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Policy Options for Reducing Defensive Medicine Behaviors: A Multi-Method Study. 减少防御性医疗行为的政策选择:一项多方法研究
Q2 Medicine Pub Date : 2024-07-29 eCollection Date: 2024-01-01 DOI: 10.47176/mjiri.38.86
Ehsan Zarei, Iman Yousefi, Saba Shiranirad, Tahmineh Poursaki, Mohamad Mehdi Zahmatkesh, Pouria Farrokhi

Background: Defensive medicine (DM) refers to taking or not taking clinical actions, mainly to prevent legal or reputational consequences. It increases patient and health system costs and threatens patient safety. This study aimed to provide policy options to reduce DM behaviors and was conducted in two phases.

Methods: First, a scoping review was conducted by searching the Web of Science, PubMed, ProQuest, and Scopus databases in 2000-2023, and interventions and strategies to control DM behaviors were identified. To recognize the advantages, disadvantages, and implementation considerations, one session of focus group discussion (FGD) with experts was designed. Finally, the policies, strategies, advantages, disadvantages, and implementation considerations were refined and categorized during two expert panel sessions.

Results: During the search, 1774 articles were retrieved. Finally, after the screening process, 58 articles were included in the study. Four main policy options were formulated: "evidence-based medicine," "legal reforms," "promotion of professional ethics and a supportive environment," and "improving the doctor-patient relationship." In the following, 13 interventions and strategies, 18 advantages, 18 disadvantages, and 21 implementation considerations were identified.

Conclusion: To manage and reduce the effects of DM behaviors, different interventions at macro, organizational, and individual levels are needed. At the micro and individual levels, the enhancement of knowledge and skills is valuable. Organizational interventions that create a supportive culture and promote ethical behavior are also important.

背景:防御性医疗(Defensive Medicine,DM)是指采取或不采取临床行动,主要是为了防止法律或声誉方面的后果。它增加了患者和医疗系统的成本,并威胁到患者的安全。本研究旨在提供减少防御性医疗行为的政策选择,分两个阶段进行:首先,通过检索 Web of Science、PubMed、ProQuest 和 Scopus 数据库(2000-2023 年)进行了范围综述,确定了控制 DM 行为的干预措施和策略。为了解其优缺点和实施注意事项,设计了一次与专家的焦点小组讨论(FGD)。最后,在两次专家小组会议上对政策、策略、优缺点和实施注意事项进行了完善和分类:在检索过程中,共检索到 1774 篇文章。最后,经过筛选,58 篇文章被纳入研究。制定了四种主要政策选择:"循证医学"、"法律改革"、"促进职业道德和支持性环境 "和 "改善医患关系"。随后,确定了 13 项干预措施和策略、18 项优势、18 项劣势和 21 项实施注意事项:为了管理和减少 DM 行为的影响,需要在宏观、组织和个人层面采取不同的干预措施。在微观和个人层面,提高知识和技能是有价值的。创建支持性文化和促进道德行为的组织干预措施也很重要。
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引用次数: 0
Correlation of Spiritual Health and Stress Related to the COVID-19 Pandemic in Cancer Patients. 癌症患者精神健康与 COVID-19 大流行相关压力的相关性。
Q2 Medicine Pub Date : 2024-07-24 eCollection Date: 2024-01-01 DOI: 10.47176/mjiri.38.85
Ali Arash Anoushirvani, Seidamir Pasha Tabaeian, Minoo Maarefi, Samira Basir Shabestari

Background: Both coronavirus disease-2019 (COVID-19) and cancer place a heavy burden on the society and mental health of patients. Spiritual health may play a prominent role in coping with stressful conditions. Considering the existing controversy regarding the correlation between spiritual health and stress related to the COVID-19 pandemic in cancer patients, this study aimed to assess the correlation between spiritual health and COVID-19 stress in cancer patients.

Methods: This cross-sectional study was conducted on cancer patients presenting to Rasoul and Firouzgar Hospitals, affiliated with Iran University of Medical Sciences, in 2022. After obtaining written informed consent, eligible patients filled out the spiritual health questionnaire and COVID Stress Scale (CSS). Data were analyzed by the Pearson and Spearman correlation coefficients and one-way ANOVA.

Results: The mean (SD) levels of COVID-19 stress and spiritual health were equal to 106.5 (44.5) and 26.2 (10.9), respectively, which are regarded as moderate levels. An inverse correlation of -0.48 was found between spiritual health and COVID-19 stress (P < 0.001). Spiritual health decreased by an increase in the stage of cancer (P < 0.001). The mean COVID-19 total stress score and its domain scores [except for the post-traumatic stress syndrome (PTSD) domain] were significantly higher in patients with poor spiritual health compared with those with good spiritual health. However, the difference in this regard was not significant between patients with poor and moderate spiritual health (P > 0.05).

