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Abstract Objective To compare the hearing outcomes of patients with idiopathic sudden sensorineural hearing loss after intratympanic (IT) injection of methylprednisolone and dexamethasone. Study design Randomized case‐controlled clinical trial. Methods Seventy‐five patients diagnosed with idiopathic sensorineural hearing loss were randomly divided into two groups based on therapy. Both groups received oral prednisolone (10 mg/kg; maximum of 60 mg) for 10 days without tapering and received IT injections two times a week for 2 weeks (four injections in total). One group received an IT injection of a 40 mg/mL solution of methylprednisolone, and the other one, 4 mg/mL dexamethasone. Three comparisons between the initial and third‐month hearing tests were made to assess the degree of hearing change: (1) pure tone improvement in each individual tone (0.5, 1, 2, 3, and 4 kHz); (2) word‐recognition score improvement; and (3) complete, partial, and no recovery of hearing calculated (as defined by American Academy of Otolaryngology‐Head and Neck Surgery Clinical Practice Guidelines). Results The study was completed with 69 of the 75 patients—34 in the methylprednisolone group and 35 in the dexamethasone group. The groups' differences in frequency‐specific hearing improvement were not statistically significant. There was no statistically significant difference in the word recognition score improvement between the two groups. Additionally, there was no discernible difference between the two groups' hearing recovery rates. Conclusion Methylprednisolone and dexamethasone IT injection therapy had similar hearing outcomes. Level of evidence 2.

This article explores the impact of exercise training on brain health in older adults, focusing on the concept of muscle-brain crosstalk. As the global population ages, understanding how lifestyle interventions like exercise can support cognitive function is increasingly important. The article reviews evidence suggesting that physical activity, particularly aerobic and resistance training, plays a crucial role in maintaining and enhancing brain health. It discusses the mechanisms underlying the beneficial effects of exercise, including improved blood flow, neurogenesis, and the release of myokines proteins produced by muscle contractions that influence brain function. Additionally, the article highlights how these myokines facilitate communication between muscles and the brain, contributing to neuroplasticity, reduced inflammation, and enhanced cognitive abilities. The concept of muscle-brain crosstalk is emphasized as a key factor in understanding how exercise promotes brain health, with potential implications for designing targeted interventions to preserve cognitive function in older adults. The article concludes by suggesting that regular exercise should be a cornerstone of public health strategies aimed at improving the quality of life and cognitive health in aging populations. Further research is encouraged to deepen our understanding of the molecular pathways involved and to develop personalized exercise programs that maximize brain health benefits for older adults.

Physiological and behavioral processes of almost all organisms depend on the time of day. In mammals, light enters these processes in the suprachiasmatic nucleus of the hypothalamus, which forms the body's central clock, and synchronizes the body's functions with the 24-hour cycle of light and darkness. In addition to perceptual and cognitive aspects of performance, circadian rhythms affect many aspects related to physiological performance such as muscle strength and flexibility. There is also a strong relationship between physical performance and circadian rhythm of body temperature, with optimal physical performance coinciding with peak body temperature in the early evening. There is a circadian clock or rhythm almost in every cell, and its disturbance leads to many diseases such as type 2 diabetes and metabolic syndrome. Previous findings show that skeletal muscle homeostasis may be disrupted not only due to lack of physica activity and low dietary protein intake, but also due to disruption of circadian rhythm conditions such as continuous night work, shift work, sleep deprivation, and jet lag. In this review study, articles were selected and studied using muscle molecular clock, exercise performance, circadian rhythm, and phenotype keywords from published texts, valid sites and search engines such as Google Scholar and Pubmed. The time of sports activities is very important for performance. Despite the timing of the activity, chrnotype can also be a very effective for performance. According to the reviewed studies, most of the sports performance such as strength, speed, endurance, accuracy, recovery ability, and harmony were better in the evening for athletes in different team and individual disciplines. This superiority in the evening can be attributed to body temperature, hormone release, circadian rhythm, rest and recovery. In some cases, such as swimming, strength and endurance performance was better in the morning.Based on the results of studies presented in this review it could be concluded that biological and physiological rhythms have an effect on individual's physical performance. Despite individual differences and personal preferences in determining training hours, taking into account a specific training time each day and training at the beginning of the day can improve performance. Higher body temperature in the evening, and increasing the level of secretion of hormones such as cortisol and testosterone, could be effective factors for better performance in the evening. However, depending on the type of activity, skill level, gender of the athletes and individual differences, the time to have a better performance can vary. In addition, individual preference to perform activities during the day or night is an important factor in improving performance.

