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This systematic review and meta-analysis compares the efficacy of three combination therapies, including transarterial chemoembolization (TACE) with radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation (CRA) for the treatment of patients with hepatocellular carcinoma (HCC).Online databases, including Scopus, Web of Science, PubMed, Embase, CNKI, Google Scholar, and Cochrane Library were searched.Forty-two studies with 5468 pooled patients (TACE + RFA: 21 studies with 3398 patients, TACE + MWA:14 studies with 1477 patients, and TACE + CRA: 7 studies with 593 patients) reported combination therapy versus TACE alone. The TACE + MWA subcohort had the best odds of long-term overall survival (OR 4.81, 95% CI 1.44, 16.08, P = 0.011) and objective response rate (OR 3.93, 95% CI 2.34, 6.61, P 0.001) compared with the other two combination subcohorts. The TACE + RFA and TACE + MWA subcohorts had approximately similar odds of 1-year recurrence-free survival (OR 5.21, 95% CI 2.13, 12.75, P 0.001 and OR 4.61, 95% CI 1.70, 12.51, P = 0.003, respectively). The disease control rate was similar between the TACE + MWA and TACE + CRA subcohorts (OR 4.01, 95% CI 2.66, 6.04, P 0.001 and OR 4.05, 95% CI 1.68, 9.74, P = 0.002) but greater than the TACE + RFA subcohort (OR 3.23, 95% CI 2.14, 4.86, P 0.001).Overall, the TACE + MWA subcohort had the best efficacy and outcomes, especially for younger patients (less than 60-year-old) with tumor size of ≤ 3 cm, compared with the TACE + RFA or TACE + CRA subcohorts.

Background: Quality of life (QOL) in the elderly has not been investigated as much as their life expectancy. Objectives: The present study aimed to evaluate the elders’ QOL. Methods: In this study, 386 elders were selected using the multistage cluster random sampling method. The Leiden-Padua (LIEPAD) questionnaire, consisting of the core components (CCQOL) and moderators (MQOL) of QOL, was used and analyzed with SPSS software. Results: The interviewees’ mean age was 68.12 ± 6.24 years. The QOL score was 83.67 ± 13.75 (out of 127), consisting of 27 (6.9%) elders with low, 316 (81.8%) elders with moderate, and 43 (11%) elders with high levels of QOL. The CCQOL and MQOL scores were 70.68 ± 9.42 (out of 93), and 20.94 ± 2.30 (out of 34), respectively. According to the multivariate analysis, sleep disorders (B = -0.15), osteoporosis (B = -0.14), female gender (B = -0.13), and not being the source of family income (B = -0.13) were inversely correlated with QOL. In contrast, sleep disorders, facing violence, female gender, migraine, psychological diseases, and not being the source of family income were inversely correlated with CCQOL. Sexual problems, facing violence, no supplementary insurance coverage, inability to walk, and migraine had inverse correlations with MQOL. Conclusions: Seven out of ten elders had a moderate level of QOL, while elderly females and elders with chronic diseases or those who were not the source of family income had lower levels of QOL. Accordingly, the elders’ QOL can be improved by integrating the elders’ care programs in the health centers.

Filgrastim, a recombinant type of granulocyte-colony stimulating factor (G-CSF), has a high potential to manage chemotherapy-induced leukopenia. It can increase stromal cell-derived factor 1 (SDF-1) which may stimulate C-X-C chemokine receptor type 4 (CXCR4) to migrate bone marrow-derived stem/progenitor cells to the bloodstream. Here, we aimed to investigate in vitro and in vivo effects of filgrastim on cell migration, invasion, and metastasis. A lentivirus vector of the anti-CXCR4 receptor was first used for the CXCR4 knockout. Effects of filgrastim on cell proliferation and migration were then investigated on 4T1 cells by Transwell migration and wound healing assay. At last, the effects of filgrastim on cell metastasis and the possible involved mechanisms have been investigated in a metastatic murine breast tumor. The knockout of the CXCR4 receptor could lead to a decrease in cell proliferation, migration, and invasion of the 4T1 cells. Filgrastim could directly target SDF-1 and upregulate the expression of the CXCR4 receptor. The knockout of the CXCR4 receptor reduced cell metastasis in an animal model of breast cancer. CXCR4 receptor stimulation by the filgrastim-affected pathways is a conserved evolutionary response that could increase cancer cell proliferation and consequent cell metastasis. Our results suggest that the activation of the CXCR4 receptor is a conserved evolutionary response that can increase cell proliferation, migration, and consequent metastasis. It seems that filgrastim may increase the chance of cancer cell metastasis in people continuously receiving it to increase the number of neutrophils. Filgrastim induces the SDF-1/CXCR4 axis on tumor cell growth. SDF-1 and its receptor CXCR4 are vital targets for filgrastim. The CXCR4 can stimulate the PI3K/AKT, NF-κB, and JAK/STAT signaling pathways. The SDF-1/CXCR4 pathway promotes cell chemotaxis and proliferation via MAPKs signaling. It also enhances cell survival, proliferation, and angiogenesis, increasing tumor cell metastasis. The STAT3-mediated inflammation is essential for tumorigenesis processes, and Akt, Wnt, STAT3, and CXCR4 signaling pathways are all correlated. CXCR4 = C-X-C chemokine receptor type 4, SDF-1 = stromal-derived-factor-1, MAPK = mitogen activated protein kinase; NF-κB = nuclear factor-κB, PI3K = phosphoinositide 3-kinase, JAK = Janus kinase, STAT = signal transducer and activator of transcription, PLC = phospholipase C, PKC = Protein kinase C, GRK = G protein-coupled receptor kinase.

Background: Public participation is of crucial importance in immunization programs. Therefore, we aimed to study the determinants of participation in immunization against coronavirus disease 2019 (COVID-19) before the distribution of the vaccines in Iran. Methods: This cross-sectional study was conducted in February 2021 with interviews and online components. The questionnaire comprised socio-demographic information, past medical history, perceived susceptibility to COVID-19 infection, and the tendency to participate in vaccination against COVID-19. Results: Of 2071 participants, 1020 (49.2%) were men, and 1803 (87.1%) were determined to participate in the COVID-19 vaccination program. Among participants, 87.1% (1803) stated that they were determined to participate in the immunization program against COVID-19. In addition, in this group, 52.1% believed vaccination could reduce mortality, and 48.8% thought the vaccine could decrease transmissibility. There was a significant association between positive attitudes toward vaccination against COVID-19 and the respondents’ socio-economic status (SES), educational levels, reporting non-communicable diseases (NCDs) in themselves or their first-degree families, perceived susceptibility toward getting COVID-19 infection in the following months in themselves or close family members and being a healthcare worker. Most respondents were determined to participate in the COVID-19 vaccination because they believed vaccination would be effective in preventing mortality and decreasing COVID-19 transmission. Conclusions: SES, educational level, positive history of NCDs, perceived susceptibility toward getting COVID-19 infection, and being a healthcare worker had a significant positive association with the respondents’ intention to participate in the COVID-19 vaccination program.

