Iranian Journal of Medical Sciences最新文献

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.

Myiasis is a parasitic infestation of fly larvae caused by dipterous larvae that live in the host's dead or living tissues. This study reported the first case of urogenital myiasis in infants from Iran caused by Lucilia sericata. The 10-month-old boy was taken to the hospital by his mother due to restlessness and abdominal pain. During the examination, motile and live larvae were observed in the penis area. The patient had no history of infectious disease or immune system deficiency, and his blood tests were normal. The entomological analysis found that the source of this myiasis was Lucilia sericata fly larvae. The report of such cases highlighted the importance of physical examination and the awareness of physicians in dealing with myiasis, as well as the necessity of educating mothers on the hygiene of the living environment and child care in rural areas.

Background: Assessment tools are essential in occupational therapy for providing client-centered care, clinical decision-making, evidence-based documentation, and defining expected outcomes. This study investigated available occupational therapy assessment tools for children and adolescents in Iran.

Methods: A comprehensive search was conducted in MEDLINE, PubMed Central, Web of Science, Embase, Scopus, SID, Magiran, and Google Scholar from their inception until May 24, 2022. Two reviewers screened records and applied inclusion criteria focused on peer-reviewed articles in English or Persian, covering children and adolescents aged 0-18 years old in Iran. The methodological quality of each study and the evidence quality of each measurement tool was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias Checklist, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

Results: A review of 66 articles published between 2010 and 2021, identified 51 assessment tools. The majority of tools (70.7%) targeted typically developing children and those with cerebral palsy, with limited options for adolescents (n=5) and infants (n=1). These tools primarily focused on assessing body functions (47.06%), particularly sensory-motor functions. While numerous tools demonstrated good reliability (66.67%) and significant content validity (31.37%), there was a paucity of high-quality evidence supporting other psychometric properties.

Conclusion: This study identified 51 occupational therapy assessment tools for Iranian children and adolescents. However, the present research identified some concerning trends, such as lack of tools available for specific populations, an overreliance on translated tools, and a predominant focus on body functions. Moreover, there were concerns about the methodological quality of studies using these tools.

Background: Conventional ultrafiltration (CUF) during cardiopulmonary bypass (CPB) is utilized to minimize hemodilution. However, removing high volumes leads to tissue hypoperfusion by activating the anaerobic glycolysis pathways. This study aimed to determine the association between weight-indexed CUF volumes and lactate in patients who underwent coronary artery bypass grafting (CABG).

Methods: In this single-center retrospective study, 641 CABG patients, who were referred to Al-Zahra Hospital (Shiraz, Iran) and underwent CPB, during 2019-2021, were recruited. Peri-operative parameters were extracted from the patient's records. The patients with non-elective status, pre-existing liver and renal diseases, ejection fraction<35%, and repeated sternotomy were excluded from the study. An increase in post-operative lactate level≥4 mmol/L after 6 hours was defined as hyperlactatemia (HL). To predict HL, univariable and multiple logistic regression modeling, while controlling confounding factors, were employed.

Results: The patients' mean age was 58.8±11.1 years, and 39.2% were women. The incidence of HL was 14.5% (93 patients). There was a significant association between weight-indexed CUF volume and HL. The volume removed in the HL patients was almost doubled (43.37±11.32 vs. 21.41±8.15 mL/Kg, P<0.001), and the higher the weight-indexed CUF volume, the more likely to develop an HL at a rate of 1.38 (Odds ratio=1.38 [1.27-1.49], 95% CI, P<0.001). Furthermore, the multiple logistic regression model showed that HL was associated with the lowest mean arterial pressure (MAP) during CPB.

Conclusion: A higher volume of ultrafiltration was associated with increased post-operative serum lactate levels.

Background: Researchers are looking for a way to improve the myogenic differentiation of stem cells. Adipose-derived stem cells (ADSCs), known for their multipotency and regenerative capabilities, have been extensively studied for their therapeutic potential. Meanwhile, PC12 cells, derived from rat pheochromocytoma, have been found pivotal in neuroscience research, particularly as a neuronal model system. The current study investigated the effect of the PC12 adrenal pheochromocytoma cell line on the myogenic differentiation of ADSCs.

Methods: This experimental study was conducted during 2019-2022 (Ahvaz, Iran). Differentiation of ADSCs was induced by using 3 μg/mL 5-azacytidine for 24 hours. Then, the culture media was changed with Dulbecco's Modified Eagle-High Glucose (DMEM-HG) containing 5% horse serum (HS) and kept for 7 days. Different percentages of differentiated ADSCs and PC12 (100:0, 70:30, 50:50, 30:70) were cocultured for 7 days in DMEM-HG containing 5% HS. PC12 was labeled with cell tracker C7000. The real-time polymerase chain reaction and Western blotting techniques were utilized to assess gene and protein expression. All experiments were repeated three times. Data were analyzed using GraphPad Prism 8.0.2 software with a one-way analysis of variance. P<0.05 was considered statistically significant.

Results: PC12 visualization confirmed the accuracy of the co-culture process. The differentiated cells showed an aligned, multinucleated shape. The differentiated ADSCs revealed significantly elevated levels of Myh1, Myh2, and Chrn-α1 gene expression compared with undifferentiated ADSCs (P<0.0001). The ADSCs cocultured with PC12 cells showed significantly higher Myh1, Myh2, and Chrn-α1 gene expression than differentiated ADSCs (P<0.001). ADSCs cocultured with 50% PC12 revealed significantly higher MYH and nAchR protein expression than the differentiated group (P<0.01 and P<0.001).

Conclusion: Coculturing PC12 cells and ADSCs improves the efficiency of myogenic differentiation. However, the effectiveness of myogenic differentiation depends on the proportions of administered PC12 cells.