Conclusion: This study confirmed the prominent role of spiritual health in the reduction of COVID-19 stress. Promotion of spiritual health in cancer patients should be considered as an inseparable part of patient care to prevent disease aggravation and decrease the stress level of cancer patients, particularly during the COVID-19 pandemic.

背景:2019冠状病毒病(COVID-19)和癌症都给社会和患者的心理健康带来了沉重的负担。精神健康可能在应对压力条件中发挥重要作用。鉴于目前癌症患者精神健康与COVID-19大流行相关压力的相关性存在争议,本研究旨在评估癌症患者精神健康与COVID-19压力的相关性。方法:这项横断面研究是对2022年在伊朗医学大学附属的Rasoul和Firouzgar医院就诊的癌症患者进行的。在获得书面知情同意后,符合条件的患者填写精神健康问卷和COVID压力量表(CSS)。数据分析采用Pearson和Spearman相关系数及单因素方差分析。结果:新冠肺炎应激和精神健康的平均(SD)水平分别为106.5(44.5)和26.2(10.9),属于中等水平。精神健康与COVID-19压力之间的负相关为-0.48 (P < 0.001)。精神健康随着癌症分期的增加而下降(P < 0.001)。精神健康状况较差的患者的平均COVID-19总压力评分及其域评分(创伤后应激综合征(PTSD)域除外)显著高于精神健康状况良好的患者。然而,精神健康状况不佳与中度患者在这方面的差异无统计学意义(P < 0.05)。结论:本研究证实了精神健康在减轻COVID-19应激中的突出作用。促进癌症患者的精神健康应被视为患者护理不可分割的一部分,以防止疾病加重,降低癌症患者的压力水平,特别是在COVID-19大流行期间。
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引用次数: 0
Factors Required to Develop Strategic Purchasing for Diagnostic Imaging Services: An Expert Opinion. 发展诊断影像服务战略采购所需的因素:专家意见。
Q2 Medicine Pub Date : 2024-07-23 eCollection Date: 2024-01-01 DOI: 10.47176/mjiri.38.84
Abdollah Soltan-Tajian, Alireza Jabbari, Nasrin Shaarbafchizadeh, Peivand Bastani

Background: In recent decades, healthcare purchasing has been continuously searching for new approaches to improve performance. The pressure of expensive services resulting from more advanced health technology has increased the necessity of these changes. Strategic purchasing of health services, as a recommended approach, remains unknown in diagnostic imaging services. This study explores the potential determinants of strategic purchasing in the context of diagnostic imaging services.

Methods: This was a qualitative study conducted through framework analysis (applying five stages of familiarization, identifying a thematic framework, indexing, mapping, and interpretation) in 2023 based on the World Health Organization for strategic purchasing. This framework includes 5 questions: what to buy? From whom to buy? For whom to buy? what mechanism to buy? At what price to buy? A dimension of what structure to buy? Data were gathered through semi-structured interviews with key informants in which data saturation was reached in 18 interviews. After transcribing each interview, data were analyzed using MAXQDA software.

Results: A total of 32 factors were identified to be influencing the strategic purchasing of diagnostic imaging services. Development of an evidence-based service package using a prospective combined payment system, consideration of the burden of disease and health needs, implementation of a referral system and family physician program integrated with the electronic health record, and most importantly, political belief and technical capacity are the most important identified factors.

Conclusion: The implementation of a strategic purchasing policy requires a systemic approach to the factors affecting it. A number of specific and sometimes interconnected activities must be carried out in different areas of strategic purchasing. Governance of purchasing is the foundation of strategic purchasing. It is suggested that this item should be investigated more in countries like Iran.

背景:近几十年来,医疗保健采购一直在不断探索提高绩效的新方法。更先进的医疗技术带来的昂贵服务压力增加了这些变革的必要性。医疗服务战略采购是一种值得推荐的方法,但在影像诊断服务中仍不为人知。本研究探讨了诊断成像服务中战略采购的潜在决定因素:这是一项定性研究,以世界卫生组织 2023 年战略采购框架为基础,通过框架分析(应用熟悉、确定主题框架、索引、制图和解释五个阶段)进行。该框架包括 5 个问题:买什么?向谁购买?为谁购买?购买的机制是什么?以什么价格购买?购买什么结构?通过对关键信息提供者进行半结构化访谈收集数据,其中 18 次访谈达到了数据饱和。在对每个访谈进行转录后,使用 MAXQDA 软件对数据进行了分析:结果:共确定了 32 个影响诊断成像服务战略采购的因素。使用前瞻性综合支付系统开发循证服务包、考虑疾病负担和健康需求、实施与电子健康记录相结合的转诊系统和家庭医生计划,以及最重要的政治信念和技术能力,都是最重要的因素:战略采购政策的实施需要对影响因素采取系统的方法。必须在战略采购的不同领域开展一些具体的、有时是相互关联的活动。采购管理是战略采购的基础。建议伊朗等国对这一问题进行更多的研究。
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引用次数: 0
BRAFV600E Mutation Analysis in Fine-Needle Aspiration Cytology of Fixed Slide Specimens in Patients with Papillary Thyroid Carcinoma. 甲状腺乳头状癌患者固定切片标本细针抽吸细胞学中的 BRAFV600E 基因突变分析
Q2 Medicine Pub Date : 2024-07-22 eCollection Date: 2024-01-01 DOI: 10.47176/mjiri.38.83
Sara Cheraghi, Maryam Honardoost, Fereshteh Abdolmaleki, Mohammad E Khamseh

Background: Papillary thyroid carcinoma is the most frequent type of thyroid cancer. The BRAFV600E mutation is associated with tumor progression. We explored the utility of the BRAF molecular testing on fine needle aspiration fixed specimens of patients with confirmed diagnoses of papillary thyroid carcinoma.

Methods: Fixed thyroid cytology slide specimens of 19 patients with Bethesda II to VI reports were used to detect BRAFV600E mutation by pyrosequencing of extracted DNA.

Results: BRAFV600E mutation was detected in 25% of the specimens with Bethesda category III and IV nodules and in 73% of the nodules with Bethesda category V and VI.

Conclusion: BRAF mutation analysis can be performed on fixed fine needle aspiration cytology specimens. Although the frequency of the mutation is higher in specimens with higher Bethesda category scores, it could support clinical decision-making in thyroid nodules with intermediate Bethesda category scores.

