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Hassan Ravari1, Ali Jangjoo2, Jalal Motamedifar2, Kasra Moazzami31Vascular and Endovascular Surgery Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, 2Department of General Surgery, Mashhad University of Medical Sciences, Imam Reza Hospital, Mashhad, 3Department of General Surgery, Tehran University of Medical Sciences, Sina Hospital, Tehran, IranBackground: The rate of wound infection after appendectomy without antibiotic prophylaxis is 10%–30%. The role of prophylactic antibiotic therapy in nonperforated appendicitis is still controversial. Metronidazole is against anaerobic organisms and its bioavailability after oral and parenteral administration has been shown to be similar. The objective of the present study is to compare the infective complications rate after open appendectomy for nonperforated appendicitis receiving either oral or intravenous metronidazole as prophylaxis. Methods and Materials: From June 2007 to July 2009 in a randomized controlled trial, 204 patients with nonperforated appendicitis underwent an open appendectomy; 122 male and 82 female with mean age of 25 years. Among these, 102 (case group) received oral metronidazole and in 102 (control group) metronidazole was administered intravenously before surgery. The rate of wound infection and duration of the postoperative hospital stay was studied in the two groups.Results: The rate of wound infection was not significantly different in the two groups. (6% and 4% in study and control group, respectively, P = 0.861). Also the hospital stay was equal in two groups (2.3 days and 2.7 days in study and control group, respectively, P = 0.293).Conclusion: Single dose of oral metronidazole prior to operation can provide a sufficient prophylaxis for nonperforated appendicitis; so, it can be substitute the parental route of antibiotic administration. Keywords: antibiotic prophylaxis, wound infection, appendectomy, complications

"n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Seroma formation, or the subcutaneous collection of fluid, is a common problem after surgery for the breast cancer. It may lead to wound-related complications and also can delay adjuvant therapy. The aim of this study was to investigate the effect of various clinical and therapeutic variables on seroma formation."n"n Methods: A prospective cross sectional study of patients who underwent surgical therapy for breast cancer was carried out. Modified radical mastectomy was performed on 67 patients (65%) and 28 patients (27.2%) underwent breast conservative surgery. Simple extended mastectomy was done for the remaining 8 patients (7.8%). Seroma formation was studied in relation to age, type of surgery, tumor size, nodal involvement, preoperative chemotherapy, surgical instrument (electrocautery or scalpel), use of pressure garment, and duration of drainage. All of the patients followed for 4 weeks after surgery."n"nResults: A total of 103 patients with breast cancer were studied. The mean age of the patients was 48.3 years (25-82). Seroma occurred in 27 (26.2%) patients. There was statistically significant relation between age and seroma formation after breast cancer surgery (p=0.005), while other factors studied was found to be significantly ineffective. In addition, there was not any relation between seroma formation and drain duration. However, two factors including type of the operation and level of lymphatic dissection was considerable with confidence interval up to 90%, but it was not statistically significant with confidence interval >95% (p=0.068 and 0.063 respectively)."n"nConclusion: These findings suggest that the age is a predicting factor for seroma formation in breast cancer patients, while other factors do not significantly affect that.

Abstract This paper proposes a new method for improving the partial discharge (PD) localization accuracy by detecting the best places of ultra‐high frequency (UHF) sensors on the power transformer tank. In this way, firstly, the critical sites inside the power transformer that can produce PD are determined. Then the sensors’ positioning is done in such a way that if the PD happens at each point of these critical sites, the distance between the estimated PD location obtained by solving the time difference of arrival (TDOA) equations and the actual PD location is laid in an acceptable range. For this purpose, the TDOA equations are linearized around the critical PD coordinates as a matrix form A.X = B. The configuration of the sensor positions that minimizes the condition number of the matrix A is the best configuration. To evaluate the effectiveness of the proposed method, several simulations and evaluations are performed on a power transformer in the CST software. The obtained results and comparing them with the previous method and also conventional arbitrary sensors positioning confirm the effectiveness of this method.

