رضا ملک زاده

Iatrogenic colonic perforation (ICP) is a rare but serious complication of colonoscopy, with an incidence ranging from 0.016% to 8% depending on the type and purpose of the procedure. Several patient-related, endoscopist-related, and procedure-related factors increase the risk of ICP, which most commonly occurs in the sigmoid colon. Following specific guidelines for colonoscopy performance and quality can help prevent ICP. Early diagnosis is essential, and imaging modalities such as radiography or CT scan may be needed to evaluate the extent of damage. The management of ICP depends on the size and location of the perforation, the presence of peritonitis or sepsis, the underlying colon pathology, and the patient's general condition. Endoscopic, surgical, or conservative methods may be used, but surgical consultation should always be sought urgently. Surgery is usually indicated for large perforations, signs of peritonitis, inadequate bowel preparation, severe comorbidity, failure of conservative treatment, underlying colon disease requiring surgery, transplant recipients, or immunocompromised patients. Laparoscopic-assisted exploration is the preferred surgical technique for ICP. The timing of a follow-up colonoscopy depends on the indication for the initial colonoscopy that led to ICP.

Despite the fact that over three years have passed since the onset of the Covid-19 pandemic, it still remains a significant public health concern in Iran and around the world. It is important to acknowledge that the current situation does not signify an end to the epidemic, and measures must be taken across various levels of prevention, treatment, and policy to effectively manage this crisis. This paper analyzes Iran's response to the epidemic, evaluating the country's performance in areas such as surveillance and healthcare systems, diagnostic testing, long-term Covid-19 complications, vaccinations, treatment, and monitoring of variants. Recommendations are also provided for decision-makers in the field of health and Covid-19.

The current complex world necessitates timely and prompt policymaking. Think tanks are one of the independent organizations that help meet this need. This study aimed to identify the key features of think tanks in Iran, with focus on the Think Tank of Good Governance for Health.

This is a practical qualitative case study. Through purposive sampling, we identified 10 key informants as members of this think tank, with whom a virtual focus group discussion was held. The focus group lasted four hours and participants were asked to respond to five questions. We used a mixed deductive-inductive approach for data analysis, which was facilitated by ATLAS.ti9 software. Validity and reliability were examined using Lincoln and Guba evaluation criteria.

We identified one main theme, four subthemes and 12 codes. The main theme was "the characteristics of a think tank in the health system". The "structure" subtheme (four codes), the "objectives" subtheme (three codes), the "implementation methods" subtheme (three codes), and finally the "financial" subtheme (two codes) were identified.

This study emphasizes that think tanks, as independent entities, can play a very effective role in health policy-making mainly via knowledge translation for both policymakers and the society. In addition, the proper, principled, and timely functioning of think tanks is essential in gaining public trust in public decisions, as well as providing an opportunity for public participation in macro-policies. To perform effectively and efficiently, think tanks need to consider some key principles in their structure, goals, implementation method, and finance.

Using computed tomography (CT) scan may cause complications in the eye lens, thyroid gland, and breasts. One of the radiation protection methods to protect patients from unnecessary and unintended exposures is utilizing non-lead shields in CT-scan tests. Before designing and using these shields, it is necessary to study their performance by a simulation.

Bismuth, tungsten, and tin with absorption edges in diagnostic radiology energy ranges were selected for this research. Each of the metals along with the silicon was used as building blocks in the Monte Carlo simulation. To determine the mass attenuation coefficient of the samples, the beam was simulated as single energy. The energy range was selected according to the common imaging tests in diagnostic laboratories from 20 to 140 keV with 20 keV steps. The flat photon source with a radius of 5 mm was placed at the origin of the geometry. Information obtained from the simulation could specify that the shield had the most attenuation coefficient at which energies.

The shield containing 10% bismuth and 90% silicon showed more attenuation in the energies above 100 keV. Tungsten and tin shields also showed greater attenuation at medium and low energies.

By using the effect of attenuation window and selecting proper percentage and metal for the energy applied in diagnostic radiology, patients can be protected from radiation exposure to radiosensitive superficial organs.

The incidence rate of cancer in Iran is lower than the global average, but this rate is increasing both in the world and in Iran in the next two decades

"Iran National Cancer Control" was developed in 2013 with a strategic planning approach and consists of 4 main processes and 7 support processes.

