alireza rasekhi

The purpose of this retrospective single-center study was to determine the frequency of sarcopenia and its association with mortality and other morbidities in children with chronic liver disease who had undergone liver transplantation.

Sarcopenia, a muscle-wasting syndrome, is common in patients with advanced liver disease and is associated with increased morbidity and mortality. While sarcopenia in adults has been extensively studied, there is little information in this regard about children and adolescents with chronic liver diseases.

The study included 108 children and adolescents who had undergone liver transplantation. Sarcopenia was measured using skeletal muscle index at the third lumbar vertebral level and assessed using abdominal computed tomography imaging.

The frequency of sarcopenia in the studied population was found to be 45.7%. Patients with sarcopenia were more likely to be male (P<0.0001), older (P<0.0001), and had lower height-for-age z-scores (P=0.012). Genetic/metabolic diseases were the most common underlying cause of sarcopenia in children. Except for a higher rate of transplant rejection in the sarcopenia group (P=0.035), there was no significant difference in mortality rates (P=0.688) or post-LT complications between the two groups. One year after LT, computed tomography-derived body composition parameters revealed no significant differences between children who survived and those who did not.

Our findings indicated a high frequency of sarcopenia in children with chronic liver disease, implying that more research is needed to better understand its impact on clinical outcomes in this population.

Bronchopleural fistula (BPF), a sinus tract between the bronchial system and the pleural space, is associated with COVID-19 and can lead to pneumothorax, which increases the mortality rate. Due to the analytical status of COVID-19 patients, sealing the BPF necessitates the least minimal invasive treatment. Herein, we demonstrated a technique of sealing post-COVID-19 BPF with direct injection of cyanoacrylate glue under the guidance of a computed tomography scan. Following glue injection, the BPF was completely sealed in all four patients. In conclusion, in COVID-19 patients with small and distal BPF, percutaneous glue injection is recommended for BPF closure.

Following the initial liver biopsy attempts, several techniques using a wide range of methodologies and materials were developed. Many studies on the evaluation of post-liver biopsy complications were conducted. However, their fundamental limitation was significant variance in patient demographics and methodology, which might account for the inconsistent outcomes. Therefore, a uniform methodology to perform percutaneous liver biopsies that result in comparable outcomes around the world is required. This study aimed to determine the precise complication rate following percutaneous liver biopsy using a consistent method in all individuals. It also aimed to establish a consistent operating procedure for a percutaneous liver biopsy that yielded comparable outcomes. Between July 2018 and July 2019, 116 patients were enrolled in this retrospective study for percutaneous liver biopsy. All individuals underwent a biopsy using the same procedure. There was an attempt to exclude elements that could have an impact on the complication rate. For this purpose, the same type and size of needle were utilized. Moreover, a single needle pass, a subcostal approach, deep inspiration breath holding, identical pre- and post-biopsy preparation, real-time ultrasonography guidance, the use of a single operator, and the absence of sedation or general anesthesia were the other approaches that were used to minimize the impact of variables that could raise complication rates. The overall complication rate was 19.8%, of which 18.9% of patients experienced pain and mild bleeding, and one patient (0.9%) experienced hematoma necessitating precautionary hospitalization. The overall percentage of patients who experienced pain was 13.8%. No further complications were observed. The findings of this study could provide an accurate estimate of the post-liver biopsy complication rate. Furthermore, due to a lower complication rate than other practiced procedures, this uniform methodology could be an attractive alternative in clinical practice. However, more research is required to confirm these results.

Osteoid osteoma is a painful benign osteoblastic lesion occurring mainly in the long bones. On the one hand, some studies have declared that post-treatment CT cannot determine the success or failure of radiofrequency ablation, on the other hand, some studies have stated that imaging follow-up can be helpful or even mandatory in some cases. The present study aims to evaluate Osteoid Osteoma's imaging features before or after radiofrequency ablation with or without curettage and during the follow-up period.

In this retrospective and cross-sectional study, we reviewed twenty seven Osteoid Osteoma patients with radiofrequency ablation who were assessed via drilling with or without curettage from March 2015 to December 2019 at Nemazi Hospital, Shiraz University of Medical Sciences.

Radiofrequency ablation with drilling was used in 22(81.5%) patients, and for the rest 5(18.5%), radiofrequency ablation with curettage and drilling was performed as a treatment procedure. The overall clinical success rate was 92.6%(25/27), with a low complication rate (7.4%). The mean diameter of nidus in pre/pos treatment was 3.46±2.02 and 2.22±1.75 mm, respectively. Femur 12(44.4%) was the most common bone in the patients. Significant differences between pre/post treatment follow up examinations in nidus size (P=0.03), nidus diameter (P=0.02), bone and calcification size (P=0.005) were detected. Additionally, it depicts that the mean values of tumor size and cortical thickening decreased after treatment.

It is noteworthy that the present study had some limitations, including the small sample size and the relatively short follow-up period. There is no significant difference between radiofrequency ablation after drilling and curettage in treating Osteoid Osteoma. It is concluded that although there was a significant difference in pre/post-treatment imaging, there is no need for continuous imaging follow-up in treated patients without clinical complications such as pain to mitigate radiation dose risks and healthcare expenses.

Several typical and atypical findings have been observed in Covid-19 high-resolution computer tomography (HRCT). To our knowledge, there is no study investigating the relationship between the presence of nodules in Covid-19 patients and the patient's condition. Therefore, the present study assessed the frequency of pulmonary nodules in Covid-19 patients according to their condition.

This cross-sectional study assessed the medical images of the patients referred to three university-affiliated centers (Nemazi, Ali Asghar and Shahid Faghihi Hospital) to perform Covid-19 HRCT from April to September 2020. The centers have been named H1, H2, and H3. Patients who were referred to these centers had good, poor, and fair conditions, respectively. The history of patients was assessed carefully. Patients' demographic information, nodule shape, number, size, location, presence of cavitation, and GGO around the nodule were assessed and recorded.

Overall, 20576 patients (mean age=46.75±16.64 years old) were included in the study. Only 2.1% of cases had solid nodules. Most of them (96.76%) were accompanied by a GGO (halo sign), and only 10.42% were associated with a cavity. The good condition, patients showed significantly more solid nodules (3.46%) than others. In size of the nodules in good-condition patients (1.8 cm) is significantly larger than in fair-condition (1.22 cm) or poor condition patients (1.15 cm). 79.86%, 12.5%, and 7.64% of nodules were multiple, dual/triple, and single, respectively.

The frequency of nodules in the HRCTs of good-condition patients was significantly higher than in fair- or poor-conditionpatients; they also had more multiple and larger-sized nodules. The Pearson-coefficient test also revealed a small negative correlation between the presence of nodules and the patient's condition. It seems the presence of nodules indicates higher immunity to viral infections. In the follow-up, it was revealed that people who had nodules were not hospitalized in the ICU. Further study is needed to prove this point.

In today's modern world, traces of artificial intelligence can be found in almost any field. In recent years, with the introduction of algorithms and machines, the fields of building engineering and construction project management have also experienced new challenges, from optimizing processes and improving product design to automating tasks and parametric design. Artificial intelligence in structural engineering involves the use of advanced algorithms and machine learning techniques to simplify and improve various aspects of the design and analysis process. Also, artificial intelligence software related to construction is a group of technological tools and solutions that use artificial intelligence to optimize various functions of this industry. On the other hand, one of the relatively new topics that artificial intelligence can enter into is the investigation of various types of damage, including progressive damage in the design and construction of structures. In this article, an attempt has been made to define artificial intelligence and machine learning, to explain the various functions of this technology, and practical algorithms, plus introduce useful and pioneering software in civil engineering, where artificial intelligence is the main origin. Also, the basic influencing parameters in the study of progressive collapse, such as critical path identification and extreme load patterns, have been investigated. According to the functions stated in this research, the importance of using artificial intelligence in theoretical studies and future applied projects is clearly known. Especially vital projects such as Spatial Structures or buildings with a special seismic bearing system such as Staggered Truss Systems and structures with high ductility requirements that need special analysis, design, and monitoring.

Biliary complications are the leading cause of morbidity and mortality in patients undergoing Liver Transplantation (LT). Post-biliary transplantation strictures (BSs) are a severe problem with a high risk of graft failure. However, management of these BSs has remained controversial, and considerable variability has been reported in Percutaneous Transhepatic Radiological Interventions (PTRIs) related to broad differences in technical procedures.

This study aimed to evaluate the efficacy of percutaneous treatments in managing post-LT BSs in a center in Shiraz.

PTRIs including balloon dilatation, metallic stent, and internal or internal-external hand-made plastic stent insertion were done for 34 transplanted patients with BSs referring to the Interventional Radiology Unit of Shiraz Namazi Hospital. Technical success rate, patency rates, and complications were evaluated.

In this study, 31 strictures were successfully treated without any significant difference between the anastomotic and non-anastomotic types of stricture (success rate: 91.2%). Based on the results, 12- , 24-, and 36-month primary patency rates were 90.1%, 84.5%, and 76.8%, respectively. The secondary patency rate was 100% at 12 and 24 months and 93.3% at 36 and 60 months. The rate of minor complications (mild cholangitis and hemobilia) was 6.4%, and no major complications were detected.

According to the findings, PTRI is an effective method for treating anastomotic and non-anastomotic strictures with a high success rate and low complications.

Pulmonary lymphangitic carcinomatosis is the spread of a tumor to the lungs through the lymphatic system, which is a rare and final manifestation of cancer with a poor prognosis. Its main symptom is gradual and progressive dyspnea. The method of choice for diagnosis is high-resolution CT (HRCT), the most common finding of which is an increase in nodular and irregular septal thickness between the lobules with the formation of a network of dense polygons. Histological findings confirm the diagnosis. Here we present a patient with lymphangitic carcinomatosis in Bushehr, which occurred secondary to pulmonary adenocarcinoma.

Otorrhagia is not a common manifestation of petrous internal carotid artery (ICA) aneurysm. Besides idiopathic cases, different etiologies, including trauma, infection, and radiation, have been suggested for petrous ICA aneurysms/pseudoaneurysms. However, there is limited experience in the management of this rare aneurysm/pseudoaneurysm with coil embolization.

A 58-year-old man, who was a known case of chronic otitis media, was referred from the otorhinolaryngology ward with intractable bleeding from the right ear. A pseudoaneurysmal lesion (7 mm × 5 mm) was detected in the petrous segment of the internal carotid artery. The patient underwent coil embolization with no complications.

To the best of our knowledge, this is the first case of petrous ICA pseudoaneurysm, presenting with only intractable otorrhagia. The patient was successfully treated with coil embolization, with no need for further interventions. Besides, a review of petrous ICA aneurysms or pseudoaneurysms presenting with otorrhagia was performed.

Spinal dural arteriovenous fistulas (SDAVFs) are characterized by an abnormal connection between a spinal radicular artery and a perimedullary vein, mainly fed by a radicular artery at the nerve root sleeve. Here, we describe the case of a 40-year-old woman, presenting with progressive weakness of the lower extremities and the sphincter. Thoracic magnetic resonance imaging (MRI) showed spinal cord edema and signal voids on the dorsal surface of the cord. Spinal angiography demonstrated a SDAVF with a nidus at the sacral level; the feeder of the arteriovenous fistula was a lateral sacral artery, as a branch of the internal iliac artery. The lateral sacral artery was subselectively catheterized, and SDAVF was embolized with 25% n-butyl cyanoacrylate (NBCA) glue (glue: lipiodol ratio, 1:3). After embolization, no definite residual connection was visualized between the arterial and venous systems.

Anatomic variations of the cystic duct (CD) are commonly encountered. Being aware of these variants will reduce complications subsequent to surgical, endoscopic, or percutaneous procedures. Magnetic resonance cholangiopancreatography (MRCP) is the least invasive and the most reliable modality for biliary anatomy surveys. This study aimed to determine the prevalence of cystic duct variations in the Iranian population. In this retrospective cross-sectional study, MRCP images of 350 patients referred to Shiraz Faraparto Medical Imaging and Interventional Radiology Center from October 2017 to October 2018 were reviewed. The CD course and insertion site to the extrahepatic bile duct (EHBD) was determined and documented in 290 cases. Descriptive statistics and Chi square test were applied for data analysis via SPSS software. About 77% of cases revealed the classic right lateral insertion to the middle third of EHBD. The insertion of CD to the upper third and the right hepatic duct was 10%, and the insertion to the medial aspect of the middle third of EHBD from anterior or posterior was noted to be about 7.6%. From 2.8% of insertions to the lower third, 1% demonstrated parallel course, and finally, 0.3% of cases presented short CD. CD variations are relatively common, and MRCP mapping prior to the hepatobiliary interventions could prevent unexpected consequences.

The objective of this study was to investigate the influence of iterative reconstruction (IR) algorithm on radiation dose and image quality of computed tomography (CT) scans of patients with malignant pancreatic lesions by designing a new protocol.

The pancreas CT was performed on 40 patients (23 males and 17 females) with a 160‑slice CT scan machine. The pancreatic parenchymal phase was performed in two stages: one with a usual dose of radiation and the other one after using a reduced dose of radiation. The images obtained with usual dose were reconstructed with Filtered Back Projection (FBP) method (Protocol A); and the images obtained with the reduced dose were reconstructed with both FBP (Protocol B) and IR method (Protocol C). The quality of images and radiation dose were compared among the three protocols.

Image noise was significantly lower with Protocol C (10.80) than with Protocol A (14.98) and Protocol B (20.60) (P < 0.001). Signal‑to‑noise ratio and contrast‑to‑noise ratio were significantly higher with Protocol C than with Protocol A and Protocol B (P < 0.001). Protocol A and Protocol C were not significantly different in terms of image quality scores. Effective dose was reduced by approximately 48% in Protocol C compared with Protocol A (1.20 ± 0.53 mSv vs. 2.33 ± 0.86 mSv, P < 0.001).

Results of this study showed that applying the IR method compared to the FBP method can improve objective image quality, maintain subjective image quality, and reduce the radiation dose of the patients undergo pancreas CT.

Fluoroscopy guided imaging, which is going to be more routine these days, requires a long time of fluoroscopic observing that could increase the radiation dose of the physician and other staff who have to stay near the patient during the procedure. In our department, one of the senior interventionists observed hair loss in his lower limb.
The objective of this study was to measure the radiation dose of the physician’s leg during common procedures in order to find out that whether the radiation dose exceeds the threshold of deterministic effects of radiation.
Patients and Thermoluminescent-dosimeters (TLD-100) set on the leg part of the anthropomorphic whole body phantom PBU-50 was used in order to measure the radiation dose in two centers where our interventionist worked. Meanwhile, the duration of exposure in important procedures was observed and recorded in center 1 for 2 months. During this period, data including age, height, and weight of the patients, and radiation exposure time, dose (mGy) and dose area product (dap) (µGy.cm2) were recorded.
The result of TLD dosimetry showed that the mean effective dose in center 1 and 2 was 0.20 and 0.86 mSv, and also the mean-dose (mSv)/min) in these centers was 0.02 ± 0.00 and 0.20 ± 0.015 mSv/min, respectively.
The effective annual dose of interventionists who work in center 1 and 2 was 143.08 and 1226.78 mSv, respectively. The high radiation dose delivered to the leg of physicians in center 2 could be an important cause of radiation dermatitis occurred on the leg of our interventionist. Patient dose during most of the procedures was less than the threshold dose for occurring erythema. However, unfortunately in transjugular intrahepatic portosystemic shunt (TIPS) procedure, which is a time-consuming procedure, the patient radiation dose exceeds the threshold. It would be useful if a plan was designed to reduce the dose of patients and even physicians.

Catheter hemodialysis is the last choice for end stage kidney disease patients. Unfortunately, long-term catheterization can lead to problems that make re-catheterization challenging. Sometimes the physician has to try catheterization through several veins and stays close to the patient during the procedure that may lead to a high radiation dose exposure to the radiologist, so that some radiologists refuse to admit such patients.
The objective of this study was an assessment of the radiation dose of radiologists and patients during the placement of double lumen catheter in difficult cases.
Patients and The thermoluminescent dosimeter (TLD) was used to measure the delivered radiation dose to physicians. During the procedure, a package of dosimeter was placed on the thyroid shield and another on the chest, under the apron in order to calculate the occupational effective dose. Moreover, patient information and parameters of the procedure were recorded in order to estimate the patient dose during the procedure.
The mean effective dose provided by TLDs, dose/procedure, and the annual dose of physicians resulted from this procedure were 30.38 µSv, 0.02 µSv/procedure, and 350.20 µSv/y, respectively. The mean dose area product, dose, and calculated peak skin dose obtained in this study were 151.44 cGy.cm2, 851.71 mGy, and 384.97 mGy, respectively.
The mean effective dose of physician per case is about 0.02 μSv/procedure which is much less than the radiation dose per other procedures. Briefly, it can conclude that double lumen replacement does not deliver an unacceptable radiation dose to the physician and even the radiation dose resulted from these cases are much less than the other procedures.

Fluoroscopy guided imaging, which is going to be more routine these days require a long time of fluoroscopic observing, which can increase the radiation dose of the physician and other staff who have to stay near the patient during the procedure. In our department, one of the senior interventionists had observed the hair loss in his lower limb. Thus the objective of this study was measuring the radiation dose of the physician’s leg during common procedures in order to find out that whether the radiation dose exceeds the threshold of deterministic effects of radiation or not?.
Thermo luminescent-dosimeters (TLD-100) set on the leg part of the anthropomorphic whole body phantom PBU-50, was used in order to measure the radiation dose in 2 centers where our interventionist work. Meanwhile, the duration of exposure in important procedures was observed and recorded in center 1 for 2 months. During this period some data such as age, height, and weight of the patients and radiation exposure time, dose (mGy) and dose area product (dap) (Gy.cm2) was recorded
The result of TLD dosimetry shown that the mean effective dose in center 1 and 2 was 0.20 and 0.86 mSv, and also the mean-dose (mSv)/min in these centers was 0.02 ± 0.00 and 0.20 ± 0.015 mSv/min respectively.
The effective annual dose of interventionists who work in center 1 and 2 was 143.08 and 1226.78 mSv respectively. The high radiation dose which delivers to the leg of physicians in center 2 can be an important cause of radiation dermatitis occurred on the leg of our interventionist. Patient dose during most of the procedures was less than the threshold dose for occurring erythema but unfortunately in TIPS procedure which is a time-consuming procedure the patient radiation dose exceeds the threshold. It would be useful if a plan design to reduce the dose of patients and even physicians.

The standard treatment for symptomatic primary hyperparathyroidism due to parathyroid adenoma is surgery, but in patients who are not good candidates for surgery, other treatment modalities including ethanol ablation, laser ablation, ultrasound wave ablation, and radiofrequency ablation are used. We describe a patient with multiple medical problems and a parathyroid adenoma who was treated with radiofrequency ablation.
A 47-year-old patient was referred to our hospital (Namazi hospital, Shiraz, Iran) in April, 2015 with intracranial hemorrhage, as well as high serum calcium and PTH (parathyroid hormone) levels (12.1 mg/dL and 1062 pg/mL, respectively), who had a parathyroid adenoma. Radiofrequency ablation was performed for the patient after he was stabilized, and three days later, his serum calcium and PTH levels decreased to 8.9 mg/dL and 38 pg/mL, respectively, and there was abnormal uptake according to the post-ablation parathyroid scan. The patient was followed for 12 months in our endocrine clinic, during which time he was in good general condition, with normal serum calcium, phosphate, and parathyroid hormone levels.
Radiofrequency ablation may be used successfully in the treatment of parathyroid adenoma when a patient cannot tolerate surgery.

The Budd–Chiari syndrome (BCS) is a rare disorder caused by the obstruction of the hepatic veins or the inferior vena cava (IVC) at the suprahepatic level. This syndrome is developed by either hepatic vein thrombosis or mechanical venous obstruction and leads to centrilobular hepatic congestion with the subsequent development of fibrosis and cirrhosis. Intracardiac tumors have been rarely reported as a cause of the BCS. These tumors usually originate from the atrial septum. Very rarely, they arise either from the junction of the IVC and the right atrium or from the Eustachian valve. There are a few case reports in the literature where atrial tumors have caused the BCS. In these cases, the tumors were malignant, and the patients died shortly after being diagnosed.
We describe a 71-year-old female patient who presented with a 3-month history of abdominal pain and protrusion. On physical examination, blood pressure and pulse rate were normal. Jugular venous pressure was about 10 cm. Cardiac examination revealed a systolic murmur, grade IV/VI, in the left sternal border without radiation. Echocardiography showed a large mass (about 6×4 cm) in the right atrium with close contact to the origin of the IVC, obstructing it. Cardiac magnetic resonance imaging, with and without gadolinium, also confirmed the diagnosis. The patient underwent surgery, and the myxoma was removed. The tumor was a large solid mass, 5×4 cm in size, which originated immediately above the entrance of the IVC. The patient is in good condition 1 year afterward. We emphasize that atrial myxomas should be considered in the differential diagnosis of tumors that cause chronic BCS.

The axillary lymph node stage is one of the single most important determinants in the prognosis of breast cancer patients. The disadvantages of the two previous methods used for evaluating axillary node metastasis, i.e., axillary lymph node dissection and sentinel lymph node biopsy, have directed researchers to investigate new techniques for this purpose. The aim of the current study was to evaluate the clinical usefulness of axillary ultrasonography in detecting axillary metastasis. This study was conducted during a 12-month period. The breast cancer cases included in this study were all clinically diagnosed as stages I and II, with no prior treatment to the axillary region by surgery and/or chemo-radiotherapy. Excluded from the study group were patients with palpable axillary lymph nodes, those who had major organ failure or concomitant malignancy. All included patients with non-palpable axillary lymph nodes underwent axillary ultrasound examination. An ultrasound- guided core needle biopsy was performed on patients with suspected metastasis. There were 125 female patients with a mean age of 49.6 years included in this study. From these, 16 (12.8%) cases had positive axillary sonographic findings. Pathologic evaluation of tissue specimens (taken by ultrasound-guided core needle biopsy) in 10 (62.5%) out of 16 patients were positive, and in the patient group of 6 (37.5%) cases, studies were negative. Axillary ultrasonography had a sensitivity of 35.7%, specificity of 93.8%, positive predictive value of 62.5%, and negative predictive value of 83.5%. The axillary ultrasonogram is a reliable technique in the determination of axillary nodal metastatic involvement in breast cancer patients. By use of this method a significant amount of complications and costs related to the previous techniques can be avoided.

Hoor-Al azim is one of most important and valuable wetland habitats. Study aimed to identifyanddetermine the abundance of fish in the Hoor-Al Azim marsh during2011-2012. In order to do this research 3 stations were selected and fish sampling was performedusing constant Gill net with 1.7 to 5cm springs. Results showed that there are 15 species of fishof 3 families in the marsh.Cyprinidae family had13 species and the highest frequency87.4. Mugilidae and Siluridae Families withone species were present. Carasobarbusluteus species in Rofaye station and Mesopotamichthys sharpeyi species inTaborstation were dominant and in total Carasobarbusluteus, Mesopotamichthys sharpeyi, Aspiusvarax,Lizaabu and Carassiusauratus species respectivelywith 28.7, 24.6, 15.7, 10.8 and 9.9 percent had the highest frequency during the study. The average water temperature, salinity, and pH in the marsh were 20.72° C, 2.07parts per thousand and 7.28, respectively.In the present study the maximum diversity wasinRofaye station with 1.93 and the minimum diversity was in Tabor station with 1.63.

Background– Multiple sclerosis (MS) is one of the most common acquired demyelinating diseases with geographic variability in both prevalence and incidence. The goal of this study was to review the epidemiologic data and to assess the risk factors for MS in Iran.Methods– From 1997 to 1999, 149 definite cases of MS were selected for study. The disease was confirmed according to clinical information and magnetic resonance imaging (MRI) findings by a neurologist and radiologist. The patients were evaluated by interview and a questionnaire. A control group of 100 sex- and age-matched non-neurologic patients were also enrolled in the study.Results– The male–female ratio was 1:1.2. Among female cases, the disease began in 61% soon after childbirth. Depression was noted in 67% of the patients. Fourteen percent of patients had a history of about one year in the recent war between Iran and Iraq. Fifty percent of patients had a history of viral exanthemas during childhood. Conclusion– MS appears to be prevalent in Iran, necessitating a large cohort study to evaluate a precise risk factor analysis.