the data on dose versus cancer mortality risk published by the United Nations Scientific Committee on the effects of atomic radiation and other investigators to construct general formulas expressing a relationship between dose and solid cancer or leukemia mortality probability after exposure to acute low-dose ionizing radiation in humans on earth. There is a remarkable agreement between formula-derived and published values of dose and solid cancer or leukemia mortality probability (P > 0.99). In this study, the above mortality formulas are applied to the measurements of the Mars Science Laboratory spacecraft containing the Curiosity rover (2012–2013) in estimating radiation safety for astronauts in a future space flight to Mars planned by the National Aeronautics and Space Administration. Results of the estimation obtained with a mathematical approach are presented in this study.

Background: Immunohistochemistry (IHC) is a routinely performed method to demonstrate estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) in surgical breast cancer specimens but not on cell block (CB) of fine-needle aspiration (FNA). The aims of this study were to evaluate the expression of ER, PR, and HER2 using immunocytochemistry (ICC) on CB and compare with the corresponding tissue blocks as gold standard as well as to compare with other similar studies. Materials and Methods: Forty-eight breast carcinoma CB specimens with their corresponding tissue blocks were identified. ICC on CB for ER, PR, and HER2 was performed and compared with tissue blocks. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value were measured for each receptor. The degree of agreement between CB and tissue blocks was calculated using Cohen's kappa (κ) test. Results: ER results showed 67.7% sensitivity, 94.1% specificity, 95.5% PPV, and a moderate agreement (κ =0.588). PR results showed 50% sensitivity, 90% specificity, 87.5% PPV, and a fair agreement (κ =0.368). HER2 results showed 58.3% sensitivity, 100% specificity, 100% PPV, and a moderate agreement (κ =0.539). Conclusion: The results of this study confirm the wide variations that occur between CB ICC and tissue block IHC in the detection of ER, PR, and HER2 in breast cancers. In comparison with other studies, we report a low sensitivity and high specificity rates for ER, PR, and HER2 in FNA CB. Further studies are recommended.

Purpose: Bilateral vocal fold immobility (BVFI) presents a challenging endeavor to surgeons and a suture lateralization (SL) procedure under endoscopy has been proposed to treat BVFI. The goal of this study is to introduce an adaptable method to calibrate an appropriate entrance on the thyroid lamina for the stitch canal to precisely reach an appropriate endolaryngeal site for the suture loop placement and minimize the endolaryngeal soft-tissue (ELT) damage. Materials and Methods: From 2007–2015, a total of 38 patients with BVFI due to various causes had undergone 40 exo-endolaryngeal SL (exoeSL) procedures in our hospital. The former 20 patients had undergone so-called blind suture loop placement procedures. The latter 18 patients had been treated with a refined suture placement technique. Results: The suture placement in former 20 patients had undergone one to three episodes of needle entrances into the ELT with average of 1.7 episodes each patient and caused one paraglottic hematoma. The latter 18 of the 38 patients had obtained one episode of ELT damage each patient and produced no vascular events. Conclusions: The topographic relationship of the pyriform recess on the thyroid lamina can serve as a consistent and surgically useful landmark for avoiding the paraglottic dead space infection from the stitching canal during the SL procedure. With this suture placement refinement, the exoeSL procedure can really obtain a relatively appropriate endolaryngeal site to place the suture loop and decrease the ELT damage.

Background: Primary or secondary spontaneous pneumothorax (PSP or SSP) is a common treatable disease but notorious for its recurrence over the years. Intercoastal tube (ICT) thoracostomy is often done to relieve pneumothorax. Simultaneous pleurodesis could be done by pushing pleurodesing chemical agent through ICT. Pleurodesis would obliterate the pleural space and prevent its recurrence. Povidone-iodine (10%) was a cheaper pleurodezing agent with efficacy rate of 60%–80% with minimal complication as per many studies. Aims: Our aims were to study the efficacy, that is, success rate as well as safety of povidone-iodine for pleurodesis in the treatment of PSP or SSP by tube thoracostomy and also to study the demographic characteristic. Setting and Design: A prospective observational study was conducted over 30 patients of PSP and SSP in a rural tertiary care hospital. Materials and Methods: As per inclusion and exclusion criteria, consecutively attending patients (male: female 26:4) were admitted. Clinicoradiologically, the diagnosis of PSP or SSP was made. Patients were treated by ICT thoracostomy under LA to relive pneumothorax. After lung expansion, pleurodesis was done by pushing the povidone-iodine solution (80 ml) through same thoracostomy tube. Follow-up (FU) was done up to 180 days. The outcome was analyzed statistically. Statistical Analysis: Descriptive statistics were used using Microsoft Excel 2007. Results: The “efficacy or success rate” of povidone iodine-induced pleurodesis was 90% (27/30) up to 3^rd FU. However, the success rate of pleurodesis was 80% (24/30) till 180 days (4^th FU). The procedure showed minimal complication. Chest pain occurred in majority 76% (23/30) of patients after pleurodesis. Spirometry, visual disturbance, and thyroid dysfunction were unaffected. Conclusion: Povidone-iodine (10%) came out as efficacious, safe, sclerosing agent for pleurodesis in PSP or SSP treatment by tube thoracostomy with a good success rate and minimal complication.