There is some evidence that citrulline malate (CM) limits the deleterious effect of oxidative stress in athletes, but its effect on team sports like soccer is not clear. Thus, the current research is designed to investigate the effect of short-term CM supplementation on oxidative stress and muscle damage markers in trained soccer players. In this randomized double-blind controlled trial, 28 healthy, highly-trained male soccer players were selected and randomly assigned into 2 groups to take 6 g/day CM or placebo for 7 days. Blood samples were then taken in a resting-state at baseline and 24 h after the 7-day supplement intervention; and serum malondialdehyde (MDA), total antioxidant capacity (TAC), catalase (CAT), glutathione (GSH), superoxide dismutase (SOD), lactate dehydrogenase (LDH), creatine kinase (CK), and uric acid levels were measured. Compared to the baseline, CM significantly decreased serum uric acid levels (P = 0.03) and significantly increased serum LDH concentrations (P = 0.002). However, there were no significant changes in serum levels of MDA, CAT, GSH, TAC, SOD, LDH CK, and uric acid compared to the placebo group (P > 0.05). It appears that short-term CM supplementation does not improve oxidative stress and muscle damage in soccer players. Further investigations should be conducted to fully understand the effects of CM on soccer players.

Objective(s): The increase in age-related cognitive impairment (CIs) and diabetes mellitus is a global health concern. Exercise training has been reported to activate the Nrf2/Keap1/ARE signaling and enhance the antioxidant defense pathways in some animal models. This study aimed to investigate the effects of ursolic acid (UA) associated with resistance or endurance training on antioxidant markers, and the Nrf2/Keap1/ARE pathway in the brain of older diabetic rats.Materials and Methods: 23-month-aged diabetes induced male Wistar rats were randomly assigned to seven groups (n=8). UA supplementation (250 mg/kg, daily) was administered along with resistance (60% maximum capacity of voluntary carrying [MVCC], 14-20 climbs) or endurance training (60-75% velocity at maximal oxygen uptake [vVO2max]), five days/week for eight weeks. Cognitive-motor functioning was assessed through open-field and passive avoidance response tests. Nrf2, Keap1, and antioxidant markers including SOD, CAT, GPx, and GSH were measured in the hippocampus tissue.Results: The results showed positive effect of resistance training (P≤0.001) on Nrf2. There was endurance training with supplementation main effect (P=0.018) on Keap1 concentration. SOD revealed a significant endurance/resistance training by supplementation interaction effect (P≤0.05); however, there was no main training or UA supplementation effects on CAT, GPx, and GSH, despite improving spatial memory changes in exercise or UA groups. Conclusion: It appears that UA treatment with resistance or endurance exercise has some beneficial effects on Nrf2 and some antioxidant markers. However, more research is needed to elucidate UA’s interaction effects and exercise interventions in diabetic situations.

Abstract Objective We aimed to compare the graft success rate and hearing outcomes in patients with large tympanic membrane (TM) perforation in underlay and over‐underlay approaches. Methods This is a prospective double‐blind randomized controlled clinical trial with a parallel design. Patients aged 15–75 years old with large TM perforation (more than 50% of TM) who operated at Khalili hospital affiliated with Shiraz University of Medical Science, Iran, were enrolled. Exclusion criteria were recent otorrhea, revision surgery, and pathologic intraoperative findings such as the presence of cholesteatoma, cholesterol granuloma, ear canal polyp, or damaged ossicle. In the first group, the underlay method and in the second group over‐underlay method were performed. Graft success rate, atelectasis, and audiology outcomes were evaluated after 6 months. Results The investigation was conducted on 84 patients in the underlay and 67 patients in the over‐underlay group. Although there was a higher rate of graft failure (9%) in the over‐underlay group in comparison with the underlay group (4.8%), the difference was not statistically significant (p‐value = .34). No atelectasis was seen in both group. Although, between‐groups comparison of the preoperative and postoperative speech reception thresholds (SRT) and air‐bone gaps (ABG) values showed statistically significantly lower SRT and ABG in the over‐underlay technique, the difference was clinically negligible. Conclusion Both techniques provide the same graft success rate, but SRT and ABG were significantly lower in the over‐underlay technique after the operation. Levels of Evidence 1b

Background and aims: Due to the widespread prevalence of the coronavirus disease 2019 (COVID-19), to overcome and understand these conditions, it is necessary to survey the physical and psychological implications on individuals within the community to uncover effective solutions. This study aimed to investigate the changes in the level of physical activity and psychological well-being due to quarantine induced by COVID-19 in Chaharmahal and Bakhtiari province. Methods: This is a cross-sectional study during the first peak of COVID-19 disease (April 10 to May 10, 2020). The International Online Physical Activity Questionnaire and the Short Mood Assessment Questionnaire were used to assess physical activity (before and during outbreak) and mood status (during outbreak), respectively, among 627 people in Chaharmahal and Bakhtiari province. Results: The samples consisted of male (20%) and female (80%) subjects. Upon comparing the physical activity before the disease outbreak and during the initial outbreak, it was demonstrated that the intensity (P < 0.001), duration (P < 0.001), and frequency (P < 0.001) of physical activity significantly decreased after the outbreak of COVID-19. However, there was no difference between men and women in intensity, duration, and frequency of physical activity as well as psychological status (P = 0.099). Further, no significant relationship was observed between physical activity variables (intensity, P = 0.214, duration, P = 0.386, and repetition, P = 0.122) and psychological status. However, a significant positive relationship was found between adherence to quarantine and mental wellbeing (P = 0.001). Conclusion: According to the results, the level of physical activity of the subjects decreased during the COVID-19 outbreak compared to before the outbreak, but the decrease in physical activity did not affect their mental state. However, the individuals who adhered to quarantine conditions experienced a worse negative mood compared to other groups. It seems that in addition to observing social distancing measures and adherence to quarantine, individuals’ overall health and physical activity levels are effective factors that can improve the body’s physiological systems and the psychological state and influence the positive mood of people.

