Iranian Journal of Medical Sciences最新文献

Background: Routine Doppler study is a common tool for early diagnosis of Fetal Growth Restriction (FGR) and Small for Gestational Age (SGA) patients. It aimed to determine the role of the Foramen Ovale Pulsatility Index (FOPI) study beside routine Doppler study among patients with FGR and SGA fetuses.

Methods: This prospective study was conducted on 35 FGR, 32 SGA, and 33 Appropriate for Gestational Age (AGA) fetuses. Demographic data, amniotic fluid index, neonatal outcome, and Doppler velocimetry, including Umbilical Artery Pulsatility Index (UMAPI), Uterine Artery Pulsatility Index (UTAPI), Middle Cerebral Artery Pulsatility Index (MCAPI), Ductus Venosus Pulsatility Index (DVPI), and FOPI were documented. Kolmogorov-Smirnov normality test, one-way ANOVA, Mann-Whitney U, Kruskal-Wallis, non-parametric pairwise comparisons adjusted for Bonferroni correction, Pearson correlation test, Chi square, Fisher's exact test, and Receiver Operating Characteristic Curve (ROC) analysis with Youden's Index (sensitivity+specificity-1) to estimate cut-off point were used to analyze the data at significance level <0.05 for all tests.

Results: FOPI cut-off points were 2.24 (sensitivity=77%, specificity=94%) and 1.15 (sensitivity=90%, specificity=20%) to predict FGR and SGA, respectively. FOPI showed a positive correlation with UMAPI and UTAPI (r=0.52 and r=0.30, P<0.001 and P=0.006, respectively), but not with MCAPI and DVPI (r=0.08 and r=0.12, P=0.50 and P=0.30, respectively). Besides, UMAPI, UTAPI, and FOPI were altered among patients with stages I and II FGR. Umbilical cord potential hydrogen (umbilical cord pH), 1- and 5-min Apgar score significantly increased by Birth weight centile; however, UMAPI, FOPI, and UTAPI significantly decreased.

Conclusion: UMAPI is recommended to predict short-term neonatal morbidities and demonstrate the early or late onset FGR. Besides, FOPI is suggested as the first-line Doppler study to detect abnormal growth velocity. More studies are warranted, especially considering long-term neonatal morbidities.

Background: Hyperglycemia-induced oxidative stress can damage the liver and lead to diabetes complications. Coenzyme Q10 (CoQ-10) reduces diabetes-related oxidative stress. However, its molecular mechanisms are still unclear. This study aimed to examine CoQ-10's antioxidant capabilities against hyperglycemia-induced oxidative stress in the livers of diabetic rats, specifically targeting the Nrf2/Keap1/ARE signaling pathway.

Methods: This study was conducted between 2020-2021 at Arak University of Medical Sciences. A total of 30 male adult Wistar rats (8 weeks old) weighing 220-250 g were randomly assigned to five groups (n=6 in each group): control healthy, sesame oil (CoQ-10 solvent), CoQ-10 (10 mg/Kg), diabetic, and diabetic+CoQ-10. Liver oxidative stress indicators, including malondialdehyde, catalase, glutathione peroxidase, and glutathione, were estimated using the spectrophotometry method. Nrf2, Keap1, HO-1, and NQO1 gene expressions were measured using real-time PCR tests in the liver tissue. All treatments were conducted for 6 weeks. Statistical analysis was performed using SPSS software. One-way ANOVA followed by LSD's or Tukey's post hoc tests were used to compare the results of different groups. P<0.05 was considered statistically significant.

