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Purpose: This study aimed to investigate the efficacy of hydrocortisone enema in preventing radiation proctitis in patients with rectal cancer undergoing short-course radiotherapy (SCRT)., Methods: This phase II randomized controlled trial enrolled patients with newly diagnosed locally advanced rectal cancer (clinically staged T3-4 and/or N1-2M0). Participants received a median of 4 cycles of neoadjuvant chemotherapy (capecitabine plus oxaliplatin) followed by 3-dimensional conformal SCRT (25 Gy in 5 fractions). Patients were randomly assigned to receive either a hydrocortisone enema (n=50) or a placebo (n=51) once daily for 5 consecutive days during SCRT. The primary endpoint was the incidence and severity of acute proctitis., Results: Of the 111 eligible patients, 101 were included in the study. Baseline characteristics, including sex, age, performance status, and tumor location, were comparable across the treatment arms. None of the patients experienced grade 4 acute gastrointestinal toxicity or had to discontinue treatment due to treatment-related adverse effects. Patients in the hydrocortisone arm experienced significantly less severe proctitis (P<0.001), diarrhea (P=0.023), and rectal pain (P<0.001) than those in the placebo arm. Additionally, the duration of acute gastrointestinal toxicity following SCRT was significantly shorter in patients receiving hydrocortisone (P<0.001)., Conclusion: Hydrocortisone enema was associated with a significant reduction in the severity of proctitis, diarrhea, and rectal pain compared to placebo. Additionally, patients treated with hydrocortisone experienced shorter durations of gastrointestinal toxicity following SCRT. This study highlights the potential benefits of hydrocortisone enema in managing radiation-induced toxicity in rectal cancer patients undergoing radiotherapy.

Objectives: The main purpose of this study was to compare the remineralizing effects of casein phosphopeptide amorphous calcium phosphate fluoride (CPP-ACPF) and tricalcium phosphate (TCP) on artificially induced enamel white spot lesions (WSLs). Materials and Methods: In this in vitro study, 45 sound extracted premolars were immersed in a demineralizing solution (pH=4.5) for 96 hours, and were randomly divided into 3 groups of TCP, MI Paste Plus, and control. They were exposed to the remineralizing agents for 5 minutes once a day for 30 days. After mounting the teeth in resin blocks and polishing, they underwent a microhardness test at 3 different depths from the enamel surface. Data were analyzed by Prism software, two-way ANOVA, and Tukey's test (α=0.05). Results: The volume percentage of mineral content (VPM) was significantly different among the three groups at 30-, 60- and 90µm depths (P<0.0001). At 30µm depth, CPP-ACPF was significantly more effective than TCP (P<0.0001). At 60- and 90µm depths, there was no significant difference between CPP-ACPF and TCP (P>0.05). Conclusion: Both CPP-ACPF and TCP had significant efficacy for remineralization of artificially induced enamel WSLs under in vitro conditions., Competing Interests: None declared., (Copyright © 2024 The Authors. Published by Tehran University of Medical Sciences.)

Background: This study assessed the prevalence of gastroesophageal reflux disease (GERD) in a general adult population in Iran. The association between GERD and various factors was also evaluated., Methods: We performed a cross-sectional study on 163,018 individuals aged over 35 who were enrolled in the PERSIAN cohort. GERD was defined as the occurrence of heartburn and/or regurgitation symptoms at least several days a month. Survey design analysis for pooled data was performed and multiple regression analysis was conducted to determine the independent risk factors for GERD., Results: The prevalence of GERD in our study was estimated at 21.86% (95% confidence interval:17.4%-36.4%). The mean age of the participants was 49.84 years±9.25 (35-70) and 44.75% of the participants were male. Symptoms of heartburn and regurgitation were reported in 18.65% (n: 29,170) and 6.06% (n: 9,717) of participants, respectively. In the multivariate analysis, several factors were found to be associated with a higher prevalence of GERD: female sex, age >50, current smoking, opium use, weekly consumption of fried foods, frequent consumption of hot tea, less than 6 hours of sleep per night, psychiatric disorders, usage of NSAIDs, and poor oral hygiene, were associated with a higher prevalence of GERD. Conversely, higher education levels and average physical activity were found to be less commonly associated with GERD., Conclusion: We found a relatively high prevalence of GERD (21.86%) in this population-based study in Iran. By identifying modifiable risk factors, this research offers opportunities for targeted interventions and lifestyle modifications to reduce the burden of GERD., Competing Interests: All authors declare that they have no conflict of interest., (Copyright: © 2024 Sadeghi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: The Kharameh cohort study (KHCS) is one branch of the 'Prospective Epidemiological Research Studies in Iran', located in the south of Iran. The enrolment phase of KHCS spanned from April 2015 to March 2017, during which urban and rural residents of Kharameh were enrolled in the study. KHCS aims to investigate the incidence of non-communicable diseases (NCDs) such as hypertension, diabetes mellitus, cardiovascular diseases and cancer, and its related risk factors in a 15-year follow-up., Participants: KHCS was designed to recruit 10 000 individuals aged 40-70 years old from both urban and rural areas of Kharameh. Thus, a total of 10 800 individuals aged 40-70 years of age were invited and, finally, 10 663 subjects were accepted to participate, with a participation rate of 98.7%., Findings to Date: Of the 10 663 participants, 5944 (55.7%) were women, and 6801 (63.7%) were rural residents. The mean age of the participants was 51.9±8.2 years. 41.8% of the participants were aged 40-49, 35.2% were aged 50-59 and the remaining 23% were 60-70 years old. Until March 2020 (first 3 years of follow-up), the total number of patients diagnosed with NCDs was 1565. Hypertension, type 2 diabetes and acute ischaemic heart disease were the most common NCDs. Furthermore, the total number of deaths during the first 3 years of follow-up was 312, with cardiovascular diseases (38.7%) as the most common cause of death, followed by cerebrovascular diseases (11.8%) and cancer (16.2%)., Future Plans: The remaining 12 years of follow-up will inevitably shed light on the genetic, lifestyle/socioeconomic status, and environmental risk and protective factors of NCDs., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

To investigate the effects of thymidylate synthase (TS) 3'UTR genotype on promotor methylation of tumor-related genes in 22 patients with sporadic colorectal cancer (CRC) from southern Iran. We evaluated the correlations of TS 3'UTR genotype with promoter methylation of hTERT, hMLH1, MSH2, MMP2, CDH1, p14, p16, and p21 genes in CRC patients. The polymorphism of TS 3'UTR was evaluated through mutagenically specific PCR. The genes promoter methylation was determined using methylation-specific PCR. For 10 patients, the gene expression profile of epigenetic regulating enzymes, histone deacetylases (HDACs) and DNA methyltransferases (DNMTs), was also examined in both tumor and normal adjacent tissues by quantitative real time PCR. There was a significant association between the hMLH1 methylation and age of patients ( P = 0.039) and also between MSH2 methylation and tumor site ( P = 0.036). There was insignificant association between gene-specific methylation and TS 3'UTR genotype. However, all polymorphic genotypes of TS were associated with higher methylation of hMLH1 and CDH1 and lower methylation of MSH2 . The -6bp/+6bp (heterozygous mutant) and [-6bp/+6bp, +6bp/+6bp] (homozygous mutant) genotypes resulted in higher methylation of p16 , and -6bp/+6bp and [-6bp/+6bp, +6bp/+6bp] genotypes were correlated with lower methylation of MMP2 . The overexpression of epigenetic enzymes, HDACs and DNMTs, was also demonstrated. There was no association between DNMTs transcript levels and gene-specific hypermethylation. The polymorphic TS genotypes, especially -6bp/+6bp, could affect methylation frequencies of studied genes. Moreover, promoter methylation status was not dependent on DNMTs gene expression. Large sample size studies may contribute to validate these findings., Competing Interests: The authors have no conflict of interests related to this publication.

