habibollah mahmoodzadeh

This study aimed to investigate how COVID-19 affects patients with Gastric Cancer (GC) and what should be expected to happen in post-CVOID-19 era. A retrospective study of GC patients referring to Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences in two parallel time periods of February 25th to December 25th of 2020 and the same period in 2019 was conducted.  Twenty-six patients during COVID-19 pandemic and 54 patients during pre-COVID-19 time were recruited. Mean age, gender, tumor location and T status distribution did not show statistically significant difference between study groups (all p-values >0.05). Regarding N status, distributions of N0, N1, N2 and N3 in pre-COVID group were as follows: 2(3%), 21(39%), 25(48%) and 6(10%). In COVID-19 period, group N0 was not reported and N1, N2 and N3 were 7(27%), 7(27%) and 13(46%), respectively (p-value <0.05). Among pre-COVID patients, 6(11%) patients had gross metastasis in Staging Laparoscopy (SL) and 10(18.5%) patients had positive malignant cytology. In COVID-19 group positive SL and positive cytology were found in 9(35%) and 11(42%) patients, respectively (all p-values <0.05). Health care systems should adopt reasonable approaches to cancer management, otherwise we might face the upcoming pandemic of locally advanced and metastatic cancers.

Mutations occurring in the CDH1 gene elevate the susceptibility to the development of hereditary diffuse gastric cancer (HDGC) as well as lobular breast cancer (LBC). LBCs with CDH1 germline mutations are classified as hereditary breast cancers, devoid of any indication of gastric carcinoma. As prophylactic gastrectomy is a recommended course of treatment for individuals with CDH1 mutations, it is advised that genetic testing be conducted for those who meet the criteria established by the National Comprehensive Cancer Network (NCCN). This study aimed to screen patients with HDGC for CDH1 testing and clinical management for the prevention of HDGC. Moreover, patients with LBC are tested for CDH1 mutation.

In this multicenter study, thirty-one patients with HDGC were selected among 615 patients and admitted for CDH1 mutation testing. PCR for all 16 exons of CDH1 and Sanger sequencing were performed. Patients with LBC who are negative for BRCA1/2 were also included in this study regardless of gastric cancer history.

The results showed that 5.04% of patients with DGC were identified as HDGC of which 9.6% of individuals had a pathogenic CDH1 mutation and only 15.38% of cases with a family history carried germline mutation in CDH1. Furthermore, 7.6% of patients with LBC and negative for a family history of gastric cancer have CDH1 mutation.

All patients who met the NCCN criteria were not CDH1 mutation-positive, indicating other genes should be involved in DGC. Moreover, patients with LBC and negative for BRCA1/2 are recommended for testing the mutation in CDH1.

Three main cell signaling pathways including the endoplasmic reticulum stress (ERS) response, autophagy, and apoptosis play critical roles in both cell survival and death. They were found to crosstalk with one another during tumorigenesis and cancer progression. This study aimed to investigate the expression of the spliced form of X-box binding protein 1 (XBP1s), p62, and caspase-3, as the essential biomarkers of ERS, autophagy, and apoptosis in patients with colorectal cancer (CRC), as well as the correlation between their expression and clinicopathological data. 

This retrospective study was conducted on formalin-fixed paraffin-embedded (FFPE) blocks, which were collected from patients and their tumor margins, from the tumor bank of Imam Khomeini Hospital (Tehran, Iran) from 2017 to 2019. Tissue microarray (TMA) was used to measure the XBP1s, p62, and caspase-3 biomarkers. Data were analyzed using SPSS software version 20, and P≤0.05 was considered statistically significant. 

Evaluating the total of 91 patients, a significant relationship was found between XBP1s expression and TNM stage (P=0.003), primary tumor (pT) (P=0.054), and the degree of differentiation (P=0.006); and between caspase-3 with pT (P=0.004), and lymphovascular invasion (P=0.02). However, no significant correlation was found between p62 and clinicopathological data. Furthermore, a positive relationship between XBP1s and p62 was confirmed (correlation coefficient: 22.2% and P=0.05).

Our findings indicated that XBP1s could be considered as a target for therapy in personalized medicine.

A significant part of deaths related to breast cancer is the result of invasion to other organs. It is essential to discover new non-invasive biomarkers to improve anticipation of recurrence risk in breast cancer patients. In this study, the plasma levels of miR-129 and miR-203a were evaluated to investigate their diagnostic potential in breast cancer and its metastasis.

