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Introduction: Psychosomatic diseases disrupt patients’ mental order, leading to chronic psychological injuries. Consequently, this study aimed to investigate the mediating role of health-promoting behaviors in the relationship between perceived stress and sense of coherence with psychosocial adaptation to the disease in patients with irritable bowel syndrome (IBS).Methods: The research method was descriptive-correlational and utilized Structural Equation Modeling. The study’s statistical population included patients with IBS referred to therapy centers and gastroenterologists in Isfahan in the autumn and winter of 2020-21. The statistical population comprised 340 patients with IBS, selected using a convenient sampling method. The applied instruments included the Psycho-Social Adaptation to Disease Scale (PSADS), Perceived Stress Scale (PSS) Sense of Coherence Questionnaire (SCQ) and Health Promoting Behaviors Questionnaire (HPBQ). Data analysis was conducted via Structural Equation Modeling and Bootstrap test using SPSS23 and AMOS23 statistical software.Results: The results showed that perceived stress, sense of coherence, and health-promoting behaviors directly affect psychosocial adaptation to disease. Furthermore, the results of the Bootstrap test showed that health-promoting behaviors have a significant mediation role in the relationship of perceived stress and sense of coherence with psychosocial adaptation to disease (P

The purpose of this research was to develop a model that could predict psychosocial ada​ptation to disease in patients with irritable bowel syndrome (IBS) based on perceived stress, sense of coherence, and the mediating function of self-compassion. Utilizing descriptive-correlational and structural equation modeling, the research was conducted. Patients with IBS who were referred to therapy centers and gastroenterologists in the city of Isfahan between the autumn and winter of 2020-2021 constituted the statistical population of the study. The statistical population comprised 340 IBS patients selected using a method of convenient sampling. Psycho-Social Adaptation to Disease Scale (PSADS), Perceived Self-compassion Scale (PSS), Sense of Coherence Questionnaire (SCQ), and Self-Compassion Questionnaire (SCQ) were among the instruments utilized. The data analysis was performed using SPSS and Amos software, version 23, in conjunction with path analysis and Bootstrap testing. Significant relationships were found between perceived stress, sense of coherence, self-compassion, and psychosocial adaptation to disease (p

Objective: Celiac disease is a common chronic inflammatory condition of the small intestine caused by permanentintolerance to gluten/gliadin. It has been demonstrated that oxidative stress is one of the mechanisms that is involvedin gliadin toxicity, and there is a correlation between oxidative damage with this disease. Similarly, increased oxidativestress was repeatedly reported in infertile men which led to low-quality of sperm function. Therefore, we aimed toassess sperm parameters and chromatin status in men with Celiac disease.Materials and Methods: In this case-control study, semen samples were collected from 11 fertile men without Celiacand 10 men with diagnostic Celiac disease. Basic semen analyses were performed according to the World HealthOrganization (WHO) 2010 protocol. The percentage of sperm with persistence histones, protamine deficiency, DNAfragmentation, malondialdehyde (MDA), and intracellular reactive oxygen species (ROS) were assessed using anilineblue, chromomycin A3, sperm chromatin structure assay, thiobarbituric acid reactive substances (TBARS) assay, anddiacetyldichlorofluorescein staining, respectively.Results: Unlike the sperm parameters, which did not show significant differences between men with Celiac diseaseand fertile individuals, sperm chromatin maturation (persistence histones and protamine deficiency) and sperm DNAdamage in men with Celiac disease were significantly higher compared to fertile individuals (P0.05).Conclusion: Celiac disease affects sperm chromatin maturation and DNA fragmentation, emphasizing its impact onreproductive health.

This study explores the prevalence of adherent-invasive Escherichia coli (AIEC) in colorectal cancer (CRC) patients and investigates the potential of effective intracellular antibiotics as a therapeutic strategy for CRC patients with AIEC infections. Considering the pivotal role of integrons in bacterial antibiotic resistance, the frequency of class 1 and 2 integrons in AIEC isolated from CRC patients, in one of the referenced 3 gastroenterology clinics in Isfahan, Iran was examined. AIEC strains were isolated from the colorectal biopsies and their antimicrobial sensitivity was assessed using the disc diffusion method. Polymerase chain reaction (PCR) was employed to detect intl1 and intl2. The multilocus sequence typing (MLST) method was utilized to type 10 selected isolates. Of the 150 samples, 24 were identified as AIEC, with the highest number isolated from CRC2 (33.4%) and CRC1 (29.16%), and the least from the FH group (8.3%) and control group (12.5%). int1 in 79.2% and int2 in 45.8% of AIEC strains were found and 41.6% of strains had both integrons. AIEC isolates with int1 exhibited the highest sensitivity to trimethoprim-sulfamethoxazole (57.9%), while those with int2 showed the highest sensitivity to ciprofloxacin (63.6%). A significant association between resistance to rifampin and integron 2 presence in AIEC isolates was observed. Furthermore, a significant correlation between integron 1 presence, invasion, survival, and replication within macrophages in AIEC strains was identified. MLST analysis revealed ST131 from CC131 with integron 1 as the most common sequence type (ST). The emergence of such strains in CRC populations poses a serious public health threat. The distribution pattern of STs varied among studied groups, with pandemic STs highlighting the importance of examining and treating patients infected with these isolates. Comprehensive prospective clinical investigations are warranted to assess the prognostic value of detecting this pathovar in CRC and to evaluate therapeutic techniques targeting drug-resistant AIECs, such as phage therapy, bacteriocins, and anti-adhesion compounds, for CRC prevention and treatment.

Human mesenchymal stromal cells are multipotent cells capable of differentiating into the mesenchymal lineage that can be isolated from bone marrow and adipose tissue or from umbilical cord blood and fetal tissues. Among the widely characterized in vitro properties, MSCs show strong anti-proliferative and anti-inflammatory effects on immune responses Exosomes derived from mesenchymal stem cells derived from different tissues are promising cell-free treatments for tissue damage repair. Exosomes serve as a potential portal for cell-free drug delivery systems, as these drugs possess the properties of the parent cell from which they are derived. Extracellular vesicles (EVs) play key roles in cell biology and may provide new clinical diagnostics and therapies. Exosomes, called extracellular vesicles (EcVs), are present in almost all cells, tissues, and body fluids. They contribute to intercellular signaling and maintain tissue homeostasis. The biogenesis of exosomes starts in the endosomal system. Researchers have identified 9769 proteins, 2838 miRNAs, 3408 and 1116 lipids present in exosome of mRNA cargo. Isolation of exosomes from cells, tissues and body fluids follows a different pattern. Exosomes interact with receptor cells through their surface receptor molecules and ligands and are internalized into receptor cells through micropinocytosis and phagocytosis. This varies depending on the origin of the EV, its physiological and pathological state, and even the exact site of cellular release. The composition of the protein inside can also indicate the presence of disease pathologies such as cancer or inflammatory diseases; However, exosomes also contain a number of common proteins as well as proteins involved in vesicle formation. Advanced technologies in regenerative medicine have caused researchers to use exosomes isolated from mesenchymal stem cells (MSCs) with high regeneration ability in diseases. Exosome cargo plays a key role in diagnosis and treatment by controlling the disease process. Various studies in laboratory conditions have shown the effectiveness and therapeutic potential of exosomes in cancer, neurodegenerative, cardiovascular and orthopedic diseases. This article describes the therapeutic role and potential of exosomes derived from mesenchymal stem cells, as well as the necessary precautions for their processing.