Covering surgical wounds with biomaterials, biologic scaffolds, and mesenchymal stem cells (MSCs) improves the healing process and reduces postoperative complications. This study was designed to evaluate and compare the effect of MSC-free/MSC-seeded new collagen/poly(3-hydroxybutyrate) (COL/P3HB) composite scaffold and human amniotic membrane (HAM) on the colon anastomosis healing process. COL/P3HB scaffold was prepared using freeze-drying method. MSCs were isolated and characterized from rat adipose tissue. After biocompatibility evaluation by MTT assay, MSCs were seeded on the scaffold and HAM by micro-mass seeding technique. In total, 35 male rats were randomly divided into five groups. After the surgical procedure, cecum incisions were covered by the MSC-free/MSC-seeded scaffold or HAM. Incisions in the control group were only sutured. One month later, the healing process was determined by stereological analysis. The Kruskal-Wallis followed by Dunn's tests were utilized for statistical outcome analysis (SPSS software version 21). COL/10% P3HB scaffold showed the best mechanical and structural properties (7.86 MPa strength, porosity more than 75%). MTT assay indicated that scaffold and especially HAM have suitable biocompatibility. Collagenization and neovascularization were significantly higher, and necrosis was considerably lower in all treated groups in comparison with the controls. MSC-seeded scaffold and HAM significantly decrease inflammation and increase gland volume compared with other groups. The MSC-seeded HAM was significantly successful in decreasing edema compared with other groups. Newly synthesized COL/P3HB scaffold improves the colon anastomosis healing; however, the major positive effect belonged to HAM. MSCs remarkably increase their healing process. Further investigations may contribute to confirming these results in other wound healing., 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 © 2023 Elsevier Inc. All rights reserved.)

Background: Sacral masses can be removed using anterior, posterior, or combined approaches. Achieving total sacrectomy through a posterior-only approach results in a shorter procedure time, minimal tissue damage, and a reduced risk of complications. In this study, we aimed to share our experience with performing total sacrectomy using a posterior-only approach in 26 patients and to assess their clinical outcomes at our center., Materials and Methods: This retrospective study examines the clinical progression, surgical response, and outcomes of 26 patients with various sacral mass pathologies. We accessed patient information from our hospital records., Results: The study included 14 men (54%) and 12 women (46%), with an average age of 49.8 years. Most cases had a normal body mass index, while 6 were overweight. Sacrectomy was performed at a high level in 12 patients and at a middle level in 14 patients. In addition to pain, motor deficits were observed in 9 patients, and sphincter dysfunction was found in 5. Preoperative embolization was conducted for 11 patients. The most prevalent lesions were chordoma (8 patients), malignant peripheral nerve sheath tumor (4 patients), giant cell tumor (3 patients), and solitary plasmacytoma (3 patients). Only 1 patient experienced a temporary partial motor deficit after surgery. There were no instances of cerebrospinal fluid leakage. Five patients experienced local recurrence, and 1 had distant metastasis., Conclusions: Performing sacrectomy for large or giant sacral tumors through a posterior approach is both feasible and safe, resulting in reduced morbidity and no significant change in overall survival., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background and Aims: Hypertension and abnormal liver enzymes are common health issues that frequently coexist, and recent research has suggested a possible association between them, warranting further investigation. Therefore, the aim of this study is to explore the relationship between liver enzymes and hypertension., Methods: This prospective cohort study utilized data from the Kharameh cohort study, which is a branch of the Prospective Epidemiological Studies in Iran (PERSIAN) database. The study included 7710 participants aged between 40 and 70 years. Hypertension was defined in accordance with the European guidelines for hypertension management, and the association between liver enzymes and hypertension was modeled and predicted using Firth logistic regression., Results: This study investigated the association between liver enzymes and hypertension risk in a cohort of 7710 individuals aged 40-70 years. The results showed that higher levels of alanine aminotransferase (ALT), gamma glutamyl transferase (GGT), and alkaline phosphatase (ALP) were associated with an increased risk of hypertension, and this relationship remained significant even after adjusting for potential confounding factors. Additionally, separate analyses within age subgroups revealed a significant association between ALP concentration and high blood pressure in certain age ranges., Conclusion: The study demonstrated a significant association between high levels of ALT, GGT, and ALP and an increased risk of hypertension, regardless of other risk factors. These results suggest that monitoring liver enzymes, specifically ALT, GGT, and ALP, could serve as a useful tool to predict hypertension risk and identify individuals who could benefit from early intervention. Overall, these findings underscore the importance of monitoring liver function in preventing and managing hypertension., Competing Interests: The authors declare no conflicts of interest., (© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Background: Cardiovascular diseases are the main cause of mortality in the world. This study aimed to estimate the incidence and identify the risk factors of these diseases., Methods: This prospective cohort study was performed on 9442 individuals aged 40-70 years in Kharameh, a city in the South of Iran, in 2015-2022. The subjects were followed up for 4 years. The demographic information, behavioral habits, biological parameters, and history of some diseases were examined. The density incidence of cardiovascular disease was calculated. The log-rank test was calculated to assess the cardiovascular incidence difference between men and women. Simple and multiple Cox regression with Firth's bias reduction method were used to identify the predictors of cardiovascular disease., Results: The mean ± SD age of the participants was 51.4 ± 8.04 years, and the density incidence was estimated at 1.9 cases per 100,000 person-day. The log-rank test showed that men had a higher risk of cardiovascular disease than women. The Fisher's exact test showed a statistically significant difference between the incidence of cardiovascular diseases in different age groups, education levels, diabetes, and hypertension in men and women. The results of multiple Cox regression revealed that with increasing age, the risk of developing CVDs increased. In addition, the risk of cardiovascular disease is higher in people with kidney disease (HR adj  = 3.4, 95% CI 1.3 to 8.7), men (HR adj  = 2.3, 95% CI 1.7 to 3.2), individuals with hypertension (HR adj  = 1.6, 95% CI 1.3 to 2.1), diabetics (HR adj  = 2.3, 95%c CI 1.8 to 2.9), and alcohol consumption (HR adj  = 1.5, 95% CI 1.09 to 2.2)., Conclusions: In the present study, diabetes, hypertension, age, male gender, and alcohol consumption were identified as the risk factors for cardiovascular diseases; three variables of diabetes, hypertension and alcohol consumption were among the modifiable risk factors, so if they were removed, the incidence of cardiovascular disease could greatly reduce. Therefore, it is necessary to develop strategies for appropriate interventions to remove these risk factors., (© 2023. The Author(s).)

