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Ghaedi M.,University of California at Davis | Ghaedi M.,Tarbiat Modares University | Ghaedi M.,Iran National Institute of Genetic Engineering and Biotechnology | Soleimani M.,Tarbiat Modares University | And 6 more authors.
Journal of Gene Medicine | Year: 2011

Inhibition of tumor-induced angiogenesis may restrict tumor growth and metastasis. Long-term systemic delivery of angiogenic inhibitors is associated with toxicity, as well as other severe side-effects. The utility of cells as vehicles for gene therapy to deliver therapeutic molecules has been suggested to represent an efficient approach. Mesenchymal stem cells (MSCs) exhibit a tropism to cancer tissue, and may serve as a cellular delivery vehicle and a local producer of anti-angiogenic agents. Methods: In the present study, we attempted to assess production of the transgene, α1-antitrypsin (AAT), in lentivirus-transduced human MSCs and its cytotoxicity against human umbilical cord vein endothelial cells (HUVEC). The secreted protein from these effector cells was determined by an enzyme-linked immunosorbent assay. The cytotoxicity of hMSCs that overexpress the human AAT gene against HUVEC was evaluated with an apoptotic assay. Results: Lentivirus-transduced hMSCs produced functional AAT and displayed much higher cytotoxicity against HUVEC than untransduced hMSCs. Moreover, AAT secreted from transduced hMSCs significantly inhibited HUVEC proliferation compared to untransduced hMSCs. The data obtained demonstrate for the first time that genetically modified hMSCs released abundant and functional AAT that caused obvious cytotoxicity to HUVEC. Conclusions: hMSC may serve as an effective platform for the targeted delivery of therapeutic proteins to cancer sites. © 2011 John Wiley & Sons, Ltd.


Sharifpour A.,Tehran University of Medical Sciences | Ashraf H.,Tehran Heart Center
Annals of Indian Academy of Neurology | Year: 2013

Objectives: Electrocardiographic (ECG) changes are reported frequently after acute strokes. It seems that cardiovascular effects of strokes are modulated by concomitant or pre-existent cardiac diseases, and are also related to the type of cerebrovascular disease and its localization. We aimed to determine the pattern of ECG changes associated with pathophysiologic categories of acute stroke among patients with/without cardiovascular disease and to determine if specific ECG changes are related to the location of the lesion. Materials and Methods : The electrocardiographic records of 361 patients with acute stroke were studied to assess the relative frequencies of ECG abnormalities among the pathophysiologic categories of stroke. Results: In the present study, the most common ECG abnormalities associated with stroke were T-wave abnormalities, prolonged QTc interval and arrhythmias, which were respectively found in 39.9%, 32.4%, and 27.1% of the stroke patients and 28.9%, 30.7%, and 16.2 of the patients with no primary cardiac disease. We observed that other ECG changes comprising pathologic Q- wave, ST-segment depression, ST-segment elevation, and prominent U wave may also occur in selected or non-selected stroke patients; thereby simulate an acute myocardial injury. We observed an increased number of patients with abnormal T-wave and posterior fossa bleedings and more rhythm disturbances for ischemic lesions, localized in the anterior fossa. Conclusion: Ischemia-like ECG changes and arrhythmias are frequently seen in stroke patients, even in those with no history or signs of primary heart disease, which support a central nervous system origin of these ECG abnormalities. Further study is necessary to better define the brain-heart interaction. © 2013 Annals of Indian Academy of Neurology.


Zeymer U.,Klinikum der Stadt Ludwigshafen Am Rhein | Waliszewski M.,B.Braun Melsungen AG | Spiecker M.,Marien Hospital Marl | Gastmann O.,Klinik fur Innere Medizin | And 6 more authors.
Heart | Year: 2014

