Iranian Journal of Medical Sciences最新文献

Multiple Myeloma (MM) is a hematologic malignancy characterized by clonal plasma cell development, leading to serious complications. Despite traditional treatments, MM remains incurable, necessitating innovative therapeutic approaches. Chimeric Antigen Receptor (CAR) T-cell therapy and Bispecific T-cell engagers (BiTEs) are emerging immunotherapies showing promise in MM treatment. CAR T-cell therapy involves modifying patient T-cells to target specific antigens, primarily B Cell Maturation Antigen (BCMA). BiTEs, on the other hand, are non-IgG-like bispecific antibodies designed to engage both CD3 and tumor-associated antigens. These therapies exhibit impressive efficacy in clinical trials, leading to FDA approvals for specific MM patient populations. Despite their successes, these therapies come with unique challenges and adverse effects, such as cytokine release syndrome (CRS) and neurotoxicity. This narrative review explores the mechanisms, efficacy, challenges, and potential benefits of CAR T-cell and BiTE therapies for MM patients, shedding light on their roles in addressing this complex disease.

Background: Erectile dysfunction (ED) is associated with cardiovascular events, and a significant proportion of men with coronary artery disease (CAD) exhibit early signs of ED. Moreover, both of these disorders shared common risk factors in previous studies. This study was conducted to determine which risk factors and conditions in CAD patients might contribute to the occurrence of ED.

Methods: This analytical cross-sectional study was conducted in the North of Iran from October 2016 to September 2017. 316 patients with coronary artery disease were enrolled. Demographic information were collected using a checklist, and the International Index of Erectile Function (IIEF-15) questionnaire was used to determine the participant's ED status. Univariate and multivariate logistic regression were used to investigate associated factors.

Results: The mean age of the participants was 56.51±9.88 years. About 55.1% of the patients had ED. Moreover, the severity of CAD was independently associated with an increased risk of ED (OR=4.11, 95%CI=1.69-9.97), with patients having more than one involved coronary artery and greater coronary artery stenosis had a higher risk of developing ED occurrence (OR=3.74, 95%CI=1.72-8.09). Besides, age (OR=1.23, 95%CI=1.18-1.29) and BMI (OR=1.26, 95%CI=1.13-1.41) were independent predictors of ED occurrence in CAD patients.

Conclusion: Higher CAD severity, older age, and higher BMI were all independent predictors of ED occurrence in CAD patients. While, diabetes mellitus, dyslipidemia, and smoking were not independent risk factors, they could contribute to the development of ED when combined with other risk factors.

The dental pulp is essential for tooth health and sensory function. However, conventional treatments for infected or necrotic pulp, such as root canal therapy, frequently result in tooth loss and increased fracture risk. Regenerative endodontic procedures (REPs) aim to regenerate pulp tissue while preserving tooth vitality. Exosomes from human umbilical cord mesenchymal stromal/stem cells (hUCMSCs) demonstrated potential for tissue regeneration. In this case report, the potential of hUCMSC-derived exosomes for regenerating the dental pulp of a pulpectomized tooth was investigated. The patient, a 40-year-old man, was presented with irreversible pulpitis in the mandibular second premolar. The patient underwent a pulpectomy, followed by the application of a chitosan and hUCMSC-derived exosome mixture into the root canal. This project was conceived and executed as a joint project in Bushehr (Iran), Shiraz (Iran), and Aktobe (Kazakhstan) from 2022 to 2024. Exosomes were isolated and characterized using scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Clinical evaluations, including visual inspection, palpation, pulp vitality tests, radiography, and cone beam computed tomography (CBCT) imaging, were conducted over 24 weeks post-treatment. The SEM and TEM images confirmed the effective isolation and characterization of exosomes. Clinical follow-ups showed no signs of infection, swelling, or tenderness around the treated tooth. Radiographic assessments indicated periapical radiolucency and periodontal ligament widening, suggesting active healing. Despite these radiographic changes, the absence of clinical symptoms indicated successful tissue regeneration and integration. This case report demonstrated the potential of hUCMSC-derived exosomes for dental pulp regeneration, with promising results in maintaining tooth vitality and promoting healing.

Background: Multiple trauma can cause an increase in creatine phosphokinase (CPK) and subsequently rhabdomyolysis and acute kidney injury (AKI). This study was designed to evaluate the effect of vitamin D3 on the serum CPK level and the incidence of rhabdomyolysis-induced AKI in patients with multiple trauma.