Results: The findings showed that induction of diabetes significantly increased Keap1 expression (2.1±0.9 folds, P=0.01), and significantly inhibited the mRNA expression of Nrf2 (0.38±0.2 folds, P=0.009), HO-1 (0.27±0.1 folds, P=0.02), and NQO1 (0.26±0.1 folds P=0.01), compared with the healthy group. In the diabetic group, the activity of glutathione peroxidase, catalase enzymes, and glutathione levels was decreased with an increase in malondialdehyde level. CoQ-10 supplementation significantly up-regulated the expressions of Nrf2 (0.85±0.3, P=0.04), HO-1 (0.94±0.2, P=0.04), NQO1 (0.88±0.5, P=0.03) genes, and inhibited Keap1 expression (1.1±0.6, P=0.02). Furthermore, as compared to control diabetic rats, CoQ-10 ameliorated oxidative stress by decreasing malondialdehyde levels and increasing catalase, glutathione peroxidase activities, and glutathione levels in the liver tissues of the treated rats in the treatment group.

Conclusion: The findings of this study revealed that CoQ-10 could increase the antioxidant capacity of the liver tissue in diabetic rats by modulating the Nrf2/Keap1/HO-1/NQO1 signaling pathway.

Background: Traumatic brain injury (TBI) is one of the most common neurological disorders worldwide. We aimed to investigate the efficacy of high-dose vitamin D3 on inflammatory biomarkers in patients with moderate to severe TBI.

Methods: Thirty-five moderate to severe TBI patients were randomly assigned to intervention and control groups. Patients in the intervention group received a single intramuscular (IM) dose of 300,000 IU vitamin D. The primary endpoints were interleukin levels (IL-1β and IL-6), and the secondary endpoints were changes in neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), Glasgow Coma scale (GCS), and Glasgow Outcome Scale-Extended (GOS-E) scores compared between intervention and control arms of the study. The linear Generalized Estimating Equations were used for trend analysis and evaluating the association of independent factors to each outcome.

Results: The results revealed a significant decrease in IL-1β levels (-2.71±3.02, in the intervention group: P=0.001 vs. -0.14±3.70, in the control group: P=0.876) and IL-6 (-88.05±148.45, in the intervention group: P=0.0001 vs. -35.54±175.79, in the control groupL P=0.325) 3 days after the intervention. The improvement in the GCS score (P=0.001), reduction in NLR (P=0.001) and PLR (P=0.002), and improvement in the GOS-E score (P=0.039) was found to be greater in the vitamin D3 arm of the study than the control group.

Conclusion: Administration of high-dose vitamin D3 in the acute phase of TBI could be effective in lowering the inflammatory markers and improving the level of consciousness and long-term performance outcomes.Trial Registration Number: IRCT20180522039777N2.

Background: Diffuse large B-cell lymphoma (DLBCL) is globally recognized as the most prevalent and aggressive subtype of non-Hodgkin lymphoma. While conventional treatments are effective initially, the disease can become resistant or relapse over time. This study aimed to examine the differentially expressed genes at the transcriptome level and molecular pathways in DLBCL patients.

Methods: This investigation utilized RNA sequencing analysis to compare differentially expressed gene samples from five diffuse large B-cell lymphoma patients with two healthy volunteers. These participants were admitted to UKM Medical Center, Kuala Lumpur between 2019 and 2020. The differentially expressed genes were identified using the DESeq2 R package (version 1.10.1) using a negative binomial distribution model. The obtained P values were corrected with the Benjamin and Hochberg method and identified using a False Discovery Rate threshold of <0.05, with log₂ fold change (FC) of ≥2 or ≤-2.

Results: Results showed 73 differentially expressed genes between the two groups, among which 70 genes were downregulated, and three genes were upregulated. The differentially expressed genes analyzed with the Reactome pathway were significantly associated with the downregulation of antimicrobial humoral response (P<0.001), neutrophil degranulation (P<0.001), chemokine receptors bind chemokines (P=0.028), defensins (P=0.028) and metabolism of angiotensinogen (P=0.040).

Conclusion: These findings suggest that the identified pathways may contribute to cancer progression and weaken the immune response in diffuse large B-cell lymphoma patients. This study offers fresh insights into previously undiscovered downstream targets and pathways modulated by diffuse large B-cell lymphoma.