Abstract Background Data management related to COVID-19 vaccination in pregnant women is vital to improve the treatment process and to establish preventive programs. Implementing a registry to manage data is an essential part of this process. This study aims to design a national model of the COVID-19 vaccination registry for pregnant women in Iran. Methods The present study is an applied descriptive study conducted in 2021 and 2022 in two stages. In the first stage, the coordinates of the National Registry of COVID-19 vaccination of pregnant women from related references and articles, as well as the comparative study of the National Registry of COVID-19 vaccination of pregnant women in the United States, Canada, and the United Kingdom was done. In the second stage, the preliminary model was designed. The model was validated using the Delphi technique and questionnaire tools and analyzing the data. Results The presented national COVID-19 vaccination registry model of pregnant women’s main components consist of objectives, data sources, structure, minimum data set, standards, and registry processes, all of which received 100% expert consensus. Conclusion The vaccination registry of pregnant women has a major role in managing COVID-19 vaccination data of pregnant women and can be one of the Ministry of Health and Medical Education priorities.

Abstract Introduction Esophageal cancer (EC) is a significant global health problem, with an estimated 7th highest incidence and 6th highest mortality rate. Timely diagnosis and treatment are critical for improving patients’ outcomes, as over 40% of patients with EC are diagnosed after metastasis. Recent advances in machine learning (ML) techniques, particularly in computer vision, have demonstrated promising applications in medical image processing, assisting clinicians in making more accurate and faster diagnostic decisions. Given the significance of early detection of EC, this systematic review aims to summarize and discuss the current state of research on ML-based methods for the early detection of EC. Methods We conducted a comprehensive systematic search of five databases (PubMed, Scopus, Web of Science, Wiley, and IEEE) using search terms such as “ML”, “Deep Learning (DL (“, “Neural Networks (NN)”, “Esophagus”, “EC” and “Early Detection”. After applying inclusion and exclusion criteria, 31 articles were retained for full review. Results The results of this review highlight the potential of ML-based methods in the early detection of EC. The average accuracy of the reviewed methods in the analysis of endoscopic and computed tomography (CT (images of the esophagus was over 89%, indicating a high impact on early detection of EC. Additionally, the highest percentage of clinical images used in the early detection of EC with the use of ML was related to white light imaging (WLI) images. Among all ML techniques, methods based on convolutional neural networks (CNN) achieved higher accuracy and sensitivity in the early detection of EC compared to other methods. Conclusion Our findings suggest that ML methods may improve accuracy in the early detection of EC, potentially supporting radiologists, endoscopists, and pathologists in diagnosis and treatment planning. However, the current literature is limited, and more studies are needed to investigate the clinical applications of these methods in early detection of EC. Furthermore, many studies suffer from class imbalance and biases, highlighting the need for validation of detection algorithms across organizations in longitudinal studies.

Abstract Background Personal Health Records (PHRs) are designed to fulfill the goals of electronic health (eHealth) and empower the individual in the process of self-care. Integrated PHR can improve the quality of care, strengthen the patient-healthcare provider relationship, and reduce healthcare costs. Still, the process of PHR acceptance and use has been slow and mainly hindered by people’s concerns about the security of their personal health information. Thus, the present study aimed to identify the Integrated PHR security requirements and mechanisms. Methods In this applied study, PHR security requirements were identified with a literature review of (library sources, research articles, scientific documents, and reliable websites). The identified requirements were classified, and a questionnaire was developed accordingly. Thirty experts completed the questionnaire in a two-round Delphi technique, and the data were analyzed by descriptive statistics. Results The PHR security requirements were identified and classified into seven dimensions confidentiality, availability, integrity, authentication, authorization, non-repudiation, and right of access, each dimension having certain mechanisms. On average, the experts reached an agreement about the mechanisms of confidentiality (94.67%), availability (96.67%), integrity (93.33%), authentication (100%), authorization (97.78%), non-repudiation (100%), and right of access (90%). Conclusion Integrated PHR security is a requirement for its acceptance and use. To design a useful and reliable integrated PHR, system designers, health policymakers, and healthcare organizations must identify and apply security requirements to guarantee the privacy and confidentiality of data.

Abstract Background Reduced or absence of melanin poses physical, social, and psychological challenges to individuals with albinism. Mobile health (mHealth) applications have the potential to improve the accessibility of information and services while reducing time and costs. This study aimed to develop and evaluate a mHealth application for self-management of albinism. Methods This applied study was conducted in two stages (development and evaluation) in 2022. Initially, the functional requirements were determined, and the conceptual model of the application was then developed using Microsoft Visio 2021. In the second phase, the application was evaluated using the Mobile Application Usability Questionnaire (MAUQ) involving patients with albinism to reflect their views on the usability of the application. Results The key capabilities of the application included: reminders, alerts, educational content, useful links, storage and exchange of images of skin lesions, specialist finder, and notifications for albinism-relevant events. Twenty-one users with albinism participated in the usability testing of the application. The users were predominantly satisfied with the application (5.53 ± 1.10; Max: 7.00). Conclusions The findings of this study suggest that the developed mobile application could assist individuals with albinism to effectively manage their condition by considering the users’ requirements and services that the application should deliver.

Adenoma detection rate (ADR) is an imperative quality measure for colorectal cancer (CRC) screening. This retrospective observational study aimed to determine the trend of polyp detection rate (PDR) and ADR in asymptomatic average- and high-risk participants in different age groups who underwent screening colonoscopy over the seven years from April 2012 to March 2019 in a tertiary gastroenterology referral center of Iran. Of 1676 participants, 51.8 % were men (mean age 52.3 years). The overall PDR and ADR were 22.7 %, and 13.5 %, respectively. Both Polyps and adenomas were more common in age groups 51–59 and ≥60 years in high-risk patients than in the corresponding groups of average-risk patients (p

Lynch syndrome (LS) predisposes individuals to early-onset colorectal and other Lynch-associated cancer. This disorder is an autosomal dominant genetic disturbance caused by germline mutations in one of the mismatch repair genes. Different clinical and molecular criteria are used to diagnose LS. Microsatellite instability testing and immunohistochemistry are two widely used methods for the molecular screening of LS-associated cancers. According to the immunohistochemistry and Microsatellite instability testing, we introduce three Persian families with Lynch-like syndrome (LLS) who met clinical Amsterdam-II criteria and their probands were mismatch repair deficient. In the case of immunohistochemistry-MLH1 absent, BRAF-V600E mutation was evaluated to rule out the sporadic colorectal cancer cases. No pathogenic germline variants were found by next generation sequencing method. Multiplex ligation-dependant probe amplification technique was done to find large in/dels within MLH1/MSH2 genes of the probands. A two-exon deletion within MLH1 gene was eventually identified in one of the patients. Finally, we have represented a molecular pipeline to diagnose LLS based on literature review and the introduced cases.