Some of the significant interventions taken in the main processes are: implementation of training programs, vaccinations and multi-sectoral collaboration to reduce the burden of risk factors, in the prevention component; implementation of breast, cervical and colon cancer screening programs and development of relevant protocols, cheap HPV testing with insurance coverage, and production of FIT kits, in the early detection component; development of 12 National Practice Guidelines for anticancer drugs and standardizing chemotherapy and radiotherapy services, in diagnosis and treatment component; development of supportive and palliative care management protocols and standardizing these services. In the supporting processes, the main measures taken in the form of 7 components of this program are: developing National Cancer Control Program and forming its secretariat, designing and implementing a geospatial infrastructure program, creating, developing and equipping early detection, and cancer treatment centers and referral laboratories, holding training courses, promoting insurance coverage for cancer services, and implementing an integrated cancer information management system.

This program has been able to achieve its short-term objectives in the defined periods, but in order to fully implement the program and achieve the expected outcomes, it is necessary to strengthen its governance structure and the commitment of health system policy makers to this program.

Research evaluation based on peer review is done to assess the quality of research. In this article, the peer review evaluation results of selected Iranian research centers are presented.

A qualitative study was conducted through peer review with 106 and 15 Iranian professors from inside and outside the country, respectively. The evaluation was implemented in four areas of leadership, structure, research products, and impact. In this study, research centers with independent research budget lines and 12 top research centers during 2015-2018 were evaluated.

The most weaknesses in these research centers were in leadership (scattered work, island and parallel activities) and impact (inefficiency of knowledge utilization in transfer chains) areas, and the greatest strengths were related to knowledge production (quantitative and qualitative development in the number of published articles and citations). In the structural part, the lack of attention to technological activities, the lack of applicability of research, and inadequate physical space were the most important weaknesses.

In the peer review method, the assessment of leadership, structure, and in particular, impact areas has a very important role in research quality promotion due to appropriate interactions with specialists and peers.
 

Nowadays, gastroenterologists work a wide variety of areas and in this field a lot of new trends have been set up worldwide. According to our nation’s goals in science production and being a leader in innovation and technology, and also creating several cohorts in digestive and liver diseases, we need to calculate and predict the workforce needed.

Among the 51 medical universities in Iran, 12 train adult and 5 train pediatric gastroenterologists and hepatologists. About 33 to 35 adult and 8 to 10 pediatric gastroenterologists are trained every year. Currently we have about 650 adult and pediatric gastroenterologists working in Iran, meaning one gastroenterologist per 124,000 population, which 30% are practicing in Tehran.

Each year 40-45 fellows of gastroenterology will be trained, leading to 950 adult and pediatric gastroenterologists by 2025. Our population is estimated to be about 90 million persons by then, leading to one gastroenterologist per every 95-100,000 population.

Estimating the need for gastroenterologists depends on the per capita income, governmental funds and insurance policies. Distribution of gastroenterologists is centralized in large cities and capitals of each province. Every year about 45 gastroenterologists enter Iran’s workforce, along with this increase we need necessary equipment for diagnostic and therapeutic endoscopic procedures. Proper distribution of graduates can facilitate and improve services in this field. Till 2025, our population is estimated to be about 90 million and we will have about 950 gastroenterologists, meaning 1 per every 95-100,000 population. Therefore, the estimates given by Strategic Planning Committee seems reasonable and justifiable.

In the recent decade, liver diseases with high mortality rate have became one of the major health problems worldwide. Liver transplantation is the most effective and the standard treatment for decompensated liver disease, but, shortage of available organs and inaccuracy in modeling of the liver diseases are the most limiting issues in treatment.Regenerative medicine and cell based therapy strategies have provided promising results through cooperating in natural liver regeneration ability or providing liver function support as a bridge before transplantation. Induction of differentiation in different types of stem cells such as embryonic, induced pluripotent stem cells, mesenchymal and hematopoietic stem cells are the most common methods that provide a functional population of hepatocytes to be used in diseases like cirrhosis, cancer and all types of fatty liver diseases, and significantly restore the normal levels of hepatic factors. In addition, mesenchymal and hematopoietic stem cells improve the symptoms of autoimmune diseases by modulatation of immune responces and reduction of inflammation. Other cell treatment strategies are isolating the patient's own hepatocytes in the lab, in vito correction of defected genes and transplanting them back to the patient that can improve the symptoms of genetic disorders. In this study, we first reviewed the basic concepts related to liver diseases, then highlighted the most recent advances in cell-based therapies and regenerative medicine for the treatment of liver disease, along with tissue engineering and bio-artificial liver devices.

