Archives of Iranian Medicine最新文献

Pancreatic perivascular epithelioid cell tumors (PEComas) are rare mesenchymal neoplasms with only a few reported cases. Their non-specific clinical presentations and imaging features often lead to misdiagnosis. We report a case of a 63-year-old female with intermittent left upper quadrant pain. Imaging revealed a hypervascular mass in the pancreatic tail, initially suspected to be a neuroendocrine tumor. The patient underwent distal pancreatectomy with splenectomy. Histopathological examination showed that the tumor consisted of epithelioid and spindle cells with clear cytoplasm, a rich vascular network and low mitotic activity. Immunohistochemically, the tumor cells were positive for HMB-45, Melan-A, and smooth muscle actin, confirming the diagnosis of pancreatic PEComa. The postoperative course was uneventful. Given the uncertain malignant potential of PEComas, complete surgical excision is the preferred treatment option, with long-term follow-up recommended. This case highlights the diagnostic challenges of pancreatic PEComas and underscores the role of histopathology and immunohistochemistry in their accurate identification and management.

Antithyroid drugs (ATDs) are often the first treatment option for hyperthyroidism due to their efficacy and safety profile. Long-term ATD treatment can effectively control hyperthyroidism and prevent relapse. In this review, we summarize the findings of clinical trials and clinical experiences on the use of ATD treatment for hyperthyroidism. We discuss the efficacy and safety of ATD treatment, as well as the optimal duration of treatment. The evidence suggests that ATD therapy is selected as initial therapy, treatment of relapse of hyperthyroidism and in patients with persistent elevation of TSH receptor antibodies after 18 months of ATD therapy. Long-term ATD treatment can be an effective and safe option for management of many patients with hyperthyroidism. However, additional studies are needed to establish the most efficacious treatment duration and to identify patients who are most likely to benefit from long-term ATD treatment.

Background: Thyroid cancer (TC) incidence varies regionally in Iran, with a notable increase observed in females. However, region-specific spatiotemporal epidemiological data are limited. This study aimed to quantify the spatiotemporal trends and geographic clustering of female TC in the Hamadan province, western Iran, from 2010 to 2019.

Methods: Female TC cases from the Hamadan province were obtained from the population-based cancer registry. County-level standardized incidence ratios (SIRs) were calculated to adjust for differences in population size, and were smoothed using a hierarchical Bayesian spatial smoothing model that accounts for spatial and temporal dependence. Temporal trends were analyzed using joinpoint regression. Spatiotemporal clusters were identified using space-time scan statistics.

Results: The incidence of female TC showed an average annual increase of 14.5% (Average annual percent change [AAPC]: 14.5, 95% confidence interval: 4.7 to 25.3; P<0.001) from 2010 to 2019 in the Hamadan province. The smoothed SIRs indicated increasing trends in northern and central counties, including Hamadan, Asadabad, Famenin, Razan, and Tuyserkan, while decreasing trends were observed in southern counties such as Nahavand and Malayer. A significant high-risk spatiotemporal cluster was identified in the Hamadan county during 2018-2019 (observed-to-expected cases ratio: 2.24, P<0.001), and a low-risk cluster was detected in Nahavand, Malayer, and Tuyserkan from 2010 to 2013 (0.51, P<0.001).

Conclusion: This study revealed significant spatiotemporal heterogeneity in female TC incidence in the Hamadan province. Identification of high-risk clusters provides an evidence base for targeted preventive measures and health resource allocation.

Background: Cervical cancer is the leading malignancy among women worldwide, posing clinical and public health challenges. This in silico study aims to identify potential diagnostic biomarkers, therapeutic targets, and prognostic markers associated with cervical cancer through integrative bioinformatics approaches.

Methods: A hybrid machine learning approach, combining genetic algorithm (GA) and support vector machine (SVM), was applied to high-dimensional gene expression data from publicly available transcriptomic datasets, including the Gene Expression Omnibus (GEO) and The Cancer Genome Atlas (TCGA). A total of 72 Geo samples (Affymetrix, Illumina) served as the primary dataset after normalization.

Results: The GA-SVM model achieved about 99% accuracy and AUC with 10-fold cross validation, clearly separating cervical cancer from normal tissues. Eight genes (CXCL9, CTGF, ZNF704, ZEB2, SASH1, PTN, KPNA2, SLC5A1) were identified as diagnostic biomarkers. Protein-protein interaction (PPI) and functional enrichment analyses revealed 42 therapeutic targets (e.g. CDK1, BRCA1, CCNB1, and AURKB) linked to regulating cell cycle, DNA repair, and mitotic processes. Survival analysis identified six genes (CXCL1, DNMT1, MMP1, MYBL2, PCNA, and RRM2) as key prognostic markers. Additionally, transcription factor analysis identified E2F1 and TP63 as major regulators of the prognostic genes, elucidating the molecular mechanisms underlying cervical cancer progression.