Background This prospective registry assessed the safety and efficacy of paclitaxel coated balloon (PCB) angioplasty for small vessel coronary artery disease in Europe and Asia with the intention to treat lesions without additional stenting. The use of PCBs in small vessels seems to be associated with favourable outcomes; however, prospective data for the use of PCBs without stenting are limited. Methods The SeQuent Please Small Vessel 'PCB only' Registry was an international, prospective, multicentre registry enrolling patients with de novo lesions of small reference diameters (≥2.0 mm, ≤2.75 mm). The primary end point was clinically driven target lesion revascularisation (TLR) at 9 months. Secondary end points were acute technical success, in-hospital outcomes, 9-month major adverse cardiac events (MACE) (death, myocardial infarction, or TLR), and the occurrence of definite lesion and vessel thrombosis. Results A total of 479 patients (66.1±10.9 years, 36.7% diabetics) were enrolled, 105 (23.5%) with an acute coronary syndrome, 41 (9.2%) with ST elevation myocardial infarction (STEMI), and 60 (14.8%) with non- STEMI. The initial procedural success rate was 99.0%; 27 patients (6%) needed additional bare metal stent implantation. TLR at 9.4±1.7 months occurred in 14 patients (3.6%), while three patients (0.6%) had vessel thrombosis in non-target lesions. There was no cardiac death or coronary artery bypass graft surgery. Conclusions To date, this is the largest prospective study with PCBs in small vessel de novo lesions in unselected patients. Rates of TLR and MACE were low, suggesting the use of PCBs may be an attractive alternative treatment option to drug eluting stents in small vessels.


Hamedani B.A.,Iran University of Science and Technology | Navidbakhsh M.,Iran University of Science and Technology | Tafti H.A.,Tehran Heart Center
BioMedical Engineering Online | Year: 2012

Background: As a main cause of mortality in developed countries, Coronary Artery Disease (CAD) is known as silent killer with a considerable cost to be dedicated for its treatment. Coronary Artery Bypass Graft (CABG) is a common remedy for CAD for which different blood vessels are used as a detour. There is a lack of knowledge about mechanical properties of human blood vessels used for CABG, and while these properties have a great impact on long-term patency of a CABG. Thus, studying these properties, especially those of human umbilical veins which have not been considered yet, looks utterly necessary.Methods: Umbilical vein, as well as human Saphenous vein, are respectively obtained after cesarean and CABG. First, histological tests were performed to investigate different fiber contents of the samples. Having prepared samples carefully, force-displacement results of samples were rendered to real stress-strain measurements and then a fourth-order polynomial was used to prove the non-linear behavior of these two vessels.Results: Results were analyzed in two directions, i.e. circumferentially and longitudinally, which then were compared with each other. The comparison between stiffness and elasticity of these veins showed that Saphenous vein's stiffness is much higher than that of umbilical vein and also, it is less stretchable. Furthermore, for both vessels, longitudinal stiffness was higher than that of circumferential and in stark contrast, stretch ratio in circumferential direction came much higher than longitudinal orientation.Conclusion: Blood pressure is very high in the region of aorta, so there should be a stiff blood vessel in this area and previous investigations showed that stiffer vessels would have a better influence on the flow of bypass. To this end, the current study has made an attempt to compare these two blood vessels' stiffness, finding that Saphenous vein is stiffer than umbilical vein which is somehow as stiff as rat aortic vessels. As blood vessel's stiffness is directly related to elastin and mainly collagen content, results showed the lower amount of these two contents in umbilical vein regarding Saphenous vein. © 2012 Hamedani et al.; licensee BioMed Central Ltd.


Ghavidel A.A.,Heart Valve Disease Research Center | Javadikasgari H.,Heart Valve Disease Research Center | Maleki M.,Shahid Rajaie Heart Hospital | Karbassi A.,Tehran Heart Center | And 2 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2014

Objectives: The aim of this study was to develop new models for prediction of short-term mortality risk in on-pump coronary artery bypass grafting (CABG) surgery using decision tree (DT) methods.Methods: Between September 2005 and April 2006, 948 consecutive patients underwent CABG surgery at Rajaie Heart Center. Potential risk factors were reviewed and univariate and multivariate analysis for short-term mortality were performed. The whole dataset was divided into mutually exclusive subsets. An entropy error fuzzy decision tree (EEFDT) and an entropy error crisp decision tree (EECDT) were implemented using 650 (68.6%) patient data and tested with 298 (31.4%) patient data. Ten times hold-out cross validation was done and the area under the receiver operative characteristic curve (AUC) was reported as model performance. The results were compared with the logistic regression (LR) model and Euro- SCORE.Results: The overall short-term mortality rate was 3.8%, and was statistically higher in women than men (P < .001). The final EEFDT selected 19 variables and resulted in a tree with 39 nodes, 20 conditional rules, and AUC of 0.90 ± 0.008. The final EECDT selected 15 variables and resulted in a tree with 35 nodes, 18 conditional rules, and AUC of 0.86 ± 0.008. The LR model selected 10 variables and resulted in an AUC of 0.78 ± 0.008; the AUC for EuroSCORE was 0.77 ± 0.003. There were no differences in the discriminatory power of EEFDT and EECDT (P = .066) and their performance was superior to LR and EuroSCORE.Conclusions: EEFDT, EECDT, LR, and EuroSCORE had clinical acceptance but the performance and accuracy of the DTs were superior to the other models. Surgery. © 2014 The American Association for Thoracic Surgery.