Purpose: This systematic review and meta-analysis aimed to assess renal function and cardiometabolic biomarkers after treatment with beraprost sodium in patients with diabetes mellitus. Methods: We systemically searched PubMed, Embase, Scopus, Web of Science, and Cochrane Library up to August 2020. Statistical heterogeneities were computed using Cochrane’s Q test and I2 test. A fixed- or random-effects model was used to calculate the weighted mean difference (WMD) and corresponding 95% confidence intervals (CI). Results: From 341citations, seven trials were included into our meta-analysis. Our findings demonstrated that beraprost sodium intake significantly decreased blood urea nitrogen (BUN) (WMD = −5.62, 95% CI [−8.49, −2.74], P < 0.001) and cystatin C (WMD = −0.57, 95% CI [−0.68, −0.46], P < 0.001). Beraprost sodium intake had no significant effect on fasting blood sugar (FBS), hemoglobin A1c (HbA1c), cholesterol (TC), triglycerides (TG), HDL-C, LDL-C, systolic blood pressure (SBP), diastolic blood pressure (DBP), and creatinine (Cr) in patients with diabetes receiving beraprost sodium in comparison with the controls. Conclusion: Our meta-analysis revealed that beraprost sodium administration significantly decreased BUN and cystatin C levels in patients with diabetes. However, no significant effect was observed on the cardiometabolic profile.

Background Limited data is available addressing gastrointestinal (GI) ischemia in coronavirus disease 2019 (COVID-19). We reviewed the clinical and radiologic features of GI ischemia and its related complications in thirty-one COVID-19 patients reported in literature. Methods A systematic literature review was performed using a search strategy on all studies published from January 1, 2020, to June 13, 2020, and updated on September 6, 2020, on databases from PubMed, Scopus, Embase, Web of Science, and Google Scholar. Every study with at least one presentation of COVID-19-related GI ischemia complication and one GI imaging finding was included. Results In total, twenty-two studies and thirty-one patients with the mean age of 59 ± 12.7 (age range: 28–80) years old were included, of which 23 (74.2%) patients were male, 7 (22.5%) female, and one unknown gender. The significant GI imaging findings include mesenteric arterial or venous thromboembolism, followed by small bowel ischemia. Nine patients (29%) presented with arterial compromise due to superior mesenteric thromboembolism, resulting in bowel ischemia. Also, 6 patients (19.3%) demonstrated occlusive thrombosis of the portal system and superior mesenteric vein. More than two-thirds of patients (20, 64.5%) required laparotomy and bowel resection. Eventually, five (16.1%) patients were discharged, of whom four cases (12.9%) readmitted. Five (16.1%) patients remained ICU hospitalized at the report time and 12 (38.7%) patients died. Conclusion Macrovascular arterial/venous thrombosis is identified in almost half of COVID-19 patients with bowel ischemia. Overall mortality in COVID-19 patients with GI ischemia and radiologically evident mesenteric thrombotic occlusion was 38.7% and 40%, retrospectively., Highlights • The significant GI imaging findings of COVID-19 patients include mesenteric arterial/venous thrombi and small bowel ischemia • Thrombosis was shown in almost half of the patients with bowel ischemia in the setting of COVID-19 infection • More than one-third mortality rate was observed in COVID-19 patients with a presentation of GI ischemia

Introduction: A systematic review and meta-analysis of clinical trials were undertaken to evaluate the effect of diacerein intake on cardiometabolic profiles in patients with type 2 diabetes mellitus (T2DM). Methods: Electronic databases such as PubMed, EMBASE, Scopus, Web of Science, Google Scholar, and Cochrane Central Register of Controlled Trials were searched from inception to 31 July 2019. Statistical heterogeneity was evaluated using Cochran’s Q test and I-square (I2) statistic. Data were pooled using random-effects models and weighted mean difference (WMD). Results: From 1,733 citations, seven clinical trials were eligible for inclusion and meta-analysis. A significant reduction in hemoglobin A1c (HbA1c) (WMD -0.73; 95%CI -1.25 to -0.21; P= 0.006; I2= 72.2%) and body mass index (BMI) (WMD -0.55; 95%CI -1.03 to -0.07; P= 0.026; I2= 9.5%) was identified. However, no significant effect of diacerein intake was identified on fasting blood sugar (FBS) (WMD -9.00; 95%CI -22.57 to 4.57; P= 0.194; I2= 60.5%), homeostatic model assessment for insulin resistance (HOMA-IR) (WMD 0.39; 95%CI -0.95 to 1.73; P= 0.569; I2= 2.2%), body weight (WMD - 0.54; 95%CI -1.10 to 0.02; P= 0.059), triglycerides (WMD -0.56; 95%CI -24.16 to 23.03; P= 0.963; I2= 0.0%), total-cholesterol (WMD -0.21; 95%CI -12.19 to 11.78; P= 0.973; I2= 0.0%), HDL-cholesterol (WMD -0.96; 95%CI -2.85 to 0.93; P= 0.321; I2= 0.0%), and LDL-cholesterol levels (WMD -0.09; 95%CI -8.43 to 8.25; P= 0.983; I2= 37.8%). Conclusion: Diacerein intake may reduce HbA1c and BMI; however, no evidence of the effect was observed for FBS, HOMA-IR, body weight, triglycerides, total cholesterol, HDL-cholesterol or LDLcholesterol.

Background: With an increasing rate of lymphadenopathies (LAP) reported following COVID-19 vaccination with various vaccines’ types, which can mimic breast cancer (BC), a comprehensive review, can disclose some practical information about BC workup that reduces the incidence and mortality of the disease along with unnecessary steps. Methods: We conducted a literature search in online databases, including Scopus, Medline (PubMed), Web of Science, Embase (Elsevier), Cochrane library, and Google Scholar. Keywords of literature search included “COVID-19”, “coronavirus disease”, “Vaccine”, and “Vaccination”, “LAP”, “Adverse event*”, “Lymph node”, “Cancer, breast”, and “Lymphadenopathy”. Results: In total, 59 studies (n = 880 cases), including 412 (46.8%) females, 146 (16.6%) males, and 322 (36.6%) cases with unknown gender were reviewed. We reviewed the LAP presentation after vaccination of first or second dosage of Pfizer-BioNTech (n = 754, 85.7%), Moderna (n = 38, 4.3%), Oxford-AstraZeneca (n = 39, 4.4%), Sputnik V (n = 1, 0.1%), Johnson & Johnson/Janssen (n = 1, 0.1%), CureVac (n = 1, 0.1%), and in 46 (5.3%) cases, the type of vaccine was not reported. The most common LAP locations were axillary (n = 540) and followed by axillary and supraclavicular (n = 271). We found that imaging findings of LAP associated with vaccination were seen from the first day to two months after vaccination of the first or second dosage of different types of COVID-19 vaccines. Conclusion: This review study can draw a broad perspective by focusing on patients with cancer, especially BC, for clinicians to proceed with the right approach at the right time without additional invasive measures and not to hold the necessary action in high-risk patients at the same time.