Abstract Background Cervical cancer is a common malignant tumor of the female reproductive system and is considered a leading cause of mortality in women worldwide. The analysis of time to event, which is crucial for any clinical research, can be well done with the method of survival prediction. This study aims to systematically investigate the use of machine learning to predict survival in patients with cervical cancer. Method An electronic search of the PubMed, Scopus, and Web of Science databases was performed on October 1, 2022. All articles extracted from the databases were collected in an Excel file and duplicate articles were removed. The articles were screened twice based on the title and the abstract and checked again with the inclusion and exclusion criteria. The main inclusion criterion was machine learning algorithms for predicting cervical cancer survival. The information extracted from the articles included authors, publication year, dataset details, survival type, evaluation criteria, machine learning models, and the algorithm execution method. Results A total of 13 articles were included in this study, most of which were published from 2018 onwards. The most common machine learning models were random forest (6 articles, 46%), logistic regression (4 articles, 30%), support vector machines (3 articles, 23%), ensemble and hybrid learning (3 articles, 23%), and Deep Learning (3 articles, 23%). The number of sample datasets in the study varied between 85 and 14946 patients, and the models were internally validated except for two articles. The area under the curve (AUC) range for overall survival (0.40 to 0.99), disease-free survival (0.56 to 0.88), and progression-free survival (0.67 to 0.81), respectively from (lowest to highest) received. Finally, 15 variables with an effective role in predicting cervical cancer survival were identified. Conclusion Combining heterogeneous multidimensional data with machine learning techniques can play a very influential role in predicting cervical cancer survival. Despite the benefits of machine learning, the problem of interpretability, explainability, and imbalanced datasets is still one of the biggest challenges. Providing machine learning algorithms for survival prediction as a standard requires further studies.

Abstract In recent studies, the void of evaluation and in-depth understanding of unknown clinically relevant potential molecular biomarkers involved in colorectal cancer (CRC) from the inflammatory stage of ulcerative colitis (UC) to CRC metastasis, which can be suitable therapeutic targets, is deeply felt. The regulation and interaction among different cancer-promoting molecules, including messenger RNAs (mRNAs) and micro RNAs (miRNAs) in CRC and its progression, were the aim we pursued in this study. Using microarray data, we investigated the differential expression for five datasets, including mRNA and microRNA samples related to UC, tumor/normal. Then, using robust data analysis, separate lists of differentially expressed genes (DEGs) and differentially expressed miRNAs (DEmiRNAs) were identified, which were used for robust rank aggregation (RRA) and co-expression network analysis. Then, comprehensive computational systems biology analyses, including gene ontology and Kyoto encyclopedia of genes and genomic pathway enrichment analyses, mRNA-miRNA regulatory network, and survival analysis, were employed to achieve the aim of this study. Finally, we used clinical samples to validate this potential and new target. According to this systems biology approach, a total of 98 DEGs and 8 DEmiRNAs with common differential expression were identified. By combining the distinct results of RRA and network, several potential therapeutic targets, and predictive and prognostic biomarkers for UC and CRC were identified. These targets include six common hub genes, CXCL1, CXCL8, MMP7, SLCA16A9, PLAU, and TIMP1, which are upregulated. Among these, the important and new biomarker SLC16A9 is negatively regulated by hsa-mir-194-5p, and hsa-miR-378a-5p take. The findings of the present study provide new insight into the pathogenesis of CRC in UC. Our study suggests future evaluation of the functional role of SLC16A9 and hsa-mir-194-5p and hsa-miR-378a-5p in CRC development.

This survey illustrates and investigates the application of polynomial rings over finite fields to generate PRN codes for Global Navigation Satellite System (GNSS) satellites. In GNSS, satellites continually broadcast signals at two or more frequencies, including pseudo-random noise (PRN) codes. Each GNSS satellite has its own PRN code, and due to the unique mathematical properties of PRN codes, all satellites can communicate at the same frequency without interfering with another one. Although PRN code appears to be devoid of any discernible structure, it is composed of a deterministic series of pulses that will repeat itself after its period. The PRN code generator employs two shift registers known as Gold polynomials, and the suitable polynomial is decided by the number of satellites. The approach used in satellites is based on the usage of two primitive polynomials, with the output of the first polynomial being used as input for the second polynomial.

BackgroundBreast cancer (BC) survival prediction can be a helpful tool for identifying important factors selecting the effective treatment reducing mortality rates. This study aims to predict the time-related survival probability of BC patients in different molecular subtypes over 30 years of follow-up.Materials and methodsThis study retrospectively analyzed 3580 patients diagnosed with invasive breast cancer (BC) from 1991 to 2021 in the Cancer Research Center of Shahid Beheshti University of Medical Science. The dataset contained 18 predictor variables and two dependent variables, which referred to the survival status of patients and the time patients survived from diagnosis. Feature importance was performed using the random forest algorithm to identify significant prognostic factors. Time-to-event deep-learning-based models, including Nnet-survival, DeepHit, DeepSurve, NMLTR and Cox-time, were developed using a grid search approach with all variables initially and then with only the most important variables selected from feature importance. The performance metrics used to determine the best-performing model were C-index and IBS. Additionally, the dataset was clustered based on molecular receptor status (i.e., luminal A, luminal B, HER2-enriched, and triple-negative), and the best-performing prediction model was used to estimate survival probability for each molecular subtype.ResultsThe random forest method identified tumor state, age at diagnosis, and lymph node status as the best subset of variables for predicting breast cancer (BC) survival probabilities. All models yielded very close performance, with Nnet-survival (C-index=0.77, IBS=0.13) slightly higher using all 18 variables or the three most important variables. The results showed that the Luminal A had the highest predicted BC survival probabilities, while triple-negative and HER2-enriched had the lowest predicted survival probabilities over time. Additionally, the luminal B subtype followed a similar trend as luminal A for the first five years, after which the predicted survival probability decreased steadily in 10- and 15-year intervals.ConclusionThis study provides valuable insight into the survival probability of patients based on their molecular receptor status, particularly for HER2-positive patients. This information can be used by healthcare providers to make informed decisions regarding the appropriateness of medical interventions for high-risk patients. Future clinical trials should further explore the response of different molecular subtypes to treatment in order to optimize the efficacy of breast cancer treatments.

Background: Cancer development is aided by the role of long noncoding RNAs (lncRNAs) that act as competing endogenous RNAs (ceRNAs) absorbing microRNAs (miRNAs). We aimed to discover a novel regulatory axis in colorectal cancer (CRC) and potential biomarkers based on miR-616-3p. Materials and Methods: The gene expression omnibus database was mined for differentially expressed lncRNAs (DELs) and mRNAs. LncRNAs and mRNAs were predicted using the RegRNA and TargetScan databases. A combination of the ciBioPortal and Ensemble databases was used to locate the mRNAs. Cytoscape 3.7.1-built CeRNA networks. A quantitative real-time polymerase chain reaction (qRT-PCR) was utilized to confirm the expression levels of these RNA molecules. Statistical analyses were implemented by GraphPad Prism 9. Results: qRT-PCR showed (Linc01282, lnc-MYADM-1:1, and Zinc Finger Protein 347 [ZNF347]) were overexpressed whereas, (salt-inducible kinases 1 [SIK1], and miR-616-3p) were down regulated. Conclusion: These results identify unique, unreported lncRNAs as CRC prognostic biomarkers, as well as prospective mRNAs as new treatment targets and predictive biomarkers for CRC. In addition, our study uncovered unexplored ceRNA networks that should be studied further in CRC.

Abstract Background and Aims Infection with Covid‐19 disease can lead to mortality in a short time. Early prediction of the mortality during an epidemic disease can save patients' lives through taking timely and necessary care interventions. Therefore, predicting the mortality of patients with Covid‐19 using machine learning techniques can be effective in reducing mortality rate in Covid‐19. The aim of this study is to compare four machine‐learning algorithm for predicting mortality in Covid‐19 disease. Methods The data of this study were collected from hospitalized patients with COVID‐19 in five hospitals settings in Tehran (Iran). Database contained 4120 records, about 25% of which belonged to patients who died due to Covid‐19. Each record contained 38 variables. Four machine‐learning techniques, including random forest (RF), regression logistic (RL), gradient boosting tree (GBT), and support vector machine (SVM) were used in modeling. Results GBT model presented higher performance compared to other models (accuracy 70%, sensitivity 77%, specificity 69%, and the ROC area under the curve 0.857). RF, RL, and SVM models with the ROC area under curve 0.836, 0.818, and 0.794 were in the second and third places. Conclusion Considering the combination of multiple influential factors affecting death Covid‐19 can help in early prediction and providing a better care plan. In addition, using different modeling on data can be useful for physician in providing appropriate care.