Background and Aims: Several studies have shown the association between obesity and sleep. Roux-en-Y gastric bypass (RYGB) surgery may improve sleep disturbances in patients with obesity by influencing a variety of factors. This study aims to evaluate the impact of bariatric surgery on sleep quality., Methods: Patients with severe obesity referred to the obesity clinic of a center from September 2019 to October 2021 were collected. The patients were divided into two groups, depending on whether they underwent RYGB surgery. Medical comorbidities and self-report questionnaires regarding sleep quality, anxiety, and depression were collected at baseline and 1-year follow-up., Results: 54 patients were included, including 25 in the bariatric surgery group and 29 in the control group. However, five patients in the RYGB surgery group and four patients in the control group were lost in the follow-up. Pittsburgh Sleep Quality Index (PSQI) was decreased from a mean of 7.7 to 3.8 in the bariatric surgery group (p-value<0.001). In contrast to the control group, the number of patients with obstructive sleep apnea was significantly reduced in the bariatric surgery group., Conclusions: We showed a significant improvement in sleep quality following RYGB surgery. Obstructive sleep apnea, obesity/overweight, and depressive symptoms significantly improved in our study. There is a lack of a better understanding of the association between these factors and sleep quality following surgery. Therefore, further studies are recommended regarding this issue., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Background. Single anastomotic surgeries can increase the risk of reflux, marginal ulceration, and gastrointestinal complications. Braun anastomosis prevents bile reflux after gastric resection and gastrojejunal anastomosis surgeries. The present pilot study evaluated Braun's efficacy in a single anastomosis sleeve ileal (SASI) bypass surgery. Methods. 28 patients with a history of SASI bypass surgery from October 2017 to September 2021 were included in the study. Patients were divided into 2 groups based on having Braun anastomosis to this surgical procedure; group A: underwent SASI bypass without Braun anastomosis; group B: underwent SASI bypass with Braun anastomosis. The surgical complications in terms of bile reflux, marginal ulcer, reflux esophagitis, and gastritis were evaluated and compared between the groups. Results. Bile reflux and reflux esophagitis were seen more in group A than in group B (37.5% vs 8.3% and 18.8% vs 8.3%, respectively). In contrast, 2 patients (16.7%) in group B had marginal ulcers compared to 1 (6.3%) in group A. Also, gastritis was seen in 1 patient in each group (6.3% in group A vs 8.3% in group B). However, the differences were not statistically different. Conclusions. Braun anastomosis is probably an effective procedure to reduce bile reflux, a concern of SASI bypass. Besides, further studies with a larger study population are needed.

Background: Bariatric surgery is an appropriate treatment for obese patients with metabolic syndrome. Adipose tissue is an active endocrine tissue secreting leptin and adiponectin that affect body metabolism. Nowadays, a high incidence of metabolic syndrome with an increased risk of serious diseases has been detected in Shiraz. This study aimed to assess the levels of leptin and adiponectin as well as the adiponectin-to-leptin ratio in three different bariatric surgeries among obese patients in Shiraz. The results will play an important role in physicians' choice of surgery by distinguishing the effects of these three bariatric surgeries., Materials and Methods: The serum adiponectin and leptin levels were measured using enzyme-linked immunosorbent assay. Blood glucose, lipid profile, weight, and liver enzyme level were measured before and 7 months after surgery., Results: This clinical trial was conducted on 81 obese patients who underwent sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and single anastomosis sleeve ileal (SASI) bypass surgeries. The results revealed a decrease in fasting blood sugar and triglyceride (TG) levels 7 months after the surgeries. In addition, decrease of body mass index (BMI) was more significantly in the SASI group (12.8 ± 3 4.95) compared to the Roux-en-Y gastric group (8.56 ± 4.61) ( P = 0.026). Besides, a more significant improvement in liver function was observed in SG ( P < 0.05). Furthermore, the results revealed a significant difference among the three groups regarding the increase in the adiponectin level ( P = 0.039). Decrease in the leptin level and increase in the adiponectin level were more significant after the RYGB surgery compared to the SG group ( P < 0.05)., Conclusion: The three bariatric surgeries were effective in increasing the adiponectin level and decreasing the leptin levels. The surgeries also changed the metabolic risk factors including TGs, high-density lipoprotein, fasting blood glucose, and BMI., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Research in Medical Sciences.)

Background and Aim: Prehypertension and hypertension are important risk factors for cardiovascular diseases. This study was carried out to evaluate the effect of prehypertension and hypertension on the development of cardiovascular diseases., Methods: This prospective cohort study was performed on 9442 people aged 40-70 in Kharameh, southern Iran. Individuals were divided into three groups: normal blood pressure ( N  = 5009), prehypertension ( N  = 2166), and hypertension ( N  = 2267). In this study, demographic data, disease histories, behavioral habits, and biological parameters were studied. At first, the incidence density was calculated. Then Firth's Cox regression models were used to investigate the association between prehypertension and hypertension with the incidence of cardiovascular diseases., Results: The incidence density in the three groups of individuals with normal blood pressure, prehypertension, and hypertension was 1.33, 2.02, and 3.29 cases per 100,000 person-days, respectively. The results of multiple Firth's Cox regression by controlling all factors showed that the risk of occurrence of cardiovascular disease in people with prehypertension was 1.33 times (hazard ratio [HR] = 1.32, 95% confidence interval [CI]: 1.01-1.73, p  = 0.03) and those with hypertension were 1.85 times higher (HR = 1.77, 95% CI: 1.38-2.29, p  < 0.0001) than the individuals with normal blood., Conclusion: Prehypertension and hypertension have played an independent role in the risk for developing cardiovascular diseases. Therefore, early detection of individuals with these factors and control of other risk factors in them can contribute to reducing the occurrence of cardiovascular diseases., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Background: Bowel obstruction is a disorder in the passage of bowel contents, the etiology of which varies depending on temporal and geographical conditions. This study investigated the etiology of bowel obstruction in a large number of patients at an adult surgery referral center in southern Iran., Methods: In this cross-sectional study, we reviewed the medical records of all patients admitted to Shahid Faghihi hospital (Shiraz, Iran) between 2014 and 2020 with a diagnosis of small or large bowel obstruction. Patients with missing or obscure data on etiology were excluded. Data was collected on the patients' age, gender, history of relevant surgeries, comorbidities, cause of obstruction, site/type of obstruction, treatment, intensive care unit (ICU) admission, length of hospital stay, and outcome. Statistical analyses were made using SPSS v. 25.0., Results: A total of 2781 bowel obstruction patients (61.4% males, 38.6% females) with a median age of 58 (IQR 43-71) years were studied. Most responded to non-surgical treatment (61.3%). While the obstruction was mostly partial (65.5%), 94.4% of patients with complete obstruction required surgery. Small bowel obstruction (SBO) was almost three times more prevalent than large bowel obstruction (LBO). Adhesion bands were the leading cause of SBO (66.77%), while LBO was primarily due to colorectal tumors (33.9%)., Conclusion: The predominant etiology of LBO was colorectal cancer, suggesting that policymakers should improve surveillance programs to detect the condition earlier. Regarding SBO, the leading cause was adhesion bands, indicating the necessity of further efforts to reduce the rate of adhesions following intra-abdominal operations., (© 2023 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background: Adaptive cognitive emotion regulation (CER) strategies toward eating play a very important role in obesity and according to schema therapy, patients with obesity learn that don't respond to their emotional stimuli by eating. Thus, this study aimed to evaluate the effectiveness of an online video-based group schema therapy in improvement of the CER strategies and body mass index (BMI) in women who had undergone bariatric surgery., Methods: Forty women who had undergone sleeve gastrectomy were selected and randomly divided into two groups of control and experimental. The experimental group received 10 weekly 90-min sessions of group schema therapy, the control group did not receive any intervention at all. Both groups completed the CER strategies questionnaire during pre-test, post-test and follow-up stages, and the data were analyzed using a multivariate analysis of covariance (MANCOVA) through SPSS software (version 20)., Results: Our results indicated that the experimental group demonstrated significantly higher adaptive CER strategies (P = 0.0001, F = 31.15) and significantly lower maladaptive CER strategies (P = 0.001, F = 9.42), significantly lower BMI (P = 0.001, F = 23.48), as compared to the control condition, following the group schema therapy after the follow-up stage., Conclusion: The findings demonstrated that group schema therapy could lead to an increases in adaptive CER strategies and a decrease in maladaptive CER strategies and BMI in women who had undergone bariatric surgery., Trial Registration: IRCT, IRCT20180523039802N2. Registered 5 August 2020, http://www.irct.com/IRCT20180523039802N2 ., (© 2023. The Author(s).)

Silver carp (Hypophthalmichthys molitrixi) was processed by sous-vide method at different temperatures (60, 65, 70, and 75°C). Then, the microbiological quality of the processed samples was monitored during cold storage (4°C) for 21 days. The target microorganisms were Enterobacteriaceae, Lactic Acid bacteria (LAB), Pseudomonas, Psychrotrophs, and total viable count (TVC). In samples processed at 75°C, the presence of Enterobacteriaceae, Pseudomonas and Psychrotrophs were not detectable up to 15 days of storage and lactic acid bacteria were not detectable even at the end of the storage period. A radial basis function neural network (RBFNN) model was established to predict the changes in the microbial content of silver carp. In this step, the relationship between processing temperature and storage duration on microbial growth was modeled by ANNs (artificial neural networks). The optimal ANN topology for modeling Enterobacteriaceae, Pseudomonas, and Psychrotroph contained 9 neurons in the hidden layer, but it contained 15 and 14 neurons for TVC and LAB, respectively. By experimenting with the temperature of -80°C, it was revealed that the obtained ANN model has a high potential for prediction., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Hosseini et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Studies indicate an association between hyperuricemia (HUA) and metabolic syndrome risk factors. On the other hand, obesity is a major modifiable and independent risk factor for HUA and gout. However, evidence concerning the effects of bariatric surgery on serum uric acid levels is limited and not completely clarified. This retrospective study was carried out with 41 patients who underwent sleeve gastrectomy (n = 26) and Roux-en-Y gastric bypass (n = 15) from September 2019 to October 2021. Anthropometric, clinical, and biochemical data, including uric acid blood urea nitrogen and creatinine fasting blood sugar (FBS), serum triglyceride (TG), and serum cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), were measured preoperatively and postoperative 3, 6 and 12 months. From baseline to 6 and 12 months, bariatric surgery resulted in a significant decrease in serum uric acid of patients with severe obesity (p < 0.001). The decreases in serum FBS, TG, and cholesterol of patients were significant during 6 and 12 months of follow-up (p < 0.05). However, the HDL increase of patients was not statistically significant in 6 and 12 months (p > 0.05). Besides, although patients' serum level of LDL decreased significantly during the 6 months of follow-up (p = 0.007), it was not significant after 12 months (p = 0.092). Bariatric surgery significantly reduces serum uric acid levels. Therefore, it may be an effective supplementary therapy for lowering serum uric acid concentrations in morbidly obese patients., Competing Interests: Conflict of Interest: The authors declare that they have no competing interests., (Copyright © 2023. The Korean Society of Clinical Nutrition.)

Introduction: SARS-CoV-2 infection (COVID-19) pandemic may influence the weight outcomes of bariatric surgeries (BS). Here, we intended to compare the weight outcome of patients who underwent BS before and during the pandemic time., Methods: In a retrospective, single-center study, the information of two groups of patients; first COVID-19 group (n = 51) consisted of those that underwent BS during the pandemic and completed a year of follow-up, second non-COVID-19 group included 50 patients who underwent BS and were followed up before the pandemic. All the patients' anthropometric and obesity-related disease data were compared between groups., Results: Weight loss and the decrease of body mass index 1 year after the surgery, as well as excess weight loss and total weight loss, were significantly higher in the non-COVID-19 group compared to the COVID-19 group (p < 0.05). Although the rate of remission for diabetes mellitus, hypertension, and dyslipidemia was higher in the non-COVID-19 group, the differences were not statistically significant (p > 0.05)., Conclusion: We showed a significantly poorer weight outcome at the 1-year follow-up of the BS during the pandemic compared to the pre-pandemic. These results need further investigations to determine the preventive measures and management by evaluating the associated factors., (© 2022 The Author(s). Published by S. Karger AG, Basel.)

Background: Kidney stone is the major cause of morbidity, and its prevalence is increasing in the world. This study aimed to assess the prevalence and risk factors of kidney stone in the adult population of southern Iran based on the data of the Kharameh Cohort Study., Methods: This cross-sectional study was conducted on 10,663 individuals aged 40-70 years old, using the baseline data of Kharamah cohort study, which started in 2014. Among all participants, 2251 individuals had a history of kidney stone. The participants' demographic characteristics, behavioral habits, and the history of underlying diseases were investigated. The crude and Age Standardized Prevalence Rate of kidney stones was calculated. Also, logistic regression was used to identify the predictors of kidney stone. To check the goodness of fit index of the model, we used the Hosmer-Lemeshow test. All analyses were performed in STATA software., Results: The prevalence of kidney stone was estimated 21.11%. Also, the Age Standardized Prevalence Rate in men and women was calculated 24.3% and 18.7%, respectively. The mean age of the participants was 52.15 years. Higher prevalence of kidney stone was seen in women aged 40-50 years (40.47%, p = 0.0001) and moderate level of social economic status (31.47%, p = 0.03), men with overweight (44.69%, p < 0.0001) and those in a very high level of social economic status (35.75%, p = 0.001). The results of multiple logistic regression showed that the chance of having kidney stone was 1.17 times higher in diabetic individuals, 1.43 times higher in hypertensive individuals, 2.21 times higher in individuals with fatty liver, and 1.35 times higher in individuals with overweight. The level of socio economic status, male sex, and age were the other factors related to kidney stone., Conclusion: In this study, underlying diseases such as fatty liver, diabetes, and hypertension as well as age, male sex, overweight, and high social economic status were identified as important risk factors for kidney stone. Therefore, identifying individuals at risk of kidney stone and providing the necessary training can greatly help to reduce this disease. However, health policymakers should prepare preventive strategies to reduce the occurrence of kidney stone., (© 2022. The Author(s).)

