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Introduction: Lower gastrointestinal bleeding (LGIB) frequently leads to emergency department (ED) visits and hospitalizations, encompassing a spectrum of outcomes from spontaneous resolution to intrahospital mortality. Aim: The purpose of this study was to validate a scoring system designed to identify cases of low-risk LGIB, allowing for safe discharge from the ED. Methods: A retrospective analysis of all gastrointestinal bleeding cases presented at three EDs in 2020 was conducted, focusing specifically on patients with LGIB. The SHA 2 PE score incorporates factors such as systolic blood pressure, hemoglobin levels, use of antiplatelet or anticoagulant medications, pulse rate, and episodes of bright blood per rectum. Results: Out of 1112 patients presenting with LGIB to the ED, 55 were hospitalized, 20 required blood transfusions, 15 underwent colonoscopies, one underwent interventional radiology procedures, and two patients died. Employing a SHA 2 PE score with a cutoff value of 1 yielded a specificity of 78.5% (95% CI (confidence interval) [75.8-81.0]), sensitivity of 76.8% (95% CI [63.6-87.0]), positive predictive value (PPV) of 17.0% (95% CI [12.6-22.2]), and negative predictive value (NPV) of 98.3% (95% CI [97.2-99.1]) for predicting the need for hospitalization and intrahospital intervention. When considering return visits to the ED within 7 days with the same presentation, the score demonstrated a specificity of 78.8% (95% CI [76.0-81.3]), sensitivity of 68.6% (95% CI [56.4-79.1]), PPV of 19% (95% CI [14.3-24.4]), and NPV of 97.2% (95% CI [95.8-98.2]). Conclusions: The SHA 2 PE score demonstrates potential in predicting cases of low-risk LGIB, offering a high NPV for hospitalization, the need for intrahospital intervention, and return visits to the ED. However, these findings should be interpreted cautiously given the low prevalence of interventions and limitations in the study's population and design., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2025 Akram I. Ahmad et al. Gastroenterology Research and Practice published by John Wiley & Sons Ltd.)

Tissue engineering has facilitated the development of novel therapeutic strategies for male reproductive disorders. Decellularized extracellular matrix (ECM) scaffolds provide a wide range of functional components that promote cellular behavior. This research aimed to develop reinforced scaffolds for testicular tissue engineering by combining testicular ECM (TE) derived pre-gel with chitosan (CS) solution at varying ratios (TE25/CS75, TE50/CS50, and TE75/CS25). To determine the optimum ratio of TE to CS solution, final scaffold properties were investigated including pore size, porosity, mechanical strength, swelling ratio, degradation rate followed by in-vitro biological evaluations. All groups revealed an interconnected porous structure with high porosity (from 76.6 % to 90.9 %) and adequate pore sizes (between 50 and 226 μm), while the pores of TE50/CS50 scaffold were distributed more uniformly. The mechanical properties of scaffolds were enhanced by combining CS with TE, whereas their swelling ratio decreased. It was observed that the scaffolds' degradation rate rose substantially as the ratio of TE to CS increased. The MTT assay revealed that none of the scaffolds exhibited cytotoxic properties. The results of this study demonstrated that all fabricated hybrid scaffolds, especially the TE50/CS50, have potential for testicular tissue engineering applications., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: To describe Purtscher's and Purtscher-like retinopathy clinical features, etiologies, management options, and visual outcomes., Methods: Our protocol was registered on PROSPERO [registration number: CRD42023406843]. Seven online databases were searched: PubMed, Scopus, Medline, ScienceDirect, CENTRAL, clinicaltrials.gov, and Google Scholar. Original articles were included if they reported at least one subject diagnosed with Purtscher's or Purtscher-like retinopathy. The primary outcome is to describe the clinical features of Purtscher and Purtscher-like retinopathies, including etiologies, results of related investigations, management lines, and visual outcomes. All analyses were conducted with the use of Statistical Package for Social Sciences (SPSS) version 27 (IBM SPSS Corp, SPSS Statistics ver. 26, USA) and Cochrane's RevMan software. The methodological quality of included studies was assessed using the NIH quality assessment tools., Results: A total of 114 articles were included, describing 168 cases of Purtscher's and Purtscher-like retinopathy. Patients were evenly distributed between males (50.89%) and females (49.11%). Average age of patients was 34.62 years old. Trauma was the leading cause of retinopathy, being reported in 39.88% of our patients, followed by systemic lupus erythematosus (SLE) (13.1%) and acute pancreatitis (11.9%). Bilateral symptoms were reported in 57.7% of patients with centrally blurred vision being the most complained symptom (OS: 34.32% and OD: 18%). 75% of patients elicited bilateral retinal findings. Cotton-wool spots were of highest prevalence (58%). Purtscher flecken was seen in 53% of patients. Macular edema was seen in 13% of patients. Overall, patients had a favorable prognosis (53%)., Conclusion: Purtscher's and Purtscher-like retinopathies are rare sight-threatening retinopathies that develop most commonly following trauma or other systemic diseases as SLE and acute pancreatitis. Little data is available regarding these conditions, and available data is of low quality. Patients develop bilateral disease in approximately 50% of cases, and several retinal findings are observed, with no specific tendency. Most observed signs are cotton-wool spots in around 55% of patients and Purtscher flecken in 51% of patients. Patients spontaneously recovered, although data is not conclusive. No clear prognostic value of etiological factors is identified, and further research is required in this regard., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Serhan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Heart failure (HF) is characterized by the activation of adverse neurohormonal systems and a high mortality rate. Noteworthy, HF is a well-known complication of chronic kidney disease (CKD), especially in end-stage kidney disease (ESKD), where dialysis patients are seven to eight times more likely to encounter cardiac arrest than the general population. Therefore, it is important to develop efficient treatments to improve cardiac function in dialysis patients and eventually reduce the cardiovascular death toll. Sacubitril/valsartan (Sac/Val) is a dual inhibitor/blocker of the neprilysin and angiotensin II receptors, which exert cardioprotective effects among patients with heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved EF (HFpEF). Unfortunately, the drug is not approved for subjects with advanced CKD or dialysis patients due to safety concerns. The current study examined the cardiac effects of Sac/Val in HD patients. Administration of Sac/Val (100-400 mg/day) to 12 hemodialysis (HD) patients with HFrEF for six months gradually improved ejection fraction (EF) independently of morphological changes in cardiac geometry, as assessed by echocardiography (ECHO), and hemodynamic alterations. Interestingly, the Cardiomyopathy Questionnaire (Kansas City KCCQ-12) revealed that quality of life significantly improved after Sac/Val treatment. No major adverse effects were reported in the present study, supporting the safety of Sac/Val at least in these patients and for the applied follow-up period. Collectively, these findings support the use of Sac/Val as a cardioprotective agent in both HD and peritoneal dialysis (PD) patients. Yet, a more comprehensive study is required to establish these findings and to extend the follow-up period for 12 months in order to solidify these encouraging results., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Nazareth Hospital EMMS Human Research Review Committee issued approval (22-21-EMMS). This study was conducted in both hemodialysis (HD) and peritoneal dialysis (PD) patients who were prescribed hemolysis and peritoneal dialysis treatment in the Department of Nephrology at Nazareth Hospital, EMMS Nazareth. The study was carried out at Nazareth Hospital. All patients provided informed consent. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Armaly et al.)

Introduction The goal of total knee arthroplasty is to replace diseased cartilage and bone with an artificial implant to improve the patient's quality of life. The knee has historically been reconstructed to the patient's mechanical axis (MA). However, kinematically aligned techniques have been increasingly used. Kinematic alignment requires less soft-tissue resection and aligns the knee with what is anatomically natural to the patient, while there is concern that kinematically aligned knees will lead to earlier failure due to potential unequal weight distribution on the implant. The purpose of this study is to compare the parallelism from the floor of the joint-line cuts using kinematic and mechanical alignment and understand if the MA is a proper estimation of the tibial-ankle axis (TA). Methods A retrospective study was conducted by recruiting all high tibial osteotomy and distal femoral osteotomy recipients operated on by two surgeons in two MedStar Health hospitals from 01/2013 to 07/2020 with full-length films in preparation for restorative procedures. Baseline osteoarthritis was graded using the Kellgren-Lawrence classification system with all patients presenting as Grade 0. The TA and the joint-line orientations of the MA and kinematic axis (KA) were measured on 66 legs. The average distance from parallelism to the ground was compared between the MA and the KA and between the MA and the TA using a paired t-test. Results KA joint-line orientation (1.705° deviation) was more parallel to the floor in the bipedal stance phase than the MA (2.316° deviation, p=0.0156). The MA (2.316° deviation) was not a proper estimation of the TA (4.278° deviation, p=0.0001). Conclusion By utilizing the KA technique, the restoration of the natural joint line, as well as a joint that is more parallel to the floor in the stance phase compared to the MA, is achieved. The parallelism to the ground of the KA during the bipedal stance phase suggests an even load distribution across the knee. In addition, due to its similarity to the KA and anatomical significance in weight-bearing distribution, further investigation into the hip-to-calcaneal axis as an approximation of the joint line is warranted., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Hamzeh et al.)

