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Tumors involving the caudate lobe present a unique therapeutic challenge due to their complex anatomy and the safety and efficacy of locoregional therapy can be variable. The purpose of this study is to analyze the outcomes of radiation segmentectomy for primary caudate lobe tumors.Eight patients [5 women and 3 men; median age = 69 y (range 50-79)] that underwent transarterial radioembolization (TARE) using yttrium-90 (Y90) glass microspheres for primary caudate lobe tumors (hepatocellular carcinoma = 6, intrahepatic cholangiocarcinoma = 2) from August 2017 to March 2021 were retrospectively analyzed. Descriptive statistics, treatment parameters, tumor response (using modified response evaluation criteria in solid tumors), adverse events [using common terminology criteria for adverse events (CTCAE)], and survival outcomes were evaluated.Eight primary caudate lobe tumors with a median size of 2.2 cm [interquartile range (IQR), 1.7-3.3] and Child-Pugh class A liver function underwent TARE of the caudate lobe. The median radiation dose was 596 Gy (IQR 356-1585), median total activity was 0.84 GBq (IQR 0.56-1.31), median specific activity was 473 Bq/sphere (IQR 226-671), and the median number of Y90 microspheres used was 1.4 million (IQR 1.2-3.4). All complications were CTCAE grade 1, and no clinically significant hilar plate complications were observed. In targeted tumors, complete response was seen in all patients. At a median follow-up period of 16.6 months (IQR 6.6-21.6) 75% (6/8) of patients were alive with no in-field progression.Radiation segmentectomy of primary caudate lobe tumors appears effective and is well tolerated in this limited case series within the described treatment parameters.Level 4, Case Series.

Purpose To investigate safety, response, and survival after ablative glass microsphere 90Y radioembolization for unresectable intrahepatic cholangiocarcinoma. Materials and methods A retrospective review of 37 radioembolizations in 28 patients treated with single compartment dose of ≥190 Gy encompassing >75% of the largest tumor was performed. Tumors were assessed for stage, morphology, and arterial supply. Response per Modified Response Evaluation Criteria in Solid Tumors (mRECIST), freedom from progression (FFP), progression-free survival (PFS), overall survival (OS), biochemical hepatic function, performance status, and adverse events were investigated. Results The median highest dose per patient was 256.8 Gy (195.7-807.8). Objective response at 3 months was 94.1% (complete 44.1% and partial 50%). Median OS was not reached and the 30-month OS rate was 59%, with a median follow-up of 13.4 months (5.4-39.4). FFP in the radiated field and overall FFP at 30 months were 67% and 40%, respectively. Favorable arterial supply was associated with improved OS (p = 0.018). Unfavorable arterial supply was associated with worse OS [HR 5.7 (95% CI 1.1-28.9, p = 0.034)], and PFS [HR 5.9 (95% CI 1.9-18.4, p = 0.002)]. Patients with mass-forming tumors had a survival benefit (p = 0.002). Laboratory values and performance status did not significantly change 3 months after radioembolization. Grade 3 and 4 adverse events occurred in 2 (7.1%) patients. Conclusions Radioembolization of unresectable intrahepatic cholangiocarcinoma with ablative intent has a high response rate, promising survival, and is well tolerated.

Background: Chest computed tomography (CT) scan has been used widely to diagnose COVID-19 in Iran. Objectives: To trace the footsteps of COVID-19 in Iran by exploring the trend in using chest CT scans and its economic impact on radiology departments. Methods: In this cross-sectional study, the number of imaging examinations from 33 tertiary radiology departments in 9 large cities of Iran was collected from September 23, 2019 to March 20, 2020 (Months 1 to 6) and the corresponding months in 2018–2019. Results: A 50.2% increase was noted in the chest CT scan utilization in 2019–2020 compared to 2018–2019. This increase was +15%, +15%, +27%, +2%, +1% in Months 1–5 of 2019–2020, respectively. In Month 6 of 2019–2020, a 251% increase in the acquisition of chest CT scans was observed compared to the Month 6 of 2018–2019. Following negative balance of revenue from Month 1 to 5 with respect to the inflation rate, the total income in Month 6 was further 1.5% less than the same Month in 2018–19. Conclusion: The observed peak in chest CT utilization in Month 3 prior to the surge in Month 6 could be explained by the seasonal influenza. However, unawareness about an emerging viral disease, i.e. COVID-19, might have underutilized chest CT in Months 4 and 5 before the official announcement in Month 6. The unbalanced increase in the workload of radiology departments in the shortage of cardiothoracic radiologists with the simultaneous decrease in income initiated a vicious cycle that worsened the economic repercussions of the pandemic.

To define reference values for various insulin sensitivity (IS) indices in healthy women in a population-based study of the five provinces in Iran In this cross-sectional study, 250 normal-weighted women without hypertension, diabetes, polycystic ovary syndrome, hormonal disorders, pregnancy, or menopause were evaluated in this study. After a 12-h fasting, blood samples were obtained from all participants, levels of metabolic markers (fasting plasma glucose, lipid profile, insulin, etc.) were measured using enzymatic colorimetric and ultrasensitive enzyme-linked radioimmunoassay methods. Multiple insulin sensitivity indices were calculated using well-known predetermined formulas. K-means cluster analysis was used to determine reference values for each insulin sensitivity index. The threshold values of homeostasis model assessment (HOMA-%β, HOMA-βcell) and fasting insulin resistance index (FIRI) were 400.41, 198.55, and 2.57 corresponding to 97th, 93rd, and 92nd percentiles, respectively. Reference values of quantitative insulin sensitivity check index (QUICKI) and TG/HDL-c were 0.44 and 4.40, both of which relate to 92nd percentile. The recently introduced single-point insulin sensitivity estimator (SPISE) was analyzed and showed a threshold of 10.10 (87th percentile) in this study. Threshold values of reciprocal insulin (1/Insulin) and glucose-to-insulin ratio (G/I) were 0.51 (95th percentile) and 76.91 (99th percentile), respectively. This study determined reference values for various insulin sensitivity indices in healthy Iranian women. These values can be used to define insulin sensitivity in women in epidemiological and clinical studies.

Summary The Middle East and north Africa are home to different populations with widely varying cultures, histories, and socioeconomic settings. Hence, their health status, health management, and access to appropriate health care differ accordingly. In this Review, we examine data on the historical and prospective status of metabolic diseases in this region including obesity, diabetes, hypertension, dyslipidaemia, and non-alcoholic fatty liver disease. Women in the Middle East and north Africa have the highest risk of metabolic diseases of all women globally, whereas men rank second of all men in this respect. Metabolic risk factors are responsible for more than 300 deaths per 100 000 individuals in this region, compared with a global mean of fewer than 250. Physical inactivity, especially in women, and an unhealthy diet (ie, low consumption of whole grains, nuts, and seafoods) stand out. More than one in every three women are obese in most countries of the region. Prevention programmes have not fully been achieved in most of these countries and the projected future is not optimistic. Comprehensive surveillance and monitoring of metabolic diseases, robust multisectoral systems that support primordial and primary preventions, continuous education of health-care providers, as well as collaboration between countries for joint projects in this region are urgently needed to overcome the paucity of data and to improve the metabolic health status of inhabitants in the Middle East and north Africa.

Objective To observe the effects of menopause, age at natural menopause (ANM), and aging on the trend in body mass index (BMI). Design Prospective cohort with a 15-year follow-up of 929 women. Data obtained from the Tehran Lipid and Glucose Study. Setting Not applicable. Intervention(s) none. Participant(s) Of women participating in the Tehran Lipid and Glucose Study, 929 who were reproductive during the study and menopaused at the last follow-up were included. Anthropometric data were measured repeatedly every 3 years, and the trend in BMI, associated with menopause and ANM, was tested using the generalized estimating equation. Main Outcome Measure(s) Body mass index in each follow-up session. Result(s) The adjusted model of the generalized estimating equation illustrates that BMI increases by age (β = 0.16) and menopausal status (β = 1.11). It also shows that women with higher ANM experienced a decreasing BMI (β = −0.03) compared with women with lower ANM. The interaction term of menopause and time (menopause × time) has a negative effect on BMI; that is, the usual increase in BMI after menopause is attenuated by time. (β = −0.4, 95% confidence interval −0.6, −0.3). Conclusion(s) Menopause and aging are independently correlated with increasing BMI. The trend in BMI, however, depends on the ANM of study participants: women with higher ANM than mean ANM of our population (i.e., 49 years) face a decreasing BMI compared with those with lower ANM.