Abstract Background Hearing loss is the second most common chronic disease, the diagnosis and treatment of which can be faster through screening. In addition, early interventions will save significant costs for the education and health systems. Therefore, the present study aimed to evaluate the cost-effectiveness of hearing screening for primary school children in Shiraz. Methods This cross-sectional economic evaluation of cost-effectiveness was conducted from the perspective of the health system. The study population comprised all seven-year-old children participating in the screening program in Shiraz. The present study dealt only with direct costs. The expected costs and outcomes, as well as the ICER index were estimated using the decision tree model. The study outcomes included averted disability-adjusted life years (DALY) and true identification of hearing loss cases. The robustness of the results was evaluated using the one-way sensitivity analysis. The TreeAge 2020 and Excel 2016 software were also used to analyze the collected data. Results The hearing screening data obtained during 6 years (2015–2020) showed that every year, an average of 22,853 children in Shiraz were examined for hearing, of which 260 were true positive (%1.1). The costs of screening and lack of screening were estimated at $30.32 Purchasing Power Parity (PPP) and $13.75 PPP per child, respectively. The averted DALY due to performing hearing screening was estimated at 7 years for each child. The ICER was positive and equal to $ 0.06 PPP for the identified cases and $ 2.37 PPP per averted DALY. The sensitivity analysis confirmed the robustness of the results. Conclusions According to the results, although hearing screening for primary school children had more costs and effectiveness, it was considered cost-effective. Therefore, universal screening with high quality and accuracy is recommended.

Abstract Objective Many methods have been described for the repair of the tympanic membrane, but there is no general consensus as to the standard method. The aim of this study was to evaluate the effect of the inferior base posterior canal skin flap on the graft success rate in large tympanic membrane perforations. Methods After the post‐auricular incision, the posterior canal skin flap with inferior pedicle was created by two vertical and one horizontal incisions. Then the flap was rotated over the temporalis fascia graft. The graft success rate and postoperation hearing test results were evaluated in 52 patients who suffered from large tympanic membrane perforations. Results We achieved a 92.3% total graft success rate with about 9 dB improvement in speech reception threshold (SRT). Conclusion The rotational inferior base posterior canal skin flap tympanoplasty technique is simple, fast, safe, and effective for the repair of subtotal tympanic membrane perforations.

Introduction:The present study aimed to investigate the necessity or unnecessity of sending all tonsillectomy specimens for pathological examinations in Shiraz, Iran; moreover, it examined malignancies, cost-saving, causes, and the ways to prevent sending all specimens. Materials and Methods:In the first retrospective phase of the study, a checklist was used to gather demographic, clinical, and cost information of 18,437 tonsillectomy specimens during 2004-2018 in Shiraz, Iran. In order to estimate the cost of each pathology specimen, the cost components, including human resources costs and consumables, were collected in the private and public sectors separately and divided by the number of cases performed. Finally, the financial burden resulting from these services (in the study centers) was calculated by multiplying each item's cost by the total number of these services. Results:Out of the total 18,437 histopathology specimens examined, only 118 (0.64%) samples were identified with unusual diagnoses, of which 66 (56%) cases had malignant tumors, and the remaining 52 (44%) samples included benign tumors (n=41), infections (n=2), and other problems (n=9). The second phase results also indicated that according to the ear, nose, and throat experts, the rules and regulations governing the country's health system and the suspicion of tumors were the main reasons for sending tonsil specimens for pathological examinations. Generally, the annual cost-saving rates in the studied public and private centers were $87,919 and $179,530 purchasing power parity, respectively.Conclusions:According to the results, sending tonsillectomy specimens should only be limited to nonroutine ones for economic-clinical reasons.