Purpose Hepatic encephalopathy (HE) is described as impaired brain function induced by liver failure. Ammonia is the most suspected chemical involved in brain injury during HE. Although the precise mechanism of HE is not clear, several studies mentioned the role of oxidative stress in ammonia neurotoxicity. In animal models, the use of some compounds with antioxidant properties was reported to reduce the neurotoxic effects of ammonia, improve energy metabolism, and ameliorate the HE symptoms. Citicoline is a principal intermediate in the biosynthesis pathway of phosphatidylcholine that acts as neurovascular protection and repair effects. Various studies mentioned the neuroprotective and antioxidative effects of citicoline in the central nervous system. This study aims to investigate the potential protective effects of citicoline therapeutic in an animal model of HE. Materials and methods Mice received acetaminophen (APAP,1g/kg, i. p.) and then treated with citicoline (500 mg/kg, i.p) one and two hours after APAP. Animals were monitored for locomotor activity and blood and brain ammonia levels. Moreover, markers of oxidative stress were assessed in the brain tissue. Results The result of the study revealed that plasma and brain ammonia and the liver injury markers increased, and locomotor activity impaired in the APAP-treated animals. Besides, an increase in markers of oxidative stress was evident in the brain of the APAP-treated mice. It was found that citicoline supplementation enhanced the animal's locomotor activity and improved brain tissue markers of oxidative stress. Conclusion These data propose citicoline as a potential protective agent in HE. The effects of citicoline on oxidative stress markers could play a fundamental role in its neuroprotective properties during HE.

Background Triple-negative breast cancer (TNBC) is an aggressive type of breast cancer (BC), and its diagnosis is associated with negative expression of hormone receptors and HER2/neu. It consists of 10-20% of all BCs diagnosed. Methods and materials This study focuses on three groups with different pathology: group one showed complete triple-negative HER2 expression with IHC of BC; groups two and three included patients with ER-, PR-, and HER21+, and ER-, PR-, and HER22+ with a negative FISH test. These three groups were compared from the point of prognosis, which consisted of tumor size, patients' age, lymphatic, vascular and perineural invasion, organ metastasis, number of lymph nodes involvement, and the survival rate. Results A total of 459 TNBC patients were enrolled, of which 268 were placed in the HER20 group, 146 in the HER21+ group, and 45 in the HER22+ group. Distant metastasis and recurrence rate were more common in HER20 patients, but bone metastasis was more common in patients with low HER2 expression. All patients with HER20 had a smaller tumor size at the time of BC diagnosis in comparison to patients in the low HER2 expression group. Patients with HER22+ had less lymphatic and vascular invasion as well as axillary lymph nodes involvement, but larger tumor size at presentation, resulting in a lower rate of recurrence and higher overall survival. Conclusion The findings revealed that patients with HER22+ had better outcome in comparison to the patients with HER20 and HER21+. Furthermore, the results showed that many patients with HER22+ expression were not basal-like and had good prognosis amongst TNBC patients.

Background Encephalocele, a rare congenital brain malformation, is herniation of brain tissue with or without meninges through a cranial fossa defect. It is classified by location and is usually associated with other congenital anomalies. Case A 29-year-old G2, P1, 36-week pregnant woman was referred for fetal ultrasound delivery planning. Sonographic abnormalities led to fetal magnetic resonance imaging, which revealed a large sac of cerebrospinal fluid herniating through the anterior cranial fossa defect with strands of neurogenic tissue in direct contact with the tongue in the absence of the palate. Agenesis of the corpus callosum and the classic "Viking helmet" appearance of the frontal horns of the lateral ventricles were clearly visible. Conclusion Prenatal diagnosis of encephalocele is rarely reported. Unfortunately, the infant in this case report died at 3 months of age despite intensive medical therapy.

Background:Diabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods:We used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990–2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals. Findings:In 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73·7% (68·3 to 77·4) were classified as due to type 1 diabetes. The age-standardised death rate was 0·50 (0·44 to 0·58) per 100 000 population, and 15 900 (97·5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0·13 (0·12 to 0·14) per 100 000 population in the high SDI quintile, 0·60 (0·51 to 0·70) per 100 000 population in the low-middle SDI quintile, and 0·71 (0·60 to 0·86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r2=0·62). From 1990 to 2019, age-standardised death rates decreased globally by 17·0% (−28·4 to −2·9) for all diabetes, and by 21·0% (–33·0 to −5·9) when considering only type 1 diabetes. However, the low SDI quintile had the lowest decline for both all diabetes (−13·6% [–28·4 to 3·4]) and for type 1 diabetes (−13·6% [–29·3 to 8·9]). Interpretation:Decreasing diabetes mortality at ages younger than 25 years remains an important challenge, especially in low and low-middle SDI countries. Inadequate diagnosis and treatment of diabetes is likely to be major contributor to these early deaths, highlighting the urgent need to provide better access to insulin and basic diabetes education and care. This mortality metric, derived from readily available and frequently updated GBD data, can help to monitor preventable diabetes-related deaths over time globally, aligned with the UN's Sustainable Development Targets, and serve as an indicator of the adequacy of basic diabetes care for type 1 and type 2 diabetes across nations. Funding: Bill & Melinda Gates Foundation.

This meta-analysis was conducted to evaluate the effects of garlic extract on total cholesterol (TC), triglycerides (TG), low-density lipoprotein-cholesterol (LDL-c), and high-density lipoprotein-cholesterol (HDL-c), among the patients with coronary artery disease (CAD). Literature searches were conducted in EMBASE, Scopus, PubMed, Web of Science, and Cochrane Library until Sep18th , 2020. Inter-study heterogeneity was examined using Cochrane's Q and I2 tests. The random-effect models were utilized to pool the weighted mean differences (WMDs) and the corresponding 95% confidence intervals (CIs). Six articles were enrolled in the current meta-analysis. Garlic consumption significantly reduced TC levels (WMD -16.32 mg/dL; 95% CI -31.22, -1.43; P = 0.032). We found no significant effects on TG (WMD -10.93 mg/dL; 95% CI -26.19, 4.32; P = 0.160), HDL-c (WMD 4.55 mg/dL; 95% CI -1.13, 10.23; P = 0.116) and LDL-c concentrations (WMD -3.65 mg/dL; 95% CI -13.21, 5.92; P = 0.455). Significant heterogeneity was observed for HDL-c (I2 =76.8%). However, the findings of sensitivity analysis revealed that upon exclusion of the potential heterogeneity source, the pooled WMD on HDL-c levels were stable. Garlic supplementation may result in a decrease in TC, but did not affect on TG, HDL-c and LDL-c levels among CAD patients.

Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12·2 million (95% UI 11·0–13·6) incident cases of stroke, 101 million (93·2–111) prevalent cases of stroke, 143 million (133–153) DALYs due to stroke, and 6·55 million (6·00–7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8–12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1–6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0–73·0), prevalent strokes increased by 85·0% (83·0–88·0), deaths from stroke increased by 43·0% (31·0–55·0), and DALYs due to stroke increased by 32·0% (22·0–42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0–18·0), mortality decreased by 36·0% (31·0–42·0), prevalence decreased by 6·0% (5·0–7·0), and DALYs decreased by 36·0% (31·0–42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0–24·0) and incidence rates increased by 15·0% (12·0–18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5–3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5–3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57–8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97–3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01–1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7–90·8] DALYs or 55·5% [48·2–62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3–48·6] DALYs or 24·3% [15·7–33·2]), high fasting plasma glucose (28·9 million [19·8–41·5] DALYs or 20·2% [13·8–29·1]), ambient particulate matter pollution (28·7 million [23·4–33·4] DALYs or 20·1% [16·6–23·0]), and smoking (25·3 million [22·6–28·2] DALYs or 17·6% [16·4–19·0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries. Funding Bill & Melinda Gates Foundation.

Background: In each immunization program, the public participation is a key factor. So, we studies determinants of participation in immunization against Coronavirus disease 2019 (COVID-19) in Iran before distribution of vaccine.Methods: This cross-sectional study conducted in February 2021. It had two formats; interview and online. The questionnaire comprised socio-demographic information, past medical history, perceived susceptibility to COVID-19 infection, and tendency for participating in vaccination against COVID-19. Results: Of 2071 participants, 1020 (49.2%) were men, and 1803 (87.1%) were determined to participate in COVID-19 vaccination program. There was a significant association between positive attitude toward vaccination against COVID-19 and the respondent’s socio-economic status (SES), educational level, reporting non-communicable diseases (NCDs) in themselves/ their first-degree families, perceived susceptibility toward getting COVID-19 infection in the following months in themselves/close family members, and being a healthcare worker. Most respondents were determined to participate in the COVID-19 vaccination because they believed vaccination would be effective in preventing mortality and decreased COVID-19 transmission. Conclusions: SES, educational level, positive history of NCDs, perceived susceptibility toward getting COVID-19 infection, and being a healthcare worker had a significant positive association with the respondents’ intention to participate in COVID-19 vaccination program.

Bilateral renal cell carcinoma is rare and most commonly occurs in patients with background of hereditary and genetic diseases. Occurrence of bilateral renal cell carcinoma in native kidneys of a renal transplant patient is even more uncommon, and less than 10 cases have been reported in the English literature. Herein, we report our experience with the youngest renal transplant patient ever reported with bilateral renal cell carcinoma, who presented with intractable urinary tract infection. We also will review all of the reported cases of bilateral renal cell carcinoma in the last 20 years in the English literature according to the presentations, treatment modalities, prognosis, and graft outcome.

The subclavian steal syndrome (SSS), also called subclavian steal steno-occlusive disease, is defined as reversal of the vertebral artery flow secondary to significant hemodynamically ipsilateral occlusion or stenosis of the proximal subclavian artery. It is usually seen secondary to atherosclerosis and aberrant right subclavian artery (ARSA), resulting in SSS which is even less common. Aberrant right subclavian artery is a kind of vascular anomaly associated with coarctation of the aorta (CoA). It usually originates from the descending aorta distal to the site of CoA. Here, we present a young man who was a case of ARSA and CoA. He developed SSS after transcatheter aortic stenting secondary to unusual origin of ARSA from the site of CoA. Awareness of this rare anomaly helps to overcome this complication in patients undergoing interventional stenting for CoA and ARSA with anomalous origin.

Background: Cellular mesoblastic nephroma is rare after infancy, and there are many controversial reports about its clinical presentation and treatment as well as outcome in infants, young children, and adolescents. Objectives: In this report, we will discuss our experience with four cases of cellular mesoblastic nephroma presented from infancy to childhood (from 18 months of age to 11 years of age). Cases: During 10 years, we had the experience of 4 cases of pediatric renal tumor with the diagnosis of cellular mesoblastic nephroma, which have been followed between 1 year and 6 years. There were three male and one female patients with the age of 1.5, 2, 2, and 11 years. These tumors showed variable characteristics according to the number of mitosis, proliferative rate, necrosis, immunohistochemical markers, and metastatic potential; however, despite of all of these variabilities, all of these patients have done well and all have been well at the end of study. Conclusion: Pediatric renal tumors with the histologic diagnosis of cellular mesoblastic nephroma have good outcome even with metastasis, mitosis, and high proliferative rate.

Rationale and Objectives Hyposmia/anosmia is common among patients with coronavirus disease-2019 (COVID-19). Various imaging modalities have been used to assess olfactory dysfunction in COVID-19. In this systematic review, we sought to categorize and summarize the imaging data in COVID-19-induced anosmia. Material and Methods Eligible articles were included after a comprehensive review using online databases including Google scholar, Scopus, PubMed, Web of science and Elsevier. Duplicate results, conference abstracts, reviews, and studies in languages other than English were excluded. Results In total, 305 patients undergoing MRI/functional MRI (177), CT of paranasal sinuses (129), and PET/CT or PET/MRI scans (14) were included. Out of a total of 218 findings reported on MRI, 80 were reported on early (≤ 1 month) and 85 on late (>1 month) imaging in relation to the onset of anosmia. Overall, OB morphology and T2-weighted or FLAIR signal intensity were normal in 68/218 (31.2%), while partial or complete opacification of OC was observed in 60/218 (27.5%). T2 hyperintensity in OB was detected in 11/80 (13.75%) and 18/85 (21.17%) on early and late imaging, respectively. Moreover, OB atrophy was reported in 1/80 (1.25%) on early and in 9/85 (10.58%) on late imaging. Last, among a total of 129 CT scans included, paranasal sinuses were evalualted in 88 (68.21%), which were reported as normal in most cases (77/88, [87.5%]). Conclusion In this systematic review, normal morphology and T2/FLAIR signal intensity in OB and OC obstruction were the most common findings in COVID-19-induced anosmia, while paranasal sinuses were normal in most cases. OC obstruction is the likely mechanism for olfactory dysfunction in COVID-19. Abnormalities in OB signal intensity and OB atrophy suggest that central mechanisms may also play a role in late stage in COVID-19-induced anosmia.