OBJECTIVE. The purpose of this study was to assess the MR enterographic features of primary small intestinal lymphoma (PSIL) and compare them with active Crohn disease (CD) presenting with severe (≥ 10 mm) mural thickening of the small bowel. MATERIALS AND METHODS. This retrospective study included 15 patients with pathologically proven PSIL and 15 patients with active inflammatory CD with severe mural thickening. Various morphologic, enhancement, and diffusion parameters were compared between the two groups at MR enterography. The ratios of the upstream to involved luminal diameter and mural thickness to luminal diameter in the involved segment were calculated. An attempt was made to define a predictive model (morphologic score) for discriminating PSIL from CD with severe mural thickening. RESULTS. Patients with PSIL were more likely than those with CD to have unifocal disease (66.7% vs 20.0%, p = 0.025), circumferential involvement (86.7% vs 26.7%, p < 0.001), luminal dilatation (60.0% vs 7.0%, p = 0.005), and an attenuated fold pattern (53.3% vs none, p < 0.001). They were less likely to have serosal surface involvement (40.0% vs 100%, p = 0.001) and mesenteric fat infiltration (33.3% vs 100%, p < 0.001). Median upstream to involved luminal diameter ratio (1.5 vs 9.6, p < 0.001) and mural thickness to involved luminal diameter ratio (1.1 vs 4.3, p = 0.044) were significantly lower in patients with PSIL than in those with CD with severe mural thickening. No significant difference was observed in enhancement and diffusion measures. Morphologic score was based on the presence of luminal dilatation, unifocal involvement, mesenteric fat infiltration, and luminal stricture, yielding accuracy of 98% for differentiation between PSIL and CD with severe mural thickening. CONCLUSION. Morphologic features seen at MR enterography rather than enhancement or diffusion parameters may be valuable for differentiation of PSIL from active CD with severe mural thickening with significantly lower ratios of upstream to involved luminal diameter and mural thickness to involved luminal diameter in PSIL.

BACKGROUND Achalasia, as an incurable disease is defined by the lack of normal esophageal peristalsis and loss of lower esophageal sphincter relaxation due to impaired myenteric neural plexus. The exact cause of myenteric neural cells degeneration in achalasia is still unknown. One hypothesis is that certain neurotropic viruses and autoimmune factors cause the inflammatory response in myenteric network, which consequently destroy neural cells. This study was designed to find the evidence of viral causes of achalasia. METHODS In this case-control study, 52 patients with achalasia and 50 controls referred to Shariati Hospital, were evaluated for the genome of neurotropic viruses, HPV, and adenovirus by polymerase chain reaction (PCR) and reverse transcription (RT) PCR techniques. RESULTS Genome assessment of neurotropic DNA viruses turned out negative in the patients, however, the genome of HSV-1 (Herpes simplex virus) was found in tissues of six controls. No neurotropic RNA viruses were observed in the tissue samples and whole blood of both the patients and controls. Among non-neurotropic viruses, adenovirus genome was positive in tissues of two out of 52 patients and three out of 50 controls. In addition, one out of 52 patients and two out of 50 controls were positive for HPV infection in tissues. CONCLUSION We could not detect any significant relationship between achalasia and HPV, adenovirus, and neurotropic viruses in the cases. Nevertheless, it does not exclude the hypothesis of either an alternate viral species or resolved viral infection as the etiology of achalasia.

Background The risk of cardiovascular disease in women increases after menopause. It has been shown that women with lower pre-menopausal ovarian reserve may experience increased cardiovascular risk. We sought to determine whether there is any association between ovarian reserve, as assessed by Anti-Mullerian hormone (AMH), and preeclampsia (PE). Methods Subjects of this study were selected from among participants of the Tehran Lipid and Glucose Study (TLGS), a population-based cohort with a 15-year follow-up (1998–2014). Out of 2412 women aged 20–50 years, there were 781 women who met eligibility criteria, including having comprehensive data on their reproductive assessment and ovarian reserve status, identified based on age-specific AMH levels according to the exponential–normal three-parameter model that was measured before pregnancy. There were 80 and 701 participants in the preeclampsia and non-PE groups, respectively. The association between dichotomous outcome variable PE and age-specific AMH quartiles was evaluated using pooled logistic regression. Results PE was observed in 23 (11.1%), 12 (6.4%), 26 (13.3%) and 19 (10%) women in the 1st, 2nd, 3rd and 4th quartiles of pre-pregnancy age-specific AMH, respectively (P = 0.16). Median and inter-quartile range of serum AMH levels was 1.05 (0.36–2.2) mg/L in women who experienced PE compared with 0.85 (0.28–2.1) mg/L in women with normotensive pregnancies (P = 0.53). Based on the pooled logistic regression analysis, the effect of age-specific AMH quartiles on PE progression (adjusted for age, BMI, smoking status, and family history of hypertension) were not significant (OR1st vs 4th: 1.5, P-value: 0.1, CI: (0.9, 2.4)). Conclusions Age-specific AMH may not be a suitable marker for prediction of PE. Further longitudinal studies, considering pre-conception measurement of AMH, are recommended for better interpretation of the association between ovarian reserve status and PE.