Comparison of radiation shields of different thicknesses and structures (especially different particle sizes of their constituents) is helpful to select an appropriate shield for patient protection in medical imaging tests particularly CT-scan. In this study micro- and nano-powders of bismuth were mixed with silicone matrix to make composite radiation shields for breast. The shields were provided in dimensions of 20×20 cm, thickness of 1 mm, and bismuth weight ratio of 10%. The chest CT test (TOSHIBA 16 multi-slice device) was performed on a female phantom with normal breast size in 100 kVp and 50 mA with slice thickness of 0.5 mm and pitch of 1 mm. To avoid image artifacts, a foam layer of 1 cm was wrapped around the phantom under the shields. Measurement of dose in the surface (equivalent to skin) and forth layer (equivalent to glandular tissue) of phantom breast was done using thermoluminescence dosimeter. Results showed that dose on the surface of phantom breast declined up to 12% and 18.4% in the presence of silicon-bismuth micro- and nanocomposite shields, respectively, and both composites reduced the breast dose significantly (p<0.5). Also, the nanocomposite shields reduced radiation dose more than the microcomposite shields. Additionally, less noise variation was observed in CT images acquired with the nanocomposite shields.

Currently, dietary supplements are used with trust to promote human health. Micronutrient deficiency as a result of insufficient nutrition is a common problem threatening general health. As a common rule, improvement of nutrition quality has a principal role in preventing the side effects of the lack of micronutrients. Nevertheless, consumption of dietary supplements including vitamins and essential minerals could have beneficial effects in specific age groups of people. For example: prescription of folic acid in women during reproductive ages and pregnancy prevents neural tube defects. Vitamin D in infants and children, and calcium plus vitamin D supplementations in older people have principal role in bone health adequacy. Due to the prevalence of non-communicable diseases, especially various types of cancer and cardiovascular diseases, which may cause death and morbidity, a theory has been raised that supplements containing multivitamin and minerals can prevent these major health issues. However, there is a big debate regarding the beneficial effects of dietary supplements in preventing non-communicable diseases in people consuming high quality diet. This review has attempted to summarise the scientific evidence regarding the beneficial effects of multivitamin minerals supplementation, which may provide evidence based recommendation for general population.

In this paper, we have studied the spectral statistics of 101 even-even nuclei in the nearest neighbor spacing distribution framework. Sequences are prepared by using all the latest experimental data for 2 levels of considered nuclei in the 40 ≥ A≥198 mass region. The maximum likelihood estimation technique has been used to extract the Berry-Robnik distribution’s parameter which explores the regular or chaotic behavior of considered sequences. Sequences are classified as their mass, quadrupole deformation parameter, the energy ratio and the shell model configuration for the last protons and neutrons of all nuclei. Our results suggest a regular dynamics for these even mass nuclei. Also, the regularity is increased for light nuclei vis-a-vis heavier ones and also the deformed nuclei vis-a-vis spherical ones. Our results show a deviation of chaotic dynamics when the spins of proton levels are decreased or the spins of neutron levels are increased.

Pancreatic cancer (PC) is classed as the 7th leading cause of cancer-related death in the world. Previous evidence indicates that hyperglycemia, insulin resistance, diabetes, and obesity are implicated in pancreatic carcinogenesis. Thus, evaluation of the dietary intakes in the etiology of PC can be useful to identify the risk factors of the disease.
Methods and Materials: We examined the association between total intake of fruits, vegetables, and dietary fiber and the risk of PC in 50,045 participants aged 40-75 years within the Golestan Cohort Study. Dietary data were collected using a validated semi-quantitative food-frequency questionnaire, which was administered at baseline. Cox proportional hazards models were used to estimate multivariate hazard ratio with 95% confidence interval.
During 383,630 person-years of follow-up and after excluding the participants with incomplete baseline information, a total of 48,676 adults were evaluated. Until October 30, 2014, 54 cases of PC were confirmed based on the exact cause of death using ICD10 criteria. After considering all potential confounding factors, there was only a statistically significant inverse association between the risk of PC for the highest tertile of daily fiber intake compared with the lowest tertile (HR=0.41; 95% CI= 0.15-1.05; P for trend= 0.05). However, the relationship between fruits and vegetables and PC risk was not statistically significant.
In summary, based on the findings of this study, increased dietary fiber may reduce the risk of PC. This result highlights the importance of a diet rich in fiber in order to prevent PC progression. Finally, given the limited number of studies in this field and inconclusive results, there is still a need for new prospective studies with long follow-up.