Methods: Patients with serum CPK levels <1000 IU/L were followed as the control 1 group. Subjects with serum CPK levels ≥1000 IU/L were randomly allocated to the control 2 or intervention group at Imam Hossein Medical Center, Tehran, Iran in 2020. Patients in the intervention group received a single dose of vitamin D3 (300,000 units) on the recruitment day. The serum level of CPK was recorded every 3 days for 14 days. Parametric and non-parametric tests were used to compare the CPK values between groups.

Results: Forty-six patients, consisting of 16, 15, and 15 in control 1, control 2, and intervention arms of the study were recruited, respectively. Unlike control groups, the significant steadily decreasing trend was seen only in the intervention group (P<0.001). This significant decrease in the intervention arm was observed on days 5 to 7 (P=0.001) and on days 8 to 10 (P<0.001) compared to the baseline. Patients in the intervention group had a lower number of AKI or need for dialysis (P=0.869 and P=0.670 for AKI and dialysis, respectively) than control group 2, although the differences were not significant.

Conclusion: The current study revealed that vitamin D3, could prevent the increasing trend of CPK during the first days and accelerate the normalization of CPK in patients with elevated CPK due to multiple trauma.Trial Registration Number: IRCT20120703010178N23.

Background: Ultraviolet B (UVB) irradiation induces photoaging and apoptosis in various cell types. Inhibition of UVB-induced apoptotic pathways has been explored in different apoptotic cascades. Conditioned media from human umbilical cord blood mesenchymal stem cells (CM-hUCB-MSC) contain important substances for cell regeneration. However, the potential of CM-hUCB-MSC in preventing UVB-induced apoptosis has not been clearly elucidated. Therefore, the current research was conducted to investigate the potential of CM-hUCB-MSC in inhibiting UVB-induced apoptosis and its role in the antiapoptotic signaling pathway.

Methods: An experimental in vitro study was conducted at PT. Prodia StemCell Indonesia, Jakarta, Indonesia, 2019-2022. Initially, hUCB-MSCs were isolated and cultured to produce CM-hUCB-MSC. NIH3T3 cells were pretreated with/without 50 μM LY294002, treated with/without 10% CM-hUCB-MSC, and then irradiated with/without UVB. Subsequently, the cells were analyzed using sub-G1, immunofluorescence, and immunoblotting assays. One-way analysis of variance (ANOVA) was used for data analysis, followed by Tukey's honest significant difference (HSD) test or the Kruskal-Wallis test, followed by the Dunn-Bonferroni test using IBM SPSS Statistics software version 21. Statistical significance was determined at P<0.05.

Results: CM-hUCB-MSC significantly inhibited UVB-induced apoptosis in NIH3T3 cells (P=0.002, Dunn-Bonferroni test). CM-hUCB-MSC significantly induced Akt phosphorylation at Ser 473 in UVB-irradiated NIH3T3 cells (P<0.001, Tukey's HSD test). The CM-hUCB-MSC-induced phosphorylation of Akt was significantly inhibited by LY294002 (P<0.001, Tukey's HSD test).

Conclusion: Taken together, it can be concluded that CM-hUCB-MSC inhibits UVB-induced NIH3T3 cell apoptosis via the activation of phosphatidylinositol-3-kinase (PI3K)/Akt signaling cascades.

Background: The relationship between diastolic function parameters and the severity of coronary artery disease (CAD) is controversial. This study aimed to determine the relationship between left ventricular diastolic function and the severity of CAD.

Methods: This cross-sectional study included 63 patients with Ischemic heart disease (IHD) or those suspected of having IHD, who underwent angiography. The study was conducted in Shafa Hospital, Kerman, Iran, from 2021 to 2022. Two-dimensional (2D) strain echocardiography was used to assess left ventricular (LV) function parameters, followed by coronary angiography. Based on the severity of the disease, patients with significant CAD were placed in the case group, and patients with insignificant CAD were placed in the control group. The correlation between the CAD severity and the severity of LV diastolic dysfunction was computed. Descriptive tests, independent t tests, and Spearman correlation coefficients were used. P<0.05 was considered statistically significant.