Background and Aims: Irritable bowel syndrome (IBS) is a chronic GI disorder that affects people all over the world. Patients frequently look for information about their ailments online. Despite being widely and easily accessible, online information's quality and readability are under doubt. In this investigation, we assessed the effectiveness and usability of IBS Arabic websites found on significant search engines., Methods: IBS-related search terms in Arabic were entered into two search engines (Google and YouTube), and the first 30 websites per word from Google, and the first 20 websites per word from YouTube were assessed for eligibility. Eligible Google websites were assessed for quality and readability, while YouTube websites were assessed for quality. Quality was assessed using the DISCERN score and the JAMA Benchmark. Readability was assessed using the automatic Arabic readability index (AARI). Associations between quality, readability, types of websites (medical/nonmedical), and video length were analyzed., Results: For Google : A total of 48 websites were evaluated, mean DISCERN score was 40.4 (SD = 10.28) indicating fair quality. The mean JAMA score was 1.6 (SD = 0.69), with the readability being worse the higher the quality. Medical websites had higher quality scores than nonmedical ones. For YouTube : A total of 34 YouTube videos were evaluated, mean DISCERN score was 34.7 (SD = 7.35), indicating poor quality. The mean JAMA score was 1.4 (SD = 0.72). Medical websites had higher quality scores than nonmedical ones. There was no association between the quality of the videos and their length., Conclusion: The majority of websites were of low to fair quality and required a high degree of readability. As a result, we advise (1) healthcare practitioners to offer helpful websites to their patients, and (2) the development of IBS-related websites under the guidance of experts, with the involvement of patients., Competing Interests: The authors declare no conflict of interest., (© 2024 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Background: Hematologic malignancies in childhood and their treatments can cause dental anomalies and jaw bone abnormalities; therefore, the aim of this study was to assess the prevalence of these disorders in children., Methods: This cross-sectional study was conducted on all children diagnosed with hematologic malignancies that referred to in Amirkola Children's Hospital from 2011 to 2018. All of children underwent clinical evaluation in a Dental Radiology Clinic and panoramic imaging was performed. The radiographs were examined for dental anomalies and jaw bone abnormalities. The data were analyzed by descriptive analysis using chi-square, Mann-Whitney and Kruskal-Wallis with a 95% confidence interval., Results: The study population consisted of 32 children and 9.46% of these patients showed intraoral signs in clinical evaluations. Panoramic radiographs indicated dental anomalies in 12 (63.9%) and jaw bone abnormalities in 17 (89.4%) patients. The most common dental anomaly and bone abnormality were taurodontism and changes in lamina dura, respectively. By measuring the mandibular cortical index (MCI), it was revealed that 13 had osteopenia, in which 4 of them had severe osteopenia (osteoporosis). The statistical analysis demonstrated that there was a significant difference between the incidence of osteoporosis and changes in lamina dura with the gender (p<0.05)., Conclusion: Due to early onset of osteopenia and osteoporosis and the presence of dental and bone abnormalities in half of study population, early assessment of their clinical and radiographic condition can be helpful in the prevention and the early treatment of their oral complications., Competing Interests: The authors state that they have no conflict of interest.

For patients who had testicular tissue cryopreserved before receiving gonadotoxic therapies, transplantation of testicular tissues and cells has been recommended as a potential therapeutic option. There are no studies that indicate the generation of sperm after human immature testicular tissue (ITT) or spermatogonial stem cells (SSCs) transplantation. The use of releasing scaffolds and localized drug delivery systems as well as the optimizing transplantation site can play an effective role in increasing the efficiency and improving the quality of testicular tissue and cell transplantation in animal models. Current research is focused on optimizing ITT and cell transplantation, the use of releasing scaffolds, and the selection of the right transplantation site that might restore sperm production or male infertility treatment. By searching the PubMed and Google Scholar databases, original and review papers were collected. Search terms were relevant for SSCs and tissue transplantation. In this review, we'll focus on the potential advantages of using scaffolds and choosing the right transplantation site to improve transplantation outcomes.

Our aim was to assess the changes in patients presenting with acute alcohol intoxications or positive screens for problem drinking during the COVID-19 pandemic compared to before the pandemic in a seven-hospital health system. A retrospective chart review of emergency department (ED) visits from seven hospitals in the Washington, DC/Baltimore, and MD area from January 2019 to June 2021 is provided. The health system utilizes a validated system for Screening, Brief Intervention, and Referral to Treatment (SBIRT) for ED patients. We evaluated trends in patients who had a positive SBIRT screen for problem drinking (AUDIT-C score ≥ 3 in women, 4 in men), alcohol misuse (≥5), and those presenting with acute alcohol intoxication before March 2020 and during the early COVID pandemic period. There were 510 648 patients who were screened, ranging from ages of 16 to 95 years during the study period. There was an overall increase in patients who screened positive for problem drinking, alcohol misuse, and acute intoxications. While there was an overall decrease in the total number of ED visits during the start of the pandemic, which later increased near prepandemic levels, alcohol-related presentations as a percentage of total visits increased during the early pandemic period. There was an overall decrease in ED visits during the COVID-19 pandemic study period; problem drinking and acute intoxication presentation held steady, leading to an overall increase in proportion compared to pre-COVID-19 levels. Future research should focus on lessons learned during this time and should navigate the postpandemic care of patients with AUD. There was an increase in the proportion of ED visits for alcohol intoxications and positive screens for problem drinking during the COVID-19 pandemic in our seven-hospital system., (© The Author(s) 2023. Medical Council on Alcohol and Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

During the last two decades, the number of tropical cyclone (TC) events in the Arabian Sea has increased dramatically. These events have led to severe human and economic damage in Oman, Iran and Pakistan. Within this context, Gonu, Phet and Shaheen were the Arabian Sea's most destructive TCs on record, leading to a total of 6.07 billion USD in damages and 159 fatalities. Previous studies have mainly focused on atmospheric, sea surface temperature (SST) and anthropogenic impacts of TC generation and intensification. By contrast, oceanographic currents, Persian Gulf water outflow and the role of ocean-atmospheric interactions on the distribution of outflow water into the Arabian Sea and their impacts on TC intensification, are poorly understood. In order to address this issue, we use historical TC records, satellite data, atmospheric and reanalyzed oceanographic data to shed new light on the relationship between large-scale atmospheric forcing and ocean currents on TC intensification in the Arabian Sea. The results demonstrate that pre-monsoon TCs mainly occurred during co-existing La Niña, cold Indian Ocean Basin Model (IOBM) and anomalous northern hemisphere circulations over the Persian Gulf. By contrast, post-monsoon TCs were generally generated during warming acceleration period. Poleward movement of the monsoon belt provided the required humidity and energy for TC generation and increased upwelling events. Water salinity and temperature have increased in the north and northwestern parts of the Arabian Sea following rising upwelling events and a decrease in Persian Gulf outflow water depth. Rapid TC intensification has increased noticeably since 2007 and >72 % of cyclones have reached category 3 or more. We find that the rate of SST rise in the Arabian Sea is higher than the other parts of the northern Indian Ocean since 1998. SST and salinity in the Arabian Sea have been controlled by Persian Gulf outflow water and oceanographic currents. TC intensity is controlled by warm and saline (>36.6 PSU) water distribution patterns, mediated by eddy and jet currents. Rapid intensification of pre-monsoon TCs occurred by tracking to the north and northwest, with most landfalls occurring during this period. Post-monsoon TCs generally affect the center and the southwest of the Arabian Sea. The risk of intensive TCs manifests an increasing trend since 2007, therefore education programs via international platforms such as the International Ocean Institute (IOI) and UNESCO are required for the countries most at risk., Competing Interests: Declaration of competing interest We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Genome-wide association studies (GWASs) show that genetic factors contribute to the risk of severe coronavirus disease 2019 (COVID-19) and blood analyte levels. Here, we utilize GWAS summary statistics to study the shared genetic influences (pleiotropy) between severe COVID-19 and 344 blood analytes at the genome, gene, and single-nucleotide polymorphism (SNP) levels. Our pleiotropy analyses genetically link blood levels of 71 analytes to severe COVID-19 in at least one of the three levels of investigation-suggesting shared biological mechanisms or causal relationships. Six analytes (alanine aminotransferase, alkaline phosphatase, apolipoprotein B, C-reactive protein, triglycerides, and urate) display evidence of pleiotropy with severe COVID-19 at all three levels. Causality analyses indicate that higher triglycerides levels causally increase the risk of severe COVID-19, thereby providing important support for the use of lipid-lowering drugs such as statins and fibrates to prevent severe COVID-19., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)