Conclusion: The identified gene signatures may serve as candidates for hypothesis generation and provide a computational framework to prioritize biomarkers and therapeutic targets in cervical cancer. However, these findings are based on in silico analyses and require experimental and clinical validation before translation into practice.

Background: Diagnosing non-ST elevation myocardial infarction (NSTEMI) in busy emergency departments is challenging. Artificial intelligence (AI) systems, particularly large language models (LLMs), offer potential as clinical decision support tools. This study aimed to evaluate the reliability of ChatGPT and Gemini in NSTEMI cases by comparing their responses to multiple-choice questions with those of emergency physicians.

Methods: This prospective, cross-sectional study was conducted via an online survey among 1,106 emergency physicians in Turkey. The survey included ten NSTEMI-related multiple-choice questions based on the 2023 European Society of Cardiology guidelines. The same questions were presented to ChatGPT 4.0 and Gemini 2.5, queried using identical standardized prompts (temperature=0, no web access) on April 20, 2025. Statistical analyses were performed using SPSS 26.0.

Results: AI models significantly outperformed physicians, correctly answering nine of ten questions versus the physicians' mean of 7.62±1.32 (P<0.001). Effect sizes indicated a very large difference for less experienced physicians and a moderate difference for specialists. Performance improved with experience, yet AI exceeded even the most experienced physicians. Participants from training and research hospitals scored higher than those from state hospitals.

Conclusion: ChatGPT and Gemini demonstrated superior performance over emergency physicians in NSTEMI clinical questions, highlighting AI's potential to enhance medical education, clinical decision support, and patient care. These findings, however, are limited by the non-proctored online setting and absence of real clinical context. Future research should focus on optimizing AI-clinician collaboration for safe and effective integration.

Background: Obstructive jaundice commonly complicates pancreatic cancer and often requires biliary decompression. Percutaneous transhepatic biliary drainage (PTBD) followed by stent placement is used for palliation, but long-term stent patency and the relationship between patency and overall survival (OS) remain incompletely characterized.

Methods: We conducted a retrospective cohort study of 60 consecutive patients who underwent sequential PTBD and biliary stent placement at the Affiliated Hospital of Jiangnan University (Wuxi, China) between January 2020 and December 2024. Primary endpoint was stent patency (time from stent insertion to radiologically confirmed occlusion or repeat intervention). Secondary endpoint was OS measured from stent insertion. Patient characteristics, stent type (covered vs uncovered), tumor location, stage, and receipt of systemic chemotherapy were extracted from electronic medical records. Kaplan-Meier analysis and Cox proportional hazards models (adjusted for age, sex, cancer stage, tumor location, baseline bilirubin and chemotherapy) were used. Proportional hazards assumption was tested using Schoenfeld residuals.

Results: Median stent patency was 12.0 months (IQR 8.0-15.0) and median OS was 9.5 months (IQR 6.0-13.0). Covered stents were associated with longer patency (median 13.0 vs 11.0 months; log-rank P=0.018). In multivariable Cox regression, Stage IV disease (adjusted HR 2.50; 95% CI 1.68-3.86; P<0.001) and age (per year, adjusted HR 1.05; 95% CI 1.02-1.09; P=0.002) were independent predictors of mortality; covered stent use was associated with lower mortality (adjusted HR 0.78; 95% CI 0.61-0.99; P=0.043). Schoenfeld tests showed no violation of the proportional hazards assumption (global P=0.18). Stent-related complications occurred in 16.7% of patients (migration 5.0%, infection 3.3%, biliary leak 1.7%, recurrent jaundice 6.7%).

Conclusion: Sequential PTBD and biliary stenting provides effective biliary decompression with a median stent patency of 12 months but only limited impact on OS, which is dominated by disease stage. Covered stents improved patency and were associated with a modest survival advantage after adjustment. Prospective, multicenter studies are required to confirm these findings and to explore integration with systemic therapies.

Background: Acute kidney injury (AKI) is a critical complication, affecting up to 30% of coronary artery bypass grafting (CABG) patients, and contributing to significant morbidity and mortality. Recent studies indicate that increased central venous pressure (CVP) might significantly contribute to the development of AKI by causing venous congestion and impairing renal blood flow. However, the association between CVP and AKI in patients undergoing CABG has not been thoroughly investigated. This scoping review evaluates the current evidence on CVP as a hemodynamic marker associated with AKI in adults undergoing cardiac surgery with cardiopulmonary bypass (CPB), with a particular focus on CABG where reported.