Post-traumatic stress disorder (PTSD) is a complex syndrome that is defined by individual exposed to intense, life-threatening trauma thereby leading to physical and psychological abnormalities. They further develop additional symptoms including persistent anxiety, exaggerated startle, cognitive impairments, and diminished extinction of fear. Most of the previous studies focused on brain and neurophysiology, but PTSD affects the whole body. Therefore, we wanted to concentrate more on the effects on sex hormones using rats. Testosterone and estradiol are major sex hormones in male and female which are well known to participate in not only reproduction but also brain function and behaviors. Two behavioral tests, open field test and tail suspension test, were used to determine whether animals have PTSD-like symptoms. At the same time, serum samples were collected for sex hormone analysis. We investigated the influences of traumatic stress and then tried to find out the correlations of behaviors and hormones. In results, 22% of rats were affected by stress based on the behavioral tests and grouped as PTSD-like. These rats showed enhanced anxiety and depression behaviors. In serum samples from the PTSD-like group, only estradiol levels in male after stress are significant higher than the control or stressed but no symptom groups. Testosterone level showed no difference after stress both in male and female. We also observed that only estradiol level in male correlates with PTSD-like behaviors. It indicates that estradiol levels in male just after traumatic stress might be an indicator for PTSD-like symptoms.

A choanal polyp (CP) manifests as a unilateral benign growth blocking the nasal passage and most commonly originates from the maxillary sinus. A lesion from the superior turbinate has never been documented earlier. We report a case of a 21-year-old male presenting with a 6-month history of left-sided nasal obstruction, purulent discharge from the left side of the nose, and snoring. A CP originating from the superior turbinate was diagnosed and was removed by endoscopic endonasal surgery. There were no intraoperative or postoperative complications occurred, and the symptoms were resolved after the surgery. This article also discusses the clinical features, pathogenesis, and surgical treatment of this entity. Although very rare, a CP arising from the superior turbinate must be considered in the differential diagnosis of a solitary nasal polyp.

Robotic-assisted laparoscopy with the use of carbon dioxide (CO₂) for insufflation is rapidly adopted procedure for gynecological surgery. Insufflation of the abdomen with CO₂can potentially cause complications such as hypercarbia, subcutaneous emphysema (SE), pneumothorax, and pneumomediastinum. The incidence of SE ranges from 0.43% to 77%. Numerous potential mechanisms were proposed for the development of these complications. Several authors speculated that the surgical time, surgical ports, age, and peritoneal insufflation pressures are related to the development of these complications. These potentially lethal complications must be diagnosed and managed promptly. We experienced a case who developed delayed massive SE extended to neck and face after robotic ovarian cystectomy, it perhaps due to weaker tissues bonding fascial planes because she was acute weight loss within 1 month.

According to the World Health Organization, about 450 million people suffer from mental and behavioral disorders worldwide,^[1] whereas depression has a lifetime prevalence between 10% and 20%.^[2] Many surgical patients may take antidepressants, and several studies have reported an increased incidence of sudden cardiac death in these patients. We here present a patient who had major depression under medication control for 20 years and underwent left nephrectomy. Severe hypotension, resistant to catecholamine (such as ephedrine, epinephrine, and dopamine) treatment, was developed after general anesthetic induction. A review of preoperative psychotropic medications on patient's hemodynamic changes and the management for the refractory hypotension after general anesthetic induction are presented and discussed in this case report.