Background: Given the projected trends in population ageing and population growth, the number of people with dementia is expected to increase. In addition, strong evidence has emerged supporting the importance of potentially modifiable risk factors for dementia. Characterising the distribution and magnitude of anticipated growth is crucial for public health planning and resource prioritisation. This study aimed to improve on previous forecasts of dementia prevalence by producing country-level estimates and incorporating information on selected risk factors. Methods: We forecasted the prevalence of dementia attributable to the three dementia risk factors included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 (high body-mass index, high fasting plasma glucose, and smoking) from 2019 to 2050, using relative risks and forecasted risk factor prevalence to predict GBD risk-attributable prevalence in 2050 globally and by world region and country. Using linear regression models with education included as an additional predictor, we then forecasted the prevalence of dementia not attributable to GBD risks. To assess the relative contribution of future trends in GBD risk factors, education, population growth, and population ageing, we did a decomposition analysis. Findings: We estimated that the number of people with dementia would increase from 57·4 (95% uncertainty interval 50·4-65·1) million cases globally in 2019 to 152·8 (130·8-175·9) million cases in 2050. Despite large increases in the projected number of people living with dementia, age-standardised both-sex prevalence remained stable between 2019 and 2050 (global percentage change of 0·1% [-7·5 to 10·8]). We estimated that there were more women with dementia than men with dementia globally in 2019 (female-to-male ratio of 1·69 [1·64-1·73]), and we expect this pattern to continue to 2050 (female-to-male ratio of 1·67 [1·52-1·85]). There was geographical heterogeneity in the projected increases across countries and regions, with the smallest percentage changes in the number of projected dementia cases in high-income Asia Pacific (53% [41-67]) and western Europe (74% [58-90]), and the largest in north Africa and the Middle East (367% [329-403]) and eastern sub-Saharan Africa (357% [323-395]). Projected increases in cases could largely be attributed to population growth and population ageing, although their relative importance varied by world region, with population growth contributing most to the increases in sub-Saharan Africa and population ageing contributing most to the increases in east Asia. Interpretation: Growth in the number of individuals living with dementia underscores the need for public health planning efforts and policy to address the needs of this group. Country-level estimates can be used to inform national planning efforts and decisions. Multifaceted approaches, including scaling up interventions to address modifiable risk factors and investing in research on biological mechanisms, will be key in addressing the expected increases in the number of individuals affected by dementia. F Carvalho and E F Fernandes acknowledge support from the University of Porto (UID/MULTI/04378/2019 and UID/QUI/50006/2019 with funding from FCT/MCTES through national funds). L F S Castro-de-Araujo acknowledges support from the Medical Research Council (London; grant number MC_PC_MR/T03355X/1). V M Costa acknowledges her grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória (DL57/2016/CP1334/CT0006). A Douiri acknowledges support from the NIHR Applied Research Collaboration (ARC) South London at King’s College Hospital NHS Foundation Trust and the Royal College of Physicians, as well as the support from the NIHR Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. N Ghith acknowledges her salary as a postdoc is covered by a grant to her research group provided by Novo Nordisk Foundation. V K Gupta and V B Gupta acknowledge funding support from National Health and Medical Research Council (NHMRC), Australia. S Haque acknowledges support from Jazan University, Saudi Arabia, for providing access to the Saudi Digital Library for this study. C Herteliu is partially supported by a grant of the Romanian National Authority for Scientific Research and Innovation (CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084). Y J Kim was supported by the Research Management Centre, Xiamen University, Malaysia (No. XMUMRF/2020-C6/ITCM/0004). M Kivimäki was supported by the MRC (S011676) and the Wellcome Trust (221854/Z/20/Z). M Kumar acknowledges support from Fogarty International Center (K43 TW010716-04). S Lorkowski acknowledges institutional support from the Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig (Germany; German Federal Ministry of Education and Research, grant agreement number 01EA1808A). S Mondello was supported by the Italian Ministry of Health (GR-2013-02354960). A Raggi acknowledges support from a grant from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C. Besta, Linea – Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). D A S Silva acknowledges support from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brasil (CAPES; Finance Code 001 / CAPES-PRINT). J P Silva acknowledges support from the Applied Molecular Biosciences Unit (UCIBIO; grant number UIDB/04378/2020), supported through Portuguese national funds via FCT/MCTES. Sí

Background: Pistacia atlantica (PA) trees grow in all areas of Iran. Pistacia atlantica fruit is edible and mostly consumed by residents. Also, PA leaves, gum, and fruit are considered to have medicinal value in traditional medicine. Objectives: This study was designed to evaluate the analgesic effects of the hydroalcoholic extract of PA leaves, gum, and fruit. Methods: Seventy-two adult male Sprague-Dawley rats were divided into 12 groups, including control and test groups. In the positive control group, the rats received the standard drug paracetamol at a dose of 100 mg/kg, IP. In the test groups, the rats received leaves, gum, and fruit extracts at the doses of 25, 50, and 100 mg/kg, IP. Then, the rats were assessed for antinociception by the tail-flick and formalin tests. In this study, the ethical guidelines approved by the Ethics Committee of Shiraz University of Medical Sciences regarding the use of animals in experimental studies were followed. Results: The results showed that the leaves extract at the doses of 25 and 50 mg/kg and the gum extract at the dose of 100 mg/kg had a substantial analgesic effect, as demonstrated by the increase in the latency time in the tail-flick test and the decrease in the pain sensitivity in the formalin test (P < 0.05). The fruit extract, compared with the other parts of the plant, had no analgesic effect. Conclusions: The stronger analgesic effects of PA leaves extract, compared to those observed for the extracts of other parts of PA, might be due to the higher concentration of components with analgesic properties in PA leaves.

RATIONALE AND OBJECTIVES: Despite all the benefits and effectiveness of the coronavirus disease 2019 (COVID-19) vaccines mentioned in recent clinical trials, some post-vaccination side effects such as lymphadenopathy (LAP) were observed. The present study reviewed all studies with imaging findings presentation of LAP after COVID-19 vaccination. MATERIALS AND METHODS: We conducted a literature search in online databases, including Scopus, Medline (PubMed), Web of Science, Embase (Elsevier), Cochrane library, and Google Scholar. RESULTS: A total of 19 studies (68 cases), including 60 (88.2%) females and eight (11.8%) males with a presentation of LAP after COVID-19 vaccination, were reviewed. LAP was identified after first or second dosages of three types of COVID-19 vaccines, including Pfizer-BioNTech (n = 30, 44.1%), Moderna (n = 17, 25%), and Oxford-AstraZeneca (n = 1, 1.5%). In 20 (29.4%) cases, vaccine type was not reported or only reported as mRNA COVID-19 vaccine. The median days of LAP presentation after the first and second dosages of COVID-19 vaccination, were 12 and 5 days, respectively. Most of the LAP imaging findings related to COVID-19 vaccination (n = 66, 97%) were seen from first day to 4 weeks after vaccination. However, LAP remained after 5 and 6 weeks of the first and second dosages of COVID-19 vaccination with decreased lymph nodes' size and residual cortical thickening in two cases. CONCLUSION: This review study of cases with LAP-associated COVID-19 vaccination guides radiologists and physicians to rely on patient's clinical context and updated resources to prevent potential disease upstaging and change in therapy.

Kawasaki‐like disease (KLD) and multisystem inflammatory syndrome in children (MIS‐C) are considered as challenges for pediatric patients under the age of 18 infected with coronavirus disease 2019 (COVID‐19). A systematic search was performed on July 2, 2020, and updated on December 1, 2020, to identify studies on KLD/MIS‐C associated with COVID‐19. The databases of Scopus, PubMed, Web of Science, Embase, and Scholar were searched. The hospitalized children with a presentation of Kawasaki disease (KD), KLD, MIS‐C, or inflammatory shock syndromes were included. A total number of 133 children in 45 studies were reviewed. A total of 74 (55.6%) cases had been admitted to pediatric intensive care units (PICUs). Also, 49 (36.8%) patients had required respiratory support, of whom 31 (23.3%) cases had required mechanical ventilation/intubation, 18 (13.5%) cases had required other oxygen therapies. In total, 79 (59.4%) cases had been discharged from hospitals, 3 (2.2%) had been readmitted, 9 (6.7%) had been hospitalized at the time of the study, and 9 (6.7%) patients had expired due to the severe heart failure, shock, brain infarction. Similar outcomes had not been reported in other patients. Approximately two‐thirds of the children with KLD associated with COVID‐19 had been admitted to PICUs, around one‐fourth of them had required mechanical ventilation/intubation, and even some of them had been required readmissions. Therefore, physicians are strongly recommended to monitor children that present with the characteristics of KD during the pandemic as they can be the dominant manifestations in children with COVID‐19.