Pancreatic cancer (PC) is classified as one of the most deadly cancers. Since the role of diet in modifying the effects of known risk factors of PC has been well established¡ exploring the dietary intakes in relation to the etiology of PC can be useful for elucidating the mechanisms of the disease progression.
This study was conducted within the Golestan prospective cohort study. The estimated intake of total fat and various dietary fat sources was calculated using a validated semi-quantitative food frequency questionnaire. The relationship between these dietary intakes and risk of PC was examined using Cox Regression and hazard ratio (HR) with 95% confidence interval (CI 95%) was reported.
During 383¡630 person-years follow-up and after excluding subjects with incomplete baseline information¡ a total of 48¡676 adults were studied. Until October 30¡ 2014¡ 54 cases of PC were confirmed by medical professionals¡ based on the medical records and the exact cause of death using the criteria of the International Statistical Classification of Diseases and Related Health Problems 10 (ICD10). After adjusting for potential confounders we did not observe any statistically significant relationship between the intake of total fat and various dietary fat sources and risk of PC. There was only a significant positive association between the risk of PC and daily intake of butter¡ cream¡ and solid vegetable oil in the age-adjusted regression models (HR=2.10; 95% CI=1.04-4.21; P for trend=0.03). However¡ this relationship was not remained significant anymore in the fully adjusted models.
Based on the results of the current research¡ after taking into account all of the potential confounding factors¡ dietary intake of total fat as well as various dietary fat sources had no significant association with the risk of PC. However¡ it is likely that consuming substantially less saturated and trans fat sources such as dairy fats as well as solid vegetable oils may be beneficial to reduce the risk of this cancer.

Cancer is the second leading cause of death after cardiovascular disease. In recent years it has been hypothesized that opiate use could be a risk factor for cancer. This study aimed to evaluate a possible association between opiate use and common cancers using ecological statistics from around the world.
To investigate the association we used ordinary linear regression models. The log10-transformed age-standardized incidence rate (ASR) of cancers was used as dependent variables in the models. We adjusted for smoking, alcohol use per capita, human development index (HDI), and body mass index (BMI) as confounding variables. We extracted these variables from different data sources including the GLOBOCAN 2012, the United Nations Office on Drugs and Crime (UNODC) annual reports, World Health Organization database, the United Nations Development Program (UNDP) report 2012, and published literature. We estimated two separate models for each cancer, one for males and the other for both sexes.
Findings: Opiate prevalence ranged from 0.01% to 2.65% and its median was 0.20%. In the multiple regression models for both sexes, opiate use was significantly associated with bladder (β = 0.59), kidney (β = 0.16), oral cavity (β = 0.27), esophagus (β = 0.33), larynx (β = 0.17) and other pharynx (β = 0.36) cancers. In the models based on the male data, the coefficient and the significances were approximately the same for the above cancers but larynx cancer was no longer significantly associated with opiate use.
There was a significant association between opiate use and risk of cancers. We suggest that more studies should be conducted, especially in high-risk areas of the world.

BackgroundPancreatic cancer (PC) is ranked as the 7th Leading cause of cancer death in the world and is among one of the most deadly cancers. Several lines of evidence indicate that insulin resistance, diabetes, and obesity are implicated in its carcinogenesis process.
Methods and MethodsWe examined the association between consumption of carbohydrate foods and risk of PC in the 50,045 participants (21241 men and 28804 women aged 40 to 75 years) of the Golestan Cohort Study in northeastern Iran. Dietary data was collected using a validated semi-quantitative food-frequency questionnaire. Cox proportional hazards models were used to estimate multivariate hazard ratio with 95% confidence interval.
Results During 8.5 years (383,630 person-years) of follow-up and after excluding participants with incomplete data, a total of 48,676 adults (20,683 men and 27,993 women) were studied. Until October 30, 2014, 54 cases of pancreatic cancer were confirmed by a medical team, based the medical records and the exact cause of death based on ICD10 criteria. After adjusting for age, total energy intake, history of diabetes, smoking status, education, opium, body mass index, waist to hip ratio, ethnicity, gender, MET, residential area and socioeconomic status we did not observe any statistically significant relationship between consumption of total carbohydrate and carbohydrate foods including whole grains and refined grains, sugars and potatoes and risk of PC.
ConclusionBased on the results of the present study, dietary intake of total carbohydrate as well as various carbohydrate food sources had no significant association with the risk of PC. Finally, given the limited number of studies in this field and their inconclusive results, there is still a need for new prospective studies with long follow up.