BackgroundDespite the increasing development of different smartphone apps in the health care domain, most of these apps lack proper evaluation. In fact, with the rapid development of smartphones and wireless communication infrastructure, many health care systems around the world are using these apps to provide health services for people without sufficient scientific efforts to design, develop, and evaluate them. ObjectiveThe objective of this study was to evaluate the usability of CanSelfMan, a self-management app that provides access to reliable information to improve communication between health care providers and children with cancer and their parents/caregivers, facilitating remote monitoring and promoting medication adherence. MethodsWe performed debugging and compatibility tests in a simulated environment to identify possible errors. Then, at the end of the 3-week period of using the app, children with cancer and their parents/caregivers filled out the User Experience Questionnaire (UEQ) to evaluate the usability of the CanSelfMan app and their level of user satisfaction. ResultsDuring the 3 weeks of CanSelfMan use, 270 cases of symptom evaluation and 194 questions were recorded in the system by children and their parents/caregivers and answered by oncologists. After the end of the 3 weeks, 44 users completed the standard UEQ user experience questionnaire. According to the children’s evaluations, attractiveness (mean 1.956, SD 0.547) and efficiency (mean 1.934, SD 0.499) achieved the best mean results compared with novelty (mean 1.711, SD 0.481). Parents/caregivers rated efficiency at a mean of 1.880 (SD 0.316) and attractiveness at a mean of 1.853 (SD 0.331). The lowest mean score was reported for novelty (mean 1.670, SD 0.225). ConclusionsIn this study, we describe the evaluation process of a self-management system to support children with cancer and their families. Based on the feedback and scores obtained from the usability evaluation, it seems that the children and their parents find CanSelfMan to be an interesting and practical idea to provide reliable and updated information on cancer and help them manage the complications of this disease.

The problem of food contamination is a matter of concern, which can cause health complications in consumers. Several international organizations have created standard permissible limits for heavy metals in meat products. Livestock such as sheep, cattle, camels, and goats are the most important sources of protein meat in the Middle East (ME) countries. Contamination of meat products with heavy metals (HMs) may be a threat to human health. Various scattered studies have been conducted in the Middle East on the contamination of red meat and meat products with HMs however, a comprehensive review on this subject has not yet been published. This study aimed to investigate the status of HMs in both raw and processed types of meat in the ME. The results of this narrative review revealed that in many ME countries, contamination of red meat with HMs was excessive. Therefore, more monitoring of livestock conditions and red meat products consumed in some Middle East countries seems necessary.

Abstract Background and Aim Implementing the diagnostic‐related groups (DRGs) promotes the efficiency of healthcare. Therefore, the present study aimed to identify the challenges facing implementing the DRGs in Iran. Methods The present study is a strategic applied research conducted in two phases. In the first phase, the challenges facing DRGs were extracted through a literature review. Then the collected data is entered into a checklist consisting of five sections including technological, cultural, organizational, strategic, and natural challenges. In the second phase, data were collected by purposive sampling and semistructured interviews with 10 managers of the Medical Services Organization of Tehran, Iran. Data analysis was performed by conventional content analysis using MAXQDA software and descriptive using SPSS software version 19. Results The challenges facing the implementing DGRs from the experts' perspective included technological, organizational, nature, strategic, and cultural in order of priority. The three main fundamental challenges were reported; lack of integrating the DGRs with health information system (70%), frequent changes of management (70%), reducing the quality of care following early patient discharge (60%). Conclusion The results of the present study showed that the DRG system faced with challenges and healthcare officials should apply policies and guidelines to reform the system before changing the reimbursement system in Iran. By considering the leading countries experiences in the nationalizing the DRG system field, the problems and solutions of the system can be identified and aid in the more successful implementation of these systems.

Background: Time management is effective in controlling stress especially for medical residents. Time management in the surgical field and residential education is very important as they are directly involved in treating patients. Proper time management will help decrease work-related stress and increase efficacy, although there is no time management in medical courses. There are few studies in Iran in this field. So, we designed this study to assess the effects of time management on improvement of educational and therapeutic services in surgical residents of Imam Hospital. Methods: This before–after study was done in Imam hospital between February-March 2015. In this before-after study, 18 surgical residents of Imam Hospital (residents of 1-4 years), were enrolled. Their activities were evaluated in 11 scopes. To evaluate the effects of this self-evaluation, 5 scopes were assessed by the staff. The time during two weeks spent on each item was claimed as a percentage of 336 hours in two weeks. The self-assessment results and their effects on their scores were considered. Data regarding age, sex, and marital status were also gathered. Data were analyzed using SPSS software. Results: Eighteen residents were enrolled in this study. Ten residents were male (55.6%) and eight were female. Six (33.3%) were married. The mean age was 30±3.7 years. Resting time and emergency room time were significantly higher in the first-year residents while studying time was higher in the fourth-year residents. Second-year residents spend more time in training classes than others. The mean score at the beginning and the end of the study was highest in the forth-year residents and lowest in the first-year residents. All scores at the end of the study were significantly higher than the beginning except clinical judgment. The increase of the mean overall score was significantly higher in the fourth-year group and lowest in the first-year group. Conclusion: Time management could improve the educational performance of surgical residents.

Abstract Introduction and goal to background Due to the importance of segmentation of MRI images in identifying brain tumors, various methods including deep learning have been introduced for automatic brain tumor segmentation. On the other hand, using a combination of methods can improve their performance. Among them is the use of wavelet transform as an auxiliary element in deep networks. The analysis of the requirements of such combinations has been addressed in this study. Method In this developmental study, different wavelet functions were used to compress brain MRI images and finally as an auxiliary element in improving the performance of the convolutional neural network in brain tumor segmentation. Results Based on the results of the tests performed, the Daubechies1 function was most effective in enhancing network performance in segmenting MRI images and was able to balance the performance and computational overload. Conclusion Choosing the wavelet function to optimize the performance of a convolutional neural network should be based on the requirements of the problem, also taking into account some considerations such as computational load, processing time, and performance of the wavelet function in optimizing CNN output in the intended task.

Background and Aim: Implementation of a program to support physicians’ working long in deprived areas is one of the most important programs of the Health System Transformation Plan in response to the challenge of the shortage of expert staff, particularly physicians. Numerous factors affect the persistence of physicians in different regions, especially in deprived ones. This study aims to explain the experiences of physicians in relation to the challenges of working long in deprived areas. Materials and Methods: The present research is a qualitative study that was conducted in 2020 in Tehran, Iran. To achieve information saturation, 16 physicians and specialists were chosen using purposive sampling method. Then, for data collection, semi-structured interviews were used. Moreover, data analysis was performed using Graneheim and Lundman contractual content analysis method, and data management was done with MAXQDA software version 12. Furthermore, Lincoln and Guba reliability criteria were applied to achieve data accuracy and reliability. Results: Three female and 13 male physicians with a mean work experience of 45.4±7.8 years and an average work experience in deprived areas of 8±6.3 years participated in the study. Six participants were native to the region and the rest were non-native. Twelve participants in the study were the faculty members of the university. When the data were analyzed, 286 initial codes were extracted. The information was divided into four main categories and eleven subcategories. Welfare, motivation, justice and security were the main categories of this study. Conclusion: Providing individual and social welfare for physicians, and fair treatment in financial payments and educational justice along with establishing security provide the necessary motivation for physicians to stay in a deprived area. Besides by combining several solutions at the same time, the presence of doctors in deprived areas can be guaranteed.