The main purpose of this systematic review was to reflect on recent literature on bariatric LGA embolization for obesity treatment and to compare this new procedure in human and animal studies. A systematic search of Scopus, MEDLINE, Web of Science, Embase, and Google Scholar was performed to identify human and animal studies employing bariatric LGA embolization to treat obesity. As well, Cochrane’s Q test and the I2 statistic were utilized to determine heterogeneity. Nine human and four animal studies recruiting a total of 118 cases (n = 78 patients and n = 40 animals) were included in analysis. All assessments on body mass index (BMI), weight, and ghrelin levels had been fulfilled based on before-after (human studies) and intervention-control designs (animal studies) using bariatric LGA embolization. The findings suggested that bariatric LGA embolization had significantly decreased BMI (mean difference (MD): − 2.66, 95% confidence interval [CI] − 3.74, − 1.58, P

Introduction We aimed to describe shear wave elastography parameters of non-mass lesions of the breast and to assess the measures of diagnostic accuracy of shear wave elastography in the differentiation of non-mass lesions compared with conventional ultrasound, using histopathologic results as the reference standard. Methods This retrospective study included breast ultrasound-detected non-mass lesions with a confirmed pathologic diagnosis during a two-year study period. B-mode ultrasound and shear wave elastography were performed for all lesions before biopsy. Ultrasound features, shear wave elastography parameters (mean elasticity and maximum stiffness color), as well as Breast Imaging-Reporting and Data System categories were recorded for each lesion. Measures of diagnostic accuracy of ultrasound and ultrasound + shear wave elastography were also assessed. Results From a total of 567 breast lesions requiring core-needle biopsy, 49 (8.6%) were considered as non-mass lesions. Based on histopathologic reports, 32 patients (65.3%) had non-high-risk benign lesions, five (10.2%) had high-risk benign lesions, five (10.2%) had ductal carcinoma in situ, and seven (14.3%) had invasive carcinoma. There was no significant difference in patients’ age and palpability between benign and malignant lesions ( p = 0.16 and p = 0.12, respectively). Mean elasticity values and Breast Imaging-Reporting and Data System categories were significantly higher among malignant lesions compared with benign non-mass lesions (both p Conclusion The complementary use of shear wave elastography with conventional ultrasound might help in the differentiation of non-mass breast lesions and has the potential to decrease the frequency of unnecessary biopsies performed for benign non-mass lesions.

There have been several reports of the incidental detection of severe acute respiratory syndrome coronavirus 2 pneumonia on positron emission tomography/computed tomography (PET/CT) studies, which represent the potential role of molecular imaging in the detection and management of coronavirus disease 2019. Here, we systematically review the value of PET/CT in this setting. We conducted a systematic search on June 23, 2020, for PET studies with findings suggestive of coronavirus disease 2019. Web of Science, PubMed, Scopus, EMBASE, and Google Scholar databases were used. Patients with at least one PET/CT imaging evaluation were included in the study. Fifty-two patients in 30 publications with a mean age of 60 ± 12.74 (age range; 27-87) were included in this study, of which 28 (53.8%) were male, and 19 (36.5%) were female. In 5 (9.7%) patients, gender was not reported. PET/CT was performed with 18F-fluorodeoxyglucose for 48 (92.3%), 18F-choline for 3 (5.8%), and 68Ga-PSMA for 1 (1.9%) patients. The mean SUV max of pulmonary lesions with 18F-fluorodeoxyglucose uptake was 4.9 ± 2.3. Moreover, 39 (75%) cases had an underlying malignancy, including 18 different type of primary cancers and 6 (11.5%) patients with metastatic disease. The most common pulmonary findings in PET/CT were bilateral hypermetabolic ground-glass opacities in 39 (75%), consolidation in 18 (34.6%), and interlobular thickening in 4 (7.6%). In addition, mediastinal 14 (27%) and hilar 10 (19.2%) lymph node involvement with increased metabolic activity was frequently identified. Early diagnosis of severe acute respiratory syndrome coronavirus 2 pneumonia is not only crucial for both appropriate patient management but also helps to ensure appropriate postexposure precautions are implemented for the department and hospital staff and those who have been in contact with the patient.

Accessory and cavitated uterine mass (ACUM) is a rare form of Mullerian anomaly that usually presents in young females with chronic cyclic pelvic pain and/or dysmenorrhea. This clinical entity is often underdiagnosed as it may be mistaken for other differential diagnoses, such as pedunculated myoma or adnexal lesions. Imaging modalities, including ultrasonography and magnetic resonance imaging (MRI), accompanied with relevant and suspicious clinical findings are important tools in making acorrect diagnosis. To date, surgical excision of the mass remains the mainstay of treatment,which provides significant symptom relief. In this study, we present a female adolescent with chronic pelvic pain since menarche who underwent laparotomy with the presumed diagnosis of a left-sided ovarian mass. Retrospective evaluation of pelvic MR images demonstrated that the lesion was in fact an ACUM, which was further confirmed by histopathological examination.

Background: Studies conducted in recent years have proposed a protective effect of vitamin D3 (VitD3) against various types of cancers. Thus, in this research, we investigated the serum levels of VitD3and its relation with prognostic clinical factors in chronic lymphocytic leukemia (CLL). Method: In this cross-sectional study, 86 CLL patients were investigated for a one-year period and evaluated for the relationship between Vit D3serum levels, Rai stages, age, gender, and pathological factors. A control group was added to the study in order to compare the VitD3 levels of CLL patients with that of the normal population. Results: The mean serum VitD3level in CLL patients was 29.76 ± 18.75 ng/ml, and most of the patients were in stage I and II. There was no significant association between age, sex, and Rai stages of CLL with VitD3 level. Except for splenomegaly (P < 0.001), the leukemia-related phenotypes, complications, and prognostic factors had no meaningful association with VitD3 (P > 0.05) level. VitD3 serum level was meaningfully different between case and control groups (P < 0.001). Conclusion: In the current research, there was no significant relationship between VitD3serum levels and investigated variables, except splenomegaly; these findings are in concordance with other studies.