Abstract Objective We carried out this research to assess and compare post‐stapedotomy hearing results of Matrix titanium prosthesis with a Teflon piston prosthesis, specifically the fluoroplastic (Teflon) Causse loop piston prosthesis in patients who suffered from otosclerosis. Methodology In this retrospective study, Causse loop piston prosthesis was used in 81 ears, and the Matrix prosthesis was applied in 44 ears. For pairwise matching with Matrix prosthesis, 44 out of 81 Causse loop piston‐treated ears were selected based on preoperative audiometric data. Then, postoperative audiometric results of these two groups were compared. The main outcomes were pure tone audiometric results and air‐bone gap (ABG) closure before and after the surgery. Incidence of postoperative sensorineural hearing loss was also evaluated and compared between the two groups. Results The results revealed no significant difference in improvement of speech reception threshold, mean air conduction, bone conduction gain, ABG closure, and incidence of postoperative sensorineural hearing loss at the frequencies of 0.5‐4 kHz between the two groups. However, performance of Matrix prosthesis was better in ABG closure at a frequency of 250 Hz. Conclusion Herein, similar postoperative improvement was achieved at the frequencies of 0.5‐4 kHz; nevertheless, Matrix provided better ABG closure at frequency of 250 Hz in short term. Level of Evidence 4

Abstract Objective Post‐tonsillectomy pain is a common morbidity in children. The aim of this study was to compare the efficacy of celecoxib with acetaminophen on pain relief in pediatric day‐case tonsillectomy. Methods We compared the analgesic effect of celecoxib (99 patients) with acetaminophen (100 patients) for the management of post‐tonsillectomy pain. Post‐tonsillectomy pain score was evaluated three times a day for 7 days. In addition, the incidence of post‐tonsillectomy bleeding and the rate of patients who returned to regular diet were evaluated. Results In the first day, we observed lower mean pain score in the celecoxib group, than the acetaminophen group (P = 0.013). The overall pain score in other days was not significantly different between the two groups. In the celecoxib group, more patients resumed regular amount of oral intake within the first 3 days. Also, the rate of post‐tonsillectomy bleeding in the two groups was not statistically different. Conclusion We recommend celecoxib as a more suitable choice than acetaminophen for post‐tonsillectomy pain management in the first day and resuming regular diet within 3 days. Level of Evidence: 1b.

INTRODUCTION One of the most important achievements of medical science in the last century is increasing life expectancy. From the beginning of the 1900-2021 century, the average life expectancy has increased from 65 to 85 years [1]. On the other hand, age is the most important factor determining the health of the cardiovascular system, and according to predictions, by 2030, the age of about 20% of the world’s population will reach more than 65 years. In this age group, cardiovascular diseases are the cause of most deaths. In addition, the costs of treating these diseases will increase significantly. Therefore, it is very important to understand the importance of age and its effect on the occurrence of cardiovascular diseases. The causes of cardiovascular diseases in humans are age, gender, smoking, lipids, diabetes, and blood pressure [2]. According to the American Heart Association, the prevalence of CVD, including high blood pressure, coronary artery disease, heart failure, and heart attacks, in men and women aged 40 to 59 years is 40%; in people aged 60 to 79 years, is 70 to 75% and in people, 80 years and over has increased to 79 to 86 percent [3]. Cardiovascular diseases, especially atherosclerosis, are one of the major causes of death in most human societies, and its rate has increased with the prevalence of mechanization of today’s lifestyle and the decrease in physical activity. Atherosclerosis is a chronic inflammatory condition caused by the narrowing of the arteries due to the buildup of cholesterol-rich plaques in the walls of the arteries. This disease is associated with an increase in total cholesterol concentration, an increase in low-density lipoprotein cholesterol, and a decrease in high-density lipoprotein cholesterol [3].

Introduction:Rational surgical antibiotic prophylaxis is suggested for some selected surgical processes. However, inappropriate utilization of antimicrobial prophylaxis reduces benefits and increases costs and risks, such as antibiotic resistance. This study aimed to evaluate the current practice of antibiotics prescribed by surgeons in common otologic surgeries. Materials and Methods:This cross-sectional study was conducted among otolaryngologists with at least 5 years of experience in common otologic surgeries (tympanoplasty, tympanomastoidectomy, stapes, or middle ear exploration (MEE) surgeries). A total of 257 otolaryngologists filled a checklist about their selected regimen and timing of antibiotic(s) administration. Results:The rates of antibiotic prophylaxis prescription in dry and wet ears in tympanoplasty were 7.4% and 87.1% (preoperative), 40.9% and 47% (intraoperative), 88.3% and 98% (postoperative); in tympanomastoidectomy with no cholesteatoma were 7.1% and 97.8% (preoperative), 39.6% and 50.9% (intraoperative), 93.7% and 99.6% (postoperative); in tympanomastoidectomy with cholesteatoma were 14% and 98.3% (preoperative), 45.4% and 51.9% (intraoperative), 98.3% and 99.6% (postoperative), respectively, and in stapes or MEE surgeries were 6.4% (preoperative), 41.7% (intraoperative) and 73.1% (postoperative), respectively. There were no significant differences in the rates of prescribing intraoperative prophylaxis between wet and dry ears, except in tympanomastoidectomy without cholesteatoma. Overall, the most prescribed antibiotics were cephazolin, cephlexin, and ciprofloxacin drop.Conclusion:The results of this study revealed the inappropriate administration and timing of antibiotic prophylaxis regarding current literature evidence. Despite the lack of evidence on the potential role of antibiotic prophylaxis in clean-contaminated and contaminated ears, a significant number of surgeons prescribed prophylactic antibiotics in tympanoplasty and tympanomastoidectomy without cholesteatoma.