背景:甲状腺乳头状癌是最常见的甲状腺癌类型。BRAFV600E突变与肿瘤进展有关。我们探讨BRAF分子检测在确诊为甲状腺乳头状癌患者的细针穿刺固定标本中的应用。方法:采用19例Bethesda II至VI报告患者的固定甲状腺细胞学切片标本,对提取的DNA进行焦磷酸测序检测BRAFV600E突变。结果:25%的Bethesda III类和IV类结节和73%的Bethesda V类和vi类结节中检测到BRAFV600E突变。结论:BRAFV600E突变分析可以在固定细针穿刺细胞学标本中进行。虽然在Bethesda分类评分较高的标本中突变的频率较高,但它可以为中等Bethesda分类评分的甲状腺结节的临床决策提供支持。
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引用次数: 0
Exploring Co-expression Modules-Traits Correlation through Weighted Gene Co-expression Network Analysis: A Promising Approach in Wound Healing Research. 通过加权基因共表达网络分析探索共表达模块与性状的相关性:伤口愈合研究中的一种可行方法
Q2 Medicine Pub Date : 2024-07-17 eCollection Date: 2024-01-01 DOI: 10.47176/mjiri.38.82
Mansoureh Farhangniya, Ali Samadikuchaksaraei, Farzaneh Mohamadi Farsani
<p><strong>Background: </strong>The skin is the biggest organ in the body and has several important functions in protection and regulation. However, wound development can disrupt the natural healing process, leading to challenges such as chronic wounds, persistent infections, and impaired angiogenesis. These issues not only affect individuals' well-being but also pose significant economic burdens on healthcare systems. Despite advancements in wound care research, managing chronic wounds remains a pressing concern, with obstacles such as persistent infection and impaired angiogenesis hindering the healing process. Understanding the complex genetic pathways involved in wound healing is crucial for developing effective therapeutic strategies and reducing the socio-economic impact of chronic wounds. Weighted Gene Co-Expression Network Analysis (WGCNA) offers a promising approach to uncovering key genes and modules associated with different stages of wound healing, providing valuable insights for targeted interventions to enhance tissue repair and promote efficient wound healing.</p><p><strong>Methods: </strong>Data collection involved retrieving microarray gene expression datasets from the Gene Expression Omnibus website, with 65 series selected according to inclusion and exclusion criteria. Preprocessing of raw data was performed using the Robust MultiArray Averaging approach for background correction, normalization, and gene expression calculation. Weighted Gene Co-Expression Network Analysis was employed to identify co-expression patterns among genes associated with wound healing processes. This involved steps such as network construction, topological analysis, module identification, and association with clinical traits. Functional analysis included enrichment analysis and identification of hub genes through gene-gene functional interaction network analysis using the GeneMANIA database.</p><p><strong>Results: </strong>The analysis using WGCNA indicated significant correlations between wound healing and the black, brown, and light green modules. These modules were further examined for their relevance to wound healing traits and subjected to functional enrichment analysis. A total of 16 genes were singled out as potential hub genes critical for wound healing. These hub genes were then scrutinized, revealing a gene-gene functional interaction network within the module network based on the KEGG enrichment database. Noteworthy pathways such as MAPK, EGFR, and ErbB signaling pathways, as well as essential cellular processes including autophagy and mitophagy, emerged as the most notable significant pathways.</p><p><strong>Conclusion: </strong>We identified consensus modules relating to wound healing across nine microarray datasets. Among these, 16 hub genes were uncovered within the brown and black modules. KEGG enrichment analysis identified co-expression genes within these modules and highlighted pathways most closely associated with the development of
背景:皮肤是人体最大的器官,具有多种重要的保护和调节功能。然而,伤口的发展会破坏自然愈合过程,导致慢性伤口、持续感染和血管生成受损等问题。这些问题不仅会影响个人健康,还会给医疗保健系统带来巨大的经济负担。尽管伤口护理研究取得了进展,但慢性伤口的管理仍然是一个亟待解决的问题,持续感染和血管生成受损等障碍阻碍了伤口的愈合过程。了解伤口愈合所涉及的复杂遗传途径对于制定有效的治疗策略和减少慢性伤口对社会经济的影响至关重要。加权基因共表达网络分析(WGCNA)为揭示与伤口愈合不同阶段相关的关键基因和模块提供了一种很有前景的方法,为采取有针对性的干预措施以加强组织修复和促进伤口有效愈合提供了有价值的见解:数据收集包括从基因表达总库(Gene Expression Omnibus)网站检索微阵列基因表达数据集,并根据纳入和排除标准筛选出 65 个系列。使用鲁棒多阵列平均法对原始数据进行预处理,以进行背景校正、归一化和基因表达计算。加权基因共表达网络分析用于识别与伤口愈合过程相关的基因之间的共表达模式。其中包括网络构建、拓扑分析、模块识别以及与临床特征的关联等步骤。功能分析包括富集分析,以及利用 GeneMANIA 数据库通过基因-基因功能相互作用网络分析确定枢纽基因:结果:使用 WGCNA 进行的分析表明,伤口愈合与黑色、棕色和浅绿色模块之间存在显著相关性。我们进一步研究了这些模块与伤口愈合性状的相关性,并对其进行了功能富集分析。共有 16 个基因被挑选出来,作为对伤口愈合至关重要的潜在枢纽基因。然后对这些枢纽基因进行了仔细研究,根据 KEGG 富集数据库在模块网络中发现了基因-基因功能相互作用网络。MAPK、表皮生长因子受体(EGFR)和ErbB信号通路等值得注意的通路以及自噬和有丝分裂等基本细胞过程成为最显著的重要通路:我们在九个微阵列数据集中发现了与伤口愈合相关的共识模块。结论:我们在九个微阵列数据集中发现了与伤口愈合相关的共识模块,其中在棕色和黑色模块中发现了 16 个枢纽基因。KEGG富集分析确定了这些模块中的共表达基因,并强调了与伤口愈合特征发展最密切相关的通路,包括自噬和有丝分裂。本研究确定的中心基因是未来研究工作的潜在候选基因。这些发现为进一步探索这些共表达模块对伤口愈合特征的影响奠定了基础。
{"title":"Exploring Co-expression Modules-Traits Correlation through Weighted Gene Co-expression Network Analysis: A Promising Approach in Wound Healing Research.","authors":"Mansoureh Farhangniya, Ali Samadikuchaksaraei, Farzaneh Mohamadi Farsani","doi":"10.47176/mjiri.38.82","DOIUrl":"10.47176/mjiri.38.82","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The skin is the biggest organ in the body and has several important functions in protection and regulation. However, wound development can disrupt the natural healing process, leading to challenges such as chronic wounds, persistent infections, and impaired angiogenesis. These issues not only affect individuals' well-being but also pose significant economic burdens on healthcare systems. Despite advancements in wound care research, managing chronic wounds remains a pressing concern, with obstacles such as persistent infection and impaired angiogenesis hindering the healing process. Understanding the complex genetic pathways involved in wound healing is crucial for developing effective therapeutic strategies and reducing the socio-economic impact of chronic wounds. Weighted Gene Co-Expression Network Analysis (WGCNA) offers a promising approach to uncovering key genes and modules associated with different stages of wound healing, providing valuable insights for targeted interventions to enhance tissue repair and promote efficient wound healing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data collection involved retrieving microarray gene expression datasets from the Gene Expression Omnibus website, with 65 series selected according to inclusion and exclusion criteria. Preprocessing of raw data was performed using the Robust MultiArray Averaging approach for background correction, normalization, and gene expression calculation. Weighted Gene Co-Expression Network Analysis was employed to identify co-expression patterns among genes associated with wound healing processes. This involved steps such as network construction, topological analysis, module identification, and association with clinical traits. Functional analysis included enrichment analysis and identification of hub genes through gene-gene functional interaction network analysis using the GeneMANIA database.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The analysis using WGCNA indicated significant correlations between wound healing and the black, brown, and light green modules. These modules were further examined for their relevance to wound healing traits and subjected to functional enrichment analysis. A total of 16 genes were singled out as potential hub genes critical for wound healing. These hub genes were then scrutinized, revealing a gene-gene functional interaction network within the module network based on the KEGG enrichment database. Noteworthy pathways such as MAPK, EGFR, and ErbB signaling pathways, as well as essential cellular processes including autophagy and mitophagy, emerged as the most notable significant pathways.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;We identified consensus modules relating to wound healing across nine microarray datasets. Among these, 16 hub genes were uncovered within the brown and black modules. KEGG enrichment analysis identified co-expression genes within these modules and highlighted pathways most closely associated with the development of","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"38 ","pages":"82"},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11644100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Case of Primary Ovarian Primitive Neuroectodermal Tumor. 原发性卵巢原始神经外胚层肿瘤1例。
Q2 Medicine Pub Date : 2024-07-16 eCollection Date: 2024-01-01 DOI: 10.47176/mjiri.38.81
Sara Parviz, Fahimeh Zeinalkhani, Masoumeh Gity, Hamidreza Saligheh Rad, Anahita Fathi Kazerooni, Fatemeh Nili, Peyman Kamali Hakim, Hadise Zeinalkhani