In this case-control study, conducted in Tarbiat Modares University, Tehran, Iran, in 2019, Invasive Ductal Carcinoma blood samples were divided into 3 groups based on their stages as I, II/III, IV. Each group contained 30 individuals. We also recruited 30 normal individuals as a control group. Real-Time PCR was conducted to evaluate miR-129 and miR-203a expression levels. The discriminatory ability of the evaluated plasma miRNAs was assessed by ROC (Receiver Operating Characteristic) curves in breast cancer diagnosis and its metastasis.

MiR-129 and miR-203a expression levels were significantly downregulated in breast cancer. Reducing tendency was observed in the mentioned miRNAs from less to more invasive stages. The expression level of miR-129 was decreased in metastatic than non-metastatic patients and it was significantly related to metastasis. A significant association between miR-129 expression level and lymph node status was also observed (P=0.04). Evaluation of ROC curves revealed that miR-129 and miR-203a were able to discriminate breast cancer fairly and poorly respectively. The ability of miR-129 in the diagnosis of breast cancer metastasis was poor.

MiR-129 and miR-203a may both act as tumor suppressor miRNAs. Our results need further evidence in a large population to be confirmed as diagnostic markers.

 The high mortality rate of Gastric Cancer (GC) is a consequence of delayed diagnosis. The early diagnosis of GC could increase the five-year survival rate among patients. We aimed to find a panel of microRNAs (miRNA) for the detection of GC in the early stages.

 In this case-control study, we selected consistently upregulated miRNAs from the results of 12 high-throughput miRNA profiling studies in GC. In the profiling phase, the differential expressions of 13 candidate miRNAs were analyzed by quantitative reverse-transcription PCR (qRT-PCR) in two pooled RNA samples prepared from the plasma of eight GC patients and eight matched controls. In the validation phase, significantly upregulated miRNAs from the profiling phase were further evaluated in the plasma samples of 97 patients with stage I-IV gastric adenocarcinoma and 100 healthy controls.

 In the profiling phase, six miRNAs (miR-18a, 21, 25, 92a, 125b and 221) were significantly upregulated in the GC patients compared to the controls (p<0.05). However, in the validation phase, only significant up-regulation of miR-18a, 21 and 125b was confirmed (p<0.05). A panel of miR-18a/21/125b was able to detect GC patients with stage I-IV from the controls (p<0.001; AUC=0.92, sensitivity=86%; specificity=85%). In addition, the panel could distinguish the early-stage GC (I+II) from the control group with an AUC of 0.83, a sensitivity of 83%, and a specificity of 75%.

 A panel of circulating miR18a/21/125b could be suggested as a potential biomarker for the early detection of GC.

In March 2020, the World Health Organization (WHO) declared the novel COVID-19 infection a pandemic. Among high-risk patients infected by the virus, upper gastrointestinal cancer patients, similar to other immunosuppressed patients, are vulnerable to developing more severe infections. Most of the routine activities of medical centers, especially cancer surgery centers worldwide, are affected by the epidemic. Thus, some modifications are needed to adjust international protocols to deal with upper gastrointestinal cancers worldwide.

The headings of upper gastrointestinal cancer management protocols have been discussed among the university-affiliated professors in different disciplines involved in upper gastrointestinal cancer management at the first peak of COVID-19 in Iran in March 2020. The discussions were done through an interactive application (WhatsApp and Telegram) in which participants considered the headlines and the latest news about COVID-19. Under each heading, we provide the consensus of all members in the related disciplines.

All members agreed to choose the most effective and the least hazardous recommendations regarding patients and medical staff in each specialty. The members understand that some recommendations may intervene with the standard best practice and reduce the best outcome that the patient can gain with standard management. Therefore, these recommendations are legitimate simply at the peak of the epidemic COVID-19 situation or the surge of any other unknown situations that we may encounter in the future. According to the consensus of cancer surgery professors in several cancer surgery centers, patients with T1 and T2 gastric cancer without lymph node involvement should undergo upfront surgery. Patients with T3 or more and/or lymph node involvement will have total neoadjuvant chemotherapy, and the surgery should be delayed until the end of the COVID-19 peak. Diagnostic laparoscopy should be postponed during the peak of COVID-19 till after the completion of neoadjuvant chemotherapy. Upfront surgery should be performed in patients with esophageal cancer (adenocarcinoma or SCC) with T1 or T2 and without lymph node involvement. In patients with T3 or more and/or lymph node involvement, neoadjuvant chemoradiotherapy (CRT) is recommended. Endoscopic stent placement is preferred for patients who complete neoadjuvant CRT during the peak of COVID 19 and have severe dysphagia. A PET-CT scan will be performed in patients without dysphagia. In the status of high uptake, surgery is reasonable, but in low uptake status without any dysphagia, only conservation is our suggestion.