Background and aims: Decreased levels of physical activity (PA) during the coronavirus disease 2019 (COVID-19) pandemic can cause physical and psychological problems for individuals. Therefore, the aim of this study was to investigate the relationship between PA, body image, and eating disorders (EDs) during the COVID-19 pandemic among high school girls in Farsan, Iran. Methods: This was a descriptive-analytical cross-sectional study, and the research population included female high school students from Farsan, Iran, who were studying in 2019-2020. In this regard, 535 high school girls (age: 15.95 ± 1.42, weight: 53.07 ± 10.01, BMI: 20.14 ± 3.48) were selected based on cluster-random sampling to participate in the study. Multidimensional Body Self-relation Questionnaire (MBSRQ), Baecke’s Physical Activity Questionnaire, and the Eating Disorder Diagnostic Scale (EDDS) were used to collect data, and Pearson correlation coefficients were administered to establish statistical relationships. Results: The results indicated significant positive correlations between body image and PA levels (r = 0.304, P = 0.001). However, no significant correlations were observed between body image and anorexia nervosa (AN) (r = -0.035, P = 0.424), bulimia nervosa (BN) (r = -0.033, P = 0.446), and binge ED (r = -0.041, P = 0.339). Likewise, no relationships were observed between PA and AN (r = 0.084, P = 0.052), BN (r = 0.073, P = 0.092), as well as binge ED (r = 0.071, P = 0.099). Conclusion: During the COVID-19 pandemic, PA was positively associated with body image but not with EDs. Based on the obtained results, it can be concluded that PA improved body image in adolescent girls during the COVID-19 pandemic.

Abstract Objective To prevent cavity problems in canal wall down mastoidectomy, silicone block for mastoid obliteration was used. Methods In this retrospective cohort study, 39 patients (21 males and 18 females) underwent canal wall down mastoidectomy and mastoid obliteration using silicone block. We evaluated the postoperative outcome, the time until epithelialization of the cavity, graft success rate, and the hearing outcome. Results The time until complete epithelialization of the mastoid cavity was 35.5 ± 5.4 days. We had a graft success rate of 100% during the follow‐ups. The postoperative evaluation revealed 36 dry ears (92.3%) patients without any cavity problems. However, one ear developed granulation tissue, and two ears had partially exposed silicone block, which required revision mastoidectomy. Regarding hearing outcomes, a complication such as deaf ear was not reported. Conclusion Silicone block is safe and suitable for mastoid obliteration and external auditory canal reconstruction in canal wall down mastoidectomy. Level of Evidence 4.

Abstract Objectives The aim of this study was to evaluate whether intraoperative ciprofloxacin‐soaked gelfoam is safe in tympanoplasty or not. Method In this randomized, double‐blind controlled clinical study, we included 100 patients between 18 and 60 years old, having perforation ≥50% of the tympanic membrane and dry ear for at least 2 months who were a candidate for underlay tympanoplasty via postauricular approach. We used ciprofloxacin soaked gelfoam in the case group and betamethasone soaked gelfoam in the control group for packing the middle ear cavity and external auditory canal during their operation. The graft success rate and tympanogram after 6 months follow‐up period was considered as the primary outcome. Also, we evaluated the postoperative hearing results 6 months after the surgery as the secondary outcomes. Results Postoperative microscopic otoscopy showed a graft success rate of 100% (44/44) and 97.7% (42/43) in the case and control groups, respectively. The level of improvement between the two groups was not significant for air‐bone gap (ciprofloxacin: 9.01 ± 7.89 dB, betamethasone 5.31 ± 10.53 dB, P = .160), and speech reception thresholds (SRT; ciprofloxacin: 10.23 ± 8.62 dB, betamethasone 7.33 ± 12.60 dB, P = .260). 93.2% of all the ears in the case group and 81.4% of those in the control group achieved postoperative air‐bone gap within 20 dB, but the difference between them was not significant (P = .118). Conclusions We found that the application of ciprofloxacin impregnated gelfoam in the middle ear, and the external auditory canal had no adverse effect on the graft success rate in tympanoplasty. Levels of evidence 1b.

Background and objectives: Bone-related osteokines play an important role in the response of bone metabolism to physical activity. The purpose of this study was to investigate effects of different intensities of resistance training on serum levels of some osteokines associated with the Wnt signaling pathway and receptor activator of nuclear factor kappa-Β ligand (RANKL) pathway in old male Wistar rats. Methods: Twenty-four old (23 months) male Wistar rats (mean weight: 437.93±33 g) were randomly divided into three groups of moderate-intensity resistance training (n=8), high-intensity resistance training (n=8) and control (n=8). Moderate- and high-intensity resistance trainings were performed at 60% and 80% maximal voluntary carrying capacity, respectively. The level of wclerostin, osteoprotegerin (OPG) and RANKL was evaluated by enzyme linked immunosorbent assay. Data were analyzed using one-way analysis of variance and at significance level of ≤0.05. Results: The results showed that sclerostin (p=0.014), OPG (p=0.049) and RANKL (P=0.034) differed significantly between the study groups. The Tukey post-hoc comparison showed that sclerostin decreased significantly in the high-intensity resistance training group compared to moderate-intensity resistance training group (P=0.048). In addition, OPG decreased significantly in the moderate-intensity resistance training group compared to the control group (P=0.033). Moreover, RANKL decreased significantly in the high-intensity resistance training group compared to the control (P=0.048). Conclusion: The results showed that resistance training with appropriate repetition and intensity can have positive effects on bone formation signaling pathways.

Background: Type 2 Diabetes (T2D) in the elderly is an epidemic that significantly impacts global health. This experimental study aimed to compare the responses of microRNA-133a (miR-133a) in different tissues and of Runt-related transcription factor 2 (Runx2) in bone marrow tissue following resistance and endurance training in old rats with High-Fat Diet and Streptozotocin (HFD/STZ)- induced type 2 diabetes. Materials and Methods: T2D was induced by HFD/low-dose STZ in 30 male Wistar rats (21-monthold, Mean±SD weight 418±43 g). The rats received HFD (55%, 31%, and 14% of energy from fat, carbohydrate, and protein, respectively; 5.2 kcal/g). The diets continued for eight weeks in both groups. Over week four, the rats in the group with HFD/STZ-induced T2D received treatment with low-dose STZ. After one week of familiarity with the laboratory environment, they were randomly divided into three groups: Diabetic Endurance Training (DET, n=10), Diabetic Resistance Training (DRT, n=10), and Diabetic Control (DC, n=10). The eight weeks of endurance training protocol comprised five sessions of moderate-intensity training (60%-75% velocity at maximal oxygen uptake (vVO2max) and low intensity (30%-30% vVO2max). In 60% Maximum Voluntary Carrying Capacity (MVCC), the resistance group climbed the ladder 14-20 times with 1-minute rest, five days a week. Results: The results of the 1-way ANOVA test showed no significant change in serum miR-133 expression (P=0.411) and muscle tissue (P=0.077) following resistance and endurance training. However, significant differences were observed in bone marrow miR-133 expression (P=0.003) and Runx2 gene expression (P=0.002) between groups. Tukey’s post hoc tests showed that the bone marrow miR-133 expression had a significant increase following eight weeks of resistance training compared to the endurance training (P=0.006) and control (P=0.002) groups, and bone marrow Runx2 gene expression in rats exposed to resistance training compared to the endurance training (P=0.044) and the control (P=0.018) groups. Conclusion: It seems that longer periods of exercise are required for cellular changes in the metabolism of these tissues after these exercise protocols. This topic should be studied in future research.

Introduction: Each type of prosthesis for ossiculoplasty has its advantages and disadvantages, and the choice of the best material has been a matter of various studies. The present study aimed to make a comparison between the hearing outcomes of partial ossicular replacement prosthesis (PORP) using titanium versus Polycel prosthesis. Material and Methods: A total of 106 patients undergoing PORP as a second stage ossiculoplasty were analyzed in this study. Following that, they were randomly assigned to two groups of titanium (n=54) and Polycel (n=52) prosthesis. Subsequently, pre-and post-operative audiometric data were assessed based on the aim of the study. Results: In general, the post-operative air-bone gap within 20 dB was given to 63.5% and 55.6% of all ears in the Polycel and titanium groups, respectively, indicating a non-significant difference (P=0.407). Finally, no SNHL was observed in the groups. Conclusion: Overall, the hearing outcomes and the success rate of PORP are comparable between titanium and Polycel prostheses. Therefore, the selection of these prostheses could be based on the surgeons’ preferences, availability, and cost.

Background: Bone-related osteokines are crucial for bone function and metabolic response to physical activity. The present study aimed to shed light on the effect of different intensities of continuous and interval endurance training on the serum levels of some osteokines that are associated with wingless-related integration site (WNT) signaling pathway and Receptor Activator of Nuclear Factor (NF)-κB Ligand (RANKL) in old male Wistar rats. Materials and Methods: A total of 24 old male Wistar rats (mean age: 23 months, mean weight: 437.93 g) were randomly assigned to three groups: interval endurance-training group (n=8), continuous endurance-training group (n=8), and control group (n=8). The continuous and interval training interventions comprised 8 weeks of treadmill exercise, 5 days a week. The continuous endurance-training group started to exercise at 60% of velocity at maximal oxygen uptake (vVO2max) for 16 min during the first week. It continued with 70% of vVO2max for 45 min from the fourth week onward. In contrast, the interval endurance-training group switched on exercise with 40%-80% of vVO2max from the first week and persisted with 30%-110% of vVO2max from the fourth week onward. As the exercise bout was completed, the enzyme-linked immunosorbent assay was applied to measure the study dependent variables. Statistical analysis was further performed using 1-way analysis of variance, considering the significance level of P≤0.05. Results: The study results demonstrated a significant difference in the levels of Oteoprotegerin (OPG) (P=0.036) and RANKL (P=0.001) in the experimental (namely, interval and continuous training) groups compared with the controls following the exercise bout. However, the level of sclerostin was not significantly changed (P=0.549). Conclusion: High-intensity endurance training in the RANKL/OPG and WNT pathways decreased sclerostin and RANKL levels, but this decrease was significant at the RANKL level. It was effective with regard to the intensities of different types of endurance exercise.

Backgrounds and Objectives: Adipokine Adipsin is one of the important adipose tissue proteins and has a beneficial role in maintaining beta cell function. The aim of this study was to examine the effect of 12-week rhythmic combined training on plasma adipsin levels and insulin resistance in Multiple Sclerosis Patients (MS) women. Materials and Methods: In this semi-experimental study, 96 female patients with MS were selected on the basis of disability levels and divided into three groups, low disability (n=44), moderate disability (n=26) and sever disability (n=26). Training program include 12 weeks combined training, three sessions per week and 45 to 60 minute for each session. Resting levels of Adipsin and Insulin Resistance were measured 24 h before and 48 h after training programs Results: The findings showed that after 12 weeks of combine training, plasma adipsin levels in low disability group significantly decrease (p=0.002). Also, 12 weeks of combined exercise significantly decreased insulin resistance in the low and severe disability group, but no significant decrease in the group with moderate disability. Conclusions: Therefore, combine training induce changes in weight, body fat percentage, BMI and waist circumference, lipids profile and decrease the plasma adipsin level in MS women

Background and aims: There are many articles about the effects of different training methods on lipid profiles in the elderly. The objective of the present study was to investigate the influence of training on the lipid profile in the elderly. Methods: In this study, databases of PubMed, Embase, Scopus, ScienceDirect, Web of Science, SID, Magiran, and Google Scholar were searched. Intervention effects were presented as mean difference (MD) with a random-effects model. Subgroup analysis and sensitivity analysis were performed to study heterogeneity, following the primary screening of the full text of the articles. Results: A total of 23 trials with 1654 individuals were included in the meta-analysis. Levels of high-density lipoprotein cholesterol (HDL-C) (MD = 0.47 mg/dL; P

Background: Non-communicable chronic diseases (NCD) are of the biggest health problems in Iran. The main purpose of this article was to review the latest scientific findings on physiological and functional effects, and mechanisms related to physical activity and exercise by preventing non-communicable chronic diseases, and finally, developing strategies of physical activity. Methods: In this narrative review study, published articles about the subject were gathered from valid websites and databases with key words of physical activity, exercise, non-communicable chronic diseases, and Iran. Findings: A low level of physical activity has been identified as the fourth leading cause of death worldwide. Regular physical activities would prevent cardiovascular disease, type 2 diabetes, some cancers, high blood pressure, obesity, and depression. According to the latest national studies on risk factors of non-communicable disease in Iran, being sedentary has increased in adults from 35.0% to 39.1%. Physical activities and exercise are the main interventions to prevent these diseases. Conclusion: It seems that obesity, cardiovascular diseases, cancer, and type 2 diabetes are greatly improved, when a part of the prevention and treatment program is physical activity and exercise. Strong epidemiological and clinical evidence suggest that physical activity reduces the risk of more than 35 different disorders, and it is the most accessible and inexpensive way to prevent death and disability caused by non-communicable diseases.

Introduction: Otolaryngology is a field with a high referral rate; however, there is a dearth of research on the quality of referral letters written in this field. This study was carried out to explicitly assess the quality of referral letters, more specifically in the field of otology. Materials and Methods: Two otologists assessed referral letters written by general practitioners or primary care physicians working as family physicians. They were asked to make independent assessment on different variables related to the quality of referral letters and their appropriateness. A “qualified referral letter” in the current study is defined as a letter with standard items, including, description of chief complaint, description of associated symptoms, relevant physical findings, past medical history, drug history, family history, and reasons for referral. Results: A total of 1000 referral letters written by 652 primary care physicians were investigated in the current study. The obtained results indicated that 74% of referral letters to otologists contained inadequate information regarding various items in the referral letters. Symptoms, diagnosis, and signs were only reported in 28.3%, 28.9%, and 3.6% of the letters, respectively. The findings showed that most common reasons for referrals were uncertainty in diagnosis (52.4%), persistence of the patient (32.6%), and failed therapy (32%). With regards to case-specific conditions, the highest referral rates were related to external otitis, otitis media with effusion, and acute otitis media. Conclusion: According to the obtained results of the current study, the content of referral letters were insufficient or inappropriate. Therefore, it is recommended to improve otolaryngology syllabus and provide suitable courses for undergraduate students in order to become familiar with the importance of referral letter writing.

Background/Aims Fatty liver is a clinical and pathologic condition in individuals with type 2 diabetes (T2D). The purpose of this study is to examine the effects of different exercise modalities on non-alcoholic fatty liver indices (fatty liver index [FLI], lipid accumulation product [LAP], hepatic steatosis index [HSI], and Framingham Steatosis Index [FSI]) in women with T2D. Methods Fifty-two women with T2D and a mean age of 55.07±5.92 yrs, body mass index (BMI) 28.94±4.09 kg/m2 , and hemoglobin A1c (HbA1c) 9.41±0.82% were randomized to a sprint interval training (SIT) (n=17), combined aerobic and resistance (A+R) training (n=17), or control group (n=18) for 10 weeks. Two-way repeated analysis of variance (ANOVA) was used to find differences between groups and the effects of time and Time×Group interactions after 10 weeks on non-alcoholic fatty liver indices. After this, ANOVA models were constructed to determine the effects of group allocation and change in non-alcoholic fatty liver indices. Results There were significant time interactions for FLI (P

Background: Drug consumption and addiction lead to serious cardiovascular diseases as well as inflammation. Cellular adhesion molecules are glycoproteins that mediate a leukocyte reaction to inflammation. This study aims to determine the effect of aerobic exercises on some cardiovascular factors in addicts treated with methadone. Methods: This is a semi-experimental research. To conduct this research, 30 male addicted patients treated with methadone with a mean age of 33.53±15.42 years, 70.06±15.42kg weight and 174.8±5.69cm were selected after medical screening and randomly divided into experimental (n=16) and control (n=16) groups. First, the height, weight and body mass index (BMI) of participants in both groups were measured. Blood samples were taken from the subjects in order to measure the intercellular adhesion molecules 1 (sICAM) and cellular vascular adhesion 1 (sVCAM) in serum. The experimental group had an aerobic exercise program including use of a treadmill with a 40 to 50% maximum heart rate in the beginning and then, a 70 to 80% maximum heart rate. The control group had only a follow-up. After 8 weeks, all variables were measured in both groups. Correlated t-test and independent t-test were used for intragroup and intergroup comparisons (P

Background & Objective: Review of literature show that there are contradictory opinions, regarding the surgical technique act as a prognostic factor in graft success rate. Therefore, the researchers decided to consider the topic by reviewing the literatures and gathering their ten years experiences information regarding this issue. Materials & Methods: This retrospective study was carried out on ears undergoing chronic otitis media surgeries. Five hundred and five ears underwent chronic otitis media surgeries were evaluated. We analyzed 225 tympanoplasty (44.6%), 93 canal walls up mastoidectomy (18.4%) and 187 canal wall down mastoidectomy (37%). The primary outcome was anatomic results (graft success rate in each surgical technique) and the secondary outcome was hearing outcomes. Results: Total graft success rate was found in 460 ears (91.1%). Also graft success rate in tympanoplasty, canal wall up mastoidectomy and canal wall down mastoidectomy groups were observed in 201 ears (89.3%), 81 ears (87.1%) and 178 ears (95.2%), respectively. But there was not significant statistical difference between different methods (P=0.14). The mean post-operation air-bone gap gains in these three surgical techniques were 7.8, 11.1 and 4.3 dB, consecutively Conclusion: However, our results showed that the overall graft success rate was in an acceptable range and graft success rate in canal wall down mastoidectomy was more than tympanoplasty and canal wall up mastoidectomy, but the surgical technique was not a prognostic factor in graft success rate.

Purpose: Aging is associated with systemic dysfunctions in lipid metabolism and chronic inflammatory state which contribute to atherosclerotic. The purpose of this study was to investigate the effect of moderate and high intensity resistance training on micro-RNAs Associated with reverse cholesterol transport in Wistar elderly rats.Methods: Thirty male Wistar rats (23 months old) were randomly, based on the weight of rats at the start of the study, divided into two experiment and one control group including moderate intensity resistance training (n = 10), high intensity resistance training (n = 10) and the control group (n = 10). Resistance training included 8 weeks of climbing a ladder with high intensity (80% MVCC) and moderate intensity (60% of MVCC) and 5 days a week. After completing training, expression of mir-33 and miR-144 and ABCA1 were measured RT-PCR technique. The statistical analysis was performed using ANOVA test with significance level of (P ≤0.05).Results: There was significance decrease in expression of miR-33a and miR-144 and increase in expression of ABCA1 in both high and moderate resistance groups (P ≤0.05). Also, there was significant difference between the mRNA expression of ABCA1 levels in high and moderate resistance training (P>0.05). However, there was no significant difference expression of miR-33a and miR-144 level between groups.Conclusion: It seems that moderate and high intensity resistance training can cause decrease the expression of miR-33a and miR-144 result to increase in mRNA expression of ABCA1.

Background and Importance: Arachnoid cysts are developmental cystic lesions which may be found as an incidental finding on neuroimaging or present with symptoms of headache, seizure and neurologic deficit. Presentation with seizure is more common with larger sizes and temporal location. Presentation with Temporal Lobe Epilepsy (TLE) is rare, and fenestration of cysts has variable results for seizure control. We reported controlling TLE symptoms following endoscopