Iranian Journal of Medical Sciences最新文献

Gastrointestinal stromal tumors (GIST) are less prevalent mesenchymal tumors, accounting for 1% of gastrointestinal malignancies. Spontaneous hemoperitoneum (SH) following gastric GIST rupture is a rare occurrence. The present study described a case of a 67-year-old female who presented with acute onset abdominal pain. Vital signs at the time of presentation were unstable. Contrast-enhanced computed tomography (CECT) of the abdomen revealed a mixed-density mass lesion with multiple hyperdense areas within. A hemogram indicated a low hemoglobin level. An emergency laparotomy revealed a ruptured pedunculated, friable mass with active bleeding arising from the lesser curvature of the stomach. A wedge resection was carried out to achieve a gross negative margin of the mass. Final pathology confirmed GIST epitheloid type with positive margins (pT3N0M0-pathologically tumor size within 10 cm with no nodal or distant metastasis) and positive for CD117, DOG1. Given the tumor rupture and positive margins, the patient was started on imatinib mesylate therapy. As demonstrated in this case, GIST rarely ruptures, resulting in hemoperitoneum. The primary treatment approach is surgical exploration and resection.

Background: The current work investigated the immunological features of insulin-producing cells (IPCs) generated from rat adipose-derived mesenchymal stem cells (ADSCs) both in vitro and in vivo.

Methods: The research was carried out at Ahvaz Jundishapur University of Medical Sciences in 2023. ADSCs were derived from rat adipose tissues and differentiated into IPCs. The control group included undifferentiated ADSCs. The amount of secreted insulin was measured using ELISA. The expression of major histocompatibility complex-I (MHC-I) and MHC-II, cluster of differentiation 40 (CD40), and CD80 by IPCs in vitro was assessed using Western Blot analysis. The in vivo study was performed on 10 male diabetic rats. The experimental group received 10⁷ IPCs in the peritoneal cavity. The control group received 10⁷ undifferentiated ADSCs. After 4 hours, the expression of CD3a and CD45 by immune cells collected from the peritoneal cavity was measured using flow cytometry. All parameters were statistically analyzed using a t test.

Results: The differentiated cells secreted much higher amounts of insulin than the control group (P=0.04). IPCs exhibited higher expression of MHC-I and MHC-II, CD40, and CD80 (P=0.02, P=0.008, P=0.07, and P=0.02, respectively). The experimental group showed higher levels of CD3a and CD45 expression than the control group (P=0.07, P=0.04, respectively).

Conclusion: Functional IPCs generated by ADSCs differentiation exhibited immunogenic activity both in vitro and in vivo. Immune-modulating strategies are required for the effective transplantation of the differentiated IPCs generated in our study.

Background: Next-Generation Sequencing (NGS) methods specifically Whole-Exome Sequencing (WES) have demonstrated promising findings with a high accuracy of 91%-99% in Pharmacogenomics (PGx). A PGx-based panel can be utilized to minimize adverse drug reactions (ADRs) and maximize the treatment efficacy. Remarkably, Cancer Pain Management (CPM) is a cutting-edge concept in modern medicine. Thus, this study aimed to investigate the WES results by a PGx-based panel containing genes involved in Pain, Anti-inflammatory, and Immunomodulating agents (PAIma) signaling pathways.

Methods: A total of 200 unrelated Iranians (100 western and 100 northern) were included. 100 WES results were analyzed through the PAIma panel. After DNA extraction, 100 samples were genotyped by Multiplex-Amplification-Refractory Mutation System (ARMS) PCR. A primary in silico investigation performed on 128 candidate genes through Protein-Protein Interactions (PPIs) and Gene-miRNA Interactions (GMIs) via the STRING database, and miRTargetLink2, respectively. Additionally, Enrichment Analysis (EA) was applied to find the unknown interplays among these three major pathways by Enrichr.

Results: 55,590 annotations through 21 curated pathways were filtered, 900 variants were found, and 128 genes were refined. Finally, 54 candidate variants (48 non-synonymous single nucleotide variants (nsSNVs), 2 stop-gained, 1 frameshift, and 3 splicing) remained.

Conclusion: Conclusively, six potentially actionable variants including rs1695 (GSTP1), rs628031 (SLC22A1), rs17863778 (UGT1A7), rs16947 (CYP2D6), rs2257401 (CYP3A7), and rs2515641 (CYP2E1) had the most deviations among Iranians, compared with the reference genome, which should be genotyped for drug prescribing. Remarkably, PPIs, GMIs, and EA revealed potential risks of carcinogenesis and cancer phenotypes resulting from PAIma pathways genes.

Background: Mild cognitive impairment is a common aging phenomenon, and the absence of problem-solving abilities significantly contributes to memory decline. This study aimed to investigate the effect of video games on cognitive performance and problem-solving ability in the elderly with mild cognitive impairment.

Methods: In 2023, a double-blind, randomized clinical trial was done on mild cognitive impairment aged randomly divided into control and intervention groups with permuted blocks randomization. The participants in the intervention group played selected smartphone video games thrice a week for 12 weeks, but the control group did not do any intervention. Mini Mental Status Examination and Problem-solving Questionnaire were completed before, 8 weeks after the start, and 4 weeks after the end of the intervention. Statistical tests were done at the significance level considered less than 0.05 and analyzed in SPSS version 16.

Results: The mean±SD age of the 60 elderly participants who finished the study was 71.43±2.59. The mean±SD scores of cognitive performance and problem-solving ability improved in the intervention group (25.18±0.93 and 21.15±1.36) but worsened in the control group (19.43±0.76 and 13.72±1.98) (P<0.001). Before the intervention, no significant difference was observed between both groups in cognitive performance and problem-solving ability. However, there was a significant difference 8 weeks after the start and 4 weeks after the end of the intervention (P<0.001).

Conclusion: Playing video games thrice a week for 12 weeks can improve cognitive performance and problem-solving ability in the elderly with mild cognitive impairment. This approach is suggested for implementation.Trial Registration Number: IRCT20211110053030N2.

T-cell-mediated immunity is essential for controlling severe acute respiratory syndrome coronavirus 2 (SARSCoV2) infection, preventing severe disease, and potentially reducing the risk of long-term coronavirus disease (COVID). This study investigated the impact of natural infection, vaccination, and hybrid immunity on T-cell responses, with a particular emphasis on the role of memory T-cells in long-term COVID-19. The present study reviewed current literature on T-cell responses, including memory T-cell development, in individuals with natural SARS-CoV-2 infection, those vaccinated with messenger RNA (mRNA) vaccines, and those with hybrid immunity. It examined studies that compared T-cell activity, immune regulation, and the prevalence of long-term COVID-19 across these groups. Natural infection induces variable T-cell responses, with severe cases showing stronger but sometimes dysregulated immunological activity, which may contribute to prolonged COVID-19. Vaccination, particularly with mRNA vaccines, elicits targeted and consistent T-cell responses, including memory T-cells, reducing disease severity, and the incidence of long-term COVID-19. Hybrid immunity combines natural infection and vaccination, provides the most robust protection, enhanceds memory T-cell responses, and reduces the risk of long-term COVID-19 through balanced immune regulation. Memory T-cells play a critical role in mitigating long-term COVID-19. Vaccination significantly enhances T-cell-mediated immunity, minimizing the risk of chronic symptoms compared to natural infection alone. Hybrid immunity provides the most effective defense, emphasizing the importance of vaccination, even after natural infection, to prevent long-term COVID-19.

Background: Developing a practical method to predict active systemic lupus erythematosus (SLE) in patients with inactive/mild status at the onset of the disease could lead to appropriate treatment that ultimately prevents future relapses. The development of SLE is influenced by steroid hormones and probably the receptors of these hormones. Therefore, we aimed to investigate the predictive effect of the levels of estradiol and testosterone hormones and their receptors on the severity of SLE disease.

Methods: Serum samples were taken from 59 female patients with inactive SLE in Golestan province in northern Iran. The concentration of estradiol (E2) and testosterone (T) hormones and their receptors, estrogen receptors (ER) and androgen receptors (AR), was measured at the beginning of the study after sampling. After a one-year follow-up (2021 to 2022), the patients were divided into active and inactive SLE groups based on the clinical criteria of the SLE activity index. T test and Mann-Whitney U-test were used to analyze the difference of variables. The correlation was analyzed using Pearson and Spearman tests. Discriminative power was measured, and a cut-off point was suggested.

Results: There was a significant difference in the average E2+ER/T+AR ratio between active and inactive SLE groups (P<0.001). It was also found that this ratio has a significant correlation with the severity of the disease (r=0.546, P<0.001).

Conclusion: Despite the normal concentration of each steroid hormone and its receptors, the E2+ER/T+AR ratio may be a good indicator of the development of active SLE.

Background: Pulmonary valve replacement is inevitable for the majority of patients with long-standing pulmonary regurgitation. The purpose of this study was to describe the experience of employing a novel technique to create an intraoperatively handmade trileaflet pulmonary valve with glutaraldehyde-treated autologous pericardium (the AAA valve).

Methods: This case series study was conducted from September 2018 to March 2021 at Shiraz University of Medical Sciences, Shiraz, Iran. The surgical technique involved harvesting and treating with glutaraldehyde of the pericardium, constructing a trileaflet valve by encapsulating the pericardium within a Dacron tube with a diameter of 22 mm and a length of 20 mm, and implanting it into the pulmonary valve position.

Results: The AAA valve was constructed for 10 patients with a mean age of 16.20±5.81 years, seven of whom had undergone surgery for tetralogy of Fallot. The patients' mean follow-up length was 32.30±13.64 months. The AAA valve regurgitation was none to moderate. At the time of follow-up, all patients had AAA valve stenosis that was less than moderate, except for one case. Cardiac magnetic resonance imaging and echocardiography results confirmed mild leaflet motion restriction in the patient with moderate stenosis. The anatomic valve parameters in MRI revealed a mean geometric height, coaptation height, and effective height of 20.23±2.40 mm, 10.42±1.67 mm, and 14.34±2.24 mm, respectively. One patient died from non-cardiac causes.

Conclusion: The surgical establishment of a native pericardial valve in the pulmonary valve position yielded satisfactory short-term to midterm results and might be considered a viable alternative to the available options.

Background: The impact of low levels of vitamin D (Vit D) on the severity of cardiovascular diseases has become a significant challenge. This study aimed to assess this impact.

Methods: This pilot cross-sectional study enrolled two hundred patients referred to Namazi Hospital, Shiraz, Iran for myocardial perfusion imaging in 2019. The assessment included myocardial perfusion imaging and Vit D level evaluation. Quantitative ischemia analysis utilized Estimated Summed Stress Scores (SSS), Summed Rest Scores (SRS), and Summed Difference Scores (SDS). Myocardial Perfusion Imaging (MPI) results were categorized into normal, mild ischemia, moderate ischemia, and severe ischemia based on estimated SSS. Ischemia severity was aligned with established criteria, designating severe quantitative ischemia as SSS>13. Vit D was categorized using cutoffs at 10, 20, and 30 ng/mL. Mann-Whitney U-test was used for quantitative variables and Chi Square test for qualitative variables.

Results: Chi Square test revealed a significant association between categorized Vit D levels below 10 ng/mL and severe ischemia (SSS>13) (P<0.001). Total Vit D level and also categorized Vit D with cut-offs of 10, 20, and 30 ng/mL showed no association with abnormal MPI. SSS was notably higher in patients with Vit D levels below 10 ng/mL (P=0.026).

Conclusion: The findings of this study emphasize an association between Vit D level below 10 ng/mL and severe myocardial ischemia, as indicated by SSS.

Background: The associations between Chinese visceral adiposity index (CVAI) and non-alcoholic fatty liver disease (NAFLD) or hepatic fibrosis in Westerners are not obvious. Furthermore, metabolic dysfunction-associated steatotic liver disease (MASLD) is the new nomenclature of NAFLD, with significantly different diagnostic criteria. The present study aimed to investigate the relationships between CVAI and MASLD or hepatic fibrosis in an American population, as well as to assess the diagnostic value of CVAI for MASLD and fibrosis.

Methods: After excluding missing data on calculations of indices, diagnosis of MASLD, and covariates, 3242 participants were selected from the National Health and Nutrition Examination Survey 2017-2020. Multivariate logistic regression analyses and restricted cubic spline (RCS) were used to determine the associations between CVAI and MASLD or fibrosis. The diagnostic capacity was evaluated by the area under the receiver operating characteristic (AUROC) curve. Data were analyzed using R software (version 4.2.2). P<0.05 was considered statistically significant.

Results: The risk of MASLD was increased at quartiles 2, 3, and 4 compared with quartile 1 of CVAI (OR [95% CI]=3.66 [2.44-5.63], 7.954 [5.31-12.23], and 14.84 [9.80-23.06], respectively), (P<0.001). The odds ratios (95% CI) of hepatic fibrosis risk were 1.23 [0.67, 2.30], 2.44 [1.39, 4.43], 7.46 [4.36, 13.30] for the quartiles 2, 3, and 4 compared to the lowest quartile (P<0.001). According to RCS, CVAI, MASLD, and fibrosis, all had positive relationships. CVAI had AUROCs of 0.759 and 0.771 for diagnosing MASLD and fibrosis, respectively.

Conclusion: The CVAI was positively related to the risk of MASLD or liver fibrosis and could be a novel biomarker for predicting MASLD and fibrosis in the American population.