Background and objective Tracheostomy in coronavirus disease 2019 (COVID-19) patients can be performed in cases of prolonged intubation or in patients with a known difficult airway. Tracheostomy is usually performed by two main approaches: open surgery or percutaneous endoscopic insertion. However, few studies have compared these two techniques in severe COVID-19 patients. The objective of the present study was to compare the efficacy of the two main methods of tracheostomy among patients with severe COVID-19 infection. We also aimed to investigate the impact of various lab data and medications on patient outcomes. Materials and methods We included all symptomatic severe COVID-19 patients in need of prolonged mechanical ventilation. We examined the patients' past medical history, arterial blood gas (ABG) analysis, laboratory workups, and medication history. We calculated the PaO 2 /FiO 2  ratio as an index to evaluate the severity of acute respiratory distress syndrome (ARDS). Results During the study period, 72 patients with severe COVID-19 underwent tracheostomy tube insertion. The average age of participants was 58.93 ±15.27 years; 44 (61.1%) were male and 28 (38.9%) were female. Of note, 54 (75.0%) patients passed away and only 18 (25.0%) survived. Among the survivors, 13 (29.5%) were men and five (17.9%) were women. The study showed a significantly higher mortality rate (23, 92.0%) among patients who underwent open surgery compared to those who received percutaneous surgery (31, 65.9%) (p=0.01). Conclusion Based on our findings, percutaneous endoscopic tracheostomy seems to be the superior approach compared to open tracheostomy. Other predictive factors associated with patient outcomes included levels of HCO 3 , FiO 2 , PaCO 2 , and PaO 2 /FiO 2 ratio., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Akbari et al.)

Background and Aim: Multimorbidity is one of the problems and concerns of public health. The aim of this study was to estimate the prevalence and identify the risk factors associated with multimorbidity based on the data of the Kherameh cohort study., Methods: This cross-sectional study was performed on 10,663 individuals aged 40-70 years in the south of Iran in 2015 to 2017. Demographic and behavioral characteristics were investigated. Multimorbidity was defined as the coexistence of two or more of two chronic diseases in a person. In this study, the prevalence of multimorbidity was calculated. Logistic regression was used to identify the predictors of multimorbidity., Results: The prevalence of multimorbidity was 24.4%. The age-standardized prevalence rate was 18.01% in males and 29.6% in females. The most common underlying diseases were gastroesophageal reflux disease with hypertension (33.5%). Multiple logistic regression results showed that the age of 45-55 years (adjusted odds ratio [OR adj] ] = 1.22, 95% confidence interval [CI], 1.07-1.38), age of over 55 years (OR adj  = 1.21, 95% CI, 1.06-1.37), obesity (OR adj  = 3.65, 95% CI, 2.55-5.24), and overweight (OR adj  = 2.92, 95% CI, 2.05-4.14) were the risk factors of multimorbidity. Also, subjects with high socioeconomic status (OR adj  = 1.27, 95% CI, 1.1-1.45) and very high level of socioeconomic status (OR adj  = 1.53, 95% CI, 1.31-1.79) had a higher chance of having multimorbidity. The high level of education, alcohol consumption, having job, and high physical activity had a protective role against it., Conclusion: The prevalence of multimorbidity was relatively high in the study area. According to the results of our study, age, obesity, and overweight had an important effect on multimorbidity. Therefore, determining interventional strategies for weight loss and control and treatment of chronic diseases, especially in the elderly, is very useful., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Introduction: No standard of anatomical variables, including stoma size, limb length, pouch size, and volume, has been determined for laparoscopic Roux-en-Y gastric bypass yet. Herein, we evaluated the effect of two different techniques for creating the gastric pouch on short-term postoperative weight loss., Methods: This retrospective cohort was conducted on patients with a laparoscopic Roux-en-Y gastric bypass history from January 2019 to September 2020. Patients were divided into two groups: in one group, patients' gastric pouch was made using two 60 mm linear staplers, while in the other group, the gastric pouch was made using three 60 mm linear staplers. Anthropometric data, including weight, height, and body mass index (BMI), were measured preoperatively and six months following surgery. Weight outcomes, such as weight loss, a decrease in BMI, excess weight loss (%EWL), and total weight loss (%TWL), were calculated as short-term weight outcomes., Results: Two groups, each containing 50 patients, were included. Patients with smaller pouches (two staplers) had 32.4 ± 9.2 kg weight loss, and those with larger pouches (three staplers) had a 31.42 ± 10.3 kg weight loss. Also, %EWL was 69.7 ± 14.9 and 63.0 ± 20.9, and %TWL was 28.2 ± 6.0 and 26.14 ± 7.5 in patients with two stapler pouches and three stapler pouches, respectively. None of the weight outcome parameters were significantly different between the groups (p-value>0.05)., Conclusion: Various studies have been conducted, resulting in different conclusions regarding the effect of the size of the gastric pouch on weight loss. One of the major differences contributing to varying literature studies results is the measurement method used for gastric pouch size. We conclude that using two staplers is not a way to achieve a better result. As the best measurement method has not been defined, studies comparing different methods are suggested; here, the aim was to use a more simple and clinical method regarding this issue., Competing Interests: None declared., (© 2022 The Authors.)

Obesity is an increasing problem that can lead to noncommunicable diseases. The role of dietary factors on one's obesity is confirmed in many studies. One nutritional approach that can be used for assessment of the foods and diets is the Index of Nutritional Quality (INQ). Our study is aimed at exploring the association between INQ and obesity. Our hypothesis is that enriched and high-quality diets reduce the risk of overweight or obesity. This study was carried out on 6248 overweight and obese participants, from whom 4356 (69.7%) and 1892 (30.3%) were overweight and obese, respectively. To assess the dietary intake for the participants, a valid food frequency questionnaire (FFQ) with 130 food items was utilized. The analysis revealed an inverse association between the overweight and the INQ of iron, thiamin, riboflavin, B6, folate, zinc, magnesium, calcium, and vitamin C and E. For the obese group, this inverse association was found for iron, B6, folate, zinc, magnesium, calcium, and vitamin C and E. These results approved our hypothesis that a rich nutrition diet may lead to a lower risk of obesity., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Maryam Jalali et al.)

Background: Sparse data are available regarding the efficacy and safety of single anastomosis sleeve ileal (SASI) bypass surgery, where most available studies utilized short-term follow-ups. Therefore, this study was conducted to evaluate the safety and outcomes of this procedure in three consecutive years after the surgery., Materials and Methods: This retrospective study was carried out with 116 patients who underwent SASI from October 2016 to September 2021. Anthropometric, clinical, and biochemical data were recorded before, 1, 2, and 3 years after surgery., Results: The 1, 2, and 3-year percentage of excess weight loss (%EWL) were 87.37%, 90.7%, and 80.6%, respectively. Remission or improvement was recorded for diabetes mellitus in 90.9%, hypertension in 80.0%, hyperlipidemia in 100%, sleep apnea in 100%, and irregular menstruation in 58.06 at 3 years after surgery. No mortality and 5.1% early major postoperative complications were recorded. Eight patients (6.8%) had reversal surgery due to EWL &gt; 100%., Conclusions: The SASI bypass is an effective bariatric surgery that achieved sequential weight loss and improvement in medical comorbidities three years after the surgery; however, standardization of SASI procedure technique is needed to ameliorate nutritional deficiencies., (© 2022. The Author(s) under exclusive licence to Société Internationale de Chirurgie.)