Primitive neuroectodermal tumors (PNET) are a family of poorly differentiated malignant neoplasms of neuroectodermal origin. According to the location of origin, PNETs could be further categorized as central or peripheral. Peripheral PNET (pPNET) is an uncommon type that accounts for 1% of all soft tissue sarcomas and occurs outside the central and sympathetic nervous systems. Ovarian PNET is a very rare tumor with a high mortality rate. We report a case of pPNET originating from the pelvic cavity of a young woman. Ultrasound and Magnetic Resonance Imaging (MRI) findings demonstrated the presence of a high-grade malignant ovarian tumor. On microscopic evaluation, the tumor was composed of solid nests and sheets of small rounded cells, and on Immunohistochemical (IHC) evaluation, the tumor cells showed intense cell-membranous immunoactivity for MIC2 protein (CD99). In the differential diagnosis of any invasive pelvic tumor in young women, pPNET should be considered.

原始神经外胚层肿瘤(PNET)是一种起源于神经外胚层的分化不良的恶性肿瘤。根据起源部位,PNET 可进一步分为中枢性和外周性两类。外周 PNET(pPNET)是一种不常见的类型,占所有软组织肉瘤的 1%,发生在中枢神经系统和交感神经系统之外。卵巢 PNET 是一种非常罕见的肿瘤,死亡率很高。我们报告了一例起源于年轻女性盆腔的 pPNET。超声波和磁共振成像(MRI)检查结果显示存在高级别恶性卵巢肿瘤。经显微镜评估,肿瘤由实性巢状和片状小圆形细胞组成,经免疫组化(IHC)评估,肿瘤细胞对 MIC2 蛋白(CD99)表现出强烈的细胞膜免疫活性。在年轻女性盆腔浸润性肿瘤的鉴别诊断中,应考虑 pPNET。
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引用次数: 0
The Coronary Angiography and Angioplasty Registry (CAAR) in Iran: Registry Protocol and Results of the Pilot Study. 伊朗冠状动脉造影和血管成形术登记(CAAR):登记方案和试点研究的结果。
Q2 Medicine Pub Date : 2024-07-15 eCollection Date: 2024-01-01 DOI: 10.47176/mjiri.38.80
Mohammad Haji Aghajani, Roxana Sadeghi, Mohammad Parsa Mahjoob, Amir Heidari, Fatemeh Omidi, Mohammad Sistanizad, Asma Pourhoseingholi, Seyed Saeed Hashemi Nazari, Mahmoud Yousefifard, Reza Miri, Niloufar Taherpour

Background: The current registry system aims to design a database that can be used for future research as a tool to produce and update new protocols for the diagnosis, treatment, management, and prevention of heart diseases.