Metastasis might be latent or occur several years after primary tumor removal. Currently used methods for detection of distant metastasis have still some limitations. Blood tests may improve sensitivity and specificity of currently used screening procedures. The present study was designed to investigate promoter methylation status of DAPK1 and CAVIN3 genes in plasma circulating free DNA (cfDNA) samples in Iranian invasive ductal carcinoma (IDC) patients. We also investigated association of two gene promoter methylations with breast cancer (BC) and metastatic BC was also assessed.

In this case-control study, MethySYBR assay was performed to determine DAPK1 and CAVIN3 promoter methylation status in breast IDC from 90 patients and 30 controls. Based on clinicopathological information, patient samples subdivided into stage I, II/III and IV groups (each group contained 30 individuals).

According to the results an increased promoter methylation level of the DAPK1 gene in BC patients was observed. It was found that as disease progressed, the percentage of methylation was changed while it was not significant. Methylation changes in metastatic and non-metastatic BC revealed that methylation levels were significantly increased in metastatic than non-metastatic group. Analysis revealed that promoter methylation of CAVIN3 gene in BC patients was significantly increased. The observed methylation changes from less to more invasive stages were not significant in the CAVIN3 gene. Moreover, promoter methylation was changed in metastatic rather than non-metastatic condition, although it was not significant.

Promoter hypermethylation of DAPK1 and CAVIN3 genes in plasma are associated with the risk of BC and they can be potential diagnostic biomarkers along with current methods. Additionally, association of aberrant DAPK1 promoter methylation with metastasis suggests its potential usage as a non-invasive strategy for metastatic BC diagnosis.

Positive peritoneal cytology is a critical factor in prognosis. Peritoneal lavage is associated with long-term survival in patients with gastric cancer. Diagnostic peritoneal lavage (DPL) is a method for diagnosing visceral injury in trauma patients. This study aimed to investigate the usage of DPL in staging the work-up of patients with gastric cancer.
In this prospective study, we enrolled gastric cancer patients referring to Cancer Institute; they underwent DPL and washing specimen was sent for cytology review. After DPL, all patients underwent staging laparoscopy (SL) via the same abdominal incision.
DPL and SL were successful in all patients. There were six (11%) cases of peritoneal seeding discovered in SL; all of these patients had positive peritoneal cytology on DPL. Also, four patients showed positive cytology in the absence of positive SL. Thus, sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of DPL were 100 % (95% CI: 54.1-100), 91.6 % (95%: 79.2-97.5), 100 % (95%CI: 85.3-100), and 60 % (95%CI: 37-79.3). The accuracy of DPL in determining the peritoneal dissemination of gastric cancer was 92.31% (95% CI: 81.5-97.9).
DPL had an excellent ability to find peritoneal dissemination in a gastric cancer patient, which is of great value in the setting of low-resource countries.

Cyclooxygenase-2 (COX-2) main product is Prostaglandin E2 (PGE2) which cause mitogenesis and inflammation. COX-2 is the product of prostaglandin-endoperoxide synthase 2 (PTGS2) gene expression. COX-2 dysregulation can cause angiogenesis, differentiation, and promotion of cancer and its suppression related to control of the tumorchr('39')s size, number, and cell shape. This study focused on the association of COX-2 expression with colorectal carcinoma (CRC) among Iranian patients on mRNA level and in the Cancer Genome Atlas Program (TCGA) colon and rectum RNAseq dataset, and its relation with pathological features.

PTGS2 expression was assayed by quantitative-PCR method from 90 tissue samples collected from 45 participants. The control samples come from the non-tumor area of the same patients. The data analyzed based on ΔΔCq. The PTGS2-RNAseq data extracted and analyzed by UCSC Xena browser, and its association assessed the occurrence of CRC and invasive-features.