Interferon-free treatments for hepatitis C have been recently available. They can cure over 95% of patients within 12 weeks without significant side effects. A combination of daclatasvir and sofosbuvir has been particularly useful as it is effective against all genotypes of hepatitis C virus (HCV). The combination of sofosbuvir and daclatasvir in a single pill has been recently manufactured in Iran (Sovodak®). The current paper is a preliminary report on the first patients treated with Sovodak.
100 patients with cirrhosis due to hepatitis C were included. All genotypes of HCV were eligible. All the patients received treatment with daclatasvir and sofosbuvir (Sovodak) in combination with ribavirin for 12 weeks and were evaluated for effectiveness of the treatment 12 weeks after termination of the treatment (SVR12, sustained virological response at 12 week). The results of the first 50 patients are presented here.
Of the first 50 patients enrolled in the study, 47 reached the endpoints. Of them, 17 were infected with HCV genotype 3 and showed 100% response to the treatment (17/17). The remaining 30 patients were infected with genotype 1 and 97% responded (29/30) to the treatment. No adverse effects were reported.
According to international guidelines, the combination of sofosbuvir and daclatasvir is the first line of treatment for all genotypes of HCV infection. For patients with cirrhosis, ribavirin is also added. In our study the efficacy of this combination in patients with cirrhosis was 97% and 100% for genotypes 1 and 3, respectively. Due to its high efficacy and ease of use, we recommend Sovodak for the treatment of all genotypes of HCV in Iran.

Taking into account the roles and positions of WHO Collaborating Centers (WHOCCs) in the furtherance of national goals and the great impact of their interaction as well as cooperative relations between these centres, this study was conducted to assess the current status of WHOCCs, identify opportunities and threats, and provide practical solutions to solve WHOCCs problems.
This cross-sectional study was conducted using an open-ended questionnaire in 2014. The questionnaire revolved around the WHOCC's status in terms of goal achievement, manpower problems, financial resources, communications, as well as suggestions to solve problems in these domains. These findings were approved in the second convention of the heads of WHOCCs in Kerman in 2014 and the questionnaires of the second phase were distributed and completed by participants. Data were analyzed using the content analysis method.
The majority of the centres assessed their performance regarding the national goals (11.59) in comparison with international goals (14.20), and self-regulated goal setting (14.7o) in an unfavorable condition. Financial problems and lack of recruitment were the most important problems for WHOCCs. The support of the Ministry of Health, WHO, supporting universities, and establishing research networks at national and international levels to foster communication, contracts to share experiences and resources, considering the author's rights as well as introducing the competencies of centres at national and international levels, were some of the suggestions proposed.
It seems that more support of the WHO, Ministry of Health, and supporting universities is needed to increase financial resources and recruit staff.

Dietary factors such as intake of minerals may play a role in the etiology of esophageal cancer. Although it has been hypothesized that manganese can affect the risk of some types ofcancer, its role in esophageal cancer is unknown. The objective of this study was to investigate the association between intakes of manganese with esophageal cancer in Golestan Cohort Study.
Golestan Cohort Study was launched in Golestan province, northeast Iran, and 50000 participants were enrolled from January 2004 to June 2008. Intake of manganese was assessed with a validated food frequency questionnaire. A Cox proportional hazard model was used to estimate hazard risks and 95% confidence intervals.
During the follow-up period, we identified 201cases of esophageal cancer according to the reports of pathological evaluations. Manganese intake was not significantly associated with the risk of esophageal cancer (Hazard Ratio (HR) for the top versus bottom quartile = 1.49, 95% CI: 0.91–2.45, p for trend =0.09). HR for 1 mg increase in manganese intake was1.05, (95% CI: 0.98–1.11, p=0.15). Although the graphical Restricted cubic spline (RCS) plots showed that the associations between manganeseand risk of ESCC washyperbolic-shaped, P for non-linear association was not significant (p =0.08).
Manganese intake is not associated with the risk of esophageal cancer in linear pattern.