Hosseini S.K.,Tehran Heart Center | Ansari M.J.A.,Tehran Heart Center | Lotfi Tokaldany M.,Tehran University of Medical Sciences | Sharafi A.,Tehran University of Medical Sciences | And 2 more authors.
Journal of Cardiovascular Medicine | Year: 2014

AIM: To evaluate the association between the preprocedural hemoglobin (Hb) level and 1 year major adverse cardiac event (MACE) in patients undergoing percutaneous coronary intervention (PCI). METHODS: A total of 2819 patients (mean age 56.6110.37 years, 69% male) with available preprocedural Hb levels were included. Patients were followed up for 12 months. MACE included cardiac death, myocardial infarction (MI), target vessel revascularization and target lesion revascularization. MACE was compared across the different levels of Hb in nonanemic, mild, moderate, and severe anemia subgroups. RESULTS: The preprocedural mean Hb level was 13.561.67g/dl. Anemic patients were older, more frequently women, and less likely to be cigarette smokers compared to the nonanemic group. Patients with Hb less than 10mg/dl had the highest proportion of renal failure (56.7%) compared to 40.1% in moderate, 34.6% in mild, and 22.7% in nonanemic groups. In-hospital MI and death occurred in 8 (0.3%) and 2 (0.1%) of the nonanemic group, respectively, and 1 (0.3%) patient with mild anemia experienced MI. After 12 months the rate of total MACE was 3.4% in all the patients. After adjustment for age, sex, interaction between sex, and Hb level, smoking, hypertension, diabetes mellitus, and creatinine clearance, only severe anemia with Hb below 10g/dl was associated with an increased risk of MACE (hazard ratio 4.623; 95% confidence interval 1.642-13.021; P?0.004). CONCLUSION: The impact of anemia on the 12-month MACE was more prominent in patients with Hb below 10mg/dl. Therefore, in patients with severe anemia listed for PCI, this level of Hb should be considered as a precaution. © 2014 Italian Federation of Cardiology.


Yaminisharif A.,Tehran University of Medical Sciences | Yaminisharif A.,Tehran Heart Center | Hoseini S.M.S.,Tehran University of Medical Sciences | Shafiee A.,Tehran University of Medical Sciences
Journal of Interventional Cardiac Electrophysiology | Year: 2014

Method: We enrolled 31 consecutive patients (mean age = 50.9 ± 11.9 years; 5 [16.1 %] male) who presented with documented clinical PSVT in superficial electrocardiography but had non-inducible arrhythmia in the electrophysiology laboratory despite applying different stimulation protocols. We delivered low-power (25 W), low-temperature (45 °C) RF currents into the AV junction region to induce AVNRT.Aims: Some patients with documented episodes of paroxysmal supraventricular tachycardia (PSVT) do not have inducible tachycardia during the electrophysiological study. In this study, we describe how multiple low-temperature, low-power radiofrequency (RF) currents in the atrioventricular (AV) junction region can increase the rate of the induction of atrioventricular nodal reentrant tachycardia (AVNRT) in non-inducible cases.Results: Arrhythmia was induced in 20 (64.5 %) patients, and it was non-sustained in 3 (9.6 %) patients. RF current was delivered into the posterior region near the coronary sinus ostium and midseptal region. RF ablation target in inducible patients was the non-inducibility of the AVNRT at the end of the procedure, while the target in the non-inducible patients was slow pathway ablation with no antegrade conduction over the slow pathway. During the follow-up period, none of the patients (either with inducible or non-inducible arrhythmia) had recurrence of AVNRT.Conclusion: Multiple low-power, low-temperature RF current application into the AV junction region is a more effective method for the induction of AVNRT in comparison with a single current use into the slow pathway. © 2014, Springer Science+Business Media New York.