PTGS2 showed very significant over-expression in tumor tissues (p< 0.0001) with an N-fold expression of 2.25. But, there was not any significant association between PTGS2 and CRC invasive-pathological features such as Lymphatic, vascular and perineural invasion, the Grades of cancer, and Pathologic-M in both parts of this study.

The increase in PTGS2 is related to the occurrence of CRC among patient samples. But in both part of this study, PTGS2 is not an invasive factor, and it does not affect the cell differentiation of tumors and metastasis. Based on the high N-fold for patient samples, it can be a strong candidate as a CRC initiator biomarker.

Anti-Müllerian hormone (AMH) is a known sensitive biomarker for fertility and ovarian reserve. The results of in vivo and human studies showed inconsistency with respect to the relation between AMH and breast cancer.

To compare the AMH level of young Iranian women with early breast cancer who have not received any treatment compared to that of healthy women.

In this case-control study, 58 breast cancer cases were recruited from the breast oncology clinic of two university hospitals. They were diagnosed with an in situ or invasive breast cancer before any anticancer treatment between August 2018 and April 2019. Healthy controls (n = 58) were selected from women referred to a gynecologic outpatient clinic without any symptoms of cancer or infertility. AMH was measured by the AMH enzyme-linked immunosorbent assay kits in one laboratory. 

Final analysis showed that the AMH means of case and control were not statistically significant (3.36 ± 2.95 vs 3.13 ± 1.79). However, the lower and higher AMH level categories are more prevalent in breast cancer compared to the control. Pearson’s correlation test showed that the AMH level was negatively correlated with age (r = -0.44, p< 0.001). The results of logistic regression analysis considering confounding factors showed the positive association between breast cancer and lower (Odds Ratio [OR] = 5.98, p = 0.02) and higher quartile of AMH level (OR = 4.95, p = 0.01).

Our results suggest that abnormal AMH level is more frequent in young breast cancer patients. Further investigation considering AMH determinants is required.

Breast cancer is the most common cancer in Iranian women. The number of people with this disease is increasing across the world. Positive family history is one of the risk factors for developing breast cancer. However, early detection is the main method to fight this disease. This study was conducted to examine the effect of education based on the health belief model (HBM) on self-care behaviors among first-degree relatives of patients with breast cancer.

This clinical trial was conducted in 2016 on 80 women in Tehran city, Iran. Data were collected using a three-part questionnaire regarding demographic data, the HBM, and self-care behaviors. The educational program based on the HBM was held in 4 ninety-minute training sessions through lectures, group discussions, question and answer, image presentations, and PowerPoint presentations. The questionnaires were completed before and 2 months following the intervention by intervention and control groups. Data were analyzed using descriptive and inferential statistics through the SPSS16 software.

The mean score of the HBM constructs before the intervention in the groups had no statistically significant differences (P > 0.05). Eight weeks after the intervention, the mean score of the constructs of the HBM in the intervention group significantly increased and a statistically significant increase in the mean score of self-care in the intervention group compared to the preintervention was found, so that the self-care behavior score in the intervention group was 0.69 ± 0.09 before the intervention and was changed to 0.74 ± 0.09 after the intervention (P < 0.0001).

Our results suggest that education based on the HBM was effective in promoting self-care behaviors among first-degree relatives of breast cancer patients. Therefore, education based on HBM may have an important implication for breast cancer prevention in Iran.

With respect to the high cost and limited availability of albumin, its use must be restricted to indications strongly supported by solid scientific evidence. It was anticipated that with the implementation of the National Health Reform Plan (NHRP), the consumption of albumin would increase as the result of decreasing patients’ out‑of‑pocket costs. This study aimed to evaluate the efficacy of protocol implementation on the rationalization of albumin use in surgery wards of Cancer Institute of Imam Khomeini Hospital Complex, Tehran, Iran.

This pre‑post interventional study was conducted in 32‑month phases from January to November 2014 in an Iranian University hospital. The first phase was before the implementation of NHRP, the second phase was after NHRP, and the last one was after the intervention. The first and second phases were conducted retrospectively. Data extraction was performed by a hospital pharmacist. During the third phase, the physicians were mandated to adhere to a local albumin protocol which had been prepared by clinical pharmacy service and approved by drug and therapeutic committee. Appropriateness of prescriptions regarding indication, dose, and duration based on local guideline was compared among groups.

Although hospital bed‑days of care remained consistent among phases, albumin was prescribed for 40, 45, and 8 patients during first, second, and third phases, respectively. This shows about 80% reduction of drug prescriptions in the last phase. The mean duration/dose of albumin in inappropriate indications reduced significantly from 11.3 ± 8.2 days/24.7 ± 21.2 vials in the second phase to 2.6 ± 1.7 days/5.6 ± 3.5 vials in the third phase, respectively (P = 0.001 and P = 0.003).

Interactive collaboration through guideline implementation seems effective in rationalizing the use of high‑cost medications such as albumin.

Most of Gastric Cancer (GC) patients are diagnosed at an advanced stage with poor prognosis. Hypermethylations of several tumor suppressor genes in cell-free DNA of GC patients have been previously reported. In this study, an attempt was made to investigate the methylation status of P16, RASSF1A, RPRM, and RUNX3 and their potentials for early diagnosis of GC.

Methylation status of the four tumor suppressor genes in 96 plasma samples from histopathologically confirmed gastric adenocarcinoma patients (Stage I-IV) and 88 healthy controls was determined using methylation-specific PCR method. Receiver operating characteristic curve analysis was performed and Area Under the Curve (AUC) was calculated. Two tailed p<0.05 were considered statistically significant.

Methylated P16, RASSF1A, RPRM, and RUNX3 were significantly higher in the GC patients (41.7, 33.3, 66.7, and 58.3%) compared to the controls (15.9, 0.0, 6.8, and 4.5%), respectively (p<0.001). Stratification of patients showed that RPRM (AUC: 0.70, Sensitivity: 0.47, Specificity: 0.93, and p<0.001) and RUNX3 (AUC: 0.77, Sensitivity: 0.59, Specificity: 0.95, and p<0.001) had the highest performances in detection of early-stage (I+II) GC. The combined methylation of RPRM and RUNX3 in detection of early-stage GC had a higher AUC of 0.88 (SE=0.042; 95% CI:0.793–0.957; p<0.001), higher sensitivity of 0.82 and reduced specificity of 0.89.

Methylation analysis of RPRM and RUNX3 in circulating cell free-DNA of plasma could be suggested as a potential biomarker for detection of GC in early-stages.

 Psychological factors play important roles in mental and physical outcomes of cancer, like disability and positive growth after exposure to cancer trauma.

 This study aimed to investigate the mediating role of health literacy in the relationship of social support and coping strategies with post-traumatic growth and functional disability among patients with cancer.

 The present descriptive, cross-sectional study included 265 patients (142 women and 123 men) with various types of cancer selected by a convenience sampling method among patients referring to the Cancer Clinics of Imam Khomeini Hospital in Tehran, Iran. Data were collected by the “WHO Disability Assessment schedule”, “post-traumatic growth inventory”, “Functional, Communicative, and Critical Health Literacy scale”, “Social Support scale”, and “Brief Cope scale”. Data were analyzed by structural equation modeling (SEM) using AMOS-24 and SPSS-20 software.

 The results showed that social support had a significant positive correlation with post-traumatic growth (P ≤ 0.001) and health literacy (P ≤ 0.001) and a significant negative correlation with functional disability (P ≤ 0.001). There was a significant positive correlation between avoidance-coping strategies and post-traumatic growth (P ≤ 0.001) and functional disability (P ≤ 0.051). Problem-focused coping strategies had a significant positive correlation with health literacy (P ≤ 0.051) and there was a significant negative correlation between health literacy and functional disability (P ≤ 0.001). Additionally, health literacy had a mediating role in the relationship between social support and functional disability (P ≤ 0.001) and between problem-focused coping strategies and functional disability (P ≤ 0.001).

 Social support and coping strategies directly or through the mediating role of health literacy are important predictors of post-traumatic growth and functional disability among patients with cancer, suggesting the need for intervening and educating in these areas to improve patients’ physical and mental status.

Zinc-finger Enhancer Binding protein (ZEB1) acts as a transcription factor to promote cancer progression through regulating Epithelial to Mesenchymal Transition (EMT). It is well-known that ZEB1 mRNA expression is directly induced by both Estrogen Receptor (ER) and Progesterone Receptor (PR). Moreover, Androgen Receptor (AR) and PR could bind to the same regulatory element. Since it has been shown that AR overexpresses in Gastric Cancer (GC) as a male-predominant tumor, the goal of this study was to evaluate whether AR could regulate ZEB1 expression in GC.