Purpose: The present study aimed to compare two newly introduced procedures, single anastomosis sleeve jejunal (SASJ) with ileal (SASI) bypass in terms of weight loss, remission of obesity-associated medical problems, complications, and nutritional status., Materials and Methods: This retrospective study was carried out with 162 patients who underwent single anastomosis sleeve gastrointestinal bypass from October 2017 to September 2021, either single anastomosis sleeve jejunal bypass (SASJ) or single anastomosis sleeve ileal bypass (SASI). The main outcome measures were weight loss and improvement in obesity-associated medical problems, nutritional status, and complications at 12 months post-surgery., Results: At 12 months, both groups showed significant weight loss and remission in obesity-associated medical problems. There were significant differences in body mass index (BMI), total weight loss (TWL), and excess weight loss (EWL) between SASI and SASJ bypass (P < 0.05). Improvements in associated medical problems after the two procedures were similar except for hypertension. The reversal surgery rate of the SASI group was significantly higher than that of the SASJ group (5.5% vs. 0.0%, p = 0.03)., Conclusions: SASJ and SASI bypass achieved satisfactory weight loss and improvement in obesity-associated medical problems that were comparable between the two groups. SASI bypass was followed by a significant difference in the rate of reversal surgery at 1 year due to a short common channel, which was not observed after SASJ bypass., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The main goal of bariatric surgery (BS) in patients with morbid obesity is reducing body mass and fat mass (FM). However, body mass loss is systematically accompanied by a decline in fat-free mass (FFM). We aimed to examine the time-course effect of BS on FFM and body FFM percentage (FFM%) in individuals with morbid obesity by conducting a systematic review and meta-analysis of controlled adult human trials. We searched PubMed, Scopus, Embase, Institute for Scientific Information Web of Science, and Cochrane databases within the period from October 2002 to May 2021, with no restriction in the English language, to find studies assessing the effect of BS on FFM and FFM% in patients with morbid obesity. A meta-analysis of 122 studies carried out on data of 10,758 patients with morbid obesity after BS showed that BS was associated with a substantial decrease in FFM at 1 (-3.47 kg [95% confidence interval [CI]: -3.88, -3.07]), 3 (-5.59 kg [95% CI: -6.01, -5.17], 6 (-6.61 kg [95% CI: -7.25, -5.98]), and 12 (-8.34 kg [95% CI: -9.04, -7.63]) months after the surgery; however, the FFM% increased at 3 (6.51% [95% CI: 5.00, 8.02]), 6 (8.56% [95% CI: 6.81, 10.31], and 12 (11.29% [95% CI: 8.94, 13.64]) months after the surgery. BS was associated with sustained declines in FFM and increases in FFM% from 1-12 months with no indication of plateau phase postoperatively. These findings emphasize that postbariatric care should focus more on FFM loss during the first year after surgery., (Copyright © 2022. Published by Elsevier Inc.)

Background: Previous studies have reported that gastrectomy and fundectomy can induce osteopenia. Body fat index is a new index of obesity that shows central obesity and other risks of obesity. Sleeve gastrectomy (SG) is a bariatric surgery and a new technique introduced as subsleeve, which only resected fundus of the stomach. In this study, it has been shown the effect of subsleeve and SG on fat index and bone densitometry in an animal model., Materials and Methods: Rabbits were underlined SG, fundectomy (surgical removal of fundus), or sham-operated (controls without any resection), and after 12 weeks, fat index and bone densitometry were obtained., Results: Our study showed that there was no significant difference between SG and fundectomy groups in bone mass density and fat mass after surgery in comparison with presurgery condition. SG group were associated with lower fat index and bone density, and it showed significantly decrease in weight after 1.5 months., Conclusion: Sub-SG did not show any significant effect on fat index and bone densitometry in comparison with SG. However, we found lower fat index in sleeve group of rabbits, but it was not statistically significant., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Advanced Biomedical Research.)

Background: The prevalence of cardiovascular disease (CVD) is rapidly increasing in the world. The present study aimed to assess the prevalence and Predictors factors of CVD based on the data of Kherameh cohort study., Methods: The present cross-sectional, analytical study was done based on the data of Kherameh cohort study, as a branch of the Prospective Epidemiological Studies in Iran (PERSIAN). The participants consisted of 10,663 people aged 40-70 years. CVD was defined as suffering from ischemic heart diseases including heart failure, angina, and myocardial infarction. Logistic regression was used to model and predict the factors related to CVD. Additionally, the age-standardized prevalence rate (ASPR) of CVD was determined using the standard Asian population., Results: The ASPR of CVD was 10.39% in males (95% CI 10.2-10.6%) and 10.21% in females (95% CI 9.9-10.4%). The prevalence of CVD was higher among the individuals with high blood pressure (58.3%, p < 0.001) as well as among those who smoked (28.3%, p = 0.018), used opium (18.2%, p = 0.039), had high triglyceride levels (31.6%, p = 0.011), were overweight and obese (66.2%, p < 0.001), were unmarried (83.9%, p < 0.001), were illiterate (64.2%, p < 0.001), were unemployed (60.9%, p < 0.001), and suffered from diabetes mellitus (28.1%, p < 0.001). The results of multivariable logistic regression analysis showed that the odds of having CVD was 2.25 times higher among the individuals aged 50-60 years compared to those aged 40-50 years, 1.66 folds higher in opium users than in non-opium users, 1.37 times higher in smokers compared to non-smokers, 2.03 folds higher in regular users of sleeping pills than in non-consumers, and 4.02 times higher in hypertensive individuals than in normotensive ones., Conclusion: The prevalence of CVD was found to be relatively higher in Kherameh (southern Iran) compared to other places. Moreover, old age, obesity, taking sleeping pills, hypertension, drug use, and chronic obstructive pulmonary disease had the highest odds ratios of CVD., (© 2022. The Author(s).)

