Iranian Red Crescent Medical Journal
Volume:25 Issue: 8, Aug 2023

There has not been an absolute consensus over the routine closure of peritoneal defect (PD) during laparoscopic totally extraperitoneal inguinal hernia repair (TEP). Pretied sutures, endoscopic stapling, and suturing are surgical techniques for closing PDs. Moreover, we observed that we could close small PDs during the TEP procedure by sealing with the LigaSure (LS).

The present study aimed to evaluate the necessity of closure PDs under a polypropylene mesh and the early intraperitoneal inflammatory, fibrotic, and adhesional effects of sealing PDs with the LS in an experimental rat model.

A total of 35 male rats were assigned to five groups. 1- Control group: mesh was not used, and the peritoneum was left open; 2- Mesh group; mesh was placed directly on the PD without repairing, and three peritoneal repairing methods; 3- Stapling group: PD was repaired with metal clips; 4- Suture group: PD was repaired with Vicryl sutures; and 5- LigaSure group: PD was closed with the LS. Rats were sacrificed on the postoperative 14th day. Adhesion scores, fibrosis, and inflammation scores were compared between all groups.

All rats completed the 14 days of follow-up without complication. The Mesh group had significantly higher adhesion scores than the other groups (P<0.001). Nonetheless, no significant difference was observed between peritoneal repairing methods (P=0.696). Fibrosis and inflammatory scores were similar in peritoneal repairing methods (P=0.394 and P=0.112, respectively).

The direct contact of foreign bodies with the intra-abdominal organs increases the risk of adhesion; therefore, the remaining PDs under the polypropylene mesh should be repaired. Sealing PDFs with LS is a simple method that does not increase the inflammatory response, fibrosis, and the risk of adhesion formation.

Gender differences, in favor of males, exist in motor skills and motor imagery (MI) ability in healthy people. The MI ability in multiple sclerosis (MS) patients was altered; however, the reduction rate in the two genders has not been compared. Knowing the gender difference in MI may be used in rehabilitation programs based on MI.

Therefore, the present study aimed to investigate whether gender difference in MI is evident in MS patients.

Forty-nine relapse-remitting MS patients (23 men) and also 51 healthy subjects (21 men) participated in this case-control study. The MI ability can be measured by Kinesthetic and Visual Imagery Questionnaire-20 (KVIQ-20), mental chronometry based on Box and Block test, and hand mental rotation task.

Healthy men performed most MI tasks better than healthy women. Unlike healthy participants, no gender differences were observed in the KVIQ-20 scale (P=0.904), mental chronometry duration (right hand, P=0.199; left hand, P=0.374) and reaction time of hand mental rotation (right-hand stimuli, P=0.057; left-hand stimuli, P=0.059). However, MS men responded to hand stimuli significantly more accurately than MS women (right-hand stimuli, P=0.007; left-hand stimuli, P=0.027).

Our findings showed that MS men exhibit MI abilities similar to MS women. Perhaps motor deficit in MS males was influenced more by neurocognitive impairment. Perhaps in MS men as compared to MS women, MI practice as motor rehabilitation, could better improve their physical performance.

Misunderstanding of disaster hinders people from devoting enough attention to disaster preparedness programs. Flood is one of the main natural hazards in Iran.

The present study aimed to determine flood risk perception among residents of a flood-prone area in Iran in 2021.

This cross-sectional study was conducted on 201 inhabitants of three villages along the Hesar-Golestan River in northeast Iran. A researcher-made questionnaire was used to assess their flood risk perception and opinions about the causes of the flood. Flood risk perception was assessed using ten questions with a 5-point Likert scale. Risk perception was calculated at three levels: low (scores 10 to 23), medium (scores 24 to 37), and high (scores 38 to 50). Multi-stage sampling technique was used for sampling.

The majority of participants (81%) had a moderate risk perception. The mean risk perception score was 30±5, which indicates a moderate risk perception. According to the participants, the three main causes of floods were environmental degradation and soil erosion, unplanned development and construction in flood-prone areas, and heavy seasonal rainfall, respectively. There was a significant relationship between gender and age with some opinions about the causes of floods.

The risk perception of participants was at a moderate level. Low or moderate flood risk perception can lead to insufficient attention, inaction, or insufficient efforts to reduce the risk and increase preparedness for floods. Taking measures such as educating people about the causes and consequences of floods using appropriate and effective methods can help to manage disasters better.

Breast cancer (BC) is a malignant tumor that occurs in the epithelial tissue of the breast gland and has become the most common malignancy in women. Various studies have reported the effect of epigenetic changes, including DNA methylation and microRNAs, on breast carcinogenesis. microRNAs play an important role in the post-transcriptional regulation of genes and are important regulators of oncogenic pathways. Studying microRNAs in BC facilitates the development of targeted therapies and early detection of this cancer.