Kassaian S.E.,Tehran University of Medical Sciences | Goodarzynejad H.,Tehran University of Medical Sciences | Goodarzynejad H.,Tehran Heart Center | Boroumand M.A.,Tehran University of Medical Sciences | And 10 more authors.
Cardiovascular Diabetology | Year: 2012

Background: Diabetes has been shown to be independent predictor of restenosis after percutaneous coronary intervention (PCI). The aim of the present study was to investigate whether a pre- and post-procedural glycaemic control in diabetic patients was related to major advance cardiovascular events (MACE) during follow up.Methods: We evaluated 2884 consecutive patients including 2181 non-diabetic patients and 703 diabetics who underwent coronary stenting. Diabetes mellitus was defined as the fasting blood sugar concentration ≥ 126 mg/dL, or the use of an oral hypoglycemic agent or insulin at the time of admission. Diabetic patients were categorized into two groups based on their mean HbA1c levels for three measurements (at 0, 1, and 6 months following procedure): 291 (41.4%) diabetics with good glycaemic control (HbA1c ≤ 7%) and 412 (58.6%) diabetics with poor glycaemic control (HbA1c > 7%).Results: The adjusted risk of MACE in diabetic patients with poor glycaemic control (HbA1c > 7%) was 2.1 times of the risk in non-diabetics (adjusted HR = 2.1, 95% CI: 1.10 to 3.95, p = 0.02). However, the risk of MACE in diabetics with good glycaemic control (HbA1c ≤ 7%) was not significantly different from that of non-diabetics (adjusted HR = 1.33, 95% CI: 0.38 to 4.68, p = 0.66).Conclusions: Our data suggest that there is an association between good glycaemic control to obtain HbA1c levels ≤7% (both pre-procedural glycaemic control and post-procedural) with a better clinical outcome after PCI. © 2012 Kassaian et al.; licensee BioMed Central Ltd.


PubMed | Tehran Heart Center and Tehran University of Medical Sciences
Type: Journal Article | Journal: Iranian journal of psychiatry and behavioral sciences | Year: 2015

Atypical cases of suicide are less likely to be seen in general hospitals, nonetheless require further investigation into the precipitating factors as well as proper follow-up. This paper illustrates a 61-year-old woman with major depressive disorder who experienced auditory hallucinations during delirious periods of taking low-dose benzodiazepines, who referred to the hospital with a sewing needle stuck in her chest wall. The needle was successfully removed. Psychiatric problems are often underdiagnosed, therefore undertreated in general hospitals. Thus close monitoring of the patients during the hospitalization and after discharge is crucial.


Davarpasand T.,Tehran Heart Center | Hosseinsabet A.,Tehran Heart Center
Interactive Cardiovascular and Thoracic Surgery | Year: 2015

OBJECTIVES: Triple valve replacement (TVR) is still deemed a complex and challenging choice for rheumatic heart disease (RHD) and carries significant mortality and morbidity. We report the short- And mid-term results after TVR in the last decade. METHODS: In a historical cohort, ninety consecutive patients, at a mean age of 47 ± 12 years underwent TVR between 2003 and 2013 for RHD. Most of the patients were in the New York Heart Association (NYHA) functional class II or III. Univariate and multivariate analyses were performed to identify the predictors of overall and event-free survival. RESULTS: The 30-day hospital mortality rate was 6% (n = 5). One-year and 4-year overall survival (cardiac survival) rates were 91.7 and 89.5%, respectively. One-year and 4-year rates of freedom from cardiac events (e.g. cardiac death, cardiac rehospitalization, cardiac reoperation, cerebrovascular events, anticoagulation-related major haemorrhage and significant valvular malfunction) were 83.5 and 69.5%, respectively. Age, diabetes and pump time were the independent predictors of overall survival, and diabetes and hypertension were the independent predictors of event-free survival. One-year and 4-year freedom rates from anticoagulation-related major haemorrhage were 96.6 and 90.7%, respectively. The 1-year and 4-year rates of freedom from a composite of valvular thrombosis, major bleeding events and thromboemboli were 94.1 and 88.5%, respectively. One-year and 4-year freedom rates from cardiac rehospitalization were 94.0 and 88.0%, respectively. One-year and 4-year rates of freedom from cardiac reoperation were 98.8 and 93.9%, respectively. One-year and 4- year rates of freedom from significant prosthetic valve malfunction (e.g. structural valve deterioration, valve thrombosis and paravalvular leakage) were 96.6 and 90.7%, respectively. The 1-year and 4-year rates of freedom from major adverse valve-related events were 86.3 and 78.5%, respectively. CONCLUSIONS: TVR for RHD appears to confer satisfactory short- And mid-term results with excellent symptomatic improvement. The overall mortality following TVR may be improved by early surgical treatment before the NYHA functional class IV. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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