Ethnopharmacological Relevance: Traditional medicine has a long history and plays an important role in the Kurdish community in Sarvabad county, Kurdistan province, Iran. Despite the great diversity of medicinal plants, cultural history, and variety of herbal medicine uses among Kurdish tribes, very few cohesive ethnopharmacological studies of this unique region are available in the scientific literature. Our study tried to gather medicinal plant species and document the associated indigenous knowledge of the ethnic groups in the Sarvabad district for the first time., Materials and Methods: Ethnobotanical data were collected from 92 local informants through semi-structured questionnaires, open interviews, and field surveys during a period of two years (2018-2020). The statistical analysis included use reports (UR) for each species, and informant consensus factor (FIC) to evaluate the data., Results: In the present study a total of 156 plant species belonging to 58 botanical families, were recorded for the treatment of 16 diseases categories. The most represented families were Lamiaceae, followed by Asteraceae, and Apiaceae. The most frequently cited plant species with the highest use report (UR) were Pistacia atlantica (161), Hymenocrater longiflorus (128), Melissa officinalis (124), Cyperus rotundus (114), Thymus transcaspicus (112), and Quercus brantii (109). Psychological (ICF = 0.96), musculoskeletal (ICF = 0.94), and digestive (ICF = 0.93), followed by respiratory problems (ICF = 0.92) showed the highest informant consensus factors among all ailment categories. Most herbal remedies were consumed as decoction. Leaves (28.5%) were the most widely used plant parts, followed by flowers (18.7%), aerial parts (14.5%), seeds (13.2%), and terrestrial parts (8.41%). Some interesting new medicinal uses for native and common species were reported. Species such as Cyperus rotundus, Hymenocrater longiflorus, Anthriscus nemorosa, Pistacia atlantica and Quercus brantii would be interesting targets for drug discovery and are suggested for further investigations., Conclusion: The plant use reports, and quantitative data analyzed demonstrate that the relative importance of plant species and shared knowledge of herbal therapies among Kurdish communities of the Sarvabad county is still rich. A systematic study and evaluation of the biological activity of highly consumed plants, could identify the possible mechanism of action., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Colorectal cancer (CRC) is the second most common cancer in women and the third most common cancer in men worldwide, with an increasing trend in its incidence in Asian countries. In the present study, we aimed to describe the 13-year results of patients with CRC based on the Shiraz Colorectal Cancer Surgery (SCORCS) registry system in patients with a pathologically confirmed diagnosis of colon cancer (CC) and rectal cancer (RC) undergoing surgery., Methods: Between 2007 and 2020, 811 patients, including 280 patients with CC and 531 patients with RC, registered in SCORCS, were included in the present study. The information collected for this study included demographic characteristics of the patients, primary clinical presentations, laboratory findings before surgery, radiologic and colonoscopy results, and surgical procedures. Death was confirmed by the physician as "CRC-related". The data were analyzed by SPSS software version 21; life table and Kaplan-Meier curve were used for evaluating the overall survival, recurrence, and metastasis rates and Log-Rank test or Breslow test to check significant differences between the subgroups. The Cox proportional regression model was fitted to evaluate the prognostic factors of survival recurrence and metastasis., Results: Laparoscopy was performed in 60% of patients (66% in RC and 51% in CC), laparotomy in 32% (27% in RC and 41% in CC), and 7% required conversion. The median time of follow-up was 29 months in all patients; 28 months in patients with RC, and 33 months in patients with CC; 1, 3, and 5 years' survival rate was 90, 70, and 63% for all the patients, 89%, 67%, and 58% for RC and 90%, 74%, and 71% for CC, respectively (P = 0.009). The Cox regression analysis revealed tumor stages II, (P = 0.003, HR:2.45, 95% CI;1.34-4.49), III, (P ≤ 0.001, HR:3.46, 95% CI;1.88-6.36) and IV, (P ≤ 0.001, HR:6.28, 95% CI;2.73-14.42) in RC and stage IV, (P = 0.03, HR:9.33, 95% CI;1.1-76.37) in CC were the significant survival prognostic factors. The metastasis and recurrence of the tumors occurred earlier in patients with RC than CC (P = 0.001 and 0.03, respectively)., Conclusions: Long-term follow-up of patients with CRC in an Iranian population indicated the significance of screening for diagnosis of early stages and improved survival of the patients., (© 2022. The Author(s).)

Background: Rectal cancer accounts for one-third of all colorectal cancer (CRC) cases. Due to physiological and anatomical differences, some researchers consider rectal cancer as a separate organ malignancy during the recent decades. However, limited studies have been conducted in this regard in Iran. Therefore, the aim of this study is to determine survival of rectal cancer and its , affecting factors in Fars province, southern Iran., Methods: In this cohort study, we used the data of 387 patients with rectal cancer gathered by the Colorectal Research Center of Shiraz University of Medical Sciences between 2007 and 2015. The impact of 35 explanatory factors including demographic information, medical history, pathologic data, and imaging findings was evaluated using Cox regression analysis., Results: Out of all patients, 111 ones (29%) died. The median follow-up period was 36 months. The patients' mean age at diagnosis was 56.72 ± 13.89 years. Their 5-year survival was 65% (95% CI: 58-69%). The results of multiple Cox regression analysis showed that sex (male/female; HR = 1.73, 95% CI: 1.15-2.67), vascular invasion (yes/no; HR = 2.40, 95% CI: 1.45-3.99), and lymph node ratio (> 0.2 vs ≤ 0.2; HR = 2.19, 95% CI: 1.41-3.40) were significantly correlated to survival., Conclusion: Various geographical parts of Iran show different rates regarding rectal cancer survival. A better 5-year survival rate was detected by this study for the patients with rectal cancer in Fars province, southern Iran, compared to many parts of the country. Moreover, gender, vascular invasion, and nodal status played an important role in survival of rectal cancer., (© 2020. Springer Science+Business Media, LLC, part of Springer Nature.)

Background and Aims: Nonalcoholic fatty liver disease (NAFLD) is common in severely obese individuals undergoing bariatric surgery. Assessing the prevalence and severity of NAFLD seems crucial since it may affect the prevention or development of more severe forms of fatty liver., Methods: This cross-sectional study was conducted on 228 severely obese individuals undergoing bariatric surgery. Abdominal ultrasonography was done, and clinical and biochemical factors (liver enzymes, lipid profile, and fasting blood sugar (FBS)) were assessed., Results: The mean body mass index (BMI) was 43.45 ± 5.92 kg/m 2 . The prevalence of NAFLD was 49.12% (mild steatosis: 37.5%, moderate steatosis: 36.6%, and severe steatosis: 25.8%). The main risk factors of NAFLD were weight ( p = 0.002), BMI ( p = 0.003), alanine aminotransferase (ALT) ( p < 0.001), aspartate aminotransferase (AST) ( p < 0.001), serum triglycerides (TGs) ( p = 0.004), and FBS ( p = 0.039). The results revealed a statistically significant decrease in the mean level of high-density lipoprotein cholesterol (HDL-C) ( p = 0.044). However, no significant association was found between the severity of liver steatosis and the presence of comorbidities such as hypertension, diabetes, hypothyroidism, and dyslipidemia., Conclusions: More severe NAFLD was associated with increased weight and BMI. Elevated ALT, AST, TG, and FBS levels and decreased HDL-C levels were also the risk factors of NAFLD and its progress to more severe conditions., Competing Interests: The authors declare no conflict of interests., (Copyright © 2022 Ladan Aghakhani et al.)

Purpose: Wounds with dead tissue, purulent wounds, and gangrene are good options for larval therapy. We aim to investigate the effect of larval therapy on diabetic wounds and compare it with traditional treatment., Methods: The sterile larvae were used in wound treatment and the infection rate, Erythrocyte Sedimentation Rate (ESR), and wound size were measured and compared before and after the treatment., Results: The scars of 40 patients in the larval therapy group were evaluated every 10 days and the mean size of the scar decreased from 38.5 cm (36.6 cm) before treatment to 5.0 cm (6.6 cm) after 60 days. ESR mean was decreased from 57.3 (18.3) before treatment to 15.8 (4.8) after treatment in the larval therapy group. These parameters were significantly decreased compared to the debridement group (p < 0.001)., Conclusions: Larval therapy is effective in diabetic wound healing. The size of the wound after larval treatment is smaller than before. There was no difference between the two groups for infection rate. ESR was significantly decreased in the larval therapy group that indicating the lower inflammation in this group., Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-022-00973-w., Competing Interests: Competing interestsNone declared., (© Springer Nature Switzerland AG 2022.)