Methods: This scoping review, conducted over 12 weeks, followed the PRISMA-ScR guidelines and Arksey and O'Malley framework. A systematic search of PubMed, Scopus, Web of Science, and MEDLINE (2016-2024) identified studies on adult CPB-supported cardiac surgery, including CABG. Eligible studies reported quantitative CVP (intra- or postoperative) and standardized AKI criteria. No formal bias assessment was performed; data extraction was independently conducted by two reviewers using a standardized form.

Results: Of 1,717 studies screened, 16 met the inclusion criteria, mostly retrospective cohorts involving CABG patients. Overall, elevated CVP showed a positive association with postoperative AKI, though thresholds varied (intraoperative 6.5-12 mm Hg; postoperative>6.6-10.3 mm Hg). Several studies revealed a synergistic effect between high CVP and low mean arterial pressure (MAP). Despite consistent trends, heterogeneity in design and CVP assessment limits comparability. Most studies used the KDIGO criteria for AKI definition.

Conclusion: High CVP is commonly linked to the occurrence of AKI in patients undergoing cardiac surgery. The evidence mapped in this review suggests a potential role for CVP monitoring in perioperative care, though clinical recommendations require validation through prospective trials. Future research should focus on establishing standardized CVP thresholds and evaluating their utility in AKI risk stratification.

Background: Barrett's esophagus (BE) is a premalignant condition resulting from chronic gastroesophageal reflux disease (GERD), associated with increased risk of esophageal adenocarcinoma. Endoscopic identification of BE remains imperfect without histological confirmation. This study evaluates the diagnostic accuracy of endoscopy in detecting BE and identifies its associated factors using data from a large cohort of dyspeptic patients.

Methods: In this retrospective study, we reviewed 41,268 adults undergoing upper gastrointestinal endoscopy for dyspeptic symptoms between 2014 and 2018. Among them, 840 had suspected BE. Biopsies were obtained per the Seattle protocol and assessed for intestinal metaplasia by expert pathologists. Clinical and endoscopic features and Helicobacter pylori status were analyzed.

Results: Histological confirmation was achieved in 423 of 840 patients (50.4%). Short-segment BE comprised 97.4% of cases. Multivariate analysis identified age≥50 years, male sex, presence of hiatal hernia, and absence of H. pylori as independent predictors of histologically confirmed BE (P<0.05 for all). H. pylori prevalence was significantly lower in BE patients (26.2%) compared to non-BE patients (47.7%).

Conclusion: Endoscopic suspicion alone significantly overestimates BE prevalence, particularly for short-segment BE. Systematic biopsies remain essential for accurate diagnosis. The inverse association between H. pylori and BE suggests that H. pylori infection may be linked with a lower prevalence of BE. Targeted screening strategies are needed, especially in high-risk populations.

Background: The present study aims to investigate the impact of stroke history on cognitive function, white matter hyperintensities (WMHs), and circulating brain-derived neurotrophic factor (BDNF) levels in brain lesion patients.

Methods: In this study, we enrolled 228 individuals exhibiting clinical symptoms of stroke from the Golestan Cohort Study. The participants were categorized into two groups based on their stroke history. Subsequently, 120 patients with a history of stroke and 108 patients without obvious brain lesions were subjected to comparative analysis using magnetic resonance imaging (MRI). Montreal Cognitive Assessment (MoCA) and Fazekas scores were used to evaluate cognitive function and WMH burden, respectively. In addition, circulating BDNF levels were measured using the Human BDNF Elisa kit.

Results: Totally, 228 patients were recruited in the study with a mean age of 63.8 years. Stroke was found in 52.6%. MoCA scores and plasma BDNF levels were significantly lower in patients with a history of stroke compared to people without such a history after adjusting for age, sex, education and type of residency (adjusted regression coefficient (RC) (95% CI)=-4.0 (-5.0 to -3.0), -3.2 (-4.2 to -2.2), respectively). In addition, the intensity burden of white matter was higher in the stroke group (adjusted RC (95% CI)=1.2 (0.8 to 1.6).

Conclusion: The study suggests that a multi-biomarker approach, encompassing measures such as the MoCA score, Fazekas score, and circulating BDNF levels, can provide valuable insight into the neurological status of post-stroke patients and highlight potential avenues for improving patient outcomes through early detection and intervention strategies.