Background: Any abnormal change in thyroid hormone levels leads to thyroid disorders, including hyperthyroidism, hypothyroidism, goiter, and so on. Recent studies have reported an increasing prevalence and incidence of thyroid disorders worldwide. This study aims to determine the hypothyroid prevalence, incidence, and risk factors related to this disorder.

Methods: Data from a comprehensive prospective cohort study, collected from a population of 10,000 Yazd (Iran) individuals over a period of 6 years (2015-2021) was analyzed. Physicians diagnosed hypothyroidism and reported it. Data processing and preparation were performed using SQL18 and Excel, while STATA17 and SPSS22 software were employed for data analysis. Descriptive statistics, logistic regression, and Chi-square tests were conducted at a significance level of 0.05.

Results: The prevalence of hypothyroidism was found to be 93/1000, and the incidence was 15/1000 of the population, respectively. Women had five folds more chance of hypothyroidism (adjusted OR=5.31, 95% CI=3.06-9.19 vs. unadjusted OR=6.28, 95% CI=3.90-10.12), and they usually developed it between the ages of 30 and 39. Eating less (iodized) salt also increased the risk of hypothyroidism (unadjusted OR=1.47, 95% CI=1.02-2.11). Iron supplementation (unadjusted OR=2.09, 95% CI=1.26-3.48) was identified as one of the significant risk factors. Based on our findings in the unadjusted model, tooth brushing once or twice a day increases the chance of hypothyroidism (OR=1.89, P=0.008, and OR=2.12, P=0.016, respectively). Tobacco smoking (unadjusted OR=0.29, 95% CI=0.107-0.786) was also among the factors that need further investigation.

Conclusion: The increasing trend of hypothyroidism is concerning in our population. The high prevalence, particularly among women of childbearing age, is notable.

Surgery is pivotal in treating esophageal cancer; hybrid esophagectomy, which combines minimally invasive and open techniques, shows promising outcomes. This historical cohort study compared the surgical outcomes of standard open esophagectomy with hybrid esophagectomy. Overall, 58 patients who underwent either hybrid or open esophagectomy at the Ulyanovsk Regional Clinical Oncology Clinic, Russia, from January 2015 to December 2023 were included. Data on demographics, surgical details, and postoperative outcomes were analyzed. The primary measures were overall complications and anastomotic leakage rates. Statistical analysis was performed using Pearson's Chi square test and t test via StatTech software (version 2.8.8). The number of removed lymph nodes was higher in the hybrid group (24±9) than in the open group (15±7) (P<0.001). In addition, the hybrid esophagectomy group showed significant reductions in operational time and blood loss (P<0.001 and P=0.014, respectively). The need for blood transfusion was higher in the open esophagectomy group (P=0.043). The postoperative length of stay in the hospital did not differ significantly between the two groups (open=20±8 days, hybrid=17±7 days, P=0.178). Cardiac complications were more frequent after an open esophagectomy (P=0.044). Hybrid esophagectomy reduced postoperative cardiac complications and other adverse events while maintaining satisfactory oncological outcomes. It had advantages over standard open esophagectomy in terms of lymphadenectomy, operative time, blood loss, and transfusion requirements, suggesting its efficacy for esophageal cancer patients.

Background: Colorectal cancer (CRC) screening is essential to reduce incidence and mortality rates. However, participation in screening remains suboptimal. ColonFlag, a machine learning algorithm using complete blood count (CBC), identifies individuals at high CRC risk using routinely performed tests. This study aims to review the existing literature assessing the efficacy of ColonFlag across diverse populations in multiple countries.

Methods: The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) were followed in reporting this systematic review. Searches were conducted on PubMed, Cochrane, ScienceDirect, and Google Scholar for English articles, using keywords related to CBC, machine learning, ColonFlag, and CRC, covering the first development study from 2016 to August 2023. The Cochrane Prediction Model Risk of Bias Assessment Tool (PROBAST) was used to assess the risk of bias.