There is increasing evidence showing that microbial dysbiosis impacts the health and cancer risk of the host. An association between adherent–invasive Escherichia coli (AIEC) and colorectal cancer (CRC) has been revealed. Cyclomodulins (CMs) have been receiving increasing attention for carcinogenic changes. In this study, the incidence and features of intracellular AIEC and cyclomodulin-encoding genes were investigated and the phylogenetic grouping and genetic relatedness were evaluated. E. coli strains were isolated from the colorectal biopsies. Adhesion and invasion assays and intramacrophage cell survival test were performed to separate the AIEC isolates. Virulence genotyping for the genes htrA, dsbA, chuA, and lpfA and the cyclomodulin toxins was also conducted. In addition, phylogenetic grouping of the isolates was determined. Subsequently, repetitive element sequence-based PCR (rep-PCR) fingerprinting was performed. A total of 24 AIEC pathovars were isolated from 150 patients. The prevalence rates of htr, dsbA, and lpfA were 70.83% and that of chuA was 91.66%. The frequencies of the cyclomodulin toxins were as follows: cnf1, 29.2%; cnf2, 25%; colibactin, 29.2%; and cdt, 4.2%; cif was not found. Among the AIEC isolates, 4.2%, 4.2%, 54.2%, 29.2%, and 8.3% with phylotypes A or C, B1, B2, D, and E were identified, respectively. Left-sided colon carcinoma and adenocarcinoma T≥1 stage (CRC2) were colonized by B2 phylogroup AIEC-producing CMs more often than the samples from the other groups. Close genetic relatedness was observed in AIEC isolates with rep-PCR.

Objectives: The health information governance (HIG) program is an extensive organizational framework for information management across its lifecycle. This program is important as a strategy for the materialization of high-quality care for individuals, social health, and the reduction of the costs of care and the reliability of health information. Considering the spectrum of this program in pioneering countries, the current review aimed to study the HIG program in the selected countries. Methods: This review article was conducted in 2017 by searching for relevant English language articles in PubMed, Scopus, ScienceDirect, and Google Scholar databases, along with the websites of relevant organizations such as Infoway and the American Health Information Management Association. The key terms included, but were not restricted to, ‘health information governance program’, ‘health information management’, and ‘health information governance components’. Finally, the data were analyzed with respect to the aim of the study. Results: The components of the HIG program, which are classified into 18 main groups, are the principles of this program including nine dimensions of accountability, goal, transparency, integrity, satisfaction with collection and disclosure, protection, compliance, availability, along with retention and disposition. Some officials and legal and natural roles are common among the three countries while some others are specific for each country. Conclusions: Considering the results of the present study, it is suggested that a strong governance structure together with the policies and regulations of health information technology should be taken into consideration in establishing a HIG program. By developing such a program at a national level, new roles are required to facilitate the implementation of the program.

BackgroundThe unique features of smartphones have extended their use in different fields, especially in the health care domain. These features offer new opportunities to support patients with chronic conditions by providing them with information, education, and self-management skills. We developed a digital self-management system to support children with cancer and their caregivers in Iran (low- and middle-income country). ObjectiveThis study is aimed at the development and preliminary evaluation of a cancer self-management system (CanSelfMan) tailored to the needs of children with cancer and their parents or caregivers. MethodsThis study was conducted in collaboration with a multidisciplinary team between January and February 2020 at MAHAK’s Pediatric Cancer Treatment and Research Center. We developed a self-management system in six stages: requirement analysis, conformity assessment, preparation of educational content, app prototyping, preliminary evaluation, and developing the final version. ResultsA total of 35 people (n=24, 69% parents and n=11, 31% children) volunteered to participate in the study. However, only 63% (15/24) of parents and 73% (8/11) of children were eligible to participate. By adopting a user-centered design approach, we developed a mobile app, CanSelfMan, that includes five main modules (knowledge base, self-management tips, self-assessment report, ask a question, and reminders) that provide access to reliable information about acute lymphocytic leukemia and the self-management skills required for side effect measurement and reporting. A web-based dashboard was also developed for oncologists and included a dashboard to monitor users’ symptoms and answer their questions. ConclusionsThe CanSelfMan app can support these groups by providing access to reliable information about cancer, facilitating communication between children or parents and health care providers, and helping promote medication adherence through a reminder function. The active participation of the target group can help identify their needs. Therefore, through the involvement of stakeholders such as patients, caregivers, and oncologists in the design process, we improved usability and ensured that the final product was useful. This app is now ready to proceed with feasibility studies.

Introduction: Chronic respiratory diseases are one of the four main groups of non-communicable diseases. People with these diseases need access to data to manage their disease and care plan. Personal health record (PHR) as a powerful health information technology tool can empower chronic patients to better manage their health status and become an active member of health care teams. This study is to determine the minimum data set (MDS) in personal health record for patients with chronic respiratory diseases. Materials and Method: This present applied research was done descriptively by Delphi method. First, the data sets of chronic respiratory diseases were extracted using a literature review. Then, using a researcher-made questionnaire and based on Delphi technique in two phases, it was evaluated by 5 pulmonologists. Results: The PHR data set for chronic respiratory diseases was classified into six categories, including physical examination and clinical observation, laboratory data, medications, specialized treatments, diagnostic procedures and vaccination. The 33 data element were identified as the main data elements with an agreement of more than 80% in the first phase of Delphi technique. Also, in the second phase, the four data elements proposed by the experts in the first phase were agreed upon above 80%. Conclusion: Given the role of PHR data in tracking the progress of chronic diseases, treating, and teamwork by physicians and other care providers, determining the minimum data set will be an effective step toward integrating and improving information management in these patients.

Context: Growing needs mandates economic growth. Entrepreneurship policies play a significant role in achieving productive employment and sustainable development for the health and wealth of society. Aims: This study is conducted to find the accordance of this document with the basic theory of the global alphabet model of entrepreneurship on the one hand and a comparison to the real entrepreneurial and economic achievements as social determinants of health (SDOH) on the other hand. Methods and Material: This research is a quantitative and qualitative content analysis of entrepreneurship documents in the health sector of Iran, using the basic theory of the global alphabet model as our target. We reviewed the Work Bank and Global Entrepreneurship Monitor (GEM) reports as world indicators to compare whether our entrepreneurship policies have been successful. Statistical Analysis: MAXQDA is a software program designed for computer-assisted qualitative and mixed methods data, text and multimedia analysis in academic, scientific, and business institutions. Results: The findings showed that the retelling of the word employment is more dominant than entrepreneurship. Imbalanced attention is paid to the components of the standard global alphabet model, and a downhill regression is seen in almost all aspects of entrepreneurial results. Conclusions: The written health policies have not been effective in promoting the development of health by wealth.