Results: The results indicated that there was no correlation between E/e' (P=0.103), left atrial volume index (LAVI) (P=0.168), tricuspid regurgitation velocity (TRV) (P=0.217), myocardial performance index (MPI) (P=0.106), E wave deceleration time (dt) (P=0.644), and late diastolic strain rate (P=0.502) with CAD severity based on SYNTAX score. However, there was a correlation between left atrial (LA) strain (P=0.017), global longitudinal strain (GLS) (P<0.001), early diastolic strain rate (P<0.001), and systolic strain rate (P=0.047) with SYNTAX score. Besides, there was a correlation between LA strain (P=0.017), GLS (P<0.001), early diastolic strain rate (P<0.001), and late diastolic strain rate (P=0.035) with numbers of epicardial coronary arteries with significant lesions.

Conclusion: In contrast with 2D strain echocardiography, this study showed that conventional echocardiography parameters had no significant relationship with CAD severity. GLS had the strongest correlation with CAD severity, and diastolic strain rates had a weaker correlation with CAD severity.

Fibrous dysplasia is a slow-progressing benign condition characterized by abnormal bone formation that leads to some skeletal disorders. Although some of the fibrous dysplasia have unusual clinical and radiographic features that can lead to a challenging diagnosis, most lesions reveal an expansile bone defect due to cortex thinning. This report presented a case of monostotic fibrous dysplasia of a 43-year-old woman with involvement of the right maxillary jaw and sinuses, which indicated unusual histopathological features. The patient was referred to the Department of Oral and Maxillofacial Surgery of Tehran University of Medical Sciences (Tehran, Iran) in 2022. Radiological and histological findings were discussed. The unusual histomorphic pattern of the lesion caused uncertainty and resulted in a missed definitive diagnosis in the primary biopsy. It was highlighted that awareness of rare histologic variants in fibro-osseous lesions especially fibrous dysplasia was required to improve diagnostic confidence.

Background: Labial adhesion (LA) is a total or partial labial fusion mostly seen in pre-pubertal children and is rare in premenopausal and postmenopausal periods. This review aimed to evaluate risk factors for labial fusion and the recurrence rate following surgical intervention in postmenopausal women.

Methods: According to PRISMA guidelines, international databases including Embase, World Cat, Web of Science, Scopus, Dimension, Open Grey, Cochrane, Google Scholar, and also PubMed gateway for PMC and MEDLINE were searched. The included studies were in English and published from 1985 until December 2023 with the keywords including vulvar diseases, agglutination, menopause, postmenopause, and recurrence. All studies that evaluated the clinical course and recurrence of LAs following surgical treatment in postmenopausal women were included. The inclusion criteria were the risk factors of LA recurrence rate, and the exclusion criteria were studies with missing required data, letters to editors, and conference studies.

Results: Thirty-four case reports were enrolled. In total, 54 patients were evaluated. The most common risk factors for LA included hypoestrogenism, virginity, sexual inactivity, cervical cancer, hysterectomy, urinary tract infections, and lichen sclerosis. Only one study reported a recurrence of labial fusion following surgical intervention in a one-year follow-up.

Conclusion: The most common risk factors for LA were hypoestrogenism, virginity, sexual inactivity, cervical cancer, hysterectomy, urinary tract infections, and lichen sclerosis. The low recurrence rate following surgical release of labial fusion has made it an effective and safe method in postmenopausal women with negligible medium-term recurrence rates.

Background: Suicide is a serious global public health issue. It is the fourth-leading cause of death among young people between the ages of 15 and 29. Therefore, the present study was conducted to determine the important risk factors associated with violent and non-violent methods of committing suicide.

Methods: This research was a cross-sectional study that included all people who attempted suicide between 2019 and 2023 and were part of the population covered by Mashhad University of Medical Sciences (Mashhad, Iran). Predictive variables for suicide attempts included age, sex, education, marital status, occupation, place of residence, drug abuse, smoking, psychiatric diagnoses, and the intended outcome of violent and non-violent methods. Logistic regression analysis was used to model the relationship between selected risk factors and the response variable. The data were analyzed using STATA software version 14. P<0.05 was considered statistically significant.

Results: Among the 18,281 people, 53% were men. Men, those who had lost their wives, people who lived in suburban areas, and people who had self-employed jobs or were unemployed, had higher rates of attempted suicide using violent methods. The chance of using violent methods was found to be 64% lower in women than in men (OR=0.36, 95%CI=0.30-0.43) and 45% higher in single individuals than in married people (OR=1.45, 95%CI=1.20-1.75).

Conclusion: This study found that several factors influenced the choice of method for committing suicide. Men, those who had lost their wives, suburban inhabitants, those with insecure jobs or unemployment, and single people were more prone to use violent methods. Meanwhile, women, the elderly, and those with higher education levels showed a preference for non-violent methods.