Iranian Journal of Medical Sciences最新文献

Background: Patent ductus arteriosus (PDA) is a congenital defect characterized by abnormal blood flow between the aorta and pulmonary artery. Existing closure devices, such as the Amplatzer Duct Occluder (ADO), face challenges with affordability, biocompatibility, and anatomical adaptability. This study evaluates the safety and feasibility of a novel nitinol-based PDA occluder, the first developed sample in Iran, designed to enhance biocompatibility, reduce thrombogenicity, and improve durability.

Methods: This preclinical study was conducted in 2024 at the Large Animal Research Laboratory, Shiraz University of Medical Sciences, Shiraz, Iran. The occluder was fabricated from custom-made nitinol wires braided into a 72-wire conical mesh, ensuring flexibility and durability. Deployment was tested in a sheep model via femoral and pulmonary artery access. Post-procedure evaluations included angiography, clinical monitoring, and histopathological analyses to assess tissue integration, thrombogenicity, and biocompatibility.

Results: The device was successfully deployed in two target sites with stable positioning and no procedural complications. Angiographic imaging confirmed vessel patency, even in an artery with a size mismatch. The animal exhibited no adverse outcomes, maintaining normal pulses and activity over a three-month follow-up. Post-mortem analysis revealed secure device placement without migration, perforation, or aneurysm. Histopathological findings demonstrated mild inflammation, neointimal formation, and re-endothelialization, with no significant thrombus or granuloma, indicating excellent biocompatibility.

Conclusion: This study provides preliminary evidence supporting the feasibility, safety, and biocompatibility of the Iranian-developed PDA occluder. These findings suggest the device may serve as a viable, cost-effective alternative for PDA closure, addressing device shortages and advancing regional medical technology.

Neonatal vaccination is a cornerstone of early-life infectious disease prevention. However, the timing and safety of these interventions require careful consideration. This review explored the neuroimmune implications of early immunization, with a specific focus on the interplay between the developing immune and nervous systems. We examined potential mechanisms through which vaccine-induced immune activation might influence brain development, through epigenetic modifications and sustained cytokine responses, particularly involving interleukin-6 (IL-6). The discussion addressed concerns related to immune overstimulation, regulatory T-cell suppression, and microbiome disruption, considering their potential links to autoimmune and neurodevelopmental disorders. In light of the identified evidence gaps, we advocate for a cautious, individualized vaccination approach guided by the "As Low and Late As Reasonably Achievable" (ALLARA) principle. This strategy aimed to balance robust protection against infectious diseases with the imperative of safeguarding lifelong neurological and immunological health.

Background: Drug-drug interactions (DDIs) are among the most important medical errors that can lead to adverse effects, increased toxicity, or reduced treatment efficacy. The frequency and severity of DDIs vary across specialties. However, studies covering multiple specialties in Iran are few and not up-to-date. This study aims to fill this gap by offering a large-scale, multi-specialty analysis of DDIs in Iran using real-world e-prescription data.

Methods: This study analyzed pharmacological DDIs in 1,049,769 e-prescription records from Shiraz, Iran, spanning from November 2021 to February 2024. We used Lexicomp^® DDI checker software and Python programming language to identify the most prevalent DDIs overall, the top contributing drug specialties for each of those DDIs, the specialties with the highest rates of potential DDIs, and the most prevalent DDI within each specialty.

Results: The analysis revealed that 38.77% of prescriptions contained at least one C, D, or X DDI. Dexamethasone, ketorolac, quetiapine, and aspirin were the drugs most commonly involved. The most frequent DDIs occurred between aprepitant and dexamethasone, ketorolac, and naproxen, aprepitant and doxorubicin, prednisolone, and tacrolimus, and diclofenac sodium and ketorolac. The medical specialties with the highest incidence of D or X level DDIs were rheumatology, endocrinology, orthopedics, oncology, internal medicine, emergency services, and psychiatry. The average counts of D or X DDIs per prescription were 0.53, 0.41, 0.40, 0.40, 0.26, 0.24, and 0.23, respectively.

Conclusion: This study underscores the need for provider vigilance and proactive measures, such as training and e-prescription alerts, to ensure patient safety.

Background: Breast cancer is the most common form of cancer among women worldwide, and the rates of both new cases and deaths have increased over the past two decades. The aim of the study was to identify and validate molecular pathways that could potentially be targeted for therapeutic interventions.

Methods: The bioinformatics resource WebGestalt was used to determine the functional annotation of the Gene Ontology, as well as enrichment analysis of Reactome and KEGG pathways in 2023-2024. GeneMANIA, a server for assessing protein-gene interactions, co-localization, pathways, co-expression, and protein-domain similarity of target genes and their interacting genes, was evaluated via this web tool. GEO was also used to determine mRNA expression levels in BRCA individuals. R packages were used to screen for differentially expressed genes for both datasets. On the other hand, the open cancer resources GENT2 TNMPlot, UCSCXena, ENCORI platform, BioXpress, OncoDB, OncoMX, and GEPIA2 were used to measure the differential expression of mRNAs in BRCA patients.

Results: Among the genes analyzed, matrix metalloproteinase-9 (MMP9) showed the greatest change. Similarly, matrix metallopeptidase 14 (MMP14) and Endogenous Vascular Endothelial Growth Factor-A (VEGFA) showed significant increases. Other up-regulated genes, including Apolipoprotein E (APOE), Hypoxia-Inducible Factor-1 Alpha (HIF1A), and Tumor Necrosis Factor (TNF) showed minimal expression changes with minor fluctuations. Finally, Interleukin-1 alpha precursor (IL1A) exhibited a slight increase in expression. Validation of gene expression changes through microarray studies on the GSE37751 and GSE42568 datasets provided consistent and significant results for several of the studied genes. GO analysis further revealed significant molecular functions, cellular components, KEGG pathways, and biological processes that were enriched among the differentially expressed genes. Among the top pathways identified based on FDR and P value were receptor binding signaling, regulation of cell migration, the extracellular matrix, and the AGE-RAGE signaling pathway.