Methods: In this hospital-based registry system, established on 27 July 2021, all the adult patients (age ≥18 years old) with signs and symptoms of cardiac diseases under coronary angiography or angioplasty in the cardiac ward of Imam Hossein Hospital of Tehran, Iran were recruited and followed-up until 30 days after discharge in the pilot phase. All data were collected using a researcher-made checklist from face-to-face interviews with patients and their medical records. The data were registered electronically in web-based software. Quality Control (QC) is conducted monthly by the QC team to ensure the documented data's quality.

Results: among 1265 patients under coronary angiography or angioplasty over a year, 97% (n=1198) of them were Iranian, and 991 (73.33%) patients lived in the country's capital, Tehran. About 55% (n=706) of patients were male. The mean age of the total patients was 60.48 ± 12.01 years. 764 (60.39%) patients were diagnosed with Coronary Artery Disease (CAD). Of all CAD patients, 32.72% (n=250) and 1.18% (n=9) were premature and very early CAD, respectively. During one year, 22.54% (n=279) and 7.02% (n=87) of patients were under PCI and CABG, respectively.

Conclusion: Since CVDs, especially CADs, are one of the most common and priority diseases in Iran's health system, establishing a coronary angiography and angioplasty registration system is an opportunity to study the epidemiological and clinical process of CVDs in the shape of an accurate registration system.

背景:目前的登记系统旨在设计一个可用于未来研究的数据库,作为制定和更新诊断、治疗、管理和预防心脏病新方案的工具:目前的登记系统旨在设计一个可用于未来研究的数据库,作为制定和更新心脏病诊断、治疗、管理和预防新方案的工具:该医院登记系统于 2021 年 7 月 27 日建立,在试点阶段,招募了伊朗德黑兰伊玛目侯赛因医院心脏科病房所有接受冠状动脉造影术或血管成形术的有心脏疾病症状和体征的成年患者(年龄≥18 岁),并对其进行随访,直至出院后 30 天。所有数据均使用研究人员自制的核对表,通过与患者面对面的访谈及其医疗记录收集而来。数据通过网络软件进行电子登记。质控小组每月进行一次质控(QC),以确保记录数据的质量。结果:在一年内接受冠状动脉造影术或血管成形术的 1265 名患者中,97%(n=1198)是伊朗人,991 名(73.33%)患者居住在伊朗首都德黑兰。约55%(n=706)的患者为男性。患者的平均年龄为 60.48 ± 12.01 岁。764名(60.39%)患者被诊断患有冠状动脉疾病(CAD)。在所有冠状动脉疾病患者中,32.72%(250 人)和 1.18%(9 人)分别属于过早和极早期冠状动脉疾病。在一年内,分别有22.54%(n=279)和7.02%(n=87)的患者接受了PCI和CABG治疗:由于心血管疾病(尤其是 CAD)是伊朗卫生系统中最常见和最优先治疗的疾病之一,因此建立冠状动脉造影和血管成形术登记系统是研究心血管疾病的流行病学和临床过程的一个机会。
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引用次数: 0
Comparison of Clinical Results Using Hamstring Versus Quadriceps Tendon Graft Versus Bone Patella Tendon in Anterior Cruciate Ligament Reconstruction Surgery: A Randomized Clinical Trial. 在前十字韧带重建手术中使用腘绳肌肌腱移植与股四头肌肌腱移植与骨髌腱移植的临床效果比较:随机临床试验。
Q2 Medicine Pub Date : 2024-07-10 eCollection Date: 2024-01-01 DOI: 10.47176/mjiri.38.79
Ehsan Fallah, Mobin Naghshbandi, Roya Ghafoury, Nima Hosseini Zare

Background: Anterior cruciate ligament (ACL) reconstruction is pivotal for restoring knee stability and function in individuals with ACL injuries. While bone-patellar tendon-bone (PT), hamstring tendon (HT), and quadriceps tendon (QT) autografts are commonly employed, their comparative effectiveness remains a subject of ongoing research. This study aims to comprehensively compare the functional outcomes, knee stability, revision rates, and incidence of anterior knee pain associated with these autografts.

Methods: In this randomized clinical trial, adult male participants undergoing primary single-bundle ACL reconstruction were randomized into three groups (PT, HT, QT) using a computer-generated sequence with allocation concealment. Blinded assessments were conducted at 2-, 6-, and 12-months post-surgery to evaluate knee function, stability, and patient satisfaction. The rehabilitation protocol was standardized across groups, including specific exercises and cryotherapy, to minimize postoperative swelling and pain.