Objective: To assess and compare the normal ranges of androgen hormones level, total testosterone (TT), free testosterone (FT), dehydrotestosterone (DHT), androstenedione (A4), dehydroepiandrosterone (DHEA), and dehydroepiandrosterone sulfate (DHEAS), in Iranian women based on different statistical methods. Materials and methods: This study was conducted on previous data collected in Iranian PCOS Prevalence Study, which details have been published before. A total of 1772 women of 18-45 years were recruited from urban areas of five randomly selected provinces in different geographic regions of Iran. The natural range of androgen hormones was determined and compared by two statistical methods including k-means cluster analysis, and receiver operating characteristic curve. Results: In women younger than 35 years old with any BMI, cut-off points obtained for FAI hormone were in lower percentiles; however, in older women, the results of the two methods were almost the same. Cut-off points of DHEAS in under 35 years old women of normal and obese weight and women older than 35 years old with normal weight calculated by ROC curve method was in higher percentiles than that in the cluster analysis method. In >35 years obese women, obtained cut-off points for DHEAS ROC curve was in lower percentiles in comparison to cluster analysis Conclusion: Although our study depicts the differences among the cutoff values among two statistical methods; however, lacking a gold standard test to define hyperandrogenism, we need further studies to obtain more comprehensive results.

The materials and methods (M&M) section is the heart of a scientific paper and is subject to initial screening of the editor to decide whether the manuscript should be sent for external review. If the M&M section of a scientific paper be considered as a recipe, its ingredients would be who, what, when, where, how, and why. M&M should effectively respond to the study question/hypothesis using the following basic elements including materials, study design, study population/subjects or animals, methods of measurements/assessments, and statistical analysis. A well-organized M&M permits other scientists to evaluate the study findings and repeat the experiments. Although there are several disciplinary differences in the M&M, similar dos and don’ts may be considered to organize a well-written M&M. Briefly, authors need to provide clear-cut, adequate, and detailed information in the M&M section. In this review, the structure, the principles, and the most common recommendations for writing the M&M section are provided, both in general and study-specific; these could help authors effectively prepare the M&M section of a scientific biomedical manuscript.

Squamous cell carcinoma is the most common histological subtype of head and neck cancers.In a retrospective longitudinal study, we assessed the risk of local or metastatic recurrence and death in 140 patients with head and neck squamous cell carcinoma (HNSCC). Multivariate and shared frailty models were used for survival analysis with sex, primary tumor site, grade and stage of the tumor, and treatment modalities as contributing factors.The most frequent site for HNSCC was the oral cavity (30%), followed by the tongue (26.4%). For most primary sites, men were at nearly 2-fold higher risk of local recurrence than women, but there was no difference by sex in the risk of metastatic recurrence. Undifferentiated HNSCC was associated with a higher risk of local recurrence (nearly 4-fold) and metastasis (6-15-fold based on the primary site) than well-differentiated tumors. In early months after surgical resection alone, the risk of local recurrence was higher compared to other treatment modalities. There was a strong dependency between the risk of local and metastatic recurrence.In conclusion, men diagnosed with HNSCC, those with higher grade or advanced state tumor, and those treated by surgery alone are at higher risk of unfavorable outcomes than others and may need more frequent follow-up visits.

Background: Insulin resistance (IR) is a major cardiometabolic risk factor in females with polycystic ovary syndrome (PCOS). The euglycemic clamp is the gold standard method to measure IR. However, considering the time and cost that it takes, surrogate markers of IR are now widely used. The current study aimed at evaluating the cutoff points of even less invasive anthropometric and body composition variables to predict IR in females with PCOS. Methods: The current cross sectional study selected 224 females with PCOS, using Rotterdam criteria, referred to reproductive endocrinology research center; 88 of which were diagnosed with insulin resistance. Receiver operating characteristics curve was used to explore the best cutoff values of each anthropometric and body composition measures. IR was defined as homeostasis model assessment formula greater or equal to 2.6: HOMA-IR = fasting insulin (mU/L) × fasting plasma glucose (mM/L)/22.5. Results: The highest area under the curve (0.751) was for the multiplication of waist circumference (WC) by body mass index (BMI), as a single index. The highest sensitivity and specificity were for body water (BW) percentage (82% for values greater than 32.85%) and WC (79% for values greater than 88 cm), respectively. Conclusions: It was concluded that there were simple anthropometric variables; e.g., WC × BMI, percentage of BW, and WC that could help to estimate IR in clinical settings especially when the gold standard or surrogate markers of IR were unavailable.