This study aimed to evaluate the expression level of miR-508-5p and miR-635 in BC tumor tissues compared to healthy marginal tissues.

In silico analysis confirmed microarray datasets (GSE40525, GSE44124 and GSE45666) downloaded from the GEO database. The analysis was defined using the Affy packages in R software to screen remarkably dysregulated miRNAs attended by utilized to predict the potential biological processes and molecular pathways of miR-508-5p and miR-635. Experimental statistical significance of differences in miRNA relative expression results was analyzed by pair-wise fixed reallocation randomization test as a statistical model included in the REST (relative expression software tool).

GEO microarray data set, similar to qPCR results, showed that miR-508-5p was downregulated in the sample group by a mean factor of 0.327 (S.E.M range is 0.031-2.000). Moreover, miR-635 was upregulated in the sample group by a mean factor of 2.361 (S.E.M range is 0.250-16.000).

miR-508-5p was downregulated, while miR-635 was upregulated in BC tissues. They may be proposed as diagnostic and therapeutic biomarkers for patients with BC.

Laparoscopic adrenalectomy (LA) is a widely accepted method for most adrenal lesions. However, bilateral LA is performed less often than unilateral adrenalectomy. The most common indication for bilateral LA is adrenocorticotropin hormone (ACTH)-dependent Cushing’s syndrome, including persistent Cushing’s disease following unsuccessful transsphenoidal surgery and ectopic ACTH syndrome.

This retrospective study was conducted to assess the indications, safety, efficacy, and outcomes for bilateral LA with the transabdominal lateral approach.

This retrospective study was conducted between January 2004 and February 2022. During the study period, transperitoneal LA was performed on 279 patients, among whom, 258 cases were unilateral LA. Therefore, our analysis included 21 consecutive patients who underwent laparoscopic bilateral LA with the transabdominal lateral approach. The surgery indication, tumor side and weight, operation time, conversion to open surgery, need for an additional trocar, complications, hospital stay, and follow-up information were analyzed.

Indications of bilateral LA were refractory Cushing’s disease (n=14), occult ectopic primary bilateral macronodular adrenal hyperplasia (n=5), ACTH secretion (n=1), and bilateral pheochromocytoma (n=1). The mean operative time was 207.8±21.3 min, including repositioning time. Intraoperative and postoperative complications were seen in 3 (14%) and 4 (19%) patients, respectively. No conversion to open surgery was observed. Median hospital stay was 7 (range, 5-10) days and median follow-up was 81 (range, 55-94.5) months. Three patients died at 62, 64, and 88 months after adrenalectomy due to heart failure, renal failure, and myocardial infarction, respectively. No adrenal insufficiency or signs of recurrent hypercortisolism was observed.

Our results demonstrated that laparoscopic bilateral LA was safe and effective, allowing acceptable morbidity and hospital stay. The most common surgical indication was ACTH-dependent Cushing's syndrome, followed by ACTH-independent Cushing's syndrome. The lateral transperitoneal approach obtains an excellent anatomical view. In our series, operative time and conversion to open surgery rate were in line with the literature.

Poor self-perineal care (SPC) by new mothers due to inadequate knowledge can result in perineal pain and poor wound healing outcome.

This study aimed to evaluate the effectiveness of self-perineal care education on knowledge and practice among primigravida mothers in Malaysia.

This quasi-experimental study was conducted in two public tertiary care hospitals from September 2019 to March 2020. In total, 125 mothers were recruited using consecutive sampling procedures from two tertiary care hospitals. The intervention group consisted of 62 mothers who received SPC education supplemented by the mobile app, while the other 63 mothers in the control group received only routine hospital care. The knowledge of mothers regarding SPC was assessed at 32 to 33 weeks of gestation and then at 4 h post-delivery. The mothers of both groups reported their perineal care practices on Day 1, Day 3, Day 5, and Day 7 post-childbirth using the SPC education mobile app.

There was no significant difference in the SPC knowledge scores between the two groups at baseline (P=0.155). Post-analysis showed a significant increase in the SPC knowledge score in the intervention group (P<0.001) but not in the control group (P=0.133). At all-time points, the mothers in the intervention group performed better SPC practice than those in the control group (P<0.001). There were significant associations between changes in knowledge and practice on all four days (P<0.001).

The increased knowledge of SPC was significantly associated with improved SPC practice among the primipara mothers postnatally.

Small-cell lung cancer (SCLC), which is in the category of intractable cancers, has a low survival rate. It is essential to understand the pathophysiological pathways underlying its development to create powerful treatment alternatives for the disease.

This study aimed to classify gene expression data from SCLC and normal lung tissue and identify the key genes responsible for SCLC.

This study used microarray expression data obtained from SCLC tissue and normal lung tissue (adjacent tissue) from 18 patients. An Extreme Gradient Boosting (XGBoost) model was established for the classification by five-fold cross-validation. Accuracy (AC), balanced accuracy (BAC), sensitivity (Sens), specificity (Spec), positive predictive value (PPV), negative predictive value (NPV), and F1 scores were utilized for performance assessment.

AC, BAC, Sens, Spec, PPV, NPV, and F1 scores from the XGBoost model were 90%, 90%, 80%, 100%, 100%, 83.3%, and 88.9%, respectively. Based on variable importance values from the XGBoost, the HIST1H1E, C12orf56, DSTNP2, ADAMDEC1, and HMGB2 genes can be considered potential biomarkers for SCLC.

A machine learning-based prediction method discovered genes that potentially serve as biomarkers for SCLC. After clinical confirmation of the acquired genes in the following medical study, their therapeutic use can be established in clinical practice.

A rise in the cancer rate causes an increase in the occurrence of cardio-toxic complications while using chemotherapy drugs. Cancer stem cells (CSCs) are cell masses resistant to cancer treatment which escape from cell death by changing signaling pathways. Therefore, increasing the dosage of chemotherapy drugs increases the damage to the heart tissue and the consequences of cardio-toxicity. Investigating the signaling pathways responsible for the survival of CSCs through changing the amount of reactive oxygen species (ROS), inflammation, and apoptosis, and the effect of these factors on cardiomyocytes at the molecular level can provide a more detailed view of how the cardiotoxicity process works. Among the important signaling pathways involved in the cardiotoxicity process, through the three processes of increasing oxidative stress, inflammation, and apoptosis, we can mention Notch, pI3K/AKT, wnt signaling pathways, and NF-kB. This approach can suggest therapeutic methods capable of destroying CSCs with less cardiotoxicity effects.

Finally, as a hypothesis, it can be said that effective factors on the survival of CSCs can influence the cardio-toxicity by impacting ROS, inflammation, and apoptosis process.

Up to now, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected and killed millions of people across the globe. In these conditions, Iran was experiencing the fifth wave of the Coronavirus disease 2019 (COVID-19) pandemic, accrued by the Delta variant, over the course of the present study.

The present study aimed to reflect on preventive behaviors, psychological distress, and their associated factors in Iranians during the SARS-CoV-2 Delta variant outbreak.

Utilizing a descriptive-analytical cross-sectional research design, this study was performed on 1,015 Iranian individuals referred to the comprehensive healthcare centers in Kashan, central Iran, selected via simple random sampling. Data collection tools included the sociodemographic information questionnaire, the Preventive Behaviors against COVID-19 Questionnaire (PBCQ), and the 12-item General Health Questionnaire (GHQ-12).

The study results revealed that the mean±standard deviation (SD) of PBCQ was 17.20±4.18 (12-36). In addition, involvement in preventive behaviors against COVID-19 was at higher levels in male (P=0.007), younger (P≤0.001), and self-employed (P=0.016) participants with a fair family economic status (P=0.007), as compared to other cases. Those receiving no vaccines (P=0.023), together with the subjects recently contracting COVID-19, also adhered to only some preventive behaviors (P≤0.001). The GHQ-12 mean±SD was equal to 2.15±2.41 (0-12). Moreover, the study results indicated that female (P=0.021) younger (P=0.017), married (P=0.024), self-employed (P=0.003) subjects with a fair or poor family economic status (P=0.001) and recent infection with COVID-19 (P=0.010) were more susceptible to psychological distress, as compared to others.

The present study demonstrated that engagement in preventive behaviors against COVID-19 significantly dwindled, and the incidence rate of psychological distress augmented in the course of the fifth wave of the pandemic in Iranians. These findings could provide healthcare planners and policymakers with valuable information.

While surgery is the most effective treatment for anorectal diseases, traditional anesthesia methods are increasingly regarded not suitable for the clinical needs of anorectal patients. Although pudendal nerve block can play a good analgesic role in the anal region, the traditional pudendal nerve block is performed under blind probing, which is inaccurate in positioning, has poor anesthesia effect, and causes many complications.

At present, ultrasound-guided pudendal nerve block for analgesia has emerged in clinical practice. Therefore, the present study aimed to investigate the analgesic effect of ALCOCK tube ultrasound-guided internal pudendal nerve block in anal surgery.

