Iranian Journal of Medical Sciences
Volume:50 Issue: 4, Apr 2025

Colorectal cancer (CRC) ranks among the most prevalent cancers worldwide and is the fourth leading cause of cancer-related deaths. Metastasis poses a significant obstacle in CRC treatment, as distant metastasis, particularly to the liver, remains the primary cause of mortality. Colorectal liver metastasis (CRLM) occurs frequently due to the liver’s direct vascular connection to the colorectal region via the portal vein. Standard treatment approaches for CRLM are limited; only a few patients qualify for surgical intervention, resulting in a persistently low survival rate. Additionally, resistance to chemotherapy is common, emphasizing the need for more effective targeted therapies. Emerging evidence highlights the pivotal role of microRNAs (miRNAs) in modulating critical pathways associated with CRLM, including tumor invasion, epithelial-mesenchymal transition, and angiogenesis. MiRNAs exhibit dual functions as tumor suppressors and oncogenes by targeting multiple genes, thus playing a complex role in both the initiation and progression of metastasis. The regulatory mechanisms of miRNAs could help to identify novel biomarkers for early diagnosis and prognosis of CRLM, as well as promising therapeutic targets to overcome chemoresistance. Despite numerous studies on miRNA involvement in CRC metastasis, dedicated reviews focusing on miRNAs and CRLM remain scarce. This review aims to approach targeted therapies by examining the current understanding of miRNA involvement in CRLM and exploring their potential as diagnostic, prognostic, and therapeutic agents. Through an integrative approach, we aim to provide insights that could transform CRLM management and improve patient outcomes.

Hepatitis D is caused by the hepatitis D virus (HDV) and affects those who have already been infected with the hepatitis B virus (HBV). The epidemiology of hepatitis D in Fars Province, Iran, is poorly understood. This study aimed to investigate the epidemiology of HDV and its associated factors in patients attending Shahid Motahari Clinic, affiliated with Shiraz University of Medical Sciences (Shiraz, Iran).

This prospective cohort study was conducted in Shiraz, Iran, from 2001 to 2023. This study screened individuals with low HBV viral load and elevated liver enzymes for HDV. Pearson Chi square, Fisher’s exact, and Mann-Whitney U tests were used to examine the univariate associations between hepatitis D and various risk factors. Risk factors with P<0.2 were analyzed using multiple logistic regression to estimate odds ratios and 95% confidence intervals. P<0.05 was considered statistically significant.

The variables were compared between the HDV+ (29) and HDV- (108). The variables of age (P=0.002) and using hookah (P=0.040) were statistically significant. The other variables examined in this study were not statistically significant. Increasing age (OR=1.06, 95% CI=[1.019, 1.102], P=0.003) was identified as a risk factor, while dental visits (OR=0.290 95% CI=[0.101, 0.836], P=0.022) were assessed as a protective factor.

Age was a significant risk factor for HDV infection, while a history of dental procedures appeared to be a protective factor. To better understand the epidemiology of HDV, further comprehensive research is necessary, focusing on diverse demographic groups in different regions.

X-ray computed tomography (CT) is a standard tool for diagnosing bone abnormalities. CT dose optimization is strongly recommended, due to the stochastic effects of x-ray. This study aims to assess the effectiveness of ultra-low-dose CT (ULD-CT) imaging, reconstructed using an Iterative Reconstruction (IR) algorithm, in detecting bone trauma and disorders. In the present cross-sectional study, 71 patients with CT requests for spine or extremity (limb) bone underwent scanning using standard dose (SD) and ULD-CT protocols, in Shahid Faghihi Hospital, Shiraz, Iran from June 2019 to June 2020. The SD and ULD-CT protocols used 120 kVp and 80 kVp, respectively. The CT images were reconstructed using the standard and IR algorithms. CT dose indices, including the volume CT dose index (CTDIvol), dose-length product (DLP), and effective dose (ED), were employed. To assess image quality, a five-point scoring system was used. The sensitivity and specificity of the ULD-CT images were calculated. The findings indicated that ULD-CT images accurately identified 113 out of 118 bone trauma and disorders. The quality of ULD-CT images received “very good”, “good” and “acceptable” scores for both spine and extremity (limb) bones. The sensitivity and specificity of ULD-CT images for bone trauma and disorders were 67%–95% and 100%, respectively, with about a 98% dose reduction. The ULD-CT protocol for bone imaging achieved a remarkable dose reduction, while the image quality was reported as acceptable. Consequently, ULD-CT images reconstructed using an IR are suitable and can be tuned further in the future for acceptable use in patients with bone trauma and disorders.

Effective pain management is crucial in septorhinoplasty and remains a significant challenge. This study investigated the effect of ketorolac and paracetamol on pain control in septorhinoplasty patients and assessed their efficacy in reducing the need for rescue analgesics.

This double-blind randomized clinical trial was conducted at Madar-Koodak Hospital (Shiraz, Iran), in 2022. Ninety-nine patients were randomly assigned to three groups to receive ketorolac 30 mg (n=33), paracetamol 1000 mg (n=33), and normal saline (n=33), respectively. All the medications  were administered intravenously (IV) 30 min before surgery. The randomization procedure followed the block randomization method. If the pain did not subside, patients were also given a single dose of pethidine hydrochloride (25 mg). Pain intensity was measured using visual analog scale (VAS) 1 hour and 6 hours after surgery. The data were analyzed using SPSS software, using paired t tests, ANOVA, and Chi square tests.

One-hour post-surgery, VAS scores in the ketorolac and paracetamol groups were significantly lower than in the placebo group (P<0.001). The mean difference with 95% CI for ketorolac-placebo and paracetamol-placebo was -0.57 (-0.94, -0.21), and -0.79 (-1.12, -0.45), respectively. The ketorolac and paracetamol groups required significantly less pethidine hydrochloride 1 hour post-surgery than the placebo group (P<0.001). The VAS scores and requiring pethidine were not significantly different between the ketorolac and paracetamol groups.

After septorhinoplasty, the administration of 1000 mg of IV paracetamol demonstrated comparable efficacy in pain reduction to 30 mg of ketorolac. It suggested that paracetamol could serve as a viable alternative to ketorolac in preventing postoperative pain after septorhinoplasty, particularly in patients for whom non-steroidal anti-inflammatory (NSAID) drugs could not be a suitable choice.Trial registration number: IRCT20180922041084N6

Colorectal cancer (CRC) is a serious health problem, and finding new treatments is important. There is growing evidence for the antitumor activity of probiotics. This study investigated the anti-cancer potential of a probiotic mix containing Lactobacillus plantarum, L. brevis, L. helveticus, and L. delbrueckii, alone or in combination with the chemotherapy drug 5-fluorouracil, against CRC.  The research was carried out in Mashhad in 2021. The cytotoxic effect of Lactobacillus isolates on CRC cells was investigated in two-dimensional and three-dimensional cell culture models. Histological staining and molecular approaches were used to investigate the regulatory mechanism of Lactobacillus isolates on cell migration, inflammation, fibrosis, cell cycle progression, apoptosis, and tumor necrosis in the CRC mouse model. Statistical analysis was performed using SPSS software version 20 with a significance level of P<0.05. The tests employed included the Kolmogorov–Smirnov, ANOVA, Dunnett’s post hoc, and Kruskal–Wallis. Lactobacillus strains effectively suppressed tumor growth in CRC by promoting cell death and inhibiting fibrosis and inflammation. These bacteria regulated apoptosis-related genes such as Bcl-2-associated protein x (P=0.0033), and BCL-2 (P=0.0029), leading to increased tumor necrosis. Treatment with bacterial supernatants reduced tumor size and fibrosis by downregulating collagen type I, alpha 1 (Col1a1) (P=0.024), Col1a2 (P=0.0231), and actin alpha 2 (P=0.0466), and transforming growth factor-beta expression. Additionally, they suppressed inflammation by decreasing tumor necrosis factor-alpha (P=0.0001), interleukin 6, and IL-1β (P=0.0198) levels in tumor tissues. Furthermore, the treatment inhibited CRC cell migration by modulating epithelial cadherin (P=0.0198) and matrix metallopeptidase 2 (P=0.033) expression.   Findings indicated that co-administration of Lactobacillus isolates with 5-FU could improve the anti-tumor properties of the standard drug, 5-FU, supporting the therapeutic potential of these safe isolated lactic acid bacteria for CRC patients in vivo.

Autophagy is also essential for both male and female infertility since it controls the development of germ cells and reproductive organs. This study aimed to investigate the effects of taurine and curcumin on the expression of genes related to autophagy in acrylamide-treated mice. 

In 2022, this experimental study was conducted at the Shiraz University of Medical Sciences, Stem Cells Technology Research Centre. Forty-eight mice were randomly assigned to eight groups (control, curcumin 200 mg/Kg, taurine 150 mg/Kg, acrylamide 50 mg/Kg, acrylamide+curcumin 100 mg/Kg, acrylamide+curcumin 200, acrylamide+taurine 75 mg/Kg, acrylamide+taurine 150 mg/Kg). Finally, oocyte characteristics and gene expression were determined in each group using one-way analysis of variance (ANOVA) by SPSS 25 and GraphPad 9, respectively. P<0.05 was conducted statistically significant. 

A significant decrease was observed in several oocytes in the acrylamide group compared to the control group (P<0.001). The expression levels of light chain 3 (LC3), autophagy-related gene (ATG)12, ATG5, and Beclin1 significantly increased in the acrylamide compared to the control group. A significant increase in the number of oocytes was observed in the taurine group compared to the control. The expression levels of LC3, ATG12, ATG5, and Beclin1 significantly decreased in the acrylamide+taurine (150 mg/Kg) compared to the acrylamide group. 

The acrylamide negatively impacts oocyte viability and causes the higher expression of autophagy-related genes. Taurine may encourage the fusion of autophagosomes with lysosomes by removing autophagic obstruction, potentially accelerating autophagy and protecting against oxidative stress. Taurine is more effective than curcumin at reducing the harmful effects of acrylamide. As a result, taurine can be proposed as a potential treatment drug for acrylamide-induced infertility.

We recently have read with great interest an article entitled “Clinical Efficacy of Intravenous Papaverine plus Ketorolac in the Emergency Treatment of Renal Colic: A Randomized, Double-blind Clinical Trial”, by Mohammadreza Pirouzi and colleagues, which was published in your esteemed journal (Vol 49, No. 11, November 2024).

We would like to address the letter critiquing our article entitled “Clinical Efficacy of Intravenous Papaverine Plus Ketorolac in the Emergency Treatment of Renal Colic: A Randomized, Double-blind Clinical Trial”, which was published in your esteemed journal (Vol 49, No. 11, November 2024). We appreciate the thoughtful comments provided in the letter and are grateful for the opportunity to respond to the points raised.