The main purpose of this systematic review was to reflect on recent literature on bariatric LGA embolization for obesity treatment and to compare this new procedure in human and animal studies.A systematic search of Scopus, MEDLINE, Web of Science, Embase, and Google Scholar was performed to identify human and animal studies employing bariatric LGA embolization to treat obesity. As well, Cochrane's Q test and the INine human and four animal studies recruiting a total of 118 cases (n = 78 patients and n = 40 animals) were included in analysis. All assessments on body mass index (BMI), weight, and ghrelin levels had been fulfilled based on before-after (human studies) and intervention-control designs (animal studies) using bariatric LGA embolization. The findings suggested that bariatric LGA embolization had significantly decreased BMI (mean difference (MD): - 2.66, 95% confidence interval [CI] - 3.74, - 1.58, P 0.001) and weight (MD: - 8.69, 95% CI - 10.48, - 6.89, P 0.001) in humans. Although overall pooled estimate showed no significant changes in ghrelin levels following this procedure (Hedges' g statistic: - 0.91, 95% CI - 1.83, 0.01, P = 0.05) in humans, a significant reduction was observed in animal studies (MD: - 756.56, 95% CI - 1098.79, - 414.33, P 0.001) along with a significant drop in weight (MD: - 7.64, 95% CI - 13.73, - 1.54, P 0.001).The present study concluded that ghrelin levels in humans had not been affected, although bariatric LGA embolization might significantly improve BMI and weight.

Aims This study aimed to make a comparison between the clinical laboratory-related factors, complete blood count (CBC) indices, cytokines, and lymphocyte subsets in order to distinguish severe coronavirus disease 2019 (COVID-19) cases from the non-severe ones. Materials and methods Relevant studies were searched in PubMed, Embase, Scopus, and Web of Science databases until March 31, 2020. Cochrane's Q test and the I2 statistic were used to determine heterogeneity. We used the random-effect models to pool the weighted mean differences (WMDs) and 95% confidence intervals (CIs). Key findings Out of a total of 8557 initial records, 44 articles (50 studies) with 7865 patients (ranging from 13 to 1582), were included. Our meta-analyses with random-effect models showed a significant decrease in lymphocytes, monocyte, CD4+ T cells, CD8+ T cells, CD3 cells, CD19 cells, and natural killer (NK) cells and an increase in the white blood cell (WBC), neutrophils, neutrophil to lymphocyte ratio (NLR), C-reactive protein (CRP)/hs-CRP, erythrocyte sedimentation rate (ESR), ferritin, procalcitonin (PCT), and serum amyloid A (SAA), interleukin-2 (IL-2), IL-2R, IL-4, IL-6, IL-8, IL-10, tumor necrosis factor-alpha (TNF-α), and interferon-gamma (INF-γ) in the severe group compared to the non-severe group. However, no significant differences were found in IL-1β, IL-17, and CD4/CD8 T cell ratio between the two groups. Significance Decrease in total lymphocytes and lymphocyte subsets as well as the elevation of CRP, ESR, SAA, PCT, ferritin, and cytokines, but not IL-1β and IL-17, were closely associated with COVID-19 severity, implying reliable indicators of severe COVID-19., Graphical abstract Unlabelled Image

‌Background: Women are at higher risk for depression progression especially during pregnancy. So, we aimed to investigate depression, anxiety, and stress level of pregnant mothers in the initial stage of the COVID-19 infection in Southwest of Iran. Methods: This cross-sectional study conducted during March and April, 2020 in Shiraz, Iran. Pregnant mothers registered in maternity clinics affiliated to Shiraz University of Medical Sciences were included. An online self-administered checklist was used. It included socio-demographic, obstetric and medical history, and the short form of Depression Anxiety Stress Scales (DASS-21) for evaluation of depression, anxiety, and stress. P-value < 0.05 was considered significant.Results: 540 pregnant mothers answered the questionnaire. 83.5% had no comorbidity. Abnormal depression score was significantly higher in those who did not have any insurance (OR= 2.5) and in those with poor self-rated health (SRH) (OR= 27.8). Pregnant mothers with lower SRH and two or more comorbidities had higher chance of having abnormal level of anxiety subscale; 6.9, 3.7 times, retrospectively. Conclusion: The study revealed that that abnormal level of depression was associated with SRH and medical insurance status. Moreover, the number of comorbidities and poor SRH were significantly increased the chance of achieving abnormal anxiety level in pregnant mothers during the COVID-19 pandemic.

Background: There is a growing need for information regarding maternal and neonatal outcomes during coronavirus pandemic. In this study, a comprehensive investigation was done regarding the possibility of vertical transmission using the available data in the literature. Methods: A systematic search was conducted using electronic databases, including PubMed, Scopus, Web of Science, Embase, and Scholar. All studies containing infected COVID-19 pregnant women who had given birth were included, and the search was done up to April 14, 2020. Results: Overall, 21 articles were reviewed, and clinical characteristics of 90 pregnant patients and 92 neonates born to mothers infected with COVID-19 were reviewed. The most common symptoms included fever, cough, and dyspnea. The main laboratory findings included leukocytosis, lymphopenia, thrombocytopenia, and elevated C-reactive protein. The most commonly reported complications were preterm labor and fetal distress. Three mothers were admitted to ICU and required mechanical ventilation; among them, one died, and one was on extracorporeal membrane oxygenation. Overall, 86 neonates were tested for the possibility of vertical transmission and 82 cases were negative in RT-PCR, while 4 were positive. Out of 92 neonates, one died, and one was born dead. Nineteen patients reported having no symptoms, while breathing problems and pneumonia were reported as the most common neonatal complications. Conclusion: There were no differences in the clinical characteristics of pregnant women and non-pregnant COVID-19 patients. COVID-19 infection has caused higher incidence of fetal distress and premature labor in pregnant women. Although the possibility of vertical transmission in infected pregnant women is rare, four neonates’ test results for COVID-19 infection were positive in this review.

Purpose Hepatic encephalopathy (HE) is described as impaired brain function induced by liver failure. Ammonia is the most suspected chemical involved in brain injury during HE. Although the precise mechanism of HE is not clear, several studies mentioned the role of oxidative stress in ammonia neurotoxicity. In animal models, the use of some compounds with antioxidant properties was reported to reduce the neurotoxic effects of ammonia, improve energy metabolism, and ameliorate the HE symptoms. Citicoline is a principal intermediate in the biosynthesis pathway of phosphatidylcholine that acts as neurovascular protection and repair effects. Various studies mentioned the neuroprotective and antioxidative effects of citicoline in the central nervous system. This study aims to investigate the potential protective effects of citicoline therapeutic in an animal model of HE. Materials and Methods Mice received acetaminophen (APAP,1g/kg, i. p.) and then treated with citicoline (500 mg/kg, i.p) one and two hours after APAP. Animals were monitored for locomotor activity and blood and brain ammonia levels. Moreover, markers of oxidative stress were assessed in the brain tissue. Results The result of the study revealed that plasma and brain ammonia and the liver injury markers increased, and locomotor activity impaired in the APAP-treated animals. Besides, an increase in markers of oxidative stress was evident in the brain of the APAP-treated mice. It was found that citicoline supplementation enhanced the animal’s locomotor activity and improved brain tissue markers of oxidative stress. Conclusion These data propose citicoline as a potential protective agent in HE. The effects of citicoline on oxidative stress markers could play a fundamental role in its neuroprotective properties during HE.