Although the diversity-disturbance relationship has been extensively studied, the differences in responses of taxonomic vs. functional diversity to natural disturbances (i.e., fire) call for an improved understanding of this relationship. Here, we investigated how fire disturbance influenced plant taxonomic and functional diversity in Golestan National Park, in northeastern Iran. We evaluated the response of α- and β-plant diversity considering both taxonomic and functional diversity and different β-diversity components (i.e., turnover and nestedness) as a function of fire regime, topographic exposure, and their interactive effect. We considered different indices of functional diversity including functional richness, functional evenness, functional divergence, functional dispersion, Rao's quadratic entropy, and community-weighted mean (CWM). Functional diversity indices were computed using four leaf traits related to species growth strategy and fire response including leaf thickness and leaf length, specific leaf area (SLA) and leaf dry matter content (LDMC). Taxonomic and functional diversity had contrasting response to fire disturbance. Fire significantly decreased taxonomic α-diversity similarly in both north and south exposures. β-diversity increased in south exposures but decreased in north exposures. Fire decreased functional richness, increased CWM of SLA, and decreased CWM of LDMC. In contrast, abundance-weighted metrics of functional diversity (functional evenness, functional divergence, functional dispersion, Rao's quadratic entropy) were not impacted by fire disturbance. Finally, the main contributors to heterogeneity were driven by a fire × exposure interaction, suggesting that fire disturbance interacts with topographic exposure. Our results suggest that taxonomic and functional α- and β-diversity have contrasting responses to fire illustrating the need to consider both dimensions to understand how disturbance impacts plant communities. At large spatial scale, species turnover and nestedness appear as essential parameters to maintain species-rich communities in response to fire disturbance., Competing Interests: There is no conflict of interest., (© 2022 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

Background and Objectives: Low back pain (LBP) is a common health condition in populations. Limited large-scale population-based studies evaluated the prevalence and predictors of LBP in developing countries. This study aimed to evaluate the prevalence and factors associated with LBP among the Iranian population., Methods: We used baseline information from the Prospective Epidemiological Research Studies in Iran (PERSIAN), including individuals from 16 provinces of Iran. LBP was defined as the history of back pain interfering with daily activities for more than one week during an individual's lifetime. Various factors hypothesized to affect LBP, such as age, sex, marital status, educational status, ethnicity, living area, employment status, history of smoking, body mass index (BMI), physical activity, sleep duration, wealth score, history of joint pain, and history of morning stiffness in the joints were evaluated., Results: In total, 163770 Iranians with a mean age of 49.37 (SD = 9.15) were included in this study, 44.8% of whom were male. The prevalence of LBP was 25.2% among participants. After adjusting for confounders, the female gender [OR:1.244(1.02-1.50)], middle and older ages [OR:1.23(1.10-1.33) and OR:1.13(1.07-1.42), respectively], being overweight or obese [OR:1.13(1.07-1.19) and OR:1.21(1.16-1.27), respectively], former and current smokers (OR:1.25(1.16-1.36) and OR:1.28(1.17-1.39), respectively], low physical activity [OR:1.07(1.01-1.14)], and short sleep duration [OR: 1.09(1.02-1.17)] were significantly associated with LBP., Conclusion: In this large-scale study, we found the lifetime prevalence of LBP to be lower among the Iranian population in comparison to the global prevalence of LBP; further studies are warranted to evaluate the causality of risk factors on LBP., (© 2022 The Authors.)

Aim: This study investigated the association between methylation status and expression levels of BTG2 , PPP1CA , and PEG3 genes in colon cancer., Background: Aberrant DNA methylation is one of the most important epigenetic modifications in the development of cancer. Evidence indicates that hypermethylation of various tumor suppressor genes could be a potential mechanism of colon tumorigenesis., Methods: The expression levels of BTG2 , PPP1CA , and PEG3 genes were evaluated in HT-29/219, HCT116, SW48, SW742, SW480, and LS180 cell lines using quantitative Real-Time PCR. The methylation status of BTG2 and PPP1CA was determined by methylation-specific PCR (MSP) method, and the methylation pattern of PEG3 was evaluated by bisulfite sequencing PCR (BSP). To investigate the effect of methylation on the expression of these genes, all colon cancer cell lines were treated by 5-Azacitidine (5-Aza) and/or Trichostatin A (TSA)., Results: The expression levels of BTG2 , PPP1CA , and PEG3 were highly heterogeneous and quantitatively correlated to their promoter methylation status in the studied colon cancer cell lines. Treatment by 5-Aza and/or TSA increased the expression of the above-named genes in colon cancer cell lines., Conclusion: Overall, it seems that BTG2 , PPP1CA , and PEG3 act as tumor suppressor genes in colon cancer, and methylation is a potential mechanism for their loss of expression. Therefore, these genes may be considered as suitable targets for demethylation approaches and, eventually, colon cancer treatment. Combined treatment by 5-Aza and TSA may be a promising therapeutic strategy for colon cancer treatment. Further studies may contribute to confirm these results., Competing Interests: The authors declare that they have no conflict of interest.

Purpose: Little is known about the symptoms of coronavirus disease 2019 (COVID-19) on patients with morbid obesity following bariatric surgery (BS) in Iran. Thus, we sought to investigate the symptoms and effect of COVID-19 in patients with morbid obesity following, or candidates for, BS in Iran., Materials and Methods: In this retrospective observational cohort study, we enrolled 236 morbid obese patients following (surgical group) or candidates (nonsurgical group) for bariatric surgery. Demographics, probable COVID-19 incidence, acute and persistent COVID-19 symptoms, and clinical outcome parameters of bariatric patients and candidates for BS were compared. The incidence of probable COVID-19 was assessed including the clinical definition of probable case, according to World Health Organization criteria., Results: The incidence of probable COVID-19 among surgical and nonsurgical groups was significantly different (20.6% vs 26.08%, respectively, p = 0.046). The probable case of surgical patients had a shorter length of symptoms and hospitalization duration, and a lower proportion of admission in ICUs and hospitals with respect to nonsurgical patients (p < 0.001). Surgical patients had a greater prevalence of persistent symptoms including anorexia, food intolerance, and anosmia-hyposmia than nonsurgical patients. Moreover, surgical patients with probable COVID-19 had a significantly higher proportion of diabetic patients than surgical patients without probable COVID-19 (20% vs 9.3%)., Conclusion: These findings highlight the need to evaluate the persistent symptoms of COVID-19 and the importance of nutritional support for at least several weeks after COVID-19 symptom onset. Moreover, it seems that COVID-19 incidence in post-bariatric surgery patients could reduce the effectiveness of bariatric surgery in the resolution of diabetes., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: The management of inflammation after colorectal surgery is important to decrease the susceptibility to postoperative complications. Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) in the peripheral blood are known as two important inflammatory markers. In this study we evaluated and compared colorectal laparoscopy and laparotomy based on the PLR and NLR., Methods: Totally, 76 patients were divided into two groups including patients who underwent laparoscopy (45 cases) or laparotomy (31 cases). The PLR and NLR were calculated based on cell blood count analysis of preoperative and postoperative day (POD) one and three in both groups. Statistical analysis was performed using SPSS software version 22., Results: The PLR and NLR have no significant association with age, gender and tumor site (p > 0.05). However, both ratios were significantly increased in laparotomy patients at POD1 compared with the laparoscopy patients (p < 0.05). According to the two by two comparisons, the preoperative and postoperative PLR were significantly different in the laparotomy group (p < 0.05) but not in the laparoscopy group (p > 0.05). However, the preoperative and postoperative NLR were significantly different in both laparoscopy and laparotomy groups (p < 0.05)., Conclusion: The NLR and PLR markers indicated that laparoscopy can be a better choice for colorectal surgery due to lower induction of inflammation compared with laparotomy., (© 2021 Asia Endosurgery Task Force and Japan Society of Endoscopic Surgery and John Wiley & Sons Australia, Ltd.)