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Introduction: Axillary lymph node dissection (ALND) is the standard of care for breast cancer patients with positive sentinel lymph nodes (SLN), which are the first lymph nodes that drain the breast. However, many patients with positive SLNs may not have additional positive nodes, making the prediction of non-sentinel lymph node (NSLN) metastasis challenging. Reliable prognostic tools are essential for accurately assessing NSLN metastasis. The Memorial Sloan Kettering Cancer Center (MSKCC) nomogram has demonstrated effectiveness in this context, but it requires further evaluation within the Iranian breast cancer population. While ALND remains the gold standard, its unnecessary application in patients without evidence of additional positive nodes raises concerns due to potential complications such as lymphedema, nerve injury, and shoulder joint dysfunction. Furthermore, integrating Artificial Intelligence (AI) and Machine Learning (ML) techniques presents an opportunity to enhance the precision of NSLN metastasis predictions., Method: This study conducts an extensive comparative analysis between the MSKCC nomogram and various ML models to predict NSLN metastasis, utilizing a dataset of Iranian breast cancer patients. Employing eXplainable Artificial Intelligence (XAI) methodologies, we analyzed 16 clinical features across a cohort of 183 patients. Our methodology includes rigorous statistical evaluations and the training and validation of ML models to assess the precision and robustness of these models compared to the MSKCC nomogram., Results: Our analysis revealed that the Random Forest (RF) model outperformed the MSKCC nomogram, achieving an accuracy of 72.2 % and an AUC of 0.77, compared to the nomogram's AUC of 0.73. Logistic Regression (LR) also demonstrated competitive performance with an accuracy of 65 % and an AUC of 0.73. The RF model exhibited high sensitivity (75 %) and precision (73 %), effectively identifying critical predictors of NSLN metastasis, including the presence of ductal carcinoma in situ (DCIS) and tumor characteristics such as type and grade. Explainable AI techniques, particularly SHAP values, provided insights into feature importance, enhancing model interpretability., Conclusion: Our study offers a comprehensive comparison between ML models and the MSKCC nomogram for predicting NSLN metastasis among Iranian breast cancer patients. These findings contribute valuable insights to the discourse on personalized treatment approaches, emphasizing the need for tailored prognostic tools across diverse populations. The implications of this research extend to clinical decision-making, potentially improving the accuracy and efficacy of breast cancer management within the Iranian healthcare landscape., 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 Ltd. All rights reserved.)

Introduction: Chest wall tumors, though rare, represent a significant subset of thoracic neoplasms, accounting for approximately 5% of thoracic and 2% of overall body neoplasms. Their management has historically posed challenges for surgeons, often leading to misdiagnosis, incomplete resection, and high complication rates. An individualized surgical approach, tailored to the specific characteristics of the disease, is crucial for optimizing outcomes., Aim: To evaluate the outcomes of chest wall masses and report on individual cases., Material and Methods: This retrospective cohort study included 131 patients diagnosed with chest wall masses at Ghaem University Hospital between 2011 and 2021. Data on demographics (age, gender), pre- and post-operative pathology, specific surgical procedures performed, duration of hospitalization, need for post-surgical reconstruction (e.g., flap reconstruction), and history of pre-operative chemotherapy/radiotherapy were collected from medical records. Data were analyzed using descriptive statistics and appropriate inferential tests depending on the variable type. Potential limitations such as missing data or selection bias were acknowledged., Results: A total of 131 patient records were examined, with an average age of 17.35 ±38.51 years. Of these, 50 (38.2%) were female and 81 (61.8%) were male. It was found that 54.2% of patients had benign tumors, while 45.8% had malignant tumors. Sarcoma (26%) and fibromatosis (21.4%) were the most common tumor types. No significant associations were observed between gender or history of chemotherapy and radiotherapy and the type of surgery performed ( p > 0.05). However, a significant association was found between tumor histology and the type of surgery performed ( p < 0.05)., Conclusions: The majority of procedures performed were for fibromatous and benign tumors, while the most common malignant tumors were sarcomas, with chondrosarcoma being the predominant subtype. Tumor type significantly influenced the extent of resection and need for chest wall reconstruction., Competing Interests: The authors report no conflict of interest., (Copyright: © 2024 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska).)

Ataxia telangiectasia (AT), Louis-Bar syndrome, is a rare neurodegenerative disorder caused by autosomal recessive biallelic mutations within the ataxia telangiectasia mutated (ATM) gene. Currently, there are no curative therapies available for this disorder. This review provides an overview of the latest advances in treatment methods including 1- Acetyl-DL-leucine, 2- Bone Marrow Transplantation, 3- Gene Therapy, 4- Dexamethasone, and finally 5- Red Blood Cells (RBCs) as a carrier for dexamethasone (encapsulation of dexamethasone sodium phosphate into autologous erythrocytes, known as EryDex). Most of the treatments under investigation are in the early stages, except for the EryDex System. It appears that the EryDex system and N-Acetyl-DL-Leucine may hold promise as potential treatment options., Competing Interests: Declarations. Competing Interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The effectiveness of immunotherapy for most cancer patients remains low, with approximately 10-30% of those treated surviving. Thus, much effort is being put into finding new ways to improve immune checkpoint therapy. Our review concludes that inhibition of proprotein convertase subtilisin/Kexin type 9 (PCSK9), which plays a critical role in regulating cholesterol metabolism, can cause movement of T cells toward tumors, with increased sensitivity to immune checkpoint therapies. We searched PubMed, NCBI, Scopus, and Google Scholar for the published articles without limitations on publication dates. We used the following terms: "PCSK9", "Cancer", "Immune Checkpoint", and "Cancer Prognosis" in the title and/or abstract. Our search initially revealed 600 records on the subject and stored them in the used databases under EndNote X8 management software. A total of 161 articles were selected and through a careful review, 76 were included in our research. We concluded that PCSK9 reduces the number of LDL receptors (LDL-R) on the cell surface, which is linked to its ability to regulate cholesterol levels in the body. Also, we discuss how suppressing PCSK9 leads to the MHC-1 accumulation on the surface of cancer cells, which results in T lymphocyte invasion. Finally, we believe that inhibiting PCSK9 may be an effective strategy for improving cancer immunotherapy., Competing Interests: The authors declared no conflict of interest., (© 2024.)

Introduction: Weight regain and insufficient weight loss are major challenges after metabolic bariatric surgery (MBS), affecting patients' comorbidities and quality of life. The current systematic review and meta-analysis aim to assess the efficacy and safety of GLP-1 receptor agonists (GLP-1 RA) in patients with weight regain or insufficient weight loss after MBS., Methods: A systematic search was conducted across PubMed, Embase, Scopus, and Web of Science databases to find the relevant studies., Results: A total of 19 articles were included. The highest doses of liraglutide and semaglutide were 3 mg per day and 1 mg once weekly, respectively, in the included studies. The mean differences in weight and body mass index after treatment were -7.02 kg or 3.07 kg/m 2 , -8.65 or -5.22 kg/m 2 , and -6.99 kg or -3.09 kg/m 2 for treatment durations of ≤ 6 months, 6-12 months, and >12 months with liraglutide, respectively. Additionally, weekly semaglutide showed significantly greater weight loss compared to daily liraglutide, with a mean difference of 4.15 kg. Common complications included nausea (19.1%), constipation (8.6%), abdominal pain (3.7%), and vomiting (2.4%)., Conclusion: Using GLP-1 RA is a safe and effective treatment for weight regain and insufficient weight loss after MBS., (© 2024 World Obesity Federation.)

Background: The opioid crisis caused a huge health concern in the United States. Despite this, few studies have examined the influence of opioid-related disorders (OD) on outcomes after bariatric surgery. The major goal of this study is to determine the impact of OD on in-hospital outcomes for patients undergoing bariatric surgery., Method: The National Inpatient Sample (NIS) database from 2016 to 2020 was used to evaluate patients with OD who underwent bariatric operations including sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch. The non-OD comparison group was created using a propensity score match (1:1). Weighted analysis was carried out utilizing NIS-provided weights. The odds ratios were obtained using multivariate logistic regression., Results: A total of 159,455 patients who underwent bariatric surgery were evaluated. Propensity score matching and weighted analysis were used to compare 11,025 in the OD group and 11,025 in the non-OD group. OD was an independent predictor for postoperative complications (odds ratio: 1.29, 95% confidence interval: 1.19-1.39, p < 0.001). Among complications, OD was a predictor for bleeding complications, postoperative nausea and vomiting, anastomotic leak, and mechanical ventilation. In addition, the OD group experienced significantly longer lengths of stay (LOS) and a higher total hospital charges., Conclusion: In patients undergoing bariatric surgery, OD is associated with a significantly higher risk of postoperative complications, as well as increased LOS and total hospital charges. These patients may benefit from further preoperative optimization, including decreasing the opioid dose and closer postoperative monitoring., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Currently, there is no consensus on the best bariatric surgery type for patients with body mass index (BMI) ≥50 kg/m 2 . This systematic review and meta-analysis aimed to compare outcomes of duodenal switch (DS) and Roux-en-Y gastric bypass (RYGB) in terms of weight loss, resolution of obesity-related comorbidities, and complications among patients with a BMI ≥50 kg/m 2 . A systematic search was conducted across databases including PubMed, Embase, Scopus, and Web of Science to include studies that compared outcomes of DS and RYGB in patients with BMI ≥50 kg/m 2 . A meta-analysis was carried out, alongside subgroup analyses based on the type of study and duration of follow-up. Twelve articles were included in this study (2678 patients, follow-up: 1-15 years). Patients with DS had 7.31 kg/m 2 higher BMI loss (95% CI: 5.59-9.03, P < .001) and 9.9% more total weight loss (95% CI: 4.47-15.28%, P < .001) compared with RYGB. The rate of complications, reoperation, mortality, and remission of comorbidities including diabetes, hypertension, dyslipidemia, and obstructive sleep apnea was not significantly different between DS and RYGB. Rate of malnutrition was 8.3% in the DS group compared with 1.2% in RYGB (OR: 5.53, 95% CI: 1.35-22.44, P = .02). In addition, 5.4% DS patients needed revisional surgery for malnutrition versus none in RYGB (OR: 6.1, 95% CI: 1.03-36.33, P = .05), and 24.6% of DS patients developed gallbladder disease needed cholecystectomy versus 4.5% after RYGB (OR: 6.36, 95% CI: 1.70-23.82, P = .01). DS leads to significantly higher BMI and total weight loss in patients with BMI ≥50 kg/m 2 but may be associated with a higher rate of major malnutrition and needed revisional surgery. These should be considered in surgical planning., (Copyright © 2024. Published by Elsevier Inc.)

To identify factors associated with post-recurrence survival (PRS), we examined our institutional recurrence patterns following definitive resection for rectal cancer. We reviewed all patients with rectal cancer diagnosed at three hospitals in the east of Iran from 2011 to 2020. The optimal cut-off value was determined by receiver operating characteristic (ROC) analysis to determine early recurrence. The effect of recurrence time was evaluated on PRS. 326 eligible patients with a mean ± SD age of 56 ± 12.8 years were included in this study. In a median (IQR: Inter-quartile range) follow-up time of 76 (62.2) months, 106 (32.5%) patients experienced at least any recurrence (locoregional or distant metastasis) following primary resection. The median (IQR) time from initial surgery to recurrence was 29.5 (31.2) months. Based on ROC analysis, early recurrence was specified at ≤ 29 months. However, for the patients who experienced only locoregional recurrence, 33 months was the cut-off to define early recurrence. Recurrence time and recurrence management were both significant variables on PRS. Moreover, TNM staging was significantly associated with early recurrence (P = 0.003). In this research, recurrence time, recurrence management and TNM staging were found to be correlated with PRS., (© 2024. The Author(s).)

Purpose: There is a strong association between metabolic dysfunction-associated steatotic liver disease (MASLD) and obesity which are both important risk factors for cardiovascular diseases (CVDs). The current study aimed to assess the association of MBS with different CVDs in patients with MASLD., Materials and Methods: The National Inpatient Sample (NIS) database from 2016 to 2020 were analyzed by using ICD-10 codes. A propensity score matching in a 1:1 ratio was done to match the MBS and non-MBS groups., Results: After weighted analysis, 1,124,155 and 68,215 patients were included in non-MBS and MBS groups, respectively. MBS was associated with significantly lower risk of hospitalization for coronary artery disease (OR 0.633 (0.569-0.703), p value < 0.001), acute myocardial infarction (OR 0.606 (0.523-0.701), p value < 0.001), percutaneous coronary intervention (OR 0.578 (0.489-0.682), p value < 0.001), and thrombolysis (OR 0.765 (0.589-0.993), p value = 0.044) compared to the non-MBS group in patients with MASLD. Furthermore, MBS was associated with 52% reduced risk of hospitalization for hemorrhagic stroke in patients with MASLD (OR 0.481, 95% CI 0.337-0.686, p value < 0.001). However, ischemic stroke was not significant between the two groups (OR 1.108 (0.905-1.356), p value = 0.322). In addition, MBS was associated with 63% and 60% reduced risk of hospitalization for heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) in patients with MASLD (OR 0.373, 95% CI 0.300-0.465 and OR 0.405, 95% CI 0.325-0.504, p value < 0.001 for both), respectively., Conclusion: The current study showed that MBS is significantly associated with a reduced risk of hospitalization for CVD in patients with MASLD., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Various hematologic parameters have been proposed as prognostic factors in rectal cancer management, but data are conflicting and unclear. This study is designed to investigate the prognostic factor capability of preoperative hematologic parameters with postoperative morbidities and mortality in rectal cancer patients undergoing curative resection., Methods: All 200 consecutive rectal cancer patients diagnosed at Ghaem University Hospital from 2017 to 2022 were retrospectively evaluated. The receiver operating characteristic (ROC) curves and machine learning (ML) algorithms of Random Forest, Recursive Feature Elimination, simulated annealing, Support Vector Machine, Decision Tree, and eXtreme Gradient Boosting were administered to investigate the role of preoperative hematologic parameters accompanied by baseline characteristics on three clinical outcomes including surgical infectious complications, recurrence, and death., Results: The frequency of infectious complications was correlated with the surgical procedure, while tumor recurrence was significantly influenced by T stage and N stage. In terms of mortality, alongside T and N stage, the status of resection margin involvement was significantly correlated. Based on the ROC analysis, the NLR >2.69, MPV ≤9 fL, and PDW ≤10.5 fL were more classified patients to mortality status. Likewise, the PLT >220 10 9 /L, MPV ≤9 fL, PDW ≤10.4 fL, and PLR >13.6 were correlated with recurrence. However, all factors examined in this study were not significant classifiers for the outcome of surgical infectious complications. The results of ML algorithms were also in line with ROC analysis., Conclusion: According to the results of both ROC analysis and ML models, preoperative hematologic parameters are considerable prognostic factors of postoperative outcomes in rectal cancer patients, and are recommended to be monitored by clinicians to prevent unfavorable outcomes., (© 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)

In the ongoing battle against adversarial attacks, adopting a suitable strategy to enhance model efficiency, bolster resistance to adversarial threats, and ensure practical deployment is crucial. To achieve this goal, a novel four-component methodology is introduced. First, introducing a pioneering batch-cumulative approach, the exponential particle swarm optimization (ExPSO) algorithm was developed for meticulous parameter fine-tuning within each batch. A cumulative updating loss function was employed for overall optimization, demonstrating remarkable superiority over traditional optimization techniques. Second, weight compression is applied to streamline the deep neural network (DNN) parameters, boosting the storage efficiency and accelerating inference. It also introduces complexity to deter potential attackers, enhancing model accuracy in adversarial settings. This study compresses the generative pre-trained transformer (GPT) by 65%, saving time and memory without causing performance loss. Compared to state-of-the-art methods, the proposed method achieves the lowest perplexity (14.28), the highest accuracy (93.72%), and an 8 × speedup in the central processing unit. The integration of the preceding two components involves the simultaneous training of multiple versions of the compressed GPT. This training occurs across various compression rates and different segments of a dataset and is ultimately associated with a novel multi-expert architecture. This enhancement significantly fortifies the model's resistance to adversarial attacks by introducing complexity into attackers' attempts to anticipate the model's prediction integration process. Consequently, this leads to a remarkable average performance improvement of 25% across 14 different attack scenarios and various datasets, surpassing the capabilities of current state-of-the-art methods., (© 2024. The Author(s).)

ZIF-8 (zeolitic imidazolate framework-8) is a potential drug delivery system because of its unique properties, which include a large surface area, a large pore capacity, a large loading capacity, and outstanding stability under physiological conditions. ZIF-8 nanoparticles may be readily functionalized with targeting ligands for the identification and absorption of particular cancer cells, enhancing the efficacy of chemotherapeutic medicines and reducing adverse effects. ZIF-8 is also pH-responsive, allowing medication release in the acidic milieu of cancer cells. Because of its tunable structure, it can be easily functionalized to design cancer-specific targeted medicines. The delivery of ZIF-8 to cancer cells can be facilitated by folic acid-conjugation. Hence, it can bind to overexpressed folate receptors on the surface of cancer cells, which holds the promise of reducing unwanted deliveries. As a result of its importance in cancer treatment, the folate-conjugated ZIF-8 was the major focus of this review., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Post-thoracotomy air leaks remain a significant challenge in thoracic surgery., Aim: This randomized controlled trial assessed the efficacy of autologous fibrin glue in reducing air leaks following thoracotomy procedures., Material and Methods: Conducted as a single-center, single-blind, randomized clinical trial, the study enrolled adult patients undergoing lung resection or decortication at a thoracic surgery clinic. Participants were randomly assigned to either the intervention group, receiving autologous fibrin glue application during surgery, or the control group, undergoing standard surgical procedures without glue application. Key inclusion criteria were adult patients undergoing elective thoracotomy for lung resection or decortication, while exclusion criteria included patients with severe comorbidities or contraindications to fibrin glue., Results: A total of 40 patients were enrolled and randomized equally to the two groups. The group treated with autologous fibrin glue demonstrated a significant reduction in the duration of air leakage and chest tube drainage, along with a shorter hospital stay, compared to the control group. There were no statistically significant differences in postoperative complications between the groups., Conclusions: The application of autologous fibrin glue during thoracotomy procedures significantly reduces postoperative air leaks and hospitalization duration without increasing complication rates. This finding suggests a beneficial role of fibrin glue in thoracic procedures requiring lung resection or decortication., Competing Interests: The authors report no conflict of interest., (Copyright: © 2024 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska).)

Objectives: Rural housewives are integral to household management and family care, yet their sedentary lifestyles present significant health risks. This study used the transtheoretical model (TTM) to investigate strategies that encourage and maintain regular exercise habits among rural housewives., Methods: A semi-experimental study was conducted in 2021 with 114 housewives aged 30 to 59 who attended rural health centers in Gorgan, Iran. Participants were randomly assigned to 1 of 2 groups. Data collection involved a validated questionnaire that gathered demographic information and constructs of the TTM. The intervention group participated in a comprehensive educational program, which included four 60-minute sessions. Data were collected again 6 months post-intervention and analyzed using descriptive and inferential statistics in SPSS version 21., Results: The study encompassed women with an average age of 39.75±6.05 years, the majority of whom had educational levels below a diploma, and over 90% were married. We observed strong correlations between the processes of change, self-efficacy, and decisional balance. At the outset, there were no significant differences in demographics or model structures between the 2 groups. However, 6 months post-intervention, the intervention group exhibited statistically significant differences in the mean scores of model structures, stages of change, and body mass index (&lt;&gt;p&lt;0.05)., Conclusions: This study highlights the importance of physical activity training for rural housewives. The findings suggest that the educational intervention, which utilized the TTM, significantly impacted the participants' model structures and their stages of change.

Introduction: Given the limited use of the 6-minute walking distance (6MWD) test as a replacement for standard tests in thoracic surgery, insufficient research exists on the prognostic value of this test, and further studies are necessary. This study aimed to investigate the correlation between pulmonary function tests (PFT) and the 6MWD test in lung resection patients., Methods: This cross-sectional study, conducted in 2021-2022, involved lung resection candidates referred to the thoracic surgery clinic. Demographic data, including age, sex, and body mass index (BMI), were collected, and pulmonary function tests and 6MWD tests were conducted for all patients. The sample size of the study was 31, and all patients received routine treatment during hospitalization., Results: Of the 31 subjects included in the study, 16 were male (51.6%) and 15 (48.4%) were female. The mean age of the patients was 33.45±13.78 years. The median forced expiratory volume in one second (FEV1) and the mean ratio of FEV1/forced vital capacity (FVC) were 2.16 (1.49-2.85) liters and 81.80±7.34%, respectively. No significant correlation was found between the results of 6MWD and PFT, including FVC, FEV1, and FEV1/FVC ratio ( P >0.05)., Conclusion: The 6MWD test is a more economical and easily accessible test than PFT. However, this study found no correlation between the 6MWD test and spirometry parameters. Therefore, we suggest that surgeons should not rely on the 6MWD test as a predictive value for assessing respiratory function in lung resection candidates. The study's findings have important implications for clinical practice., Competing Interests: There is no conflict of interest., (© 2024 The Author(s).)

One of the chief pathways to regulate p53 levels is MDM2 protein, which negatively controls p53 by direct inhibition. Many cancers overproduce MDM2 protein to interrupt p53 functions. Therefore, impeding MDM2's binding to p53 can reactivate p53 in tumor cells may suggest an effective approach for tumor therapy. Here, some Monastrol derivatives were designed in silico as MDM2 inhibitors, and their initial cytotoxicity was evaluated in vitro on MFC-7 and MDA-MB-231 cells. A small library of Monastrol derivatives was created, and virtual screening (VS) was performed on them. The first-ranked compound, which was extracted from VS, and the other six compounds 5a-5f were selected to carry out the single-docking and docking with explicit waters. The compound with the best average results was then subjected to molecular dynamic (MD) simulation. Compounds 5a-5f were chemically synthesized and evaluated in vitro for their initial cytotoxicity on MFC-7 and MDA-MB-231 cells by MTT assay. The best compound was compound 5d with ΔG ave  = -10.35 kcal/mol. MD simulation revealed a median potency in comparison with Nutlin-3a. The MTT assay confirmed the docking and MD experiments. 5d has an IC 50 of 60.09 μM on MCF-7 cells. We attempted to use Monastrol scaffold as a potent inhibitor of MDM2 rather than an Eg5 inhibitor using in silico modification. The results obtained from the in silico and in vitro evaluations were noteworthy and warranted much more effort in the future., (© 2023 John Wiley & Sons Ltd.)

Neuropathic pain is a disabling condition caused by various diseases and can profoundly impact the quality of life. Unfortunately, current treatments often do not produce complete amelioration and can be associated with potential side effects. Recently, herbal drugs have garnered more attention as an alternative or a complementary treatment. In this article, we summarized the results of randomized clinical trials to evaluate the effects of various phytomedicines on neuropathic pain. In addition, we discussed their main bioactive components and potential mechanisms of action to provide a better view of the application of herbal drugs for treating neuropathic pain., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

The current study aims to evaluate the effect of bariatric metabolic surgery (BMS) on the New York Heart Association (NYHA) class and left ventricular ejection fraction (LVEF) in patients with diagnosed heart failure (HF). Fourteen related articles with 217 patients were included in the final analysis. LVEF significantly improved after BMS in patients with HF with a mean difference of 7.78% (CI 95%: 3.72, 11.84, I 2  = 83.75, p-value < 0.001). Also, the NYHA class significantly decreased after BMS with a mean difference of - 0.40 (CI 95%: - 0.62, - 0.19, I 2 : 47.03, p-value < 0.001). A total of 27 patients with obesity and HF were listed for cardiac transplantation after BMS. Of those, 20 patients successfully underwent heart transplantation after BMS., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: There are some concerns about the higher risk of certain gastrointestinal (GI) cancers in patients with a history of bariatric metabolic surgery (BMS). The current study aimed to investigate the association of BMS with GI cancer hospital admission including esophageal, gastric, colorectal, small intestinal, liver, gallbladder, bile duct, and pancreatic cancers., Methods: The analysis utilized the US national inpatient sample (NIS) data from 2016 to 2020, employing ICD-10 codes. A propensity score matching in a 3:1 ratio was done to match the BMS and non-BMS groups., Results: A total of 328,369 patients with a history of BMS and 4,989,154 with obesity and without a history of BMS were included in this study. BMS was independently associated with a higher risk of gastric and pancreatic cancers hospital admission (OR: 1.69 (CI 95%: 1.42-2.01) and OR: 1.46 (CI 95%: 1.27-1.68)), respectively. In addition, BMS was independently associated with a lower risk of colorectal and liver cancer hospital admission (OR: 0.57 (CI 95%: 0.52-0.62) and OR: 0.72 (CI 95%: 0.52-0.98)), respectively. Besides, esophageal, gallbladder, bile duct, and small intestinal cancer were not significantly different between the two groups. In patients with GI cancer, although the BMS group had significantly lower total charges and length of hospital stay compared to the non-BMS group, the rate of in-hospital mortality was not significantly different., Conclusion: The current study showed that bariatric surgery may be associated with a higher risk of gastric and pancreatic cancer and a lower risk of colorectal and liver cancer hospital admission. Further research is needed to explore this association., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: Previous research has suggested the ameliorating effect of bariatric surgery (BaS) on patients with pulmonary hypertension (PH), but there is a lack of data on the effect of bariatric surgery on the odds of cardiovascular diseases in PH patients. The current study aims to evaluate the association of BaS and coronary artery diseases (CAD), heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF), cardiac valve diseases, cardiac rhythm disorders, acute pulmonary embolism, and in-hospital mortality in patients with PH., Methods: The national inpatient sample (NIS) data from 2016 to 2019 were analyzed by using ICD-10 codes. A propensity score matching in a 3:1 ratio was performed to match the BaS and non-BaS groups., Results: A total of 3605 patients with a history of BaS and 501419 patients without a history of BaS were included. After propensity matching, BaS was independently associated with a lower CAD hospital admission and a lower rate of in-hospital mortality. On the contrary, BaS was associated with a higher prevalence of atrial fibrillation (AF) and acute pulmonary embolism in patients with PH. HFpEF, HFrEF, other cardiac rhythm disorders, complete heart block, cardiac valve diseases, and ischemic stroke were not significantly different between the two groups in patients with PH., Conclusion: BaS is independently associated with a reduced rate of in-hospital mortality and CAD hospital admission in patients with PH. However, the risk of atrial fibrillation and acute pulmonary embolism was higher in these patients., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Comparison of natural orifice specimen extraction (NOSE) and transabdominal specimen extraction (TASE) in colorectal surgery remains controversial. Herein, we aimed to perform a retrospective analysis on surgical outcomes of NOSE and TASE at three hospitals in east of Iran., Method: Consecutive locally advanced rectal adenocarcinoma patients who underwent laparoscopic surgery using either NOSE or TASE from 2011 to 2017 were recruited. These patients were followed-up till 2020. Data, including postoperative complications, long-term overall and recurrence-free survival were analyzed retrospectively., Results: 239 eligible patients were included in this study. 169 (70.71%) patients underwent NOSE, and 70 (29.29%) patients underwent TASE. Although this study has achieved similar outcomes in terms of overall and recurrence-free survival, metastasis, circumferential margin involvement as well as complications of intra-operative bleeding, obstruction, anastomosis-fail, rectovaginal-fistula in women and pelvic collection/abscess in both groups, we observed higher rates of locoregional recurrence, incontinency, stenosis and the close distal margins involvement in NOSE group and also obstructed defecation syndrome in TASE cases., Conclusion: According to our findings, NOSE laparoscopic surgery showed significantly higher incontinency, impotency, stenosis and involvement of the close distal margins rates. Nevertheless, considering the similarity of long-term overall and recurrence-free survival, metastasis, circumferential margin involvement, NOSE procedure is still could be considered as a second choice for lower rectal adenocarcinoma patients., (© 2023. The Author(s).)

Background: Considering the prevalence of overweight and abdominal obesity in middle-aged women, this study was conducted to determine the effect of empowerment program to reduce sugar consumption based on the Multi-Theory Model (MTM) on Body Mass Index (BMI) and abdominal obesity in women aged 30-60 in Joven., Methods: This quasi-experimental study (include descriptive and interventional sections) was conducted on the Joven city, Khorasan Razavi province, Iran country from October 2020 to August 2021. Sampling was performed as a multi-stage cluster. First, a descriptive study was performed among 400 women, and then 128 people who were eligible to enter the interventional phase of the study were selected. In the control group, 63 people and in the intervention group, 65 people were eligible to enter the study. The educational intervention was performed in five 60-minute sessions for groups of 12 people. The instruments included the demographic questionnaire, sugar consumption checklist and researcher-made questionnaire based on MTM constructs. Before the intervention, one, three and six months after the intervention, the questionnaire was completed by both intervention and control groups also measurement of waist circumference and BMI were performed using standard instruments. The obtained data were analyzed by SPSS 17., Results: After the educational intervention, there was a significant difference between the intervention and control groups in all the MTM constructs. Also, six months after the educational intervention, BMI, waist circumference and amount of consumption of sugary substances decreased significantly in the intervention group (p < 0.05)., Conclusion: Educational intervention based on the MTM can be effective in reducing the consumption of sugary substances and shaping behaviors related to healthy lifestyle in women., (© 2023. The Author(s).)

The second leading cause of cancer death in women worldwide is breast cancer (BC), and despite significant advances in BC therapies, a significant proportion of patients develop metastasis and disease recurrence. Currently used treatments, like radiotherapy, chemotherapy, and hormone replacement therapy, result in poor responses and high recurrence rates. Alternative therapies are therefore needed for this type of cancer. Cancer patients may benefit from immunotherapy, a novel treatment strategy in cancer treatment. Even though immunotherapy has been successful in many cases, some patients do not respond to the treatment or those who do respond relapse or progress. The purpose of this review is to discuss several different immunotherapy approaches approved for the treatment of BC, as well as different strategies for immunotherapy for the treatment of BC., (© 2023 Wiley Periodicals LLC.)

Aim: In this study, novel hybrid structures of pyrimido-indole-oxadiazole were developed as MDM2 inhibitors for restoring the regular function of the p53. Materials & methods: A multistep chemical pathway was used to synthesize the derivatives. Nutlin-3a was used as a standard lead in molecular docking and molecular dynamics simulations. Finally, cytotoxicity was evaluated against MCF-7 cancer cells versus Doxorubicin. Results: The most promising candidate was 12c , which had an NO 2 group in the para position of the oxadiazole ring (IC 50 : 1.1 μM). A satisfactory result was obtained with the combined application of 12c and Doxorubicin (IC 50 decreased to 0.63 μM), which could be potentially attributed to MDM2 inhibition. Conclusion: These hybrid structures can be further investigated as potential MDM2 inhibitors.

Background: The purpose of the present study was to study the potential anti-arthritic and antioxidant effects of trehalose in an experimental model of complete Freund's adjuvant (CFA)-induced arthritis., Methods: Arthritis was induced via subcutaneous injection of CFA (0.1) into the right footpad of each rat. Trehalose (10 mg/kg per day) and indomethacin (5 mg/kg) as a reference drug were intraperitoneally injected into CFA-induced arthritic rats from days 0 to 21. Changes in paw volume, pain responses, arthritic score, and oxidative/antioxidative parameters were determined., Results: Trehalose administration could significantly decrease arthritis scores (p <0.01) and paw edema (p <0.001), and significantly increase the nociceptive threshold (p <0.05) in CFA-induced arthritic rats. Trehalose also significantly reduced the pro-oxidant-antioxidant balance values when compared to CFA treatment alone. In addition, no significant difference was found between the trehalose group and indomethacin as a positive control group., Conclusion: The current study suggests that trehalose has a protective effect against arthritis, which may be mediated by antioxidative effects of this disaccharide., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Intimate partner violence (IPV) is the most common type of domestic violence often used by men against their wives. Due to the destructive and widespread social and health consequences of IPV, the present study aimed to investigate the prevalence and related factors of IPV among married women in Garmsar, Iran., Methods: Using multi-stage clusters sampling method, this cross-sectional study included 400 married women in Garmsar, Iran. The data collection process was conducted during October and December 2019 using a researcher-made questionnaire. The content validity of the questionnaire was confirmed using content validity ratio (CVR) and content validity index (CVI) indicators (0.85 and 0.88, respectively). Also, the reliability was confirmed by examining the internal consistency and obtaining a score of 0.93 for Cronbach's alpha. Descriptive and analytical statistics were performed using t-test, analysis of variance (ANOVA), and Tukey's post-hoc test., Results: Most participants were in the age range of 20-40 years (mean age: 34.9 years). The overall exposure of women to IPV was 56.11%. In addition, the most prevalent types of IPV included legal (24%), social (24%), financial (22%), verbal (16%), physical (13%), emotional (12%), and sexual (11%). The effective factors on the prevalence of IPV included number of children, education level, occupation, and age (P less than 0.05)., Conclusions: We witnessed that women living in Garmsar faced different types of IPV and their overall exposure to this phenomenon was higher than the national and global average. To resolve the problem, the following measurements are recommended: a careful investigation of the reasons for the spread of IPV, implementing interventions based on reliable evidence, and serious cooperation of the experts and relevant governmental and non-governmental institutions, particularly citizens.

Background: Domestic violence against women is a global problem that can lead to many negative consequences on physical, mental, and social health that various sociocultural causes play a role in its occurrence in different societies. Therefore, this study was conducted to determine the causes and type of violence against spouses in married men in Kerman., Materials and Methods: This cross-sectional study was performed in 2018. The study was conducted on 400 married men who experienced violence against their wives. Sampling was a multistage cluster sampling method. The data collection tool was a questionnaire on violence against women. Data were analyzed using descriptive statistics, one-way analysis of variance (ANOVA), and two-variate analysis., Results: The results of the data showed that the highest rate of violence in the group of housewives was related to physical violence and in the group of women living in dormitories and pregnant women was related to verbal violence. The results of data analysis with a one-way ANOVA test showed that between the three groups, all dimensions of violence and the overall score of violence had significant changes ( P < 0.05). The results of the two-variate analysis test showed that there was a significant relationship between the variables of age, duration of marriage, male education, spouse education, type of marriage, male job, and spouse job with the overall score of violence in all three groups ( P < 0.05)., Conclusion: According to the results of the present study, it seems that the empowerment of women in all dimensions to improve and promote health to deal with domestic violence is essential. As a result, the relevant measures should be taken by the support systems taking into account the circumstances of the individuals., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Education and Health Promotion.)

Background: Benefactors of nongovernmental organizations (NGOs) are the hidden public health promotion systems. These benefactors are the symbol and intermediary of people participation, which is one of the main arms of health promotion and reduction of poverty and injustice in the societies. The present study is aimed to identify the benefactors' experiences in NGOs in terms of providing and promoting health-oriented services., Materials and Methods: This study was conducted with a qualitative approach. The total number of participants was 32, which consisted of 25 chief executive officers from active and inactive organizations. Active organizations refer to organizations that submitted their 6-month report at the time of the investigation and whose operating license was renewed and in operation and seven officials of the social deputy of governmental organizations related to NGOs. Data collection was performed by using semi-structured interviews and with purposive sampling and then continued until data saturation. Furthermore, the content analysis method was used for data analysis. MAXQDA software version 2007 was used to manage quality data., Results: During the data analysis, the following four subcategories were obtained: "high effort in empathy with fellow human beings," "role of merit in the success of donors," "creating a platform for social attention for the client's spontaneity," and "respect of the client," which were the results of experience and dimensions. The performance of non-governmental organizations is in line with the confrontation and responsibility of non-governmental organizations with a focus on health-oriented services., Conclusion: Having benevolent motives, benefactors attempt to provide conditions, in which help seekers have more chance for living through establishing new, sustainable, and future-reassuring conditions., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Education and Health Promotion.)

Background: In recent years, an increased incidence of breast cancer has made this disease the most common malignancy among Iranian women. Since education plays an important role in the implementation of preventive behaviors in breast cancer treatment, this study investigates the effect of educational interventions on the promotion of lifestyle-related behaviors that prevent breast cancer in middle-aged women., Methods: In this randomized control study, 120 women referred to Neyshabur Health Services Centers were randomly selected and divided into two groups: an intervention group (60 subjects) and a control group (60 subjects). An educational intervention was carried out over five sessions, based on protective motivation theory constructs. Participants completed a researcher-designed questionnaire immediately and again 2 months after the intervention. The data were analyzed using IBM SPSS ver. 19.0 software (IBM Corp., Armonk, NY, USA)., Results: The results revealed a significant difference between the mean scores of participants exposed to protective motivation theory, awareness, and physical activities immediately and also 2 months after the intervention (P<0.05). Although the healthy diet scores of the two groups differed significantly immediately after the educational intervention (P<0.05), there was no significant difference between the groups 2 months after the intervention (P<0.05)., Conclusion: Given the effective role of education in protective motivation theory and the physical activity levels of the women who participated in this research, it seems clear that the women's financial status shaped their ability to consume more fruits and vegetables. As this social element impacts the health of individuals, training programs alone cannot succeed.

Background: Antimicrobial resistance among community-acquired uropathogens is an emerging concern over the past decades that warrants a continuing reevaluation of the appropriateness of recommended empiric antimicrobial regimens for treatment of urinary tract infections (UTIs)., Aims: To describe the microbial spectrum and resistance profile of community-acquired uropathogens and predictors of isolation of resistant strains., Methods: Between October 2017 and June 2019, individuals who visited the outpatient clinics for diagnosis of UTIs or screening of asymptomatic bacteriuria were included in the study if they were tested for urine culture in one of the three main medical diagnostic laboratories of Mashhad, Iran. The standard disk diffusion antimicrobial susceptibility testing was used, with the Clinical and Laboratory Standards Institute (CLSI) threshold cutoffs for susceptibility of isolated uropathogens., Results: Three hundred thirty cases were included with a median age of 47 years. Two hundred seventy-six (83.6%) were female. The most common isolated uropathogens were Escherichia coli in 201 (60.9%) cases and Klebsiella species in 46 (13.9%) cases. E. coli isolates showed the highest rates of susceptibility to nitrofurantoin (89.3%), cefixime (75%), and gentamicin (72.4%). Exposure to antibiotics in the past 3 months was a predictor of resistance to ciprofloxacin (OR: 2.8, 95% CI: 1.33-6.28), and older age was a predictor of resistance to TMP-SMX (OR: 2.1, 95% CI: 1.07-3.97) among E. coli isolates. Conclusion. E. coli and Klebsiella species accounted for about two-thirds of community-acquired uropathogens. In regard to the high susceptibility rates, nitrofurantoin was identified as the first-choice agent for empiric treatment of community-acquired cystitis, while cefixime and gentamicin might be the second-choice alternatives. Ciprofloxacin and TMP-SMX, on the other hand, cannot be considered appropriate agents for empiric therapy of community-acquired UTIs, particularly in those who had exposure to antibiotics in the past 3 months and the elderly., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2020 Mohammad Moein Vakilzadeh et al.)

This study aimed to investigate dominant predictor components of moral intelligence (MI) based on the Lennick and Kiel's model in students of Shahid Beheshti University of Medical Sciences (SBMU). In this descriptive-analytical study, 322 students of SBMU were chosen through cluster sampling. To collect data, a 40-item questionnaire, whose validity and reliability was confirmed in previous studies, based on the Lennick and Kiel's model was used. The collected data were analyzed by SPSS 21 software using appropriate descriptive and analytical statistics. Of 322 participants, 180 and 142 were female and male, respectively. The mean age of the participants was 22.30±2.69 years. The study's regression analysis revealed that the most and the least direct effects were related to the forgiveness (R2=0.320) and compassion (R2=0.284) components, respectively. Among the inspected components, the responsibility component with an overall effect of R2=0.655 was shown to be the strongest predictor component of MI. Universities play a significant role in students' moral development and enhancement. The present study's findings suggest that developing strategic plans and interventions can enhance MI level (e.g., incentive systems for individuals maintaining high moral responsibility). Since today's students will be tomorrow's medical and healthcare professionals, upgrading of MI level in students studying in various divisions of medical sciences enhances their moral responsibility through setting out strong ethics principles to follow and the quality of care that they will provide to patients, thereby improving health., (© 2020 Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences. All rights reserved.)

Background: The average age of using illicit drugs for the first time in adolescents has decreased in Iran over the past years. Studies show that family and environment play a notable role in keeping adolescents away from substances., Aims: The present study is an attempt to develop and validate a model-based questionnaire to measure parental factors related to substance use prevention in adolescents., Methods: This methodological study was carried out on 336 parents of high school students in Sabzevar- Iran, in 2018. The first draft of the questionnaire, including 136 items, was developed based on the constructs of the Health Promotion Model (HPM) using similar questionnaires, literature review, and interviewing 9 qualified experts. The validity of the questionnaire was measured through face validity (qualitative and quantitative), content validity (qualitative and quantitative), and construct validity (confirmatory factor analysis). The reliability of the questionnaire was measured by internal consistency and test-retest reliability. SPSS ver. 16 and LISREL ver. 8.2 software was used for statistical analysis., Results: Throughout the validation process, 35 items were omitted, and the final version of the questionnaire consisting of 101 items was developed. The overall content validity ratio was 0.81, which indicates the proper and understandable content of the items. The overall content validity index was 0.96, which indicates excellent expert validity. The Cronbach's alpha coefficient of the questionnaire was 0.85 (constructs range= 0.73-0.96), and the intraclass correlation coefficient of the questionnaire was 0.78 (constructs range= 0.46-0.91), which indicates that the questionnaire has good internal consistency and test-retest reliability. Further, the confirmatory factor analysis yielded an appropriate fit for the model (RMSEA= 0.069, χ2/df= 2.77, GFI= 0.60, AGFI= 0.83, CFI= 0.83, NNFI= 0.83)., Conclusion: The validity and reliability of the HPM-based questionnaire were supported. Therefore, the questionnaire can be used by health educators and health policymakers in empowerment programs for parents to improve their behavioral skills concerning the prevention of substance use in their adolescents., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Objectives: Health education programs are one of the most important strategies for controlling cutaneous leishmaniasis (CL) in endemic areas such as Neshabur city. This study aimed to develop and evaluate a comprehensive health education program to improve preventive behaviors for CL., Methods: This was an interventional study conducted on 136 high school students in Neishabur city. Data collection instruments included a demographic questionnaire and a researcher-made questionnaire based on the "Health Belief Model" and "Beliefs, Attitudes, Subjective Norms and Enabling Factors Model" constructs. The control and intervention groups completed the questionnaires before and 2 months after the intervention. The intervention was conducted in 6, 1-hour educational sessions for the intervention group students and 2, 1-hour sessions for school administrators, teachers, and students' parents., Results: There was no significant difference between the 2 groups in the pre-intervention phase. However, in the post-intervention phase, there were significant differences between the 2 groups for mean scores of knowledge, perceived susceptibility, perceived severity, perceived benefits, cues to action, self-efficacy, attitude, subjective norms, behavioral intention, enabling factors, and behavior associated with CL., Conclusion: Health education program based on the "Health Belief Model" and the "Beliefs, Attitudes, Subjective Norms and Enabling Factors Model" model constructs may be a comprehensive and effective educational program to improve preventive behaviors against CL in students., Competing Interests: Conflicts of Interest The authors have no conflicts of interest to declare for this study.

Background: Various theory-based interventions (TBIs) have been done to prevent STI/HIV. The current study aimed at reviewing the TBIs for STI/HIV prevention in Iran. Methods: We systematically searched 6 English and Persian electronic databases to identify TBIs conducted for STI/HIV prevention in Iran. General searches were conducted using PubMed MeSH terms. Articles were included if they were interventional and conducted using models and theories, aimed at reducing the risk of STIs, were quasi-experimental or experimental, and if their full text was available. Results: Overall, 1042 studies were found. Finally, 13 original studies met our inclusion criteria. The findings indicated that HBM and TPB were the most frequently used theory/models. High school students and drug abusers were the most common target groups in the included studies. Conclusion: The results revealed that the majority of the conducted TBIs contained a methodological weakness. Conducting randomized controlled trials is needed to evaluate the effectiveness of the TBIs.

Spatial distribution of cone and rod photoreceptors in human eye retina, are studied by using non-extensive statistics. We show that photoreceptors' packing density obeys q-exponential and q-Gaussian distributions. Cones retinal distribution has higher non-extensivity in young subjects in comparison with old ones. Absolute value of q-parameter for spatial distribution of both types of photocells gets higher values along horizontal meridian. We also calculate Shannon's additive entropy and Tsallis' non-additive entropy for cone photocells distribution in retina, and compare their results. Information entropy, especially Tsallis entropy, is capable to discriminate between young and old subjects, properly. Our results confirm the ability of non-extensive statistics to unveil retinal eye problems caused by abnormal photoreceptors distribution., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Healthy lifestyle is a major strategy to promote current and subsequent health status. The aim of this study was to assess the status of health-promoting the lifestyle and its determinants among students., Methods: A stratified random sample of 500 students in a university in the city of Sabzevar, Iran participated in this cross-sectional study. Health-promoting lifestyle was measured using Walker's health-promoting lifestyle profile II., Results: There was a significant correlation between all domains of health-promoting the lifestyle. The highest score among the domains was for an interpersonal relationship (70.8%), and the lowest score was for nutrition (53.6%), and physical activity (53.4%). Significant differences were found in physical activity by gender (P ≤ 0.05). There were significant differences in health responsibility, spiritual growth and body mass index by marital status (P < 0.01)., Conclusions: Since one out of five students in this study were overweight/obese, health program planning to promote lifestyle, especially physical activity and nutrition among students is recommended. Our findings may be helpful for faculty administrators, curriculum planners, and health educators in designing guidelines to structuralize a healthier campus and to develop health promotion programs supporting healthy choices among students.

The presence of a long-range correlation in the spatial distribution of a relevant word type, in spite of random occurrences of an irrelevant word type, is an important feature of human-written texts. We classify the correlation between the occurrences of words by nonextensive statistical mechanics for the word-ranking process. In particular, we look at the nonextensivity parameter as an alternative metric to measure the spatial correlation in the text, from which the words may be ranked in terms of this measure. Finally, we compare different methods for keyword extraction., (© 2011 American Physical Society)