Background: There are inconsistent results about the effect of gastric bypass surgery on thyroid function tests in morbidly obese subjects. The aim of this study was to investigate the changes in thyroid function tests and insulin resistance status in euthyroid morbidly obese subjects before and three months after gastric bypass surgery (GBS). Methods: Twenty-nine subjects with morbid obesity (BMI≥40) were enrolled in this before-after study. Patients with known thyroid disorders or a history of thyroid ablative therapy, users of drugs that affect thyroid function, or fasting blood sugar and insulin were excluded. TSH, Free T4, total T3, fasting blood sugar and insulin level, and BMI were measured before and 3 months after GBS. Statistical analysis was performed with appropriate tests and p

Objective(s): Sentinel lymph node biopsy (SLNB) has been proven as a safe and efficient procedure in some cancers like breast cancer and melanoma with a reduction of complications and side effects of unnecessary lymphadenectomy in many patients. However, the diagnostic value of SLNB in gastric cancer is a point of debate. This study evaluated the diagnostic value of SLNB using radiotracer and isosulphan blue dye injection in patients with Gastric Adenocarcinomas (GA).Methods: This descriptive study was performed at Imam-Reza HOSPITAL on 39 patients diagnosed with GA with no lymphatic metastasis using two methods: the combination of radionuclide with isosulphan together (R&I) method compared with the isosulphan alone method. Lymphatic dissection was performed in all patients. The pathological results were compared between the sentinel lymph nodes (SLN) and other lymph nodes and their accordance rate was calculated.Results: In the T1 group, the sentinel lymph node biopsy detection rate was 100% for the combination of the R&I method and 60% for the isosulphan method and the false negative rate was zero. These values respectively were 88.8% and 88.8% in the T2 group with a false negative rate of 75%. In the T3 group, the values were 100% for the combination of the R&I method and 93.7% for the isosulphan method with a false negative rate of 40%. In the combination of the R&I method, the sensitivity, specificity, and positive and negative predictive values were 57.9, 100, 100, and 69.2 percent respectively.Conclusion: Based on the false negative rate (47.4%), SLNB by injection of isosulphan blue dye alone is not a diagnostic enough value for predicting lymph node metastasis in GA. Although, SLNB by combination of the R&I had better accuracy compared to the isosulphan alone, more studies with larger samples are needed to prove this result.

Background and aims: The Achillea genus, part of the Asteraceae family, is native to the Northern Hemisphere, from Europe to Asia. These plants thrive in temperate climates and are often found in dry or semi-dry conditions. This research aimed to examine the therapeutic uses of Achillea plants, drawing from traditional medicine texts and laboratory and clinical studies. Methods: This narrative review involved a comprehensive search of major scientific databases to gather information on Achillea and its extracts from native or endemic species within the Achillea genus. The review spanned several decades and utilized sources such as Google Scholar, Scopus, PubMed, Institute for Scientific Information Web of Science, and botanical and local books (1990 - present). Results: Achillea is a medicinal plant used for the treatment of gynecological problems, diabetes control, gastrointestinal disorders, side effects of cancer such as mucositis caused by chemotherapy and radiotherapy, skin reactions caused by radiotherapy, treatment of prostate cancer, breast cancer, cervical cancer, and human gastric cancer. Conclusion: Considering the role of medicinal herbs in improving the side effects of cancer, treating certain types of cancer, controlling diabetes, and treating gastrointestinal problems, it is recommended to use this plant as a complementary medicine alongside routine treatments.

Introduction This study aimed to evaluate the possible role of urolithin A (UA) and urolithin B (UB) on the mRNA expression levels of LDL receptor (LDLR) and PSCK9 genes, and also of the uptake of LDL particles in HepG2 cells. Material and methods The potential role of UA and UB on the induction of LDL uptake and the expression of its regulatory genes was explored using HepG2 cells and curcumin (20 µM), berberine (50 µM), UA (80 µM), and UB (80 µM) as the treatments in the experimental tests. Results The LDL uptake and cell-surface LDLR were higher in cells treated with UA in comparison with cells treated with UB, and even in relation to the cells treated with curcumin and berberine as positive controls. In addition, cells treated with UB showed approximately 2 times greater LDLR expression levels compared with curcumin (FC = 2.144, p = 0.013) and berberine (FC = 2.761, p = 0.006). However, UA treatment resulted in significantly lower expression levels of LDLR compared with curcumin (FC = 0.274, p < 0.001) and berberine (FC = 0.352, p = 0.009). UB demonstrated approximately 8 times higher LDLR expression levels when compared with UA (FC = 7.835, p = 0.001). Compared with UB, as well as curcumin and berberine as positive controls, UA was more efficient in reducing PCSK9 expression levels. Although UB did not show any significant differences compared with curcumin and berberine, it showed higher levels of PCSK9 expression when compared with the UA group (FC = 3.694, p < 0.001). Conclusions The present results suggest that UA was more effective than UB in promoting LDL uptake as well as cell surface LDLR in HepG2 cells. This effect seems to be mostly mediated through the suppression of PCSK9 expression but not the induction of LDLR expression.