Results: A total of 75 participants were followed for 12 months post-surgery. While significant improvements in knee function and stability were observed across all groups, there were no statistically significant differences between the autograft types in terms of revision rates or the incidence of anterior knee pain. Detailed statistical analysis revealed effect sizes and confidence intervals, substantiating the clinical relevance of the findings.

Conclusion: PT, HT, and QT autografts each provide favorable outcomes for ACL reconstruction without significant differences in efficacy up to one year postoperatively.Level of Evidence: Level 2 (Randomized Clinical Trial).

背景:前交叉韧带(ACL)重建是恢复前交叉韧带损伤患者膝关节稳定性和功能的关键。虽然骨-髌腱-骨(PT)、腘绳肌腱(HT)和股四头肌腱(QT)自体移植是常用的方法,但它们的比较效果仍是一个持续研究的课题。本研究旨在全面比较这些自体移植物的功能效果、膝关节稳定性、翻修率和膝关节前部疼痛的发生率:在这项随机临床试验中,接受初级单束前交叉韧带重建术的成年男性参与者被随机分为三组(PT、HT、QT),采用计算机生成的序列进行分配隐藏。在术后 2 个月、6 个月和 12 个月进行盲法评估,以评价膝关节功能、稳定性和患者满意度。各组的康复方案都是标准化的,包括特定的锻炼和冷冻疗法,以最大限度地减少术后肿胀和疼痛:结果:共有 75 名参与者接受了为期 12 个月的术后随访。所有组别在膝关节功能和稳定性方面都有明显改善,但自体移植物类型之间在翻修率或膝关节前侧疼痛发生率方面没有统计学意义上的显著差异。详细的统计分析显示了效应大小和置信区间,证实了研究结果的临床相关性:结论:PT、HT和QT自体移植物均能为前交叉韧带重建提供良好的结果,术后一年内的疗效无显著差异:2级(随机临床试验)。
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引用次数: 0
Effect of Silymarin on Expression of micro-RNA-21 and Matrix Metalloproteinase (MMP) 2 and 9 and Tissue Inhibitors of Matrix Metalloproteinase (TIMP) 1 and 2 in Hepatocellular Carcinoma Cell Line (HepG2). 水飞蓟素对肝细胞癌细胞系(HepG2)中微-RNA-21、基质金属蛋白酶(MMP)2 和 9 以及基质金属蛋白酶组织抑制剂(TIMP)1 和 2 表达的影响
Q2 Medicine Pub Date : 2024-07-09 eCollection Date: 2024-01-01 DOI: 10.47176/mjiri.38.78
Maryam Hormozi, Meysam Moulaee, Mahdi Alaee, Nasim Beigi Boroujeni, Mandana Beigi Boroujeni

Background: Silymarin is a flavonolignan that has various medicinal properties such as liver protection, antioxidant, anti-inflammatory, anti-cancer and heart protection activities. The aim of this study was to investigate the effect of silymarin on the expression level of mir-21, matrix metalloproteinase(MMP), and their tissue inhibitors (TIMPs) in liver cancer HepG2 cell line.

Methods: An in-vitro experimental study was conducted on the human HepG2 cells prepared from Pasteur Institute, Tehran, Iran. Four concentrations of 0 (control), 50, 100, and 150 µM of silymarin were considered as the study groups according to the MTT assay. Gene expression study was performed using real-time PCR. The studied genes were mir-21, MMP-2, MMP-9, TIMP-1 and TIMP-2. In addition, some apoptosis-related genes including BAX, BCL2 and Caspase3 (CAS3) were investigated. GAPDH was used as an internal control. Relative expression was calculated by REST program using t-test on the logarithm of expression considering a significance level of 0.05.

Results: The significant up-regulations consisted of TIMP genes for doses 100 µM and 150 µM, and the apoptosis activating genes CAS3 and BAX (P < 0.05). The significant down-regulations consisted of MMP-9 in all concentrations, MMP-2 in concentration 100 µM, and the apoptosis inhibitory gene BCL2 in concentrations 50 µM and 100 µM (P < 0.05). In addition, mir-21 as an oncogenic micro-RNA showed significant down-regulation for all doses (P < 0.05). All the comparisons were with the control group.

Conclusion: The present study showed that silymarin could affect the HepG2 cell line at the gene expression level via increasing apoptosis and changing the expression of MMP-2, MMP-9, TIMP-1, TIMP-2 and mir-21. These findings were in line with each other and in favor of suppression of tumoral activity in this cell line.