Conclusion: The results predict that the hub genes correlated with angiogenesis may serve as potential therapeutic targets or could be biomarkers for breast cancer.

Background: Syncope is defined as a transient loss of consciousness, with vasovagal syncope (VVS) being the most common cause. Although VVS episodes are typically self-limiting, they can significantly impact patients' quality of life. The syncope functional status questionnaire (SFSQ) is an internationally standardized tool designed to assess two major health dimensions: the physical and psychosocial domains. This study aimed to translate and culturally adapt the SFSQ into Persian and assess its validity and reliability.

Methods: This study was conducted in Tehran, Iran, between October 2022 and January 2023. It consisted of three phases: first, the translation and cultural adaptation of the questionnaire into Persian; second, an assessment of the comprehensibility of the pre-final version through a pilot study involving 50 individuals; and third, an evaluation of the reliability and validity of the final translated version. We assessed test-retest reliability, content validity, and convergent validity by examining the correlations between the dimensions of the translated SFSQ and other relevant measures.

Results: Among 50 patients, 26 were women, and 24 were men. The mean age of the participants was 26.5±5.5 years. Test-retest reliability was good, with a Cronbach's alpha coefficient of 0.84. Both face validity and content validity index (CVI) were deemed acceptable, with a misunderstanding index of 18% (below the 20% significance threshold) and a CVI of 92% (above the 88% significance threshold for all questions).

Conclusion: The Persian version of the SFSQ was found to be a reliable and valid tool for data collection in patients with syncope. This instrument represents a significant step toward standardizing syncope-related research.

Background: Tongue cancer is the most common malignant tumor in the oral and maxillofacial region. Novel effective therapies are urgently needed. Apatinib, a small-molecule antiangiogenic tyrosine kinase inhibitor, has demonstrated efficacy in gastric cancer, but its role in tongue cancer remains unclear. This study evaluated the antitumor effects and mechanisms of apatinib using patient-derived xenograft (PDX) models of tongue cancer.

Methods: Fresh tumor tissues from two tongue cancer patients (Affiliated Stomatological Hospital of Nanchang University, 2019-2021) were subcutaneously inoculated into immunodeficient mice to establish PDX models, validated by histology and human-specific gene identification. Eighteen P4-generation PDX mice were randomized into three groups (*n*=6/group): Control: 100 μL/day saline (oral gavage), Cisplatin: 5 mg/Kg/week (intraperitoneal injection), Apatinib: 100 mg/Kg/day (oral gavage). After 21 days of treatment, tumor volume/weight was measured. Immunohistochemistry (IHC) assessed microvessel density (MVD, via CD31) and cell proliferation (Ki-67). Data were analyzed by one-way ANOVA with Tukey's post hoc test.

Results: Apatinib significantly inhibited tumor growth, reducing tumor weight (0.21±0.07 g vs. Control 0.93±0.30 g, P=0.036) and volume (211.32±166.38 mm³ vs. Control 800.98±581.05 mm³, P=0.0002). IHC revealed decreased MVD (0.88±0.07 vs. Control 4.30±0.34, P=0.0192) and Ki-67-positive cells (2.75%±0.28% vs. Control 32.05%±4.34%, P=0.047), indicating suppressed angiogenesis and proliferation. Mouse body weight remained stable, suggesting minimal toxicity.

Conclusion: Our findings revealed that apatinib significantly suppressed tumor growth in these models, accompanied by a reduction in tumor microvascular density and Ki-67 expression, indicating its potential mechanism of action through inhibiting angiogenesis and tumor cell proliferation. These findings support its potential as a targeted therapy for tongue cancer and highlight the utility of PDX models for preclinical drug evaluation. Further studies with larger cohorts are warranted to validate these results.

Background: Breast cancer is the most frequent malignancy among women. The COVID-19 pandemic significantly impacted healthcare systems, potentially affecting the management of this disease. Due to the critical importance of early diagnosis and treatment, and the limited data on the pandemic's specific effects, this study aimed to determine the correlation between the COVID-19 pandemic and various breast cancer parameters.

Methods: This retrospective study included patients with breast cancer in Shiraz, Iran. Patients were divided into two groups, including those diagnosed before and after the start of the COVID-19 pandemic (from September 2018 to March 2021). Variables included demographic, clinical, and management features. Continuous variables were reported as mean±SD, and the categorical data were reported as frequency and percentage. The significance level was set as P<0.05.

Results: The study documented 1,435 patients: 811 patients were diagnosed before the pandemic, and 624 patients were diagnosed after. The mean initial tumor size at the time of diagnosis was significantly larger in the post-pandemic group than the pre-pandemic group (2.29±1.44 vs. 2.11±1.39 cm, respectively; P=0.001). The distribution of cancer stages also differed significantly (P=0.001). While the prevalence of stage 1 disease was similar between groups (30.1% vs. 28.9%), the prevalence of stage 2 (14.8% vs. 8.5%) and stage 3 (10.1% vs. 7.0%) was significantly higher in the post-pandemic group (Stage 1: 30.1 vs. 28.9%, Stage 2: 8.5 vs. 14.8%, Stage 3: 7 vs. 10.1%; P=0.001).

Conclusion: Following the COVID-19 pandemic, patients presented with significantly larger breast tumors, increased axillary involvement, and more advanced stages after the COVID-19 pandemic.

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