Iranian Journal of Medical Sciences最新文献

Background: Premature birth (delivery before 37 weeks of gestation) is a leading cause of neonatal morbidity and mortality worldwide. Specific genetic polymorphisms were associated with immune and inflammatory pathways that might contribute to its pathogenesis. This study investigated the associations between preterm birth and sociodemographic indicators, clinical outcomes, genetic polymorphisms, and microbial factors in Kazakh women.

Methods: This case-control study was conducted from September 2022 to September 2023. It enrolled women with preterm and full-term births in Kyzylorda, Kazakhstan. Data included sociodemographic, clinical variables, genotyping (TLR2 rs4986790 and MBL2 rs11003125), and microbial data. The quantification of Fusobacterium nucleatum (F. nucleatum) in saliva samples was performed using TaqMan real-time PCR. Statistical analysis was conducted using SPSS software (version 26), employing independent sample t tests, Chi square tests, Mann-Whitney U tests, and logistic regression. The level of significance was set at P<0.05.

Results: Sociodemographic analysis showed no significant differences between the studied groups, except for a higher prevalence of previous preterm birth in the case group. Clinical comparisons revealed significantly lower gestational age at delivery, reduced newborn weight and height, decreased placental weight and dimensions, lower hemoglobin levels, and erythrocyte counts in preterm cases. Genetic analysis demonstrated that all women with preterm labor carried the homozygous AA genotype of TLR299 rs4986790, while the GG genotype and the G allele of the MBL2 rs11003125 gene were predominant in this group. Furthermore, the quantitative analysis identified significantly higher F. nucleatum levels associated with premature birth, highlighting a potential microbial role in its pathogenesis.

Conclusion: These findings suggested that a history of preterm birth, specific genetic polymorphisms, and microbial factors collectively were associated with an increased risk of preterm birth.

Background: Peritendinous adhesion as a common post-surgical complication usually occurs as a result of a large portion of sports and hard job-related injuries. This study aims to evaluate the repurposed potential of the immunosuppressive approved drug, tacrolimus, in decreasing adhesion band formation post-Achilles tendon surgeries in an animal model.

Methods: Rats were randomly assigned to four groups control, sham with surgical intervention but no adhesion, positive control group with surgical transection and adhesion received no treatment, tacrolimus group was the same as the positive control group except that rats were treated with 2 mg/Kg/day tacrolimus orally for 21 days. The anti-inflammatory and fibrinolytic properties of oral tacrolimus treatment in attenuating the formation of adhesion bands were analyzed by One-way ANOVA or the Kruskal-Wallis test.

Results: Tacrolimus decreased the length (P=0.001), density (P=0.001), grading (P=0.023), severity (P=0.001), and thickness (P=0.008) of post-surgical adhesion bands compared to the untreated group. Histopathological changes and recruitment of inflammatory cells to the tendon tissue sections were attenuated in the tacrolimus-treated group (P=0.001) in comparison with the positive control group. Compared to the untreated group, tacrolimus treatment decreased the expression of IL-1β (P=0.059) in the tendon tissue, but the difference was not statistically significant. Moreover, tacrolimus elicited anti-fibrotic responses by reducing the expression of tissue growth factor-β (TGF-β) in the tendon and inhibiting collagen deposition, fibrosis quantity (P=0.001), fibrosis grading (P=0.001), and total fibrosis scores (P=0.001), as visualized by Masson's trichrome staining.

Conclusion: These results support the protective properties of tacrolimus in decreasing post-operative adhesion band formation in the animal model.

Background: Modulation of intestinal barrier, which function through zonulin pathway downregulation, represents a promising therapeutic strategy for chronic diseases. This systematic review aimed to evaluate the effects of prebiotic dietary fibers, probiotics, and synbiotics on intestinal permeability and immunity.

Methods: A systematic literature search of the EMBASE, PubMed, Web of Science, and Scopus electronic databases was conducted from database inception up to May 2024, supplemented by manual reference list searches. Included studies met the following criteria: (a) English language publications; (b) clinical trials; (c) investigated each factor of serum or fecal zonulin levels, serum or fecal calprotectin, glucagon-likepeptide-2 (GLP-2), short chain fatty acids (SCFAs), long chain fatty acids (LCFAs), fecal bile acid (BA), LPS-binding protein (LBP), lipopolysaccharide (LPS), intestinal microbiota composition, or inflammatory factors such as interleukin 6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP); (d) supplemented prebiotic dietary fibers, probiotics, or symbiotics. Studies were excluded if they contained insufficient data or involved supplementation alongside other interventions. The study quality and risk of bias were assessed using Jadad's Score.