Results: A total of 949 articles were identified during the literature search. Ten studies were found to be eligible. ColonFlag yielded Area Under the Curve (AUC) values ranging from 0.736 to 0.82. The sensitivity and specificity ranged from 3.91% to 35.4% and 82.73% to 94%, respectively. The positive predictive values ranged between 2.6% and 9.1%, while the negative predictive values ranged from 97.6% to 99.9%. ColonFlag performed better in shorter time windows, tumors located more proximally, in advanced stages, and in cases of CRC compared to adenoma.

Conclusion: While ColonFlag exhibits low sensitivity compared to established screening methods such as the fecal immunochemical test (FIT) or colonoscopy, its potential to detect CRC before clinical diagnosis suggests an opportunity for identifying more cases than regular screening alone.

Background: Post-dural puncture headache (PDPH) is the most common complication following spinal anesthesia among parturients undergoing cesarean section surgery. The purpose of this study was to evaluate the effectiveness of acetaminophen and caffeine in preventing PDPH.

Methods: This double-blind, randomized clinical trial was conducted on 96 obstetric women, who were candidates for elective cesarean section. Following the randomization of participants into two groups, participants in the intervention group received tablets of acetaminophen (500 mg)+caffeine (65 mg), and participants in the control group received placebo tablets orally 2 hours before spinal anesthesia induction and then every 6 hours after surgery up to 24 hours. All parturients were evaluated for frequency and intensity of PDPH every 6 hours until 24 hours after surgery and then 48 and 72 hours after surgery. Overall satisfaction during the first 72 hours of postpartum was evaluated. The data were analyzed using SPSS software. P<0.05 was considered statistically significant.

Results: Participants in the intervention group were 70% less likely to experience PDPH after spinal anesthesia (OR=0.31 P=0.01, 95% CI [0.12-0.77]). They also experienced significantly milder headaches 18 hours, 48 hours, and 72 hours later. Participants in the intervention group reported higher levels of satisfaction at the end of the study (P=0.01). No side effects related to the intervention were reported.

Conclusion: Prophylactic administration of acetaminophen+caffeine decreases 70% the risk of PDPH and significantly attenuates pain intensity in obstetric patients who underwent spinal anesthesia for cesarean section.

Background: Primary biliary cholangitis (PBC) is a condition affecting the liver and immune system. In this study, the impact of autologous bone marrow-derived mononuclear cell (BM-MNC) transplantation on PBC patients was investigated.

Methods: Sixteen eligible PBC patients participated at the National Scientific Medical Center in Astana, Kazakhstan, between 2017 and 2022, and BM-MNCs were harvested from their anterior iliac crest. After isolating and cultivating the BM-MNCs, they were infused back into the patient's peripheral veins. Changes in BM-MNC and peripheral blood mononuclear cell (PB-MNC) phenotypes were assessed before and after a 24-hour cultivation period and 72 hours post-transplantation. We monitored liver function parameters over 6-month intervals and conducted flow cytometry analysis to assess CD markers on BM-MNCs before and after cultivation and PB-MNCs before and after transplantation. Statistical analysis included the Friedman test for liver parameters and the Wilcoxon signed-rank test for BM-MNC and PB-MNC comparisons.

Results: Our findings revealed significant reductions in liver function tests after multiple transplantations. Flow cytometry analysis before and after a 24-hour culture and autologous BM-MNC infusion revealed the expansion of specific cell populations, with significant increases in CD3+, CD4+, CD16+, CD20+, CD25+, CD34+, CD105+, CD73+, СD117+, and CD34+populations, while CD4+25+, CD34+105+, and CD4+FOXP3+ populations decreased. Interestingly, a contradictory finding was observed with a decrease in bone marrow CD34+105+ cell lines (P=0.03) alongside an increase in peripheral CD34+105+ population (P=0.03).

Conclusion: In summary, our study shows that BM-MNC transplantation in PBC patients leads to changes in immune cell populations and liver function. These findings suggest potential therapeutic applications of BM-MNC transplantation in managing PBC and offer insights into the dynamics of immune cells associated with this treatment approach.