Irritable bowel syndrome (IBS) is one of the common and chronic functional gastrointestinal disorders that cause a great burden for the patients and the society. Therefore, investigation of psychological variables related to IBS can be useful in understanding, management and decrees of symptoms severity in IBS patients. The present study was performed to examine the mediating role of alexithymia on the relationship between early maladaptive schemas and severity of symptoms in patients with irritable bowel syndrome. One hundred and eighty patients with irritable bowel syndrome (114 men, 66 women) participated in this study. All patients were asked to complete the IBS symptom severity scale (IBS-SSS), young schema questionnaire-short form (YSQ-SF), and Toronto Alexithymia scale (TAS-20). The results demonstrated that early maladaptive schemas and alexithymia had a significant positive association with severity of IBS symptoms )p

Irritable bowel syndrome (IBS) is one of the common and chronic functional gastrointestinal disorders that causes a great burden for the patient and the society. Therefore، investigation of psychological variables related to IBS can be useful in understanding، managing and reducing symptom severity in IBS patients. The present study was performed to examine the mediating role of intolerance of uncertainty on the relationship between early maladaptive schemas and severity of symptoms in patients with irritable bowel syndrome. One hundred and eighty patients with irritable bowel syndrome (66 women، 114 men) participated in this study. All patients were asked to complete the IBS Symptom Severity Scale (IBS-SSS)، Young Schema Questionnaire-Short Form (YSQ-SF) and Intolerance of Uncertainty Scale (IUS-12). Results demonstrated that early maladaptive schemas and intolerance of uncertainty had a significant positive association with severity of symptoms. Early maladaptive schemas had a significant positive association with intolerance of uncertainty. Results showed that intolerance of uncertainty did not play a mediating role on the relationship between early maladaptive schemas and severity of IBS symptoms. According to the results of the present study، it can be concluded that early maladaptive schemas and intolerance of uncertainty can predict severity of IBS symptoms. Considering these psychological variables would be helpful in the processes of prevention، diagnosis and treatment of IBS.

Irritable Bowel Syndrome is the most common functional gastrointestinal disease and is among the most common reasons for outpatients doctor visit both in primary and specialty clinics. Except for some changes in functional brain imaging and some mild GI mucosal inflammation there is no gross structural changes or pathological finding. Patients suffer from lifelong chronic abdominal pain, diarrhea, constipation, bloating and flatus often associated with anxiety depression with significant opposing effect on the quality of life and will force the patients to use the healthcare system repeatedly and induce a huge cost for health care system. It will also result in abstinence from work and its economic consequences. There are no known underlying cause, but stress, childhood problems, infections and neurotransmitter changes in brain and genetic susceptibility, have been implicated as potential risk factors. The diagnosis is challenging but could almost always be made positively without extensive work up. A minimal preliminary work up in patients who don’t have the alarming symptoms may be necessary. Treatment of irritable bowel syndrome is symptom based and  is one the most challenging aspect of clinical practice. Recently there is accumulating evidence in favor of dietary therapy as one of the cheapest and most effective therapy for IBS. We aimed to look at the recent literatures about the role of diet in therapy of IBS.Â

Cancer stem cells are subpopulation of cancer cells that show self-renewal potential and the capacity to differentiate into diverse populations comprising a tumor. One of the characteristics of CSCs is their ability to form floating spheroids under anchorage-independent conditions in a serum-free media. The aim of this study was isolation of colon cancer stem cells by sphere formation assay and characterization of them in human colonic adenocarcinoma HT-29. In this experimental study, colon CSCs markers including CD44 and EPCAM in spheroid and HT-29 cells were analyzed by flow cytometry. The expression levels of stemness genes in both spheroid and HT-29 cells were investigated using real-time PCR. Tumorigenic potential of spheroid cells was evaluated using in vivo xenografts assay. Our data showed over 92% of spheroids were CD44+/EpCAM+, while HT-29 cells only have expressed 37% of CD44/EpCAM markers. In compared with the HT-29 cells, expression levels of ‘‘stemness’’ genes, like Sox2, Oct4, Nanog, C-myc, and Klf4 were significantly increased in spheroid cells (p< 0.05). Further, As little as 2500 spheroid cells were sufficient to obtain tumor growth in nude mice, while 1x106 of HT-29 cells was needed to form tumor. Our data suggest that spheroid formed by colon cancer cell lines highly enriched in CSCs and showed increasing expression of stemness genes and tumorigenic in nude mice.