Since breast cancer is the commonly cause of death among women around the world, diagnosis at the early stages is significantly important to prevent the metastasis of the cancer. Among the various growth factors that are involved in angiogenesis, vascular endothelial growth factor (VEGF) is believed to be the most important factor. Overexpressed VEGF receptor on tumors surface, is particularly interesting for cancer cells targeting purposes. In this study, citric acid dendrimer conjugated with VEGF antagonist peptide was synthesized. The obtained product was confirmed by FT-IR, TEM, DLS, and EDS. In vitro cytotoxicity assay showed no toxicity on normal cells and indicated the notably dose-dependence toxicity on cancer cells. Box-Behnken software as a computational method was used to determine the optimum amount of radiolabeling parameters. Optimized parameters for reducing agent, dendrimer-anti-VEGF, and time were 1.4 mg, 17.5 mg, and about 30 min respectively. Radiochemical purity of radio-labeled conjugated dendrimer was determined about 90 percent. SPECT imaging was done to observe the in vivo accumulation of dendrimer-anti-VEGF in the tumor site. Images showed high accumulation of radio-tracer in the tumor region. All in all, obtained results confirmed our hypothesis that the dendrimer-anti-VEGF can be a good radio-tracer for diagnosis of cancer., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Pollution generated from landfill solid wastes constitute one of the major threat to the environment. The landfill leachate contains various toxic pollutants, making it the most dangerous issue of the landfills. Monitoring the xenobiotic organic concentrations in landfill leachate is an important step to evaluate the environmental impacts. This work aims to characterize the seasonal variation of 55 xenobiotic organic compounds including polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), phthalic acid esters (PAEs) and bisphenols (BPs) in the leachate from municipal solid waste landfill of Tripoli, Lebanon. And also, the quantity of the pollutant's flux to the Abou Ali River and the Mediterranean Sea nearby has been estimated. The organic pollutants were extracted by using the solid-phase extraction and quantified by using GC-MS/MS. The results showed high level of PAEs, BPs, PCBs, and PAHs in the leachate samples. The fluxes of pollutants to the Abou Ali River and Mediterranean Sea have been detected at 0.23 kg, 0.01 kg, 116.85 kg, 15.93 kg, and 7.58 kg for Σ 16 PAHs, Σ 28 PCBs, Σ 6 PAEs, Σ 4 BPs, and 4-NP respectively., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Aberrant DNA methylation has emerged as a hallmark in several cancers and contributes to risk, oncogenesis, progression, and prognosis. In this study, we performed imputation-based and conventional methylome-wide association analyses for breast cancer (BrCa) and prostate cancer (PrCa). The imputation-based approach identified DNA methylation at cytosine-phosphate-guanine sites (CpGs) associated with BrCa and PrCa risk utilising genome-wide association summary statistics (N BrCa  = 228,951, N PrCa  = 140,254) and prebuilt methylation prediction models, while the conventional approach identified CpG associations utilising TCGA and GEO experimental methylation data (N BrCa  = 621, N PrCa  = 241). Enrichment analysis of the association results implicated 77 and 81 genetically influenced CpGs for BrCa and PrCa, respectively. Furthermore, analysis of differential gene expression around these CpGs suggests a genome-epigenome-transcriptome mechanistic relationship. Conditional analyses identified multiple independent secondary SNP associations (P cond  < 0.05) around 28 BrCa and 22 PrCa CpGs. Cross-cancer analysis identified eight common CpGs, including a strong therapeutic target in SREBF1 (17p11.2)-a key player in lipid metabolism. These findings highlight the utility of integrative analysis of multi-omic cancer data to identify robust biomarkers and understand their regulatory effects on cancer risk., (© 2022. The Author(s).)

Statement of the Problem: Growth assessment has become an important issue in many medical and dental fields. Determining the stages of dental development and skeletal maturation are essential methods in evaluation of growth phases., Purpose: This study aimed to assess the relationship between developmental stages of maxillary and mandibular canines and second molars by Nolla's method and skeletal maturation stages by cervical vertebral maturation. In addition, diagnostic performances of dental developmental stages were evaluated to identify growth phases., Materials and Method: In this descriptive-analytical study, 201 digital panoramic and lateral cephalometry of children referred to the Orthodontic Department of Babol Dental School (8 to 15 years) were examined. The stages of dental development were determined by Nolla's method, and the stages of skeletal development were determined by cervical vertebral maturation stages (CVMs). Positive likelihood ratio (LHR+) was used to determine the diagnostic performances to identify growth phases. The Kendall's Tau-b correlation coefficient was used to measure the association between the CVM stages and dental calcification stages. In this study, p ≤ 0.05 was considered significant., Results: The relationship between dental development and skeletal maturation in different teeth was significant ( p ≤ 0.05). Kendall's Tau-b correlation coefficient between the stages of dental development and skeletal maturity in girls ranged from 0.578 - 0.634 and in boys ranged from 0.588 - 0.655. The right second molar in maxilla presented the highest correlation coefficient. The right and left second molars in maxilla and left second molar in mandible in stage 5 had the highest LHR+ to identify the pre-pubertal growth phase., Conclusion: Despite the high correlation coefficient between dental development and skeletal maturity, the LHR+ for determining growth stages in only a small number of teeth was more than 10., (Copyright: © Journal of Dentistry.)

Statement of the Problem: Regular dental checkups to diagnose early childhood caries (ECC) are critical for maintaining and improving children's oral health and well-being. The prevalence of ECC is important for planning proper oral health programs., Purpose: This study aimed to investigate the prevalence of ECC and its related factors in children aged 3 to 5 years at Babol, Iran., Materials and Method: This cross-sectional study was conducted on 280 children aged 3-5 years in the kindergartens of Babol. Children were examined for dental caries according to World Health Organization criteria. The variables such as age, gender, health, nutritional habits, parents' educational level, parents' job status, and level of dental care were recorded in the questionnaire. Data were analyzed using t-test, chi-square and ANOVA and p < 0.05 was considered significant., Results: Average decayed-missing-filled teeth (dmft) were 4.03±3.6 and 73.2% in children with ECC, while 26.8% were caries-free. A significant association was found between age, snack consumption, father's education, mother's job, nocturnal drinking milk, tooth-brushing, and a history of dental check up before age 2 with ECC., Conclusion: The results of this analysis showed a high prevalence of ECC in Babol. Therefore, educational and interventional programs in prevention and dental health care, especially for mothers, nurses, and teachers of these age groups, should be considered., (Copyright: © Journal of Dentistry.)

Migraine is a common complex disorder with a significant polygenic SNP heritability ([Formula: see text]). Here we utilise genome-wide association study (GWAS) summary statistics to study pleiotropy between blood proteins and migraine under the polygenic model. We estimate [Formula: see text] for 4625 blood protein GWASs and identify 325 unique proteins with a significant [Formula: see text] for use in subsequent genetic analyses. Pleiotropy analyses link 58 blood proteins to migraine risk at genome-wide, gene and/or single-nucleotide polymorphism levels-suggesting shared genetic influences or causal relationships. Notably, the identified proteins are largely distinct from migraine GWAS loci. We show that higher levels of DKK1 and PDGFB, and lower levels of FARS2, GSTA4 and CHIC2 proteins have a significant causal effect on migraine. The risk-increasing effect of DKK1 is particularly interesting-indicating a role for downregulation of β-catenin-dependent Wnt signalling in migraine risk, suggesting Wnt activators that restore Wnt/β-catenin signalling in brain could represent therapeutic tools against migraine., (© 2022. The Author(s).)