Background: Increased number of intestinal intraepithelial lymphocytes (IELs) is a key histological finding in the diagnosis of celiac disease (CD); however, the number of IELs in celiac patients and healthy subjects may vary from one region to another. Additionally, there are some seronegative celiac patients with a borderline histology. Objective: To determine the number of the CD3+ and CD8+ IELs T-cells in the celiac patients and healthy subjects (controls) in Isfahan. Methods: The duodenal biopsies were obtained from the celiac patients (n=15) and the controls (n=19). The total number of IELs/100 epithelial cells (ECs) were counted using the hematoxylin-eosin (H&E) staining method, and that of CD3+ and CD8+ IELs/100 ECs were counted using the immunohistochemistry (IHC) staining method. Results: This study defined the upper normal limit for each variable as mean + 2SD. Accordingly, the upper normal limits of the total IELs, CD3+ IELs, and CD8+ IELs/100 ECs were calculated as 37 (95% confidence intervals, CI: 33–41), 22 (95% CI: 19–25) and 12 (95% CI: 10–14), respectively. In 3 clinically CD diagnoses, the total IELs counts/100 ECs were below the upper normal limit, and the histopathological and serologic assays were negative. Nevertheless, the CD8+ IELs T-cells counts/100 ECs showed borderline values. Interestingly, these patients responded to a gluten-free diet (GFD). Conclusions: The study findings suggest that in the clinically diagnosed celiac disease, IELs count/100 ECs below the upper normal limit as well as negative histopathological and serologic assays and the cell density counts of the CD8+ IELs T-cells/100 ECs could be a useful parameter for CD diagnosis and make a decision to put them on a GFD.

Hereditary non-polyposis colorectal cancer (HNPCC) is the most frequent autosomal dominant predisposition for development of colorectal cancer (CRC) caused by germline defects in mismatch repair (MMR) genes. Current study was aimed to find genetic variations in MSH2 and MLH1 genes and their correlation with the serum levels of Carcinoembryonic Antigen (CEA) in seven Iranian HNPCC families. Seven unrelated Iranian families including 11 HNPCC patients and 7 affected family members were selected. They were initially screened for mutations in exons 7 of MSH2 and exon 15 of MLH1 gene through polymerase chain reaction single-strand conformation polymorphism (PCR-SSCP). Positive PCR results were further analyzed through exon sequencing. Serum CEA level was determined using the ELISA test. PCR-SSCP was positive in 8 out of 18 patients (44%) for exons 7 of MSH2 gene, whereas two samples (11%) demonstrated to bear a mutation in exon 15 of the MLH1 gene. Sequencing analysis of both amplified exons in positive and negative samples have confirmed no mutation in negative samples while revealed 5 and 7 novel mutations in exons 7 and 15, respectively. The mean serum concentration of CEA had a significant difference between HNPCC patients and their healthy family members. Our results demonstrated that the PCR-SSCP method has high specificity and sensitivity in the first step of mutation screening of HNPCC families. High frequency of novel alterations found in the current assay may revise the mutation screening of MSH2 and MLH1 genes and abet further assessment of their frequency among individual HNPCC patients.

Background and purpose: Thalassemia is a preventable genetic disorder that is a major health problem. It is now two decades since implementation of the national program for preventing β-thalassemia major in Iran. This study was conducted to compare the costs and results of this program from 2010 to 2014 in Mazandaran University of Medical Sciences. Materials and methods: Economic evaluation was done in this descriptive analytic study. We extracted the data from surveillance reports of health deputy and costs of laboratory services from the private and public sectors and Legal Medicine Organization tariffs. Other cost items were determined using published reports and articles, and interviewing the administrators and researchers. All costs were calculated in Excel 2007 based on the economic value of 2014. Results: The total direct costs of medical services, direct non-medical and non-medical direct costs of implementation of national program for preventing β-thalassemia major in one year were over 18,418,872,744 Rials. The average cost of prevention of a β-thalassemia major birth case was estimated to be be 341,090,236 Rials. The cost ratio of prevention to treatment was 1:12. Five-year implementation of the national program prevented 270 babies born with thalassemia. The success rate of this program was 95% in Mazandaran. Conclusion: Cost benefit analysis showed that the national program for preventing β-thalassemia major was efficient and economically valuable in Mazandaran province.

Hypertension is a chronic condition, and a major risk factor for other chronic conditions requires management. Considering the growth and extensive use of mobile health (mHealth) technologies and their capabilities, it is essential to examine the effects of these technologies on hypertension control and self-management. The present systematic review examined the effect of using mHealth technologies in controlling blood pressure and investigated the functionalities of mHealth technology on self-management aspects of patients with hypertension. A systematic search was conducted on PubMed, Web of Science, Embase, and Scopus databases. Clinical trials in English investigating the use of mHealth technologies for blood pressure control published from 2005 to 2018 were included in this study. The functionalities of these technologies were also investigated. These functionalities were divided into five categories of monitoring, alarms, feedbacks, education, and communication. The most frequently used technology for hypertension control was smartphones in the 15 articles examined. Moreover, the most frequent functionalities used for self-management of hypertension were communications and reminders, education, monitoring, and feedback, respectively. In the majority of the studies, these functionalities were employed in combination with mHealth technologies, a feature that affects hypertension control and self-management. The use of mHealth technologies, such as smartphones, positively affects hypertension self-management and reduces blood pressure. Functionalities such as communication and reminders, education, monitoring, and feedback are effective in hypertension self-management programs. The simultaneous use of these functionalities combined will be more effective in hypertension self-management programs.

Background: The information content of medical tourism websites could influence the decisions patients and their families make regarding medical centers. This study aimed to investigate the information content of medical tourism websites. Methods: This systematic review was carried out in 2017. Key terms used for searching consisted of, but not restricted to, medical tourism, information content, information needs, and medical tourism website. The terms were searched on PubMed, Science Direct, Web of Science, Embase, ProQuest and Cochrane. One hundred and ninety-two articles out of 1185 retrieved were duplicated and removed from the study. Titles and abstracts of the remaining identified studies were scanned considering the aim of the study. Finally, 31 relevant studies were included in the study. Results: The information content of medical tourism websites can be grouped into three main categories including general information (with six subgroups), medical information (with eight subgroups) and tourism information (with one subgroup). The subgroups include information about medical centers, target country, costs and insurance, contact details, website information, photo galleries, the quality of services, trustworthiness, the quality of supportive services, risks, patient rights, physicians and their specialties, and patient instructions for receiving medical and tourism services. Conclusion: The medical tourism websites should provide a wide range of information. Considering the important role of medical tourism websites in meeting patients’ information needs, the relevant bodies should improve the information content of medical tourism websites to help patients to make their decisions reliably.

No Abstract

BACKGROUND: Understanding the close interaction between the specialties of cardiology and oncology is necessary for early detection of cardiovascular disease (CVD) events in cancer patients. For the risk assessment of CVD in Breast and Colorectal Cancers (CIBC) study, in the current study we aimed to validate a questionnaire for the assessment of clinical history in patients with breast cancer and colorectal cancer (CRC).METHODS: We determined the content validity of the questionnaire using the 2 indexes of content validity ratio (CVR) and content validity index (CVI) to examine the specificity, simplicity, clarity, and transparency of the items. Content validity assessment was performed through a panel of experts including 2 oncologists, 5 cardiologists, 2 general practitioners, and 1 epidemiologist. The reliability of the questionnaire was estimated using Cronbach's alpha coefficient in 50 patients. Intraclass correlation coefficient (ICC) was used to examine the reproducibility of the questionnaire during 1 week.RESULTS: The CRC and breast cancer questionnaire were designed with 16 and 32 questions, respectively. To obtain acceptable CVR, 5 and 11 questions were removed from the CRC and breast cancer questionnaires, respectively. Cronbach's alpha was 0.70 in the breast cancer questionnaire and 0.94 in the CRC questionnaire. All questions had a CVI of higher than 80%. The ICC in the breast cancer questionnaire ranged between 0.71 and 0.96 and in CRC questionnaire ranged between 0.78 and 0.98.CONCLUSION: The validity and reliability of our newly developed questionnaire was desirable. The reliability of the breast cancer questions was acceptable and that of the CRC questions was excellent. Thus, thus questionnaire can be used in this group of patients regardless of whether the goal is cardiac care or not.