Background and aims: The research investigated the effect of care training during discharge on the stress and anxiety levels of mothers whose babies are undergoing open heart surgery. Parents of children with CHD experience high levels of stress and anxiety starting from the time of diagnosis, throughout the hospitalization for cardiac surgery, and even in the months and years that follow. Methods: In this quasi-experimental study, 60 mothers of children undergoing open heart surgery referred to the Tehran Children’s Medical Center Hospital entered the study through lottery sampling in 2019. Then, the Teach-back Method program was implemented for the intervention group in four sessions. Data were collected before and immediately after the intervention using a Questionnaire measuring parents’ stress and the Spielberger anxiety questionnaire. It was then analyzed using SPSS software version 16. Results: The study found that following the intervention, there was a significant decrease in the average scores of states and trait anxiety compared to the initial scores (P=0.006 and P=0.007, respectively). Additionally, the average stress score after the intervention was significantly lower than the initial score (P=0.001). Conclusion: The findings of this study suggest that offering oral instructions to mothers during the discharge phase of their children’s open-heart surgery can lead to positive outcomes by reducing post-operative anxiety and stress. These results highlight the need for further research to explore the long-term effects of post-operative oral education in various clinical settings.

Key Clinical Message Although gastro‐pleural fistulas after bariatric surgeries are rare, they are life‐threatening complications that should be suspected in patients who present with gastrointestinal or respiratory symptoms after bariatric surgery. Abstract Previous studies showed an incidence rate of 0.2%–0.37% for gastro‐pleural fistulas after bariatric surgery. We report a 56‐year‐old female with a rare presentation of gastro‐pleural fistula after Roux‐en‐Y gastric bypass, simultaneous fistula of the gastric pouch, and remnant to the pleural space.

Objective: The prevalence of obesity is increasing globally, necessitating effective treatment strategies. The effectiveness of Metabolic and Bariatric surgery (MBS) as a therapeutic option across different age groups remains debated. This study aimed to compare the outcomes and complications of MBS in patients less than 50 years old and 50 years or older. Methods and materials: This retrospective study analyzed data from patients who underwent MBS in a referral hospital in Mashhad, Iran, between April 2012 and March 2017. The recorded follow-up information was included for patients with at least six months post-surgery. Results: The study included 709 patients, 519 patients aged ≤ 50 years, and 190 patients > 50. The average age, weight, and BMI of the participants were 42.7 ± 13.24 years, 126.6 ± 31.23 kg, and 47.2 ± 10.37 kg/m2, respectively. Both age groups demonstrated significant improvements in BMI, cholesterol, and TG levels post-surgery, while significant improvements in FBS levels were observed only in the younger group (p < 0.05). Overall, substantial reductions in the prevalence of obesity-related comorbidity were observed in both age groups post-surgery (p < 0.05). None of the post-surgical complications had a statistically significant difference between the two age groups (p > 0.05). Conclusion: MBS is effective in reducing obesity-related comorbidities, regardless of age. Age should not be a limiting factor for MBS, as the benefits and complications do not differ significantly between patients under and over 50 years old. [ABSTRACT FROM AUTHOR]

Introduction. Gastric bypass surgery is a gold standard therapy for severe obesity. This study aimed to evaluate anthropometric predictors for short-term excess weight loss (EWL) after Roux-en-Y gastric bypass surgery (RYGB) in a sample of severely obese patients. Materials and Methods. This cohort study was conducted on severely obese candidates for RYGB bariatric surgery in Mashhad, Iran. Indirect calorimetry, anthropometric measurements, and body composition data were collected before, one, and six months after RYGB. Results. Fifty-four participants (43, 79.6% women and 11, 20.4% men) with a mean age of 39.63 ± 9.66 years participated in this study. The mean total weight and BMI loss within six months were 32.89 ± 20.22 kg and 12.37 ± 7.34 kg/m2, respectively. The mean reduction in adipose tissue and fat-free mass was 24.49 kg and 7.46 kg, respectively. The mean resting metabolism rate (RMR) reduction at one and six months after RYGB was 260.49 kcal and 396.07 kcal, respectively. There was a significant difference in mean RMR between the baseline and one and six months after RYGB (p0.05). Baseline skeletal muscle mass (SMM), excess BMI loss (EBMIL) at first month after surgery, and baseline neck circumference (NC) could predict EWL six months after surgery. Conclusion. Reduced RMR shortly after RYGB may be due to FFM reduction. Some anthropometric and their acute changes after RYGB may predict the short-term EWL in RYGB patients.