Introduction When performing total knee arthroplasty (TKA), surgeons may use either the mechanical alignment (MA) or the kinematic alignment (KA) to guide implant placement and joint balancing. By measuring preoperative and postoperative patellar height (PH), surgeons can predict knee stability after TKA. Improper PH is associated with knee instability which may complicate the postoperative course and lead to patient dissatisfaction or need for revision. The purpose of this study is to measure patellar height using the Insall-Salvati Index (ISI), Caton-Deschamps Index (CDI), and Blackburne-Peel Index (BPI) preoperatively and postoperatively in patients who underwent TKA with either MA or KA to assess for changes in patellar height. Methods We performed a retrospective eight-year review of 256 patients who underwent TKA with either MA or KA by a single surgeon at a single hospital site. We obtained demographic data, including gender, age, and BMI, via the electronic health record. Furthermore, we calculated the ISI, CDI, and BPI using necessary parameters from preoperative and postoperative radiographs. We used these measurements to assess any statistically significant difference in postoperative PH. Results The MA cohort consisted of 104 patients with an average age of 63 years and an average BMI of 34.1 kg/m 2 . The KA cohort included 152 patients with an average age of 64 years and an average BMI of 34.9 kg/m 2 .  For the MA population, the average postoperative score with ISI was 1.10 [1.05 to 1.16] (p < 0.001), with CDI was 1.05 [0.98 to 1.11] (p < 0.001), and with BPI was was 0.94 [0.89 to 0.99] (p < 0.001). While for the KA population, the average postoperative score with ISI was 1.03 [0.99 to 1.06] (p = 0.17), with CDI was 0.87 [0.82 to 0.91] (p = 0.15), and with BPI was 0.82 [0.78 to 0.86] (p = 0.34). Conclusion TKA with a KA has a statistically significant improvement in postoperative PH and better postoperative maintenance of preoperative PH. Improved PH may lead to increased patellofemoral stability and superior postoperative outcomes in patients undergoing TKA. Future studies should focus on whether differences in preoperative and postoperative PH measurements result in changes in clinical outcomes in patients with MA versus KA TKA., Competing Interests: The authors have declared financial relationships, which are detailed in the next section., (Copyright © 2022, Elkadi et al.)

Background: Appendiceal lymphoma is a very rare entity accounting for 0.015% of all gastrointestinal lymphoma cases. Acute appendicitis is the most common presentation of primary appendix neoplasms. Burkitt's lymphoma presenting as an acute appendicitis is a rare entity with around 21% of the cases presenting as a lower iliac fossa mass. Case Presentation . A 23-year-old male was admitted to the surgical ward as a case of acute appendicitis with localized tenderness in the right iliac fossa, positive rebound tenderness, a positive Rovsing's sign, and ultrasound findings of suspected complicated appendicitis. Appendectomy was performed. Histopathological examination of the appendectomy specimen revealed a double-expressor non-Hodgkin diffuse large cell lymphoma with Burkitt's-like morphology. He was sent for chemotherapy treatment., Conclusion: Only 34 cases of Burkitt's lymphoma have been reported to present as acute appendicitis. Histological examination following appendectomy for an apparent appendicitis is essential. Furthermore, complete blood count and a computed tomography scan aid the diagnosis of lymphoma. Double-expressor lymphoma has been shown to have poor outcomes. Therefore, prompt and aggressive treatment is vital., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Osama N. Dukmak et al.)

Lichen planus is an autoimmune inflammatory disease that can be associated with infections, drugs, and vaccines. Recently, it has been reported to occur following mRNA-based COVID-19 vaccines, particularly the Pfizer/BioNTech vaccine. We present the first reported case of lichen planus that developed after five days following the administration of the first dose of the Oxford-AstraZeneca vaccine in a 46-year-old healthy male. The skin eruption was purple, ill-defined, non-scaly, itchy, and distributed over his face, abdomen, back, and legs. The clinical appearance of the skin eruption and histopathology confirmed the diagnosis of lichen planus. The skin lesions were not responding well to topical steroid and oral antihistamine treatment. Thus, the patient was commenced on systemic hydroxychloroquine. The mechanism of lichen planus development following the administration of COVID-19 vaccines is unclear and needs more investigations and explanations. Healthcare providers should be aware of this possible adverse reaction following the administration of different severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines. The histopathological features of lichen planus in our case are different from those found in the lichenoid drug eruption. This finding indicates different pathophysiology that needs further investigation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Alrawashdeh et al.)

Aim: To share the results of a national screening program for amblyopia in school children in the north of Jordan., Methods: This is a prospective national screening study for amblyopia. The program rolls first and second-grade children (6 to 7 years old) in the north of Jordan. The eye examination included: best-corrected visual acuity, cover-uncover test, and cycloplegic retinoscopy. Monocular visual acuity was tested using an ETDRS visual acuity chart without correction. Moreover, children were tested with full cycloplegic refraction when the test criteria were met. Unilateral amblyopia was defined as a best-corrected visual acuity difference of 2 or more lines. In comparison, bilateral amblyopia was defined as a best-corrected visual acuity of 20/40 or worse in the best eye., Results: The prevalence of amblyopia for the total sample tested ( n =17 203) was 2.78% ( n =479). The most common cause of amblyopia was hypermetropia (64.45%), followed by previous ocular surgeries (15.1%), myopia (10.43%), strabismus (9.39%), and congenital cataract (0.63%)., Conclusion: This is the first and only study, identifing modifiable risk factors in Jordanian children with amblyopia. In their first couple of years of elementary education, many Jordanian children are affected by amblyopia and pass unnoticed. A more governmental effort is needed into screening programs to improve vision in the Jordanian population., (International Journal of Ophthalmology Press.)

Purpose: Colon cancer is a leading cause of mortality worldwide. It has a relatively poor prognosis; therefore, new therapies are needed. One of the tumour-related enzymes that has gained considerable interest is CYP4Z1. This enzyme has been expressed in many tumours and has been hypothesized as a potential biomarker or target for novel anticancer therapies., Patients and Methods: CYP4Z1 overexpression was immunohistochemically examined in a large panel of colon tissue types including normal, benign, primary and metastatic ones, and the enzyme's relation to histopathological features and patient survival was evaluated., Results: A high CYP4Z1 expression was observed in benign, primary and metastatic colon tissues compared to a weak or lack of expression in normal tissues. Importantly, there was a significant differential in CYP4Z1 expression where it was stronger in metastatic, primary and benign, respectively ( p < 0.05). A significantly high rate of CYP4Z1 expression was found in high histological grades and late stages of the disease, where its expression was more evident in patients with metastasis in the lymph nodes ( p < 0.05). Interestingly, CYP4Z1 expression was identified an independent prognostic predictor of poor overall survival of colon cancer patients (p = 0.003)., Conclusion: CYP4Z1 was distinctly overexpressed in benign, primary and metastatic colon tissues compared to corresponding normal tissues. This differential in CYP4Z1 expression across different types of colon tissues strongly supports CYP4Z1 as potential biomarker and target for novel anticancer therapy development., Competing Interests: The authors report no conflicts of interest in this work., (© 2021 Al-saraireh et al.)

The availability of genome-wide association studies (GWASs) for human blood metabolome provides an excellent opportunity for studying metabolism in a heritable disease such as migraine. Utilizing GWAS summary statistics, we conduct comprehensive pairwise genetic analyses to estimate polygenic genetic overlap and causality between 316 unique blood metabolite levels and migraine risk. We find significant genome-wide genetic overlap between migraine and 44 metabolites, mostly lipid and organic acid metabolic traits (FDR < 0.05). We also identify 36 metabolites, mostly related to lipoproteins, that have shared genetic influences with migraine at eight independent genomic loci (posterior probability > 0.9) across chromosomes 3, 5, 6, 9, and 16. The observed relationships between genetic factors influencing blood metabolite levels and genetic risk for migraine suggest an alteration of metabolite levels in individuals with migraine. Our analyses suggest higher levels of fatty acids, except docosahexaenoic acid (DHA), a very long-chain omega-3, in individuals with migraine. Consistently, we found a causally protective role for a longer length of fatty acids against migraine. We also identified a causal effect for a higher level of a lysophosphatidylethanolamine, LPE(20:4), on migraine, thus introducing LPE(20:4) as a potential therapeutic target for migraine., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2021 American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Conflicts of interest None disclosed.