Results: A total of 36 studies were included in this review. Of these, 14 articles (n=580 participants) evaluated the effect of dietary prebiotics, 18 articles (n=1502 participants) evaluated the effect of probiotics, and six articles (n=517 participants) examined the effect of synbiotics on intestinal health and immunity markers. According to the evidence presented in this study, prebiotic whole foods or food enriched with prebiotics, probiotics, and synbiotics might have favorable effects on the serum levels of zonulin as a measure of intestinal permeability. The effects on GLP-2, gut microbiota, and their metabolites (e.g., LCFAs/SCFAs and BA) were contradictory and inconclusive. Some studies indicated increased levels of Bifidobacteria and SCFA with prebiotic supplementation or prebiotics-enriched food products. Fecal calprotectin (as an important marker of the local gut inflammation), tumor necrosis factor-α (TNF-α), and hs-CRP were unaffected in most studies.

Conclusion: The lack of consistent replication across studies made it difficult to draw definitive conclusions about the effects of prebiotics, probiotics, and synbiotics on gut-related health and immunity. Therefore, further evidence is required before definitive recommendations can be established.

Background: Exosomal molecules derived from cancer cells have been recognized as candidate biomarkers for cancer diagnosis and prognosis. This study aimed to evaluate the potential of the LDH-C4 expression level in cervical carcinoma.

Methods: A retrospective study was conducted on patients with cervical carcinoma at the Third Hospital of Hebei Medical University, in Shijiazhuang, China, between July 2021 to September 2023. Peripheral blood was obtained, and serum and exosomes were extracted. Lactate dehydrogenase (LDHC) gene expression levels were quantified using reverse transcription-quantitative polymerase chain reaction (PCR), and these were compared with protein expression levels in cervical carcinoma tissues. Statistical analyses, including independent t tests, Chi square tests, receiver operator characteristic (ROC) curves, Kaplan-Meier analysis, and subsequent log-rank tests, were performed with the SPSS software version 21. Univariate and multiple analyses were used to analyze independent prognostic risk factors. P<0.05 was considered statistically significant.

Results: A total of 220 individuals were recruited, including 120 with cervical carcinoma and 100 healthy controls. In patients with cervical carcinoma, the LDHC gene expression levels were 5.58% and 11.28% in serum and exosomes of healthy donors and were 79.38% and 66.27% in patients with cervical carcinoma. There was a statistically significant difference in the LDHC expression between the patient group and the control group (P=0.008, in serum; P=0.011, in exosomes). In addition, LDH-C4 protein expression was associated with histology grade (P=0.022), tumor stage (P=0.019), and lymph node metastasis (P=0.016). The overall survival of patients with cervical carcinoma with positive LDH-C4 expression was 83.54%; patients with a higher LDH-C4 expression exhibited a poorer overall survival rate than those with lower LDH-C4 expression. Multiple Cox regression analysis demonstrated that LDH-C4 expression is a poor independent prognostic factor for patients with cervical carcinoma.

Conclusion: LDH-C4 levels in serum and exosomes may exhibit potential in identifying patients with cervical carcinoma, thus providing a novel approach for the early screening of cervical carcinoma.

Different side effects have been reported for leech therapy, such as local itching, skin reactions, infection, bleeding disorders, and anemia. The present study described a rare and lethal adverse event following leech therapy. A 63-year-old man was referred to Nemazee Teaching Hospital (Shiraz, Iran) in December 2020 with a two-week history of progressive right lower extremity swelling, erythema, and ecchymosis. One week before symptom onset, he had undergone leech therapy on the lateral calf and upper thigh of the right lower extremity, administered by a traditional healer. Physical examination revealed gangrene of the right leg and absence of all pulses. Color Doppler sonography of the leg and computed tomography angiography (CTA) of the thoracic aorta to the lower extremities revealed complete thrombosis of all right lower extremity arteries, extending to the right iliac artery and abdominal aorta. With a diagnosis of arterial occlusive disease and septic thrombophlebitis, the patient received intravenous antibiotics and anticoagulant therapy. Due to the inadequacy of medical treatments, a right lower extremity amputation was performed. The patient expired 5 days postoperatively due to septic shock and multiorgan failure.

Background: Sickle cell disease (SCD) prevalence is predicted to rise dramatically in the upcoming years. Although several medications have received Food and Drug Administration (FDA) approval in recent years, low- and middle-income countries (LMICs) still struggle to access these medications due to their remarkably high prices. Crizanlizumab, owing to its clinical and economic privileges, appears to be the most suitable option for addition to pharmacotherapy guidelines. However, no study has yet investigated its cost-effectiveness in Iran's healthcare system.