Patients and Methods: In this descriptive study, biopsies were taken from 192 patients with dyspepsia who underwent endoscopic evaluation. For diagnosis of H. pylori infection and histologic assessment, samples were stained by Giemsa and hematoxylin-eosin (H & E) staining. Based on the Sydney system for classification of gastritis, extent of H. pylori infection and severity of gastritis were measured. To determine antibiotic resistance after culturing on Brucella agar medium, antibiogram test was done using modified disk diffusion method on Mueller-Hinton agar considering standard conditions. Data analysis was done by the SPSS 16.0 software, using the chi-square and T-test methods. Results: Overall prevalence of H. pylori was 83% among all patients and 90.3% among those with gastritis (CI 95% = 85.9% - 94.6%). There was no significant correlation between the extent of H. pylori infection and age (P = 0.182) and gender (P = 0.466). Yet, there was a significant correlation between H. pylori infection and severity of gastritis (P = 0.001). Rates of resistance to metronidazole, clarithromycin, amoxicillin, ciprofloxacin and tetracycline were 50%, 16.1%, 5.2%, 4.6% and 3.6%, respectively. Conclusions: Prevalence of H. pylori infection in our patients was similar to that of developing countries. Severity of gastritis is correlated with the extent of H. pylori infection. Moreover, the antibiotic resistance rate observed in this study signifies the ever-growing importance of further antibiotic sensitivity studies to help with proper treatment regimens against H. pylori.

Objective: To explore the relationship between age-specific anti-Müllerian hormone level, as a predictor of ovarian reserve status, and electrocardiographic silent coronary artery disease in a population-based, prospective cohort, the Tehran Lipid and Glucose Study. Methods: For the present study, 1015 reproductive-aged participants in the Tehran Lipid and Glucose Study met our eligibility criteria. According to the Whitehall criteria, silent coronary artery disease was defined as an electrocardiogram showing possible or probable coronary heart disease using Minnesota codes. By excluding those with a history of coronary heart disease and silent coronary artery disease at the initiation of the study (n = 49), there were 108 events of silent coronary artery disease at electrocardiograms among 752 women followed for 9.5 ± 0.9 years (missing data: n = 214); the association between this outcome with age-specific anti-Müllerian hormone levels was explored after adjustment for confounding variables using logistic regression analysis. Cardiovascular disease risk scores were assessed for all participants using the guidelines of the American College of Cardiology and the American Heart Association. Results: There were 108 events of silent coronary artery disease over the 10-year follow-up. Logistic regression analysis, considering age-specific anti-Müllerian hormone and atherosclerotic cardiovascular disease risk score as independent variables, revealed an odds ratio of 1.146 (95% confidence interval 1.008–1.303) for cardiovascular disease risk score (p = 0.038) and odds ratio of 1.002 (95% confidence interval 0.996–1.009) for age-specific anti-Müllerian hormone (p = 0.526). Conclusion: No association has been found between age-specific anti-Müllerian hormone levels and events of silent coronary artery disease in a 10-year follow-up of reproductive-aged women.

Objective To see the changes of cardio-metabolic risk factors overtime in polycystic ovary syndrome vs. control women. Methods This study was conducted on 637 participants (85 PCOS and 552 control reproductive aged, 18–45 years) of Tehran Lipid and Glucose Study (TLGS), an ongoing population-based cohort study with 12 years of follow-up. The cardiovascular risk factors of these groups were assessed in three-year intervals using standard questionnaires, history taking, anthropometric measures, and metabolic/endocrine evaluation. Generalized estimating equation was used to analyze the data. Results Overall mean of insulin (3.55, CI: 0.66–6.45), HOMA-IR (0.63, CI: 0.08–1.18), and HOMA-β (45.90, CI: 0.86–90.93) were significantly higher in PCOS than in healthy women after adjustment for age, BMI, and baseline levels. However, the negative interaction (follow-up years × PCOS status) of PCOS and normal women converged overtime. Comparing third follow-up with first, insulin and HOMA-IR decreased 10.6% and 5%, respectively in PCOS women; and increased 6.7% and 14.6%, respectively in controls (P