Introduction: In this paper, we studied several serum clinical chemistry tests of cardiovascular disease (CVD), iron deficiency anemia, liver and kidney disorders in migraine., Methods: We first explored the association of 22 clinical chemistry tests with migraine risk in 697 migraine patients and 2722 controls. To validate and interpret association findings, cross-trait genetic analyses were conducted utilising genome-wide association study (GWAS) data comprising 23,986 to 452,264 individuals., Results: Significant associations with migraine risk were identified for biomarkers of CVD risk, iron deficiency and liver dysfunction (odds ratios = 0.86-1.21; 1 × 10 -4  <  p  < 3 × 10 -2 ). Results from cross-trait genetic analyses corroborate the significant biomarker associations and indicate their relationship with migraine is more consistent with biological pleiotropy than causality. For example, association and genetic overlap between a lower level of HDL-C and increased migraine risk are due to shared biology rather than a causal relationship. Furthermore, additional genetic analyses revealed shared genetics among migraine, the clinical chemistry tests, and heart problems and iron deficiency anemia, but not liver disease., Conclusions: These findings highlight common biological mechanisms underlying migraine, heart problems and iron deficiency anemia and provide support for their investigation in the development of novel therapeutic and dietary interventions.

Background: The development of colon cancer has been described as a multistep process of carcinogenesis. Understanding molecular and cellular changes underlying this process is required to determine potential biomarkers and therapeutic targets in colon cancers. Several molecular entities, including glypicans, are implicated in cancer development. Among these is glypican-6, which is overexpressed in a limited number of cancers. This study aims to characterise the glypican-6 expression in different types of colon cancer., Methods: Immunohistochemistry was used to characterise glypican-6 expression in a panel of archived formalin-fixed, paraffin-embedded colon tissue types. These types included 39 normal colon tissues, 10 colon tubular adenomas, 60 colon adenocarcinomas without metastasis and 60 colon adenocarcinomas with metastasis. Glypican-6 expression relation to demographic and clinicopathologic features was also examined., Results: Glypican-6 was strongly expressed in benign, primary and metastatic colon tumours. Normal tissue samples exhibited low to undetectable levels of glypican-6. A significantly high glypican-6 expression was displayed in colon cancers with lymph node metastasis, high depth of invasion, distant metastasis, high histological grades and late stages of the disease ( P  < 0.05). Importantly, a significant differential in glypican-6 expression was found between normal tissues and different types of colon cancer tissues. Moreover, the highest glypican-6 expression was more frequently found in metastatic tumours, followed by primary tumours and the least in benign tumours ( P  < 0.05)., Conclusions: Selective expression of glypican-6 may establish a basis for potential use as a tissue biomarker or as a novel therapeutic target in treatment of colon cancer., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Extracranial rhabdoid tumor is a rare tumor that can originate in multiple organs, and it is most commonly seen in the kidneys. This tumor has a grave prognosis. We report to the best of our knowledge the first case of infantile scalp extracranial rhabdoid tumor in a 6-month-old male baby who presented with a right parietal scalp mass since the age of 1 month. This mass was initially diagnosed as scalp hemangioma based on clinical and imaging findings. However, this mass was growing fast which necessitated excision. Pathologic examination after excision showed a malignant tumor composed of sheets of rhabdoid cells. Immunohistochemically, this tumor tested positive for vimentin, CD 99, glypican-3, synaptopysin, WT-1, CK, and EMA. INI-1 immunostain was lost in the tumor cells. Subsequently, this tumor was pathologically diagnosed as extracranial scalp rhabdoid tumor. After tumor excision, the patient was referred to pediatric oncology to receive chemotherapy. Experience with scalp extracranial rhabdoid tumors is limited. However, this tumor in other organs carries a grave prognosis. Although scalp extracranial rhabdoid tumor is an extremely rare tumor, it should be kept in mind in the differential diagnosis of infantile scalp masses given the need of combined surgical and chemotherapeutic treatment., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Sura Al Rawabdeh et al.)

Diazinon (DZN) is an organophosphate insecticide that affects the liver adversely. Ginger exhibits antioxidant properties. We investigated the hepatoprotective effects of an ethanolic extract of ginger root on DZN induced hepatotoxicity. We measured total phenolics and flavonoids in the hydroalcoholic extract. We used Wistar rats divided into four groups: control, 100 mg/kg/day ginger by gavage, 10 mg/kg/day DZN intraperitoneally, and ginger + DZN group treated with ginger 1 h before DZN. All treatments were for 30 consecutive days. One day after the last treatment, we evaluated oxidative stress parameters, serum biochemistry, histopathology and immunohistochemistry. The ginger extract contained 101.33 ± 2.73 mg total flavonoid and 237.9 ± 3 mg total phenolic content/g dry ginger plant roots. We found that DZN increased oxidative stress significantly. Histopathology of the liver tissue was consistent with increased AST, ALT, and ALP. Ginger extract treatment reduced oxidative stress and improved histopathology. DZN increased caspase-3 immunoreactivity and ginger extract reduced it. Ginger extract exhibited hepatoprotective effects against DZN induced hepatic injury owing to its antioxidant and anti-apoptotic activity.

Bladder cancer is the tenth most common cancer worldwide, where its burden remains a challenge and needs new novel therapies. Several reports indicate expression of CYP4Z1 and CYP1B1 in many tumours. Their expressions are associated with a poor prognosis, and therefore proposed as promising biomarkers or targets for anticancer therapy. By using immunohistochemistry, expression of CYP4Z1 and CYP1B1 was evaluated in a panel of different types of bladder cancer, and the enzymes' relation to histopathological features were assessed. Results showed an increased expression of CYP4Z1 (54.3%) and CYP1B1 (76.9%) in the majority of bladder cancers compared to weak or lack of expression of both enzymes in normal tissues. CYP4Z1expression was significantly associated with tumour grade and stage where the expression was markedly increased in a high grade and advanced stage of the disease (p < 0.05). Additionally, CYP1B1 expression was also associated with TNM staging (p < 0.05) and its expression was increased in patients with lymph node metastasis. The expression profiles of CYP4Z1 and CYP1B1 suggest that both enzymes have the potential to be biomarkers or targets for novel anticancer therapy for bladder cancer. Nevertheless, further studies are needed to better delineate whether these enzymes are druggable targets.

Introduction and Importance: Mesenteric cystic lymphangiomas are rare benign lesions of the abdominal cavity characterized by lymphatic vessels malformation with an unknown etiology. Despite the silent clinical course of mesenteric cystic lymphangiomas, they are considered as clinically tricky lesions with an immense spectrum of presentations., Case Presentation: We present a case of abdominal mesenteric cystic lymphangioma in a 1-year 9-month-old female patient, who complained of fever and abdominal pain for 10 days duration. Laboratory investigations, abdominal X-ray, ultrasonography, computed tomography and histopathological examination were all used to establish the diagnosis., Clinical Discussion: A trial of true-cut biopsies performed by an interventional radiologist was not informative, so a multidisciplinary team decision was made to excise the mass. Intraoperative findings include multiloculated fused cystic lesion (8.0 × 5.0 × 4.0 cm) on the descending mesocolon. Histopathological examination revealed the diagnosis of a mesenteric cystic lymphangioma. The postoperative period was not complicated., Conclusion: Mesenteric cystic lymphangiomas are mostly asymptomatic in nature, yet predisposed to life threating events. Surgical excision is the modality of treatment characterized by low recurrence rate and a non-complicated postoperative period., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aims: This study aimed to evaluate the effect of the stress management interventional program in reducing occupational stress and improving coping strategies among public health nurses., Design: A double-blind, cluster-randomized approach was used as a randomization method for this study to evaluate the stress management interventional program., Methods: A cluster-randomized controlled trial was carried out in eight comprehensive healthcare centres in Amman city, Jordan; four centres were randomly assigned to each experimental and control group. One hundred and seventy nurses were selected randomly from March 2019 - August 2019 and data were collected by using the Nursing Stress Scale & brief COPE over three data collection times. Both descriptive and inferential statistics (repeated measure ANOVA, Independent t test, and chi-squared) were used to answer the research questions of this study., Results: The results showed that both the levels of occupational stress and coping strategies were significantly different between the two study groups over the three data collection points (p < 0.05)., Conclusion: Based on the findings of this study, the stress management program is an effective non-invasive method that can be used to reduce stress levels and improve coping strategies for public health nurses. The implementation of stress management interventions in health care is likely to help nurses manage occupational stress in practice., Impact: Nurses suffer from a high level of occupational stress. In particular, approximately74% of nurses experience severe occupational stress, which can lead to many mental and physical disorders. However, nurses were less able to utilize the correct stress preventive strategies due to gaps in knowledge, skills, and awareness. This study contributed to the provision of empirical evidence of the effectiveness of the stress management program in reducing occupational stress and improving coping strategies among public health nurses. A stress management intervention program is a valuable non-invasive method that can be used by healthcare organizations to reduce stress levels and improve coping strategies for nurses in practice., Clinical Trial Registration Number: NCT03833986., (© 2020 John Wiley & Sons Ltd.)