Background: Long noncoding RNAs (lncRNAs) have been recognized as the main modulatory molecules in various cancers and perform as competing endogenous RNAs (ceRNAs). The nuclear hormone receptor superfamily of ligand-activated transcription factors (NR3C1) regulates numerous proliferative and metabolic processes such as tumorigenesis and metabolic diseases. Furthermore, X-linked inhibitor of apoptosis protein (XIAP) belongs to a family of the inhibitors of apoptosis proteins, is located downstream of the glucocorticoid receptor (GR or NR3C1) pathway, and cooperates with GR to suppress apoptosis. However, the underlying mechanisms of NR3C1 and XIAP in colorectal cancer (CRC) remain mainly unclear. This research aims to clarify the potential RNA biomarkers and to construct a novel ceRNA network in CRC. Materials and Methods: Multistep bioinformatics methods such as Lnc2cancer and miRDB databases were applied to identify candidate lncRNAs and miRNAs. The interaction energy between lncRNAs, NR3C1, and XIAP genes was analyzed by the LncRRIsearch database. Plus, microRNAs and lncRNA were evaluated via the Diana tools database to select microRNAs with the most binding scores. Quantitative reverse transcription–polymerase chain reaction (QRT-PCR) was applied to verify RNA molecules' expression levels and their association with the clinicopathological factors in 30 CRC tissues compared to 30 adjacent tissues. Results: QRT-PCR showed upregulation of KCNQ1OT1, NR3C1, and XIAP and downregulation of miR-421. The ceRNA network was constructed with 17 lncRNAs, 2 mRNAs, and 42 miRNAs. Thus, we explained the potential interactions between KCNQ1OT1 and miR-421 with NR3C1 and XIAP genes. Conclusion: Our study represents potential prognostic biomarkers and a new ceRNA network for further study in CRC.

Background: Anemia is a usual systemic complication of inflammatory bowel disease (IBD) and can be presented in combination of iron deficiency anemia (IDA) and anemia of chronic disease (ACD). In the present study, anemia in IBD was assessed. Methods: This was a cross-sectional study conducted on 25 patients with Crohn’s disease (CD), 49 patients with ulcerative colitis (US), and 14 patients with undetermined colitis in years 2016-17. Hematological indices including ferritin, transferring saturation, hemoglobin, mean corpuscular volume (MCV), vitamin B12, and folate were measured. Demographic information and region of intestinal involvement were compared as well. Findings: Based on gender distribution, anemia was not significantly different between Crohn’s disease, ulcerative colitis, or undetermined colitis (P = 0.89). In addition, type of anemia including iron deficiency anemia, anemia of chronic disease, and macrocytic anemia was not different (P = 0.97) between the colitis types. Anemia was not in association with site of intestinal involvement (P = 0.89). Conclusion: Based on the findings of the current study, anemia is not statistically associated with type of bowel involvement, and site of bowel involvement. Further studies are recommended.

Introduction: Mobile health is the use of mobile and wireless technologies for health-related goals. To this end, various mobile applications have been created in different medical fields. The goal of this study was subject categorization of mobile health applications in Iran and to find their priority according to physicians. Methods: This was a descriptive study. The study population consisted of all Iran mobile applications and also specialized physicians from Iran University of Medical Sciences, Shahid Beheshti and Tehran universities of medical sciences. First, mobile health applications in Iran were investigated and categorized based on their subject area and then their priority from the perspectives of physicians was determined using a researcher-made questionnaire. Results: Based on the application and physicians views, mobile health applications were divided into 21 categories of prevention, diagnosis and treatment, general and plastic surgery, medical tests, medical calculations, radiology, nursing, psychology, self-care, medical education, anatomy and atlases, medical informatics, medicine and pharmacy, rehabilitation, glossary and abbreviations, journals, medical ethics and rights, consultation, emergency and relief, social harm and traditional medicine. Conclusion: It is necessary that developers of mobile health software consider the identified priorities in developing applications in order to make physicians and general users more willing to use mobile health services.

Background: Hypocalcemia is one of the most prevalent complications following total thyroidectomy. Over recent years, in addition to hormone parathyroid hormone (PTH), vitamin D has been also studied as a factor causing post-total thyroidectomy hypocalcemia. This survey seeks to study the relationship between the serum level of vitamin D before surgery and during post-total thyroidectomy hypocalcemia. Methods: A group of 57 patients volunteering for total thyroidectomy were studied on Vali-e-Asr Hospital, Tehran, Iran, from March 2013 to March 2015. In all these patients, pre-surgery calcium, vitamin D and parathyroid hormone (PTH) as well as the level of calcium during the post-surgery first two days were measured. Based on objectives of this study, the relationship be-tween pre-surgery vitamin D level and post-surgery hypocalcemia was examined. Results: The average age of patients participating in the survey was 24.1±13.3. They included 19 women (33.3%) and 38 men, total of 40 patients (70.2%). Their average post-surgery calcium level was 9.2±0.77 milligrams per deciliters (mg/dl) and their average vitamin D content before the surgery was 42±12.1 nanomole per liter (nmol/l). The average calcium level before the surgery and the first post-surgery day were meaningfully different in terms of statistics (P0.001). Of 37 patients with pre-surgery vitamin D deficiency, 31 suffered post-surgery second-day hypocalcemia and of 20 patients with vitamin D insufficiency, 18 suffered second-day hypocalcemia. This difference was not statistically meaningful either (P>0.001). Conclusion: The current study showed that the serum level of vitamin D before total thyroidectomy does not have any role in the occurrence of post-surgery hypocalcemia which is almost common after this type of surgery.

Objective : Germline mutations in mismatch repair (MMR) genes cause Lynch syndrome (LS). LS is an inherited disease, and an important consequence of MMR deficiency is microsatellite instability (MSI) phenotype. MSI phenotype influences the efficacy of 5 fluorouracil (5-FU) chemotherapy. Reproducible, cost effective, and easy to perform laboratory tests are required to include MSI detection in routine laboratory practice. Evaluation of CAT25 as monomorphic short tandem repeat sequence enables CAT25 to be an efficient screening tool among hereditary nonpolyposis colorectal cancer (HNPCC) patients compared with other methods used currently. Methods : Based on Amsterdam II criteria, 31 patients in 31 families were shortlisted from a total number of 1,659 colorectal cancer patients. MSI status was examined in these patients using CAT25 and a commercially available Promega MSI five-marker-based detection system as well as immunohistochemical (IHC) staining of four important MMR proteins. Patients were scored as high microsatellite instable (MSI-H), low (MSI-L), or stable (MSS). MSI status determined by CAT25 single mononucleotide marker was compared with that of five mononucleotide markers, Promega commercial kit, and IHC method. Results : MMR protein deficiency was observed on 7/31 probands using IHC methodology and 6/31 categorized as MSI-H using commercial kit or CAT25 single marker. The sensitivity and specificity of the CAT25 single marker were the same as those detected by five-marker Promega commercial kit in our patients. Conclusions : Based on our results, the performance of the CAT25 single mononucleotide marker for MSI status determination in our HNPCC patients is the same as that of the five-marker-based commercial kit.