The expression profile of ZEB1 in 60 fresh GC and adjacent non-tumor tissues and 50 normal gastric specimens was assessed by qRT-PCR, and the association of ZEB1 expression with clinicopathological features was investigated. Furthermore, possible correlation between ZEB1 and AR was evaluated to elucidate a novel prognostic marker using Kaplan-Meier method and Cox regression model. Finally, molecular interaction of ZEB1 and AR was assessed using a potent AR antagonist in GC cells.

Among GC patients, 70.2% (40/57) overexpressed ZEB1 and 64.91% (37/57) overexpressed AR relative to normal gastric tissues. ZEB1 overexpression was significantly correlated with the AR overexpression in GC patients. Moreover, ZEB1 overexpression was remarkably associated with lower overall survival; however, it was not an independent prognostic factor. Evidence shows that simultaneous evaluation of ZEB1 and AR expression could independently predict survival of GC patients (HR= 2.193, p=0.047).

These findings have clinical importance suggesting simultaneous evaluation of ZEB1 and AR expression as a potential prognostic marker. Moreover, AR may regulate ZEB1 expression in GC cells proposing a possible promising targeted therapy for GC patients.

Surgical site infection (SSI) is defined as infections occurring within 30 days after a surgical operation or within one year if an implant is left in place after the procedure. Antibiotic prophylaxis formed as part of surgical care to reduce SSI. Antibiotic prescription pattern for SSI prophylaxis and it's concordance withAmerican Society of Health-System Pharmacists(ASHP) guideline were evaluated throughout this study.

This study was conducted in Imam Khomeini hospital, cancer institute. Patients with cancer who underwent abdominal surgery were included in this study. The information about type of antibiotic used for prophylaxis, dose, initiation time, and duration were collected during study. Compliance was assessed with the ASHP guideline for every aspect of antibiotic prophylaxis. SSI was assessed during 30 days after surgery.

All the patents needed antibiotic prophylaxis among them,only 103 patients received it. Antibiotic choice, dose and initiation time of prophylaxis were concordant with ASHP guideline in 36.3%, 1.6% and 60.5%, respectively. Unlike the ASHP, the duration of prophylaxis was more than 24 hours in all patients. Finally, 32 patients experienced SSI during 30 days after surgical procedure.

This study showed poor adherence to guideline in various aspects such as type, dose and duration of antibiotics for SSI prophylaxis. It is essential to implement interventions to improve the rational use of antibiotics in this setting

With respect to the role of chronic inflammation in the induction and progression of breast cancer (BC). The relationship between tumor and tumor microenvironment may be a hopeful strategy for BC therapy. According to the effect of β-D-Mannuronic acid (M2000) as a novel non-steroidal anti-inflammatory drug (NSAID) on BC murine model and 4T1 cell line, we started to study that was a phase II, randomized, controlled clinical trial. 24 women with BC were included in this study and were followed by fixed oral doses of M2000, 500 mg two times a day (6-8 weeks). Blood samples were collected at baseline and weeks 6-8. To compare the patterns of matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9), C-C motif chemokine ligand 22 (CCL22) and The transforming growth factor-beta 1 (TGFβ1) gene expression and T regulatory cells (Tregs) frequency of healthy women normal controls with BC patients, a set of 10 blood samples of women healthy volunteers was collected. The gene expression was evaluated by quantitative Real-time PCR (qRT-PCR) and the frequency of Tregs was assessed by flow cytometry. Our results showed, reduction in MMP-2 (p=0.08), MMP-9 (p=0.03), CCL22 (p=0.003) and TGFβ1 (p=0.1) gene expression and Tregs frequency (p=0.01) which play a main role in the development of chronic inflammation, angiogenesis, tumorigenesis and metastasis. Our findings demonstrated that M2000 therapy as a novel designed NSAID had valuable therapeutic effects on BC. No adverse effects were observed following the use of M2000 after 6-8 weeks.

Neoadjuvant chemotherapy (NAC) is increasingly used to treat patients with breast cancer, but the reliability of sentinel lymph node biopsy (SLNB) following chemotherapy is in doubt. In this meta‑analysis, we aimed to evaluate studies that examine the results of SLNB after NAC to assess identification rate (IR) and false‑negative rate (FNR).