背景:水飞蓟素是一种黄酮木脂素,具有保护肝脏、抗氧化、抗炎、抗癌和保护心脏等多种药用特性。本研究旨在探讨水飞蓟素对肝癌 HepG2 细胞系中 mir-21、基质金属蛋白酶(MMP)及其组织抑制剂(TIMPs)表达水平的影响:对伊朗德黑兰巴斯德研究所制备的人 HepG2 细胞进行了体外实验研究。根据 MTT 检测法,将 0(对照组)、50、100 和 150 µM 四种浓度的水飞蓟素作为研究组。基因表达研究采用实时 PCR 技术进行。研究基因包括 mir-21、MMP-2、MMP-9、TIMP-1 和 TIMP-2。此外,还研究了一些与细胞凋亡相关的基因,包括 BAX、BCL2 和 Caspase3 (CAS3)。GAPDH 用作内部对照。在显著性水平为 0.05 的情况下,用 REST 程序对表达量的对数进行 t 检验,计算相对表达量:在剂量为 100 µM 和 150 µM 时,TIMP 基因以及凋亡激活基因 CAS3 和 BAX 的表达明显上调(P < 0.05)。明显下调的基因包括所有浓度下的 MMP-9、100 µM 浓度下的 MMP-2,以及 50 µM 和 100 µM 浓度下的凋亡抑制基因 BCL2(P < 0.05)。此外,mir-21 作为一种致癌微 RNA,在所有剂量下均出现显著下调(P < 0.05)。所有结果均与对照组进行了比较:本研究表明,水飞蓟素可通过增加细胞凋亡和改变 MMP-2、MMP-9、TIMP-1、TIMP-2 和 mir-21 的表达,在基因表达水平上影响 HepG2 细胞系。这些发现相互吻合,有利于抑制该细胞株的肿瘤活性。
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引用次数: 0
Comparing the Effectiveness of Two Kinds of Reading Interventions on Reading Outcomes in Third to Fifth Grade Farsi Speaker Students with Dyslexia: An Exploratory Study. 比较两种阅读干预措施对患有阅读障碍的三至五年级波斯语学生阅读结果的影响:一项探索性研究。
Q2 Medicine Pub Date : 2024-07-08 eCollection Date: 2024-01-01 DOI: 10.47176/mjiri.38.77
Samira Mazaheri, Zahra Soleymani, Roxanne F Hudson, Saeed Talebian

Background: This research marks the exploration into comparing the effectiveness of two reading interventions in improving reading outcomes for third to fifth-grade Farsi-speaking students with dyslexia.

Methods: In this randomized control trial study, twenty students in Tehran were randomly assigned to a multi-component group and a comprehension-based intervention group, each receiving 36 sessions of 45 minutes. The effectiveness of the interventions was evaluated using adjusted mean differences with a one-way ANCOVA.

Results: The results revealed the comprehension-based intervention's superior effect size across most outcomes, except for the letters string. The effect size was large for word reading 0.93 (CI -0.002 to 1.85), medium for phoneme deletion 0.67 (CI -0.23 to 1.5), small for text comprehension 0.25 (CI -0.62 to 1.13), and trivial for both rhyme identification 0.1 (-0.77 to 0.98) and non-word reading 0.11 (CI -0.76 to 0.98). The multi-component intervention had a greater effect size on letters string than the other intervention, although it was small -0.21 (CI -1.09 to 0.66).

Conclusion: The study concluded that comprehension-based intervention was more effective for Farsi-speaking students with dyslexia in grades 3-5, emphasizing the need for diverse intervention approaches to address their specific needs.

研究背景本研究是一项探索,旨在比较两种阅读干预措施在提高三至五年级有阅读障碍的波斯语学生的阅读成果方面的效果:在这项随机对照试验研究中,德黑兰的 20 名学生被随机分配到一个多成分干预组和一个以理解为基础的干预组,每组接受 36 节课,每节课 45 分钟。干预效果采用单向方差分析的调整平均差进行评估:结果表明,除字母串外,基于理解力的干预在大多数结果上都具有更优越的效果。单词阅读的效应大小为 0.93(CI -0.002-1.85),音素删除的效应大小为 0.67(CI -0.23-1.5),文本理解的效应大小为 0.25(CI -0.62-1.13),韵律识别的效应大小为 0.1(CI -0.77-0.98),非单词阅读的效应大小为 0.11(CI -0.76-0.98)。与其他干预措施相比,多成分干预措施对字母串的影响更大,尽管影响很小-0.21 (CI -1.09 to 0.66):研究认为,以理解为基础的干预对 3-5 年级有阅读障碍的波斯语学生更有效,这强调了需要采用不同的干预方法来满足他们的特殊需要。
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引用次数: 0
期刊
Medical Journal of the Islamic Republic of Iran
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