Background: Celiac disease (CeD) is a chronic inflammatory small intestine disorder caused by an abnormal immune response to an array of the epitopes of the wheat gluten and related proteins of rye and barley in genetically susceptible individuals. Midkine (MK) is an angiogenic cytokine, chemotactic in the direction of polymorphonuclear neutrophils and macrophages, and a T-regulatory cell suppressor. So far, a possible relationship with CeD has not yet been explored. Diagnosis of CeD is based on serologic test in a clinical setting suggestive of CeD and confirmatory histologic examination of the duodenal biopsy. Sometimes, genetic testing of human leukocyte antigen (HLA)-DQ2 and HLA-DQ8 may be needed. The objective of this study was to measure and compare the circulating MK in the celiac patients and healthy individuals. Materials and Methods: Twenty newly untreated CeD cases and 20 normal controls were enrolled in this study. The enzyme-linked immunosorbent assay was used to measure the circulating MK in the celiac patients and controls. Results: There was insignificant difference in the circulating MK between the patients and controls (P > 0.05). Conclusions: The study results suggest that the MK marker does not have any diagnostic value in CeD activity to be used at the time of diagnosis or during follow-ups.

Introduction: Strategic thinking is the infrastructure of artistic maneuvers of managers based on creativity and ‎true perception of business environments. It results in the creation of strategies suitable to the ‎present changing business environment. Due to the failure of strategic plans and organizational ‎changes in more than half of organizations, it can be concluded that there might be a common ‎cause for these failures. The goal of the present study was to assess the relationship between ‎readiness to change and strategic thinking in managers of social security hospitals of Isfahan, Iran, ‎based on the Liedtka model including the five elements of systemic thinking, intensive focus, ‎hypothesis approach, intelligent opportunism, and thinking in time. Methods: This practical, analytical, and correlative research was conducted using the Strategic Thinking ‎Assessment Questionnaire (α = 87.3) and Readiness to Dunhaim Change Assessment ‎Questionnaire (α = 84) in 2013. The participants consisted of 94 head, intermediate, and ‎operational managers of social security hospitals in Isfahan. Our response rate was 85% (80 ‎questionnaire). Data were analyzed using the Pearson correlation and regression analysis in SPSS ‎software. Results: Strategic thinking (Pearson coefficient = 0.25) (P < 0.02) and its elements based on the Liedtka ‎model, including systemic thinking (Pearson coefficient = 0.28) (P < 0.01), intensive focus (Pearson coefficient = 0.24) (P < 0.03), and intelligent opportunism (Pearson coefficient = 0.22) (P < 0.04), had a meaningful relationship with readiness to change. However, the findings ‎revealed no significant relationship between hypothesis approach (Pearson coefficient = 0.18) (P ‎‎< 0.01) and thinking in time (Pearson coefficient = 0.10) (P < 0.2), and readiness to change. Conclusion: Since there was an overall relationship between most elements of strategic thinking and readiness ‎to change among the managers in this study, education and development of strategic thinking may ‎enhance readiness to change among managers of institutions.

مقدمه: سرطان‌های بدخیم کولورکتال، چه در صورت تکی و چه در صورت خانوادگی، اگر با افزایش میزان ناپایداری در میکروستلایت همراه باشند، پیش‌آگهی بهتری دارند، راهکار متفاوتی برای جراحی در آن‌ها اتخاذ می‌شود و پاسخ متفاوتی نسبت به داروی شیمی‌درمانی 5FU (Fluorouracil) خواهند داد. بنا بر این، امروزه برای بیماران مبتلا به سرطان کولورکتال ارثی و غیر ارثی، آزمایش سنجش وضعیت ناپایداری میکروستلایت انجام می‌شود. هدف این مطالعه، سنجش کارایی نشانگر تک نوکلئوتیدی MT1XT20 در جمعیت بیماران مبتلا به سرطان کولون ارثی غیر پولیپی (HNPCC یا Hereditary nonpolyposis colorectal cancer) کشور ایران بود. علاوه بر نشانگر پیش‌گفته، از دو روش بررسی وضعیت میکروستلایت با پنل 5 نشانگری و استاندارد Promega و نیز آزمایش ایمنوهیستوشیمیایی استفاده شد. روش‌ها: در این مطالعه، نشانگر تک نوکلئوتیدی MT1XT20 و کیت استاندارد Promega از طریق روش PCR (Polymerase chain reaction) بر روی 20 خانواده‌ی مبتلا به HNPCC ایرانی مورد سنجش قرار گرفت و آزمایش ایمنوهیستوشیمیایی نیز برای بررسی وضعیت 4 پروتئین مهم دخیل در مسیر ترمیم ناجور جفت شدگی مورد استفاده قرار گرفت. یافته‌ها: در روش سنجش ناپایداری میکروستلایت از طریق پنل Promega و نشانگر تک نوکلئوتیدی MT1XT20 به ترتیب 8 (40 درصد) و 5 نمونه (25 درصد) از 20 نمونه وضعیت ناپایداری نشان دادند. در روش ایمنوهیستوشیمیایی نیز، 7 نمونه از 20 نمونه (35 درصد) وضعیت کمبود پروتئین مسیر ترمیم ناجور جفت شدگی را نشان دادند. در میان نشانگرهای مورد استفاده در کیت Promega، نشانگر BAT26 ناپایدارترین نشانگر بود و در هر 8 نمونه، Microsatellite instability-high (MSI-H) تشخیص داده شده توسط کیت Promega ناپایداری نشان داد. نشانگرهای NR21 و NR24 در 7 نمونه (5/87 درصد) ناپایداری نشان دادند و نشانگرهای BAT25 و MONO27 به ترتیب با نشان دادن ناپایداری در 6 (0/75 درصد) و 5 نمونه (5/62 درصد)، پایدارترین نشانگرها بودند. نتیجه‌گیری: MT1XT20 در جمعیت ایتالیایی، به عنوان نشانگر تک نوکلئوتیدی مورد اعتماد ارزیابی شده است، اما این مسأله در رابطه با جمعیت ایرانی صدق نمی‌کند. در عوض، BAT26 با نشان دادن ناپایداری در تمام نمونه‌های MSI-H ارزیابی شده توسط کیت Promega، می‌تواند به عنوان نشانگری موثق و قابل مقایسه با پنل 5 نشانگری Promega در جمعیت ایرانی در نظر گرفته شود.

Objectives: The effect of dietary protein intake on bone mineral density (BMD) has not been explained in patients with spinal cord injury (SCI). In this study, we looked at the relationship between BMD and higher protein intake in patients with SCI while controlling for possible confounders. Methods: Patients with SCI, who were referred to the Brain and Spinal Cord Injury Research Center between November 2010 and April 2012, were included in the study. In total, the dietary intakes of 103 patients were assessed by 24–hour dietary recall interviews. We used dual-energy X-ray absorptiometry to measure BMD in the femoral neck, trochanter, intertrochanteric zone, hip, and lumbar vertebras. Results: Eighty-six men and 17 women participated in this study. Protein intake was negatively associated with the BMD of lumbar vertebrae (p = 0.001, r = –0.37 for T-score and p = 0.030, r = –0.24 for Z-score). The BMD of lumbar vertebrae were negatively associated with intake of tryptophan, isoleucine, lysine, cysteine, and tyrosine (p = 0.007, 0.005, 0.009, 0.008, and 0.008 for T-score, respectively). Higher intakes of threonine, leucine, methionine, phenylalanine, valine, and histidine were related to a lower BMD of lumbar vertebrae (p = 0.006, 0.010, 0.009, 0.010, 0.009, and 0.008 respectively for T-scores). Conclusions: We found that high protein intake led to a lower BMD of lumbar vertebrae in patients with SCI after controlling for confounders including demographic and injury-related characteristics and calcium intake. No relationship between higher amino acids intake and BMD of the femur and hip was detected. Intake of alanine, arginine, and aspartic acid were not related to BMD.