Background. Morbid obesity is frequently complicated by chronic liver diseases, including nonalcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH), and fibrosis. Parathyroid hormone (PTH) is found to be elevated in morbid obesity due to the defective hepatic metabolism of vitamin D. Bariatric surgery is performed to help patients with BMI>40 kg/m2 to effectively lose weight, particularly in patients with obesity who are afflicted with complications such as NAFLD/NASH. Objective. This study aimed to evaluate the PTH level as a predictor of hepatic function in individuals with morbid obesity who have undergone bariatric surgery. Methods. Ninety subjects with morbid obesity referred for Roux en-Y gastric bypass surgery were recruited. After IRB approval, demographic profiles, anthropometric factors, liver biopsy, and laboratory tests were obtained. The two-dimensional shear wave elastography (2D-SWE) technique was applied to assess hepatic stiffness. Results. A significant reduction occurred six months after bariatric surgery in the anthropometric indices p

Background and Aims. Visceral adiposity index (VAI) is a novel marker of fat distribution and function which incorporates both anthropometric and laboratory measures. Recently, several studies have suggested VAI as a screening tool for metabolic syndrome (MetS). Here, we aimed to consolidate the results of these studies by performing a systematic review and meta-analysis. Methods and Results. We searched PubMed and EMBASE online databases for eligible studies that investigated the association of VAI and MetS. After reviewing 294 records, we included 33 eligible papers with a sum of 20516 MetS and 53242 healthy participants. The risk of bias in the included studies was assessed, and the relevant data was extracted. All included studies reported a significant association between VAI and MetS screening, but were highly heterogeneous in their reported effects. We pooled the diagnostic test accuracy metrics of VAI for MetS screening and showed that it has a moderate-to-high accuracy with an area under the summary receiver operating characteristics curve of 0.847, a pooled sensitivity of 78%, and a pooled specificity of 79%. Besides, we pooled the difference in means of VAI between patients with MetS and healthy controls, revealing that VAI was 2.15 units higher in MetS patients. Conclusions. VAI is an accurate, low-cost, and widely available screening marker for MetS. However, further studies are needed to evaluate its applicability in clinical practice, determine an optimal cut-off, and identify populations that would benefit the most from it.

There is evidence in the literature to suggest that low back pain may change spine–pelvis coordination during activities of daily living. This study aimed to compare the variability of the spine–pelvis coordination during sit-to-stand in people with and without LBP. Ten healthy individuals with a history of LBP and ten individuals without history of LBP participated in this study. Three-dimensional kinematic data of the upper trunk (UT), lower trunk (LT), lower back (LB), and pelvis segments during sit-to-stand and stand-to-sit were recorded using a multi-segmental spine and pelvis models using a motion capture system. The coordination patterns and the variability of the adjacent segments (UT, LT, LB, and pelvis) were calculated using the modified vector coding method that was implemented through a custom MATLAB code. An independent sample t-test was utilized to assess the differences in the coordination pattern, and a statistical parametric mapping method was used to quantify the differences in coordination variability between the two groups. The results indicate that there are some differences in coordination patterns between groups during sit-to-stand and stand-to-sit. However, a significant difference in coordination variability was only observed during sit-to-stand. The results showed that LBP can alter the kinematics coordination even in the upper (pain-free) parts of the spine during sit-to-stand by changing the coordination between UT and LT in a way that can lead to an increase in the loading on these segments. Additionally, people with LBP showed more coordination variability during sit-to-stand, which can be associated with a coordination strategy that facilitates an optimal and possibly pain-free coordination pattern.

Background: There are inconsistent results about the effect of gastric bypass surgery on thyroid function tests in morbidly obese subjects. The aim of this study was to investigate the changes in thyroid function tests and insulin resistance status in euthyroid morbidly obese subjects before and three months after gastric bypass surgery (GBS). Methods: Twenty-nine subjects with morbid obesity (BMI=40) were enrolled in this before-after study. Patients with known thyroid disorders or a history of thyroid ablative therapy, users of drugs that affect thyroid function, or fasting blood sugar and insulin were excluded. TSH, Free T4, total T3, fasting blood sugar and insulin level, and BMI were measured before and 3 months after GBS. Statistical analysis was performed with appropriate tests and p<0.05 was considered significant. Results: Body mass index (BMI), insulin sensitivity index (HOMA-IR), and total T3 significantly decreased after bypass surgery (all with p<0.001) but no significant changes were seen in TSH (P=0.203) and FreeT4 (P=0.33). There was a significant negative correlation between changes in HOMA-IR and changes in FreeT4 (P=0.038, r= -0.38). There was no statistically significant correlation between the percentage of excess BMI loss (%EBMIL) and changes in T3 (P=0.66), Free T4 (P=0.92), TSH (P= 0.27), and HOMA-IR (P=0.17). Conclusion: Although significant changes can occur in BMI, insulin sensitivity index, fasting blood sugar, and T3 in short-time follow-up after bariatric surgery, significant TSH and FreeT4 changes may need longer follow-ups. [ABSTRACT FROM AUTHOR]