Methods: This cost-effectiveness evaluation was conducted in 2022 at the Pharmacoeconomic and Pharmaceutical Administration Department of the Faculty of Pharmacy at Tehran University of Medical Sciences, Tehran, Iran. A decision-tree model was designed, followed by a cost-utility analysis for crizanlizumab in two separate scenarios, targeting not only monotherapy with crizanlizumab in SCD compared with placebo, but also crizanlizumab's concomitant use with hydroxyurea compared with hydroxyurea. The study reports the outcomes from Iran's healthcare system perspective. Direct medical costs, quality-adjusted life years related to vaso-occlusive crisis, hospitalizations, and adverse effects were calculated. Incremental cost-effectiveness ratios were compared. SUSTAIN trial was the main clinical source for modeling crizanlizumab's effectiveness in SCD. A sensitivity analysis was performed to measure the sensitivity of outcomes to changes in medication costs. Microsoft Excel 2020 was utilized for calculations and modeling.

Results: Concomitant therapy with low-dose crizanlizumab added to hydroxyurea led to the lowest Incremental Cost Effectiveness Ratio (ICER) of 398,881 United States dollars (USD), exceeding Iran's accepted cost-effectiveness threshold. Sensitivity analysis results demonstrate that even a 20% reduction in the price of crizanlizumab does not lead to its cost-effectiveness in Iran.

Conclusion: Crizanlizumab administration in sickle cell disease is not found cost-effective in Iran, neither as a monotherapy nor added to hydroxyurea.

Background: The preservation of reproductive organs in females with muscle-invasive bladder cancer (MIBC) might improve reproductive and sexual function. This study aimed to identify potential clinical risk factors for reproductive organ involvement (ROI) using preoperative data from transurethral resection of tumor (TURT) reports and imaging findings.

Methods: This retrospective analysis was conducted on 143 women with bladder cancer who underwent radical cystectomy (RC) at Modarres and Labafinejad Medical Centers in Tehran, Iran, between 2010 and 2019. Demographic, clinical, and pathological data, along with follow-up reports, were collected from medical records and analyzed.

Results: The mean age of the participants was 69.17±10.62 years, with an ROI rate of 16.8%. The vagina was the predominantly involved organ. Significant independent risk factors for ROI included clinical T stage (P=0.042), bladder neck or trigonal location of the tumor (P<0.001), tumor size> 5 cm (P=0.002), presence of carcinoma in situ (CIS) (P=0.014), lymphovascular invasion in TURT reports (P=0.002), and preoperative hydronephrosis in imaging (P<0.001). Patients with ROI demonstrated significantly lower 5-year survival rates than those without ROI, with overall survival rate of 20.8% versus 63.9% and cancer-specific survival rate of 19% versus 64.8%, respectively.

Conclusion: This study represented a comprehensive analysis of preoperative TURT and imaging predictors of ROI. Clinical T stage, tumor location, maximum tumor size, concomitant CIS, presence of lymphovascular invasion, and hydronephrosis were identified as significant preoperative clinical factors associated with ROI. These findings might help guide surgical planning for organ preservation in female MIBC patients.

Background: An incapacitating chronic inflammatory neurodegenerative illness, known as multiple sclerosis (MS), is characterized by lymphocyte infiltration into the central nervous system. We aimed to identify specific miRNAs whose altered expression correlates with MS diagnosis and therapy selection, which could be biomarkers for these aspects of the disease.

Methods: The GSE21079 dataset was obtained for this study using Geoquery version 2.50.5 from the Gene Expression Omnibus database. The miRNAs exhibiting the highest variance were selected, and a miRNA-miRNA interaction network was constructed through a Bayesian network utilizing the bnlearn R package (version 4.7.1). The adjacency matrix generated from the learned network was subsequently analyzed in the Cytoscape environment. For the workbench lab, whole blood samples were collected from the MS Research Center and Al-Zahra Hospital in Isfahan, Iran, between June 2019 and October 2019. RNA extraction was conducted in the laboratory at Isfahan University. Real-time PCR (RT-PCR) was employed to validate the expression changes of the candidate mirRNAs (hsa-miR-520d-3p, hsa-miR-449a). The results were analyzed using REST 2009 software.

Results: The Notch1 signaling pathway was targeted by hsa-miR-520d-3p and hsa-miR-449a in MS patients, which led to downregulation of critical genes, such as LIM and SH3 protein 1 (LASP1), Tubulin Alpha1c (TUBA1C), and S100 calcium binding protein A6 (S100A6). Furthermore, the results from RT-PCR among 50 whole blood samples, comprising 30 cases of MS and 20 control cases, indicated that the expression levels of miRNA in patients with MS exhibited a statistically significant difference compared to those in healthy individuals, with values of 0.324 for hsa-miR-520d-3p and 0.075 for hsa-miR-449a. These values correspond to a downregulation of 3.1-fold and 13.3-fold, respectively.

Conclusion: The findings indicate that MS patients have lower expression levels of hsa-miR-520d-3p and hsa-miR-449a.