A prospective study was conducted. A total of 134 patients who underwent anal surgery in Hangzhou Lin'an District First People's Hospital from May, 2021 to July, 2022 were divided into three categories according to mixed hemorrhoids, anal fistula, and anal fissure and randomly divided into control and experimental groups. The two groups were treated with corresponding surgical treatment, and the experimental group was treated with bilateral pudendal nerve block under the guidance of ALCOCK tube ultrasound at the end of the operation. The operation time, blood loss, initial postoperative pain time, and visual analogue scale, postoperative pain score at each time point, incidence of complications, and patient satisfaction were recorded and analyzed.

The operation time of the experimental group was significantly longer than that of the control group, the bleeding volume of anal fistula in the experimental group was more than the control group, the first pain time of anal fistula in the experimental group was higher than that of the control group. The first pain score of anal fistula in the experimental group was lower than that of the control group. Follow-up showed that the pain scores of anal fistula and anal fissure groups were inconsistent 48 h after surgery. The total incidence of adverse reactions was lower, and the patient satisfaction was higher in the experimental group than in the control group.

The application of internal pudendal nerve block under the guidance of ALCOCK tube ultrasound in anal surgery has a good analgesic effect and high patient satisfaction, which is worthy of promotion.

Urban planning and urban planning activities have increased the pressure on nature and weakened its resilience, often bringing negative and even irreparable consequences.

One of the most important issues in urban management in recent years is the emergence of resilient cities. Hormozgan is one of the most important provinces of the country, and Bandar Abbas, in the center of this province, is considered one of the major coastal cities of Iran from a national point of view.

To identify and examine the resilience of Bandar Abbas against environmental crises, based on which an information base was created, the place and spatial information of this database was prepared in 5 criteria and 29 sub-criteria. They include 1. socio-economic criteria, 2. structural criteria, 3. access criteria, 4. physical criteria, and 5. Ecological criteria. In the next step, to weigh and value the research criteria and sub-criteria in the resilience model of Bandar Abbas, the network analysis method (ANP) was used. In this model, the first 50 questionnaires were prepared by the Delphi method and distributed among experts in the field of environment and disaster management.

The findings of this study indicated that the weight and value of ecological, socio-economic, physical, accessibility, and physical-structural criteria in resilience were 0.256, 0.236, 0.194, 0.171, and 0.141, respectively. Among the ecological criteria, the sub-criterion of distance from polluted points, the socio-economic criterion, the sub-criterion of access to medical-health centers, the sub-criterion of access to medical-health centers, among the physical-structural criteria, flood risk sub-criterion, and functional zone sub-criterion, and among access criteria, the sub-criterion of access to the fire station obtained the highest values in resilience.

Environmental crises, such as earthquakes, floods, accidents, air pollution, and storms, have resulted in the environmental vulnerability of the city and posed serious threats to the security of Bandar Abbas. A thorough understanding of the vulnerability of Bandar Abbas against urban environmental crises will enable policymakers to propose management solutions to reduce vulnerability and risk and increase resilience. Consequently, the main goal of this study was to evaluate the resilience of Bandar Abbas against environmental crises. The results of this study can be of great help in the decision-making of city managers and the lives of city residents.

Most traditional breast reconstruction surgeries require the removal of the patient's own tissue or the use of artificial implants for reconstruction. The improvement of the efficiency and safety of breast reconstruction surgery assumes critical importance for the rehabilitation of breast cancer patients. Immediate latissimus dorsi breast reconstruction surgery, which utilizes the patient's own tissue to perform immediate reconstruction, can address this issue in a targeted manner, avoiding the cumbersome and complex nature of multiple surgeries.

To analyze the efficacy and safety of immediate latissimus dorsi breast reconstruction (BR) after breast cancer surgery.

A total of 91 female patients with breast cancer diagnosed and treated by breast surgery in our hospital from August 2017 to July 2021 were retrospectively analyzed. The patients were assigned to the prosthetic implant group (n=39) and latissimus dorsi group (n=52) according to the method of immediate postoperative BR. The difference in curative effect can be analyzed by comparing the operation time, intraoperative bleeding, postoperative drainage time, and aesthetic evaluation of BR. The safety of postoperative BR was analyzed by comparing the postoperative complications, local recurrence rate, distant metastasis rate of breast cancer, and rehabilitation rate.

There was no dramatic difference in intraoperative bleeding, postoperative drainage time, and rehabilitation rate between the latissimus dorsi and prosthetic implantation groups (P>0.05). Nonetheless, there was a significant difference in operation time, aesthetic evaluation of BR, postoperative complications, local recurrence rate, and distant metastasis rate of breast cancer in the latissimus dorsi group than the prosthetic implant group(P<0.05). In general, the latissimus dorsi group exhibited better therapeutic effects.

Immediate latissimus dorsi BR dramatically affects postoperative breast repair of breast cancer patients and is safer than prosthesis implantation. As an evaluation of their safety and effectiveness, it is necessary to provide patients with more stable and reliable medical outcomes to ensure their surgical safety.