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Summary: 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/m2, −8.65 or −5.22 kg/m2, and −6.99 kg or −3.09 kg/m2 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

An attempt is made to settle the controversy on a theory of the concentric distribution of dialectal variants for snails. This theory was presented in 1927 by Kunio Yanagita (1875-1962), outstanding Japanese folklorist. Over more than 95 years, however, its verification remains pending. On the basis of the recent achievement in the linguistic atlas project, time series analysis is made for fitting to the long-tailed rank-frequency relations of cumulative syllabics that are included in the entire dialect sequence of snails. The time reversal asymmetry (TRA) is revealed through comparison between the forward and backward analysis. The validity of the methodology is confirmed through comparison with results for several examples. Computed results show substantial TRAs between the periphery-to-center and center-to-periphery analysis for fitting to the long-tailed distribution in the cumulative frequency versus rank. This feature for the categorial data sequence is consistent with those observed for typical numerical data such as music and heartbeat signals that obey nonGaussian statistics. Application to the most parsimonious principle yields results being compatible with the above ones, which reproduces the validity of our conclusion. Finally, perturbation analysis is made for several artificially disturbed arrangements of the dialectal strata. [ABSTRACT FROM AUTHOR]

Polyoxometalates (POMS) are a class of mineral clusters of transition metals or rare-earth elements linked together by Oxo ligands. POMs have been identified as antibacterial, antiviral, and anticancer agents after decades of research since the onset of the 20th century. Furthermore, in recent years POMs have been studied for their applications in diagnosis, photodynamic therapy, photothermal therapy, and theragnostic. However, these last-mentioned POM applications have rarely been reviewed. Considering the potential characteristic features of POMs, comprising their easy, inexpensive, and scalable synthesis, and with special attention to the challenges of their application, POMs would be great alternatives to many conventional medical tools in the field of cancer treatment and diagnosis. In this review, we report recent updated research around utilizing POMs in cancer diagnosis and theragnostic. Publications are on basic topics including POMs in magnetic resonance imaging (MRI), POMs in computed tomography (CT), POMs in cancer photoluminescence (PL) imaging, POMs in multimodality, POMs in radiation therapy applications, POMs as radiosensitizer and promotor of drug release, and POMs in theragnostic applications. It is hoped that this review paper will be useful for those researchers who are interested in expanding the applications of polyoxometalates in the field of cancer treatment and diagnosis. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Vaginal cuff dehiscence post‐hysterectomy is rare yet significant. Early recognition and prompt surgical intervention are crucial to prevent complications like bowel infarction. Consider second‐look laparotomy in cases of uncertain bowel viability. Vaginal cuff dehiscence (VCD) is a rare but potentially life‐threatening complication following a hysterectomy characterized by the separation of the vaginal vault. This condition, which may result in vaginal evisceration (VE), presents a significant risk of pelvic contents, particularly the small bowel, protruding into the vagina. Early diagnosis and prompt surgical intervention are paramount to prevent severe complications, including bowel infarction, obstruction, and peritonitis. Although VCD and VE are rare, they require urgent surgical management to avoid adverse outcomes. We reported a case of small bowel evisceration in a woman with a history of total abdominal hysterectomy 6 months ago. VCD and VE are very rare but life‐threatening complications of hysterectomy. Discussing the symptoms with patients who have multiple risk factors is crucial to avoid severe sequels following hysterectomy. Based on our experience, performing a second‐look laparotomy is a reliable approach to ensure the viability of the intestinal loop. However, it will likely increase the risk of infection. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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 >220 109/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. [ABSTRACT FROM AUTHOR]

Objective: This study was performed with the aim to evaluate the results of the treatment of vaginal fistulas caused by pelvic malignancy and to present a new surgical technique. In this retrospective study, patients with vaginal fistula who have been treated in Ghaem and Omid Hospitals of Mashhad University of Medical Sciences from 2004 to 2020 were studied. The inclusion criteria were the patients whose fistulas were caused by malignant neoplasia with pelvic organ origin. The patients with fistulas caused by other causes were excluded from the study. Patients' information was collected from the electronic records and the hospital archives and also the information recorded by the surgeon. Results: Out of 26 patients with vaginal fistula caused by pelvic malignancies, 18 cases had enterovaginal fistula. Cancer of cervix (11 cases) was the most prevalent cancer. Time interval between the incidence of fistula and the onset of the disease was 43.5 months. About 16 patients had a history of radiotherapy before the onset of the fistula, and 23 cases had undergone surgery before the onset of fistula. About 11 patients were treated with resection, 8 patients with ostomy, and 5 with fistulized loop bypass. Discussion and conclusion: In cases of extensive pelvic involvement with a tumor, it is recommended to use intestinal bypass in fistula site with the technique provided in this article, since it controls the symptoms of the patient and has limited complications. [ABSTRACT FROM AUTHOR]

Background & Objective: Vaginal birth after Cesarean (VBAC) is often offered as an option after a single cesarean section (CS). To evaluate the success rate of vaginal birth after two cesarean sections (VBAC-2). Materials & Methods: We searched MEDLINE, EMBASE, PubMed, Scopus, using search terms (cesarean OR cesarean OR caesarean OR caesarian) AND ("Vaginal birth after cesar Keywords: Vaginal birth after Cesarean, Cesarean section, Maternal, Fetal outcomesean" OR VBAC) AND (two OR Twice OR second OR multiple). Two independent reviewers performed the study selection, and abstracted and tabulated data and pooled estimates were obtained. Meta-analyses were performed using Open-meta and Comprehensive Meta-Analysis. Results: Mean success rate of VBAC-2 was 72% (2174 out of 3020 cases) with a range of 24-90%. The mean hysterectomy rate was 0.43% ranging from 0% to 1.7%. Our meta-analysis showed no significant difference between VBAC-2 and CS-3 in the case of hysterectomy, with a pooled odds ratio (OR) of 0.699, but with a wide confidence interval (95% CI was 0.347-1.407). VBAC-2 being associated with 2-fold increased risk of perinatal mortality compared to CS-3. Conclusion: Vaginal delivery is a suitable option for women with two previous cesarean sections; the outcomes are significantly more favorable for women with a history of vaginal birth. [ABSTRACT FROM AUTHOR]

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 ΔGave = −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 IC50 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Although rectal foreign bodies are rare presentations, this condition should be considered in patients with preanal pain, lower pelvic pain, or rectal bleeding. Rectal foreign bodies are a rare occurrence and can pose a therapeutic challenge for surgeons. These objects may be inserted through the anus or ingested orally. This study presents a retrospective review of all cases of trapped rectal foreign bodies at a single university hospital. From 2001 to 2020, twelve cases of rectal foreign bodies were diagnosed and treated at Ghaem Hospital in Mashhad. Demographic information, type of foreign body, clinical presentation, and removal method were collected retrospectively. All cases of rectal foreign bodies entered through the anus. Twelve cases involved male patients, with a mean age of 47.5 years (ranging from 24 to 70 years), and two cases involved female patients, with a mean age of 29.5 years (ranging from 29 to 30 years). Patients' main complaint was defecation disorder, accounting for 57% of cases. The types of rectal foreign bodies included two body sprays, two wood pieces, two glass bottles, glasses, eggplants, cucumbers, squash, and anal dilators. One case involved surgical gas. In five cases, rectal foreign bodies were removed under general anesthesia through the rectum by dilatation. Rectal foreign bodies were removed by rectosigmoidoscopy in three cases, forceps in two cases, and abdominal maneuvers in one case. Only one case required laparotomy. Minor complications such as scratches or small mucosal tears were observed in some cases after removal of the foreign body, but no deaths were reported. Although rectal foreign bodies are rare, this condition should be considered in patients with preanal pain, lower pelvic pain, or rectal bleeding when no justification for recent endoscopic examinations is found. Most rectal foreign bodies are removed through the anus under appropriate anesthesia. Rectosigmoidoscopy is a good alternative if needed. Surgical measures are necessary for cases that lead to peritonitis or are likely to cause serious injury. [ABSTRACT FROM AUTHOR]

Arid regions are especially vulnerable to climate change and land use. More than one-third of Earth's population relies on these ecosystems. Modern observations lack the temporal depth to determine vegetation responses to climate and human activity, but paleoecological and archaeological records can be used to investigate these relationships. Decreasing rainfall across the Late Holocene provides a case study for vegetation response to changing hydroclimate. Rock hyrax (Procavia capensis) middens preserve paleoenvironmental indicators in arid environments where traditional archives are unavailable. Pollen from modern middens collected in Dhofar, Oman, demonstrates the reliability of this archive. Pollen, stable isotope (δ13C, δ15N), and microcharcoal data from fossil middens reveal changes in vegetation, relative moisture, and fire from 4000 cal yr BP to the present. Trees limited to moister areas (e.g., Terminalia) today existed farther inland at ~3100 cal yr BP. After ~2900 cal yr BP, taxa with more xeric affiliations (e.g., Senegalia) had increased. Coprophilous fungal spores (Sporormiella) and grazing indicator pollen revealed an amplified signal of domesticate grazing at ~1000 cal yr BP. This indicates that trees associated with semiarid environments were maintained in the interior desert during ~3000-4000 yr of decreasing rainfall and that impacts of human activity intensified after the transition to a drier environment. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Clinicians must pay attention to the clinical presentation and consequences of hydatid cysts in rare sites. Cysts close to the aorta require planning and assistance of a cardiac or vascular surgeon before surgical intervention can be considered. [ABSTRACT FROM AUTHOR]

Using a nephroscope in a laparoscopic operation to relieve the hepaticojejunostomy stricture (HJS) by transjejunal dilatation is a minimally invasive and applicable method. It can be used as the first step for such patients. Using a nephroscope in a laparoscopic operation to relieve the HJS by transjejunal dilatation is a minimally invasive and applicable method. It can be used as the first step for such patients. [ABSTRACT FROM AUTHOR]

Background and aims: The aim of this study was to investigate the combined effect of interval training and resveratrol consumption on the regulatory and executive factors of hepatocyte apoptosis in male rats with diabetes. Methods: Frothy-two male Wistar rats were randomly divided into healthy control, diabetic, saline diabetic, resveratrol supplement, intermittent exercise, and resveratrol+intermittent exercise groups. The interval training program consisted of 8 weeks of training with an intensity of 50%-70% of the maximum oxygen consumption. Resveratrol was injected in two training groups with resveratrol supplement and resveratrol+supplement at a dose of 20 mg. Results: The concentrations of caspase-3 and BAX in diabetic saline and diabetic groups were significantly higher than in control groups (P=0.001). On the other hand, Bcl-2 (B-cell lymphoma 2) levels in diabetic saline and diabetic were significantly lower than in the control groups (P=0.001). The concentration of the BAX/Bcl-2 ratio in diabetic and diabetic saline was significantly higher compared to control groups (P=0.001) The effect of interval training, administration of resveratrol alone, or especially with interval training caused a significant decrease in the concentration of BAX and caspase-3 (P=0.001), a significant increase in the mean Bcl-2 concentration (P=0.001), and a significant decrease in the mean BAX/Bcl-2 ratio (P=0.001) in male rats with diabetes compared with the diabetic and diabetic groups. Conclusion: The combined effect of eight-week resveratrol supplementation and interval training decreased apoptosis markers, while it increased the concentration of Bcl-2 in male rats with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Fibrovascular polyps of the esophagus are rare, benign, intraluminal submucosal tumors. In this report, we present a case of esophageal polyp in a young woman and discuss its diagnostic and surgical aspects. Esophageal polyps are rare and asymptomatic; however, they can grow extensively and cause significant discomfort for the patient. Therefore, it is crucial to consider them as a differential diagnosis. [ABSTRACT FROM AUTHOR]

The presence of primary retroperitoneal hydatid cysts is rare, even in endemic areas. The authors report a young man with a retroperitoneal hydatid cyst who underwent total cystectomy. The surgeons should suspect hydatid cysts in case of any abdominal cysts, especially in endemic areas, and avoid any spillage and puncture. Even in endemic locations, primary retroperitoneal hydatid cysts are scarce. However, practitioners, particularly surgeons, should think about hydatid cysts as a possible differential diagnosis for retroperitoneal masses. [ABSTRACT FROM AUTHOR]

The current study evaluates a rare case of parietal bone osteoid osteoma in pediatrics and review the differential diagnosis of button sequestrum sign in the literature. A 12‐year‐old girl expressed localized pain in the right parietal bone. MRI represented enhancing nodule with button sequestrum sign appearance. Due to the rarity of condition in children, osteoid osteoma should be considered as a differential diagnosis of button sequestrum sign in magnetic resonance imaging in children. [ABSTRACT FROM AUTHOR]