Statement of the Problem: Several additives have been introduced to decrease the setting time of MTA (mineral trioxide aggregate). For clinical applications, it is essential to investigate the biocompatibility of these materials., Purpose: The present study evaluated the tissue response to MTA that has been separately mixed with citric acid, calcium lactate gluconate (CLG), and Na 2 HPO 4 ., Materials and Method: In this experimental study Twenty one Wistar rats were divided into three groups of 7, 14 and 30 days follow up periods. Sterile polyethylene tubes were subsequently filled with MTA separately mixed with distilled water, 0.1% citric acid, 0.43% calcium lactate gluconate (CLG) and 15% Na 2 HPO 4 and afterwards implanted subcutaneously. Empty tubes were implanted as negative control. At the end of their respective periods, the animals were sacrificed by anesthetic overdose and a biopsy was performed. The inflammatory responses were scored, classified and statistically analyzed using Kruskal-Wallis and Man-Whitney tests. Statistical significance was defined as p < 0.05., Results: There was no significant difference between test groups in any time period after implantation but the mean values of inflammatory responses were significantly more than that of the negative control group ( p > 0.05). The mean values of inflammatory responses were decreasing over time in all test groups. These values did not significantly differ in any group except the CLG and Na 2 HPO 4 groups., Conclusion: The inflammatory responses induced by MTA mixed with citric acid and MTA mixed with Na 2 HPO 4 were comparable to that of the control MTA. MTA mixed with CLG provoked a moderate-to-severe inflammatory response at 7 days after implantation, so further study is required before clinical application of this cement., (Copyright: © 2020: Journal of dentistry (Shiraz).)

BACKGROUND Tumor lysis syndrome is common in hematological malignancy, but less frequent in chronic and solid tumors. Almost always it is observed after chemotherapy or radiotherapy initiation, but rarely occurs spontaneously. CASE REPORT A 89-year-old female with stable chronic lymphocytic leukemia was admitted to the hospital because of worsening dyspnea and dry cough. Her vital signs were normal, except for sinus tachycardia. On physical examination, she appeared distressed, dyspneic, sweaty but afebrile, anxious, but alert and well oriented. Lung examination revealed reduced air entry with bibasilar crackles. No peripheral edema was seen, pulses were normal, and no signs of deep vein thrombosis were observed. Laboratory analysis revealed leukocytosis; but normal hematological and biochemical parameters. Intravenous (IV) furosemide and antibiotics (IV ceftriaxone and orally azithromycin) were started along with steroid therapy (methylprednisolone 62.5 mg, IV). The treatment with steroids lasted for 1 day only, and in the following day, the patient was switched to prednisone (20 mg/day orally) for only 1 additional day. White blood cell count increased on day 1, 2 and 3 after admission, along development of hyperuricemia, hyperphosphatemia, hyperkalemia, acute renal failure and elevated troponin levels. Hemodiafiltration/hemodialysis was initiated, and the patient was discharged after serum concentrations of these electrolytes and kidney function were restored. One month after discharge, the patient denied any malaise and was at stable condition. CONCLUSIONS Herein, we present a case of a patient with stable chronic lymphocytic leukemia, who developed spontaneous tumor lysis syndrome after short low dose of steroid therapy. This case highlights the importance of including spontaneous tumor lysis syndrome in the differential diagnosis of any acute renal failure in the constellation of any malignancy.

Background: The psychosocial impact of dental aesthetics questionnaire (PIDAQ) is an efficient tool for assessment of oral health-related quality of life (OHRQoL). It evaluates the effect of dental esthetics on the psychosocial status of young adults. This questionnaire has been translated to many languages so far. However, it has not yet been translated to Persian. This study aimed to assess the validity and reliability of the Persian version of PIDAQ for use among the young adults., Material and Method: The questionnaire was translated to Persian, back-translated to English and underwent cultural adaptation and pretesting. It was then filled out by 398 young adults (215 females and 183 males) between 18 to 30 years in Shiraz, Iran. The Persian version of PIDAQ along with the index of orthodontic treatment need-aesthetic component (IOTN-AC) and the perception of occlusion (POS) index were administered among participants to assess its discriminant validity., Results: Factor analysis extracted four domains and the factor loading of domains ranged from 0.479 to 0.837. The Cronbach's alpha for the Persian version of PIDAQ ranged from 0.809 to 0.886. The mean score for each of the domains and the total score for PIDAQ, classified according to IOTN-AC and POS, showed a significant difference. The mean score acquired by subjects requiring orthodontic treatment was significantly higher than the score acquired by those not requiring orthodontic treatment (P = 0.00)., Conclusion: The Persian version of PIDAQ has optimal validity, reliability and responsiveness for assessment of the psychosocial impact of malocclusion on the Iranian young adults.

Background: Cyclophosphamide (CP), as a chemotherapy drug, causes severe damage in testicular tissue through producing free radicals. Cerium oxide nanoparticles (NC) exhibit antioxidant and anti-inflammatory properties. The purpose of this study was to investigate the protective effect of NC on CP-induced testicular damage in mice., Methods: In this experimental study, thirty-two male mice were divided into four groups (eight mice in each group). The control group was received intraperitoneally (IP) normal saline, NC group was received NC for three consecutive days (100 μg/kg, IP), CP group was received CP (200 mg/kg, IP), and the CP + NC group received NC, three consecutive days before receiving CP. After 2 days, testicles were assessed for biochemical, histomorphometrical, histopathological, and immunohistochemical analyses., Results: CP administration caused statistically significant increases in sperm abnormality, malondialdehyde, protein carbonyl levels, reactive oxygen species, level and apoptosis, and decreases in sperm count, sperm viability, testosterone, glutathione activity, the mean thickness of the germinal epithelium, diameter of seminiferous tubules in mice. Degeneration, necrosis, arrest of spermatogenesis, congestion, and atrophy in testicular tissue confirmed the low Johnsen's Testicular score in CP group. Administration of NC significantly ameliorated the CP-induced adverse effects on testis compared with the CP group. In addition, pretreatment mice with NC significantly reduced caspase-3 immunoreactivity induced by CP in testis., Conclusions: This study showed that NC with scavenging free radicals and antiapoptotic properties enable to reduce the side effects of CP in the testicular tissue., Competing Interests: There are no conflicts of interest.

Cyclophosphamide (CP), as a chemotherapy drug, induces hepatotoxicity through causing oxidative stress. Atorvastatin (ATV) at a low dose has antioxidant and anti-inflammatory properties. The present study was designed to investigate the protective effects of ATV against CP-induced hepatotoxicity in rat. In this experimental study, 32 rats were treated with ATV orally at a dose of 10 mg/kg for 10 consecutive days, 5 days before and 5 days after the administration of a single intraperitoneal injection of CP (150 mg/kg). The hepatoprotective effect of ATV was evaluated by measuring liver function markers, oxidative markers, histological and immunohistochemical assays. The biochemical results showed that administration of CP increased hepatic biomarkers enzymes as aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) levels. CP increased malondialdehyde (MDA), protein carbonyl (PC) and decreased glutathione (GSH) content in rats. Moreover, administration of CP was associated with periportal leucocyte infiltration, dilation sinusoids, hepatocyte vacuolation, congestion and hemorrhage in livers of rats. CP significantly increased immunoreactivity of caspase-3 as a marker of apoptosis in liver tissue. ATV markedly mitigated liver injury through reduction in oxidative stress biomarkers, histopathological findings and apoptosis. The antioxidant and anti-apoptotic activities of ATV are main proposed mechanisms involved in its hepatoprotective effects against CP-induced hepatic injury.

Background: Cyclophosphamide (CP), as an anticancer agent, causes ovarian toxicity and subsequent infertility in women. Atorvastatin (ATV) at a low dose has antioxidant and anti-inflammatory properties., Objective: The aim of this study was to investigate the protective effect of ATV against CP-induced ovarian injury in rat., Materials and Methods: In this experimental study, thirty-two female Wistar rats were randomly divided into four groups as I) control, II) ATV (10 mg/kg), III) CP (150 mg/kg), and IV) CP +ATV. The ATV treated groups were received ATV for 10 days via oral gavage. In the CP+ATV group, ATV was administrated on 5 days before and 5 days after CP injection. Histological structure, apoptosis (caspase-3), oxidative stress parameters as malondialdehyde, reactive oxygen species, protein carbonyl levels and cell viability were evaluated in ovary tissue by histological scores, immunohistochemistry, histochemical and biochemical assays. The levels of estrogen and progesterone hormones were measured on the 12th day of study., Results: ATV pretreatment significantly decreased the levels of oxidative stress biomarkers as malondialdehyde, reactive oxygen species and protein carbonyl levels and increased cell death in CP-treated rats as compared with the CP alone group. ATV significantly increased estrogen and progesterone levels in CP-treated rats. In addition, the histological examination showed ATV mitigated acute inflammation, degenerative cells in stroma and follicles, stromal edema, vacuolization, atresia of the follicles and congestion of blood vessels in the CP-treated animals. Furthermore, ATV significantly reduced immunoreactivity level of caspase-3 in CP-treated rats., Conclusion: Our results showed that the ATV with antioxidant and anti-apoptosis (caspase-3) activities protected ovarian against CP-induced toxicity., Competing Interests: The authors have declared that no conflict of interests exists.

Purpose: Kidneys are exposed to ionizing radiation during radiotherapy in patients with abdominal malignancy. The aim of this study is to investigate the protective effect of atorvastatin (ATV) against ionizing radiation-induced nephrotoxicity in mice., Materials and Methods: Sixty male BALB/c mice were randomly divided into six groups (10 mice per group); control, irradiation (IR), IR plus ATV (10, 20 and 50 mg/kg) and only ATV (50 mg/kg). ATV groups received ATV for seven days via oral gavage before exposure to IR. Animals were exposed to 2 Gy whole body of X-ray on day 8. After exposure to IR, biochemical, histological and immunohistological assays were performed., Results: ATV significantly decreased the level of oxidative stress biomarkers in irradiated mice in comparison with IR alone. A significant reduction in the urea and creatinine levels was observed in ATV plus IR group compared to IR alone. Tubular degeneration, glomerular atrophy, interstitial expansion and fibrosis were observed in irradiated mice. Tubular degeneration and atrophy in the kidneys of IR plus ATV group were less than IR group. In addition, pre-treated animal with ATV significantly showed reduction in caspase-3 immunoreactivity., Conclusion: ATV has significant protective effect against radiation-induced nephrotoxicity in mice and is a promising medication for protection of patients during radiotherapy.

Background: Asthma is the most common chronic disease in childhood. Parents have an important role in managing asthma in children. Studies have shown a higher degree of depression and anxiety and lower family performance in mothers of asthmatic children in comparison with the control group., Objective: The aim of this study was to evaluate the parenting styles and also depression, anxiety and stress parameters in mothers of children with asthma., Methods: This case-control study was performed on 45 mothers of 3 to 15 years old asthmatic children in the allergy clinic of Mashhad University of Medical Sciences, Mashhad, Iran, during the years of 2014 to 2016. The control group was 45 mothers of non-asthmatic children who were matched for the age of their children with the case group in the same population. The parenting styles, as well as depression and anxiety of mothers were evaluated using parenting scales, and the depression-anxiety-stress scales (DASS). The mothers were also asked to fill a strengths and difficulties questionnaire (SDQ) for their children. Furthermore, parenting styles in the case group were compared to mothers of children without asthma as the control group. The data were then analyzed by SPSS 11.5, using Chi-square, ANOVA, and independent-samples t-test., Results: The results of this study showed that 21 mothers (74.6%) were normal, but 12 mothers (26.7%) had a mild -, 9 (20%) a moderate - and 3 (6.7%) a severe degree of abnormality according to DASS. Independent-samples t-test showed a significant difference between the case and control groups regarding depression in mothers and laxness (p<0.001), over reactivity (p<0.013) and verbosity (p<0.031) in children with asthma., Conclusion: The results of this study demonstrated that anxiety and depression are partially frequent in mothers of children with asthma, and parenting styles are less affective in these families., Competing Interests: Conflict of Interest: There is no conflict of interest to be declared.

Background: Despite the success of the Biliopancreatic Diversion with Duodenal Switch procedure (BPD-DS) in weight loss and comorbidities resolution, reversal of BPD-DS is necessary in 0.2-0.6% of BPD-DS cases for vitamin, protein, and other micronutrient deficiencies. Different techniques are available to reverse the malabsorptive component of the BPD-DS., Methods: A retrospective chart review for a 37-year-old female patient who presented with lower leg edema and signs of malnutrition 5 years after a BPD/DS. The patient was not compliant with the required daily vitamin and protein intake. Thus, after extensive discussion with the patient, a decision was made to reverse the malabsorptive component of the BPD-DS., Results: A laparoscopic reversal of the malabsorptive component of the BPD-DS was concluded by transecting the roux limb distally at the ileo-ileal anastomosis and reconnecting it to the proximal jejunum thus substantially lengthening the common channel for absorption. At 6 months follow-up, the patient normalized her vitamin deficiency and had a normal level of serum protein. Her weight, BMI, EWL%, and TBWL% were 72 kg, 27.5 kg/m 2 , 90%, and 45%, respectively., Conclusions: Proper nutrition and vitamin supplementation is essential to avoid nutritional complications. Different techniques are available to reverse the malabsorptive component of the BPD-DS. However, no standard approach is adopted by the surgical community. We demonstrate our preferred technique in reversing the malabsorptive component of the BPD-DS.

Background: Venous thromboembolism (VTE) is a feared complication after bariatric surgery. Biliopancreatic diversion with duodenal switch (BPD-DS) is a complex bariatric procedure that is offered typically to super morbidly obese patients. Scarce data exist in reporting VTE outcome and identifying the risk factors associated with it after BPD-DS., Objective: To determine the risk factors for VTE after BPD-DS at 90-day follow-up., Setting: A nonprofit regional referral center and teaching hospital in Pennsylvania., Methods: A retrospective chart review was performed on prospectively collected data over 10 years, between January 1, 2006 and December 31, 2016. Patients who underwent laparoscopic or robotic BPD-DS were included. Preoperative variables, selected risk factors, and methods of VTE prophylaxis were analyzed., Results: A total of 662 patients who underwent BPD-DS were identified. The mean age was 44.7 ± 10.4 (20-72) years; 474 patients were female (71.7%), and the mean body mass index of the cohort was 50.5 ± 7.5 (34-98) kg/m 2 . Overall, 16 patients (2.4%) experienced VTE complication at 90-days follow-up post-BPD-DS with 100% follow-up rate; deep vein thrombosis was experienced by 10 patients (1.5%), and 6 patients (0.9%) experienced pulmonary embolism (1 patient experience both). None of those patients had a previous history of VTE. Only operative time (P value = .009) and length of stay (P value ≤ .001) were associated with VTE events. Other factors such as age, sex, body mass index, previous history of VTE, preoperative heparin injection, preoperative inferior vena cava filter insertion, intermittent compressive device use, interval heparin time, and postoperative chemical prophylaxis did not show a statistical association. A logistic regression analysis showed a statistically significant increase of VTE outcome with length of stay; odds ratio of 1.161, (95% confidence interval, 1.048-1.285), P value = .004., Conclusion: With proper preoperative evaluation and aggressive VTE prophylaxis protocol, the risk of VTE post-BPD-DS is comparable to other bariatric procedures. Every effort should be adopted to shorten the length of stay, and thus reduce VTE risk., (Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Oxidative stress interferes with the functional roles of the hippocampus and results in cognitive decline. Antioxidant supplementation has a cognitive enhancing activity through protecting hippocampus brain cells from the damaging effects of the reactive oxygen species. The dried methanolic extract of the aboveground parts of Moringa peregrina (Forssk.) Fiori (Moringaceae) was hypothesized to have memory-enhancing activity via its antioxidative properties. HPLC and LC-MS methods were used for qualitative analysis of the marker compounds. Six major compounds of the methanolic extract of M. peregrina were identified, namely, rutin, myricetin, α-amyrin, β-amyrin, lupeol acetate, and β-sitosterol. Male Wistar rats were administered via oral gavage three dose levels (50, 100, and 500 mg/kg) of M. peregrina methanolic extract for 2 months. The radial arm water maze (RAWM) was used to test spatial learning and memory. In addition, ELISA was used to analyze the levels of brain-derived neurotrophic factor (BDNF) and to assess the level of some oxidative stress markers. M. peregrina (150 mg/kg) resulted in short- and long-term memory enhancement (P < 0.05). Moreover, M. peregrina administration elevated BDNF levels in the hippocampus (P < 0.05) and caused favorable changes in oxidative stress biomarkers. In particular, an increase in glutathione (GSH), a decrease in oxidized glutathione (GSSG), and an increase in the antioxidant enzyme glutathione peroxidase (GPx) levels in the hippocampus were elicited after treatment with M. peregrina. Taken together, our data show that oral administration of M. peregrina enhances both short- and long-term memory functions via combating oxidative stress and increasing BDNF levels in the hippocampus. Consuming this safe plant may thus help promote spatial learning and improve memory.

The biliopancreatic diversion with duodenal switch (BPD/DS), a modification of the classic Scopinaro procedure, carries the highest rate of success in terms of weight loss, comorbid resolution, and maintenance of weight loss. The substantial challenges, technical complexity, and expected roadblocks of adding BPD/DS option to the bariatric surgeon's resources are reflected in the number of BPD/DS procedure performed in the USA, being less than 1% of all bariatric surgeries. Adjustments to the length of the common channel and the size of the vertical sleeve would increase the pool of candidates for BPD/DS and offer comprehensive management of obesity and metabolic comorbidities. Proper educational programs and multiple proctoring to bariatric surgeons aid to implement BPD/DS to their practice.

Introduction: Weight regain after Roux-en-Y gastric bypass (RYGB) is a frustrating long-term complication in some patients. Revision of RYGB to biliopancreatic diversion with duodenal switch (BPD-DS) is an appealing option. There is a paucity of information in literature regarding this type of conversion., Setting: Regional referral center and teaching hospital, Pennsylvania, United States; nonprofit., Methods: Between 2013 and 2016, a retrospective chart review was performed on all our revision cases. Patients who underwent conversion from RYGB to BPD-DS were selected and analyzed., Results: Conversion from RYGB to BPD-DS was performed on 9 patients (8 females, 1 male; mean age: 49.2±7.6 [36-61] years). The mean body mass index (BMI) before the initial RYGB was 54.2±14.2 (36.2-79) kg/m 2 . The lowest mean BMI reached before conversion was 33.9±6.2 (27.9-43.3) kg/m 2 before it increased to 45.6±8.7 (28.8-60.2) corresponding to excess weight loss (EWL) of 33.1%±17.7% (10.6%-68.1%), before conversion. The average operative time was 402.6±65.8 (328-515) minutes for 1-stage conversions. No morbidities, reoperation, or readmission over 30 days postoperatively were reported. No leaks or mortalities were identified. The mean duration of follow-up postconversion is 16.3±13.6 (3-42) months. After conversion surgery, the mean BMI was 35.8±8.2 (27.6-49.5) kg/m 2 , while mean EWL loss was 64.1%±18.8% (45.9%-88.7%). The BMI of the cohort decreased by a mean of 9.8±5.1 (0.5-16.8) and the EWL increased by 31%±23.1% (4%-76.6%)., Conclusion: Our results indicate that conversion of failed RYGB to BPD-DS is laparoscopically or robotically safe and effective. A large cohort study with long-term follow-up is necessary to further assess the safety and efficacy of this method., (Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

The cake or lump kidney is a rare form of fusion. The pancake kidney is always found in the pelvic cavity, in the greater or lesser pelvis. However, we report a case of pancake kidney which was found inside abdominal cavity while investigating 32-year-old male for lower limb pain. CT scan with IV contrast reveals 'fused mass situated in the right side of abdominal cavity with course uncrossed ureters opening separately into the urinary bladder found incidentally with patient work up'. Pancake kidney in this case was managed conservatively without any complication. This malformation is usually present in pelvic cavity, so blood supply is almost constant but in rare cases might be different and follows location of this anomaly.

Background: Common bile duct exploration (CBDE) is an available option in the management of choledocholithiasis. We aimed to analyze outcomes comparing laparoscopic and open approaches to CBDE using the American College of Surgeons (ACS) NSQIP database., Study Design: This was a retrospective cohort study of patients undergoing CBDE between 2008 and 2013, using the ACS NSQIP database. The cohort was split into 2 groups and compared based on operative approach: laparoscopic vs open CBDE., Results: There were 2,635 patients who underwent CBDE during the study period, and 52% underwent an open approach. After adjusting for all confounding variables, open CBDE was associated with a statistically significant increase in mortality (adjusted odds ratio [AOR] 2.95; 95% CI 1.18 to 7.41; p = 0.02), composite morbidity (AOR 2.19; 95% CI 1.56 to 3.07; p < 0.0001), bleeding (AOR 1.86; 95% CI 1.11 to 3.12; p = 0.02), return to the operation room (AOR 1.90; 95% CI 1.16 to 3.12; p = 0.01), and readmission related to the first operation (AOR 1.55; 95% CI 1.00 to 2.39; p = 0.05). On the other hand, retained common bile duct stones were 2.8 times more likely to occur in the laparoscopic group. The mean operative time was longer by 73 minutes for patients who underwent open CBDE., Conclusions: Patients undergoing open CBDE suffer from a statistically significantly higher rate of mortality and overall complications compared with patients undergoing the laparoscopic approach. Laparoscopic CBDE should be considered as the preferred procedure whenever possible., (Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Median arcuate ligament syndrome (MALS) is a rare entity that occurs when the median arcuate ligament of the diaphragm is low-lying, causing a compression to the underlying celiac trunk. We reviewed the vascular changes associated with MALS in an effort to emphasize the seriousness of this disease and the complications that may result., Methods: This is a retrospective descriptive analysis of 23 consecutive patients diagnosed with MALS between January 1, 2012 and December 31, 2015 at a tertiary medical center. Computed tomographic (CT) scans, medical records, and patient follow-up were reviewed., Results: The number of patients included herein was 23. The median age was 56 years (17-83). Sixteen patients (69.6%) had a significant arterial collateral circulation. Eleven patients (47.8%) were found to have visceral artery aneurysms; 4 patients (36.4%) bled secondary to aneurysm rupture. All ruptured aneurysms were treated with endovascular approach. The severity of the hemodynamic changes appears to be greater with complete occlusion, CONCLUSIONS: MALS causes pathological hemodynamic changes within the abdominal vasculature. Follow-up is advised for patients who develop a collateral circulation. Resulting aneurysms should preferably be treated when the size ratio approaches three. Treatment of these aneurysms can be done via an endovascular approach coupled with possible celiac artery decompression to restore physiologic blood flow.

Xanthogranulomatous reaction is uncommon non neoplastic reaction involving multiple organs, commonly kidney and gallbladder. Its rarely involve testicle. We report 69-year old man present to clinic with right testicular swelling for six month duration. Testicular markers within normal range. Us scrotum revealed right large avascular heterogeneous mass inside testicle. Right inguinal orchiectomy done and revealed Xanthogranulomatous orchitis.

Introduction: One of the biggest disadvantages of dental amalgam is that gaining its ultimate strength is a slow process. The use of a rapid-setting amalgam with high early compressive strength could be a better option in preventing early fractures in pediatric dentistry. The aim of this study was to determine the effect of diode laser irradiation on compressive strength of dental amalgam., Methods: A case-control study was performed on 180 amalgam samples made at the Tehran Dental Material Research Center in 2014. Fifteen and thirty minute compressive strength of regular setting and fast setting amalgams were measured as control. In case groups, the samples were irradiated by 810nm diode laser with power of 1 and 2 watt and in pulsed and continuous mode, and compressive strength was measured after 15 and 30 minutes. Statistical analysis was performed with SPSS 18 using one and two way ANOVA and Scheffe multiple comparisons test and p<0.05 was considered significant., Results: Numerous kinds of laser irradiation led to a significant increase in compressive strength compared to regular setting control groups. Fifteen minutes-compressive strength of regular-setting amalgam irradiated by 2 watt laser was significantly more than fast-setting control group (p<0.05)., Conclusion: Irradiation by 810nm diode laser can significantly increase the compressive strength of dental amalgam especially in the first 15 minutes., Competing Interests: Conflict of Interest: There is no conflict of interest to be declared.