Background Quality of life (QOL) in the elderly people was not addressed as much as their life expectancy. Aim The aim of this study was to evaluate the QOL in the elders. Method In this cross-sectional study, the elders were selected by multi-stage cluster random sampling from health centers-covered population of Shiraz, Iran and interviewed individually. The Persian version of the Leiden-Padua (LIEPAD) questionnaire, consisting of core components (CCQOL) and moderators (MQOL) of QOL was used. SPSS software (version 25) was applied for data analysis. Results The mean age of 386 participants was 68.12 ± 6.24 years. The female to male ratio was 1.1 and 350 (90.7%) educated up to 12 years. The mean score of QOL (sum of CCQOL and MQOL) was 83.67 ± 13.75 (out of 147); consisting of 27 (6.9%) participants with low, 316 (81.8%) with moderate and 43 (11%) with high level of QOL. The mean scores of CCQOL and MQOL were 70.68 ± 9.42 (out of 93) and 14.14 ± 2.46 (out of 54), respectively. Multivariable analysis showed that sleep disorder (B = -0.15), osteoporosis (B = -0.14), female gender (B = -0.13), and not being the source of family income (B = -0.13) were significantly and inversely associated with QOL, while sleep disorder, facing to violence, female gender, migraine, psychological disease and not being the source of family income were inversely associated with CCQOL. Sexual problem, facing to violence, not having supplementary insurance, inability to walk and migraine had a significant and an inverse correlation with MQOL. Conclusion Four out of five elders in the Shiraz region have moderate level of QOL, while the elder females and the elders with chronic diseases, as well as the elders who are not the source of their family income had a lower level of QOL. Quality of life in the elders can be improved through an integrated care program in the health centers.

Objective To determine the optimal cut-off value for follicle stimulating hormone (FSH) to predict the outcome of microsurgical testicular sperm extraction (micro-TESE) in patients with nonobstructive azoospermia (NOA). Subjects and methods We included a total number of 180 patients with NOA. The serum level of FSH was determined and all the subjects underwent micro-TESE. We determined the optimal cut-off value for FSH and assessed whether the test could be effectively used as a successful predictor of sperm retrieval by calculating the Receiver Operating Characteristic (ROC) area under the curve. Results Overall we included a total number of 171 patients with mean age of 34.3 ± 8.6 years. The micro-TESE was considered to be successful in 79 (43.8%) while it failed in 92 (56.2%) patients. We found that the mean level of serum FSH was significantly higher in group those with failed micro-TEST compared to successful group (p < 0.001). The cut-off value for FSH was calculated to be 14.6 mIU/mL to predictive the outcome of micro-TESE with a sensitivity of 83.5% [73.5%-90.9%] and a specificity of 80.3% [69.5%-88.5%]. At this value, the other parameters were calculated to be PPV, 81.5%; NPV, 82.4; LR+, 4.23; and LR-, 0.21. Conclusions The results of the current study indicate that FSH plasma levels above 14.6 mIU/mL can be considered to be the failure predictor of the micro-TESE in NOA patients.

Background: Pulmonary hypoplasia is a significant decrease in lung volume by any cause in comparison to the normal volume for gestational age. Objectives: To evaluate the application of prenatal magnetic resonance imaging in order to predict pulmonary hypoplasia, measurement of fetal lung volume (FLV) was aimed to establish a reference data in normal fetuses. Patients and Methods: Three hundred forty two fetuses with abnormal ultrasound findings underwent fast spin-echo T2-weighted MR imaging at a single tertiary care hospital (Shahid Faghihi Hospital, Shiraz, Iran). Data of 241 fetuses at 18 - 36 weeks’ gestation without thoracic malformations were obtained for a FLV normative curve. To acquire a best-fit formula for the mean total fetal lung volume based on each gestational week with 95% confidence interval (CI), we used the regression model applied by Rypens et al. This resulted in a formula calculating the expected fetal lung volume based on gestational age. A one-sample t-test was also carried out to compare the mean total fetal lung volume at each gestational week with the expected mean total fetal lung volume predicted by the formula by Rypens et al., Meyers et al., and Osada et al. Results: Normal FLV increased with gestational age as the spread of values. The expected fetal lung volume was derived from the following formula: Fetal lung volume (mL) = 0.002 × (gestational age [GA]2.913), in which GA is gestational weeks. FLV in our population had a more consistent correlation with Japanese fetuses than European or American fetuses. Conclusion: In fetuses with normal lungs, FLV distribution against gestational age is simply measured prenatally with MR imaging. A single universal formula might not be suitable for fetuses worldwide. In our region, acquired data were more consistent with Asian normal values.

Purpose The main goal of this systematic review was to assess the technical and clinical success, adverse events (AEs), surgery, and overall mortality proportion after percutaneous catheter drainage (PCD) of two pancreatic lesions. Methods An extant search in online databases including Scopus, PubMed (Medline), Embase (Elsevier), Web of Science, Cochrane library, and Google Scholar, was conducted to recognize all studies that used PCD intervention in the management of pancreatic necrosis (PN) and pancreatic pseudocysts (PP). Random effects meta-analysis was performed, and Cochrane’s Q test and I2 statistic were utilized to determine heterogeneity. In addition, meta-regression was used to explore the influence of categorical variables on heterogeneity. Results Thirty-two studies (1398 patients) including PN in 26 (1256 cases, 89.8%) studies and PP in 6 (142 cases, 10.2%) studies were identified. Technical success proportion was 100% (95% confidence interval [CI] 100%-100%, I2: 0.0%), clinical success 63% (95% CI 55%-71%, I2: 92.9%), AEs 26% (95% CI 21%-31%, I2: 78%), surgery after PCD intervention 33% (95% CI 25%-40%, I2: 92.4%), and overall mortality was 13% (95% CI 9%-17%, I2: 82.8%). The most common ADs after PCD intervention were development of fistula (106, 42.6%), hemorrhage (44, 17.7%), sepsis (40, 16.1%). Conclusion A significant clinical success proportion with low AEs, surgery, and overall mortality proportion after PCD intervention was found, although the results should be interpreted with caution due to the high heterogeneity.

Oxytocin (OT) is a nonapeptide hormone that can improve cardiomyocyte proliferation, suggesting a potential heart regeneration function. Here, we investigated the role of oxytocin and the c-Myc pathway in cardiac remodeling in neonatal rats undergoing cardiac apical resection. We have utilized a knockout of oxytocin receptor (OTR) with OTR-shRNA. A neonatal rat model of cardiac resection (≈10%-15%) was first established. The protein levels of OTR and c-Myc and the expression of cyclin d1 and c-Myc genes were then evaluated in the cardiac tissues at 1, 7, and 21 days after cardiac resection. We also analyzed the proliferation of cardiomyocytes through α-actinin, BrdU, and ki-67 markers. At last, the hemodynamic and electrophysiologic functions were evaluated eight weeks after cardiac resection. At 21 days, the regeneration of cardiomyocytes was repaired among rats in the control and resection groups, while OTR-shRNA groups were failed to improve. Inhibition of OTR failed cardiac regeneration and reduced the number of proliferating cardiomyocytes. The c-Myc protein was significantly reduced in the OTR-shRNA injection hearts. Moreover, we have severely found a depressed heart function in the OTR-shRNA injection animals. These observations revealed that the OT must improve cardiac remodeling in neonatal rat hearts by regulating the c-Myc pathway.