Systemic searches were performed in the PubMed, ISI Web of Sciences, Scopus, and Cochrane databases from January 1, 2000, to November 30, 2016, for studies of SLNB after NAC for breast cancer and followed by axillary lymph node (LN) dissection in two subgroups: initially node negative and node positive converted to node negative. Two reviewers independently review quality of included studies. A random‑effects model was used to pool IR and FNR with 95% confidence intervals (CI), and heterogeneity among studies was assessed by I2 and Q‑test.

A total of 23 studies with 1521 patients in the initially node‑negative subgroup and 13 studies with 1088 patients in the node‑positive converted to node‑negative subgroup, were included in this meta-analysis with IR and FNR of 94% (95% CI: 92–96) and 7% (95% CI: 5–9) in the initially node‑negative subgroup and 89% (95% CI: 85–94) and 13% (95% CI: 7–18) in the node‑positive converted to node‑negative subgroup, respectively.

Our meta‑analysis showed acceptable IR and FNR in initially node‑negative group and it seems feasible in these patients, but these parameters did not reach to predefined value in node‑positive converted to node‑negative group, and thus, it is not recommended in these patients.

For many years, the acceptable margins of the resections for ductal carcinoma in situ (DCIS) has been 2 mm, although, in some reports and the recent updates of some guidelines, the closer margins are also declared as acceptable in some circumstances. Despite these new recommendations, the safe margin in DCIS remains a matter of controversy in many institutional and national guidelines.
A woman with invasive breast cancer with associated DCIS presented to our clinic. She underwent breast-conserving surgery, and pathology report showed one focus of DCIS at a distance of Question: The question was whether the patient should be operated again to obtain more extensive margins for DCIS or the radiation therapy would be enough as the next step in her treatment.
According to the latest published guidelines, the members of panel decided to accept the margin and informed the patient about the risk of recurrence and the need for adjuvant radiotherapy and follow-up modalities.

Malignant melanoma is the most lethal type of skin cancers with unfavorable prognosis. Alpha-MSH peptide analogues have a high affinity for melanocortine-1 (MC1) receptors on melanocytes over expressing in malignant melanoma cells. Pre-clinical studies have shown promising results for radiolabeled MSH imaging in this malignancy. The purpose of this study is to assess the diagnostic value of 99mTc-α-MSH imaging in malignant melanoma.
Twenty-one patients (13 men) with pathologically confirmed malignant melanoma with or without metastatic distribution were included in this study. 740-1110 MBq 99mTc-α-MSH was injected and whole body scans were performed 20, 120 and 240 minutes post injection and were assessed both qualitatively and semi-quantitatively using target (T) to background (BG) ratio.
The T/BG ratio for the primary tumor bed was 2.51±2.26, 2.56±2.48 and 1.92±1.79 minutes in the whole body scans 20, 120 and 240 minutes post injection, respectively. The sensitivity, specificity, negative and positive predictive values were 75%, 80%, 50% and 92% for primary lesion and 25%, 100%, 68% and 100% for distant metastasis, respectively.
99mTc-α-MSH is a newly introduced agent for diagnosis of tumoral lesions in malignant melanoma. Our study showed a high sensitivity with this modality in primary lesions as well as lymph node involvements. However the detection rate was not high in distant metastasis. The preliminary results are promising especially as a new complementary imaging method in management of malignant melanoma.

Burden of cancer is increasing in developing countries, where healthcare infrastructures and resources are limited. Evaluating the pattern of care would provide evidence for planning and improvement of the situation.
We studied the pattern of residential place and clinical information of cancer patients who were admitted to the Cancer Institute of Iran from January 1, to May 31, 2012.
We studied 1,705 consecutive cancer patients admitted to the Cancer Institute in the study period. The most common cancers were breast (29.2%), colorectal (9.0%), stomach (8.3%), head & neck (8.0%) and esophageal (3.8%) cancers. Radiotherapy was the main treatment (52.1%) followed by chemotherapy (43.8%) and surgery (29.1%). We found that 60% of the patients presented in the loco-regional or advanced stages. About 35% of patients travelled from other provinces mainly from Mazandaran (13.4%), Lorestan (10.6%), Zanjan (7.8%) and Ghazvin (6.6%). On average, the cancer patients travelled about 455 kilometers to receive care in the cancer institute. We found more than 38% patients who were referred from other provinces had an early stage tumor.
Establishment of comprehensive cancer centers in different geographical regions and implementation of a proper referral system for advanced cancer patients is needed to improve the patient outcomes and mitigate the burden of travel of patients for cancer care.

A sentinel lymph node (SLN) biopsy is an interesting issue in the field of surgical oncology and has recently been introduced to the treatment of gastric cancer. The purpose of this study is to assess accuracy, sensitivity, specificity, and false negative rates (FNRs) of SLN biopsies, and to ascertain whether or not this procedure is useful for locally advanced gastric cancer.
From December 2013 to March 2014, 22 patients with gastric cancer were enrolled in this study. After laparotomy, patent blue was injected around the tumor subserosaly, resection was then done, and SLNs were detected on a back table. Afterward, D2 dissection was carried out. Finally, SLNs and other specimens were submitted for permanent pathology.
SLNs were detected in 20 of 22 patients. The total number of SLNs was 87. SLNs were positive in 7 patients, and the total number of positive SLNs was 17. In three patients, the SLNs were negative, whereas other LNs were positive, with an FNR of 15%. 18 patients received neoadjuvant. Complete pathologic responses with negative LNs were seen in 3 patients. Accuracy, sensitivity, specificity, and negative predictive values were 80%, 66%, 90%, and 76%, respectively.
This research demonstrated that SLN mapping in advanced gastric cancer is an appropriate method with acceptable levels of accuracy, sensitivity, and negative predictive values, even in those patients who received neoadjuvant treatment.

Modified radical mastectomy (MRM), as a surgical treatment in breast cancer patients, may lead to important complications with significant morbidities including seroma formation. In this study, we used topical phenytoin to evaluate its impact on breast and axillary wound drainage and seroma formation after MRM. In a double-blinded randomized clinical trial, patients with breast cancer who were candidates for modified radical mastectomy (MRM) were enrolled. The patients were randomly assigned to two groups using a simple randomization method. Group A received topical phenytoin 1% solution for the irrigation of the mastectomy wound during the MRM procedure while group B (control group) underwent wound irrigation with normal saline solution. In addition to demographic data, postoperative variables including daily drainage of breast and axillary drains, drain removal days, and possible complications including seroma formation and their management were recorded. Except for daily drainage recorded on the fifth postoperative day, the drainage of both axillary and breast drains were significantly different between group A and B in the following days. Compared to group B, axillary drains could be removed significantly earlier in group A. In regard to the breast drains, they were removed earlier in group A with no statistically difference compared to group B, the difference was not statistically significant. Seroma was detected in 7(8.3%) patients, 3 patients in group A and 4 patients in group B, with no significant differences between the two groups. All the patients underwent repeated aspirations. Our findings showed that topical irrigation of the surgery site with phenytoin was effective in reducing axillary surgical wound drainage.

The Gail model has been widely used for estimation of absolute risk of breast cancer development. The original model and most of the validation studies have been performed among western populations and controversial results have been reported regarding the applicability of this model in Asian populations. Our aim was to investigate the performance of this model in Iranian women. In a cross-sectional study, a total of 280 patients with breast cancer and 280 participants with normal screening results were enrolled as case and control groups, respectively. Risk factors used in the latest version of the Gail model were compared between the two study groups. Gail score was calculated by using Breast Cancer Risk Assessment Tool and based on the cut-off point of 1.67, patients were categorized in order to assess model performance. In total, 560 patients with a mean age of 43.07±8.60 years were enrolled. Comparison of different risk factors between the two groups revealed significant associations of patients’ age (P < 0.001), age at first pregnancy (P = 0.022), previous history of breast biopsy (P < 0.001) and atypical hyperplasia (P = 0.002) with risk of breast cancer. No association was found between age at menarche (P = 0.115) or first-degree family history (P = 0.117) and increased risk. Considering the Gail score for 5-year risk of breast cancer development, the difference between the two groups failed to reach significance (P = 0.052). The sensitivity and specificity of the model were 13.9% and 94%, respectively. Based on the current findings, it can be suggested that employing the current version of the Gail model for breast cancer risk assessment will underestimate the risk of cancer development in Iranian women.

Concomitant papillary thyroid cancer and parathyroid adenoma is rare. We report a 55 years old female with papillary cancer admitted for surgery. Preoperative laboratory findings revealed hypercalcemia and then primary hyperparathyroidism. Thyroidectomy, neck dissection and excision of parathyroid adenoma were performed. Histological examination revealed parathyroid adenoma. Serum calcium returned to normal range after surgery. We recommend preoperative check of calcium in patients with thyroid cancer.