Background: Obesity is a chronic inflammatory condition associated with increased circulating levels of C-reactive protein (CRP). Bariatric surgery has been reported to be effective in improving both inflammatory and liver status. Our aims were to elucidate the relationships between pre-surgery high sensitivity-CRP (hs-CRP) values and post-surgery weight loss and liver steatosis and fibrosis in patients with severe obesity undergoing Roux-en-Y gastric bypass. Methods: We conducted an observational prospective study on 90 individuals with morbid obesity, who underwent gastric bypass. Anthropometric indices, laboratory assessment (lipid panel, glycemic status, liver enzymes, and hs-CRP), liver stiffness and steatosis were evaluated at baseline and 6-months after surgery. Results: There was a significant post-surgery reduction in all the anthropometric variables, with an average weight loss of 33.93 ± 11.79 kg; the mean percentage of total weight loss (TWL) was 27.96 ± 6.43%. Liver elasticity was significantly reduced (from 6.1 ± 1.25 to 5.42 ± 1.52 kPa; p = 0.002), as well as liver aminotransferases, nonalcoholic fatty liver disease fibrosis score (NFS) and the grade of steatosis. Serum hs-CRP levels significantly reduced (from 9.26 ± 8.45 to 3.29 ± 4.41 mg/L; p < 0.001). The correlations between hs-CRP levels and liver fibrosis (elastography), steatosis (ultrasonography), fibrosis-4 index, NFS, and surgery success rate were not significant. Regression analyses showed that serum hs-CRP levels were not predictive of liver status and success rate after surgery in both unadjusted and adjusted models. Conclusions: In patients with morbid obesity, bariatric surgery caused a significant decrease in hs-CRP levels, liver stiffness and steatosis. Baseline hs-CRP values did not predict the weight-loss success rate and post-surgery liver status.

Objective(s): Sentinel lymph node biopsy (SLNB) has been proven as a safe and efficient procedure in some cancers like breast cancer and melanoma with a reduction of complications and side effects of unnecessary lymphadenectomy in many patients. However, the diagnostic value of SLNB in gastric cancer is a point of debate. This study evaluated the diagnostic value of SLNB using radiotracer and isosulphan blue dye injection in patients with Gastric Adenocarcinomas (GA). Methods: This descriptive study was performed at Imam-Reza HOSPITAL on 39 patients diagnosed with GA with no lymphatic metastasis using two methods: the combination of radionuclide with isosulphan together (R&I) method compared with the isosulphan alone method. Lymphatic dissection was performed in all patients. The pathological results were compared between the sentinel lymph nodes (SLN) and other lymph nodes and their accordance rate was calculated. Results: In the T1 group, the sentinel lymph node biopsy detection rate was 100% for the combination of the R&I method and 60% for the isosulphan method and the false negative rate was zero. These values respectively were 88.8% and 88.8% in the T2 group with a false negative rate of 75%. In the T3 group, the values were 100% for the combination of the R&I method and 93.7% for the isosulphan method with a false negative rate of 40%. In the combination of the R&I method, the sensitivity, specificity, and positive and negative predictive values were 57.9, 100, 100, and 69.2 percent respectively. Conclusion: Based on the false negative rate (47.4%), SLNB by injection of isosulphan blue dye alone is not a diagnostic enough value for predicting lymph node metastasis in GA. Although, SLNB by combination of the R&I had better accuracy compared to the isosulphan alone, more studies with larger samples are needed to prove this result. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Although gastro‐pleural fistulas after bariatric surgeries are rare, they are life‐threatening complications that should be suspected in patients who present with gastrointestinal or respiratory symptoms after bariatric surgery. Previous studies showed an incidence rate of 0.2%–0.37% for gastro‐pleural fistulas after bariatric surgery. We report a 56‐year‐old female with a rare presentation of gastro‐pleural fistula after Roux‐en‐Y gastric bypass, simultaneous fistula of the gastric pouch, and remnant to the pleural space. [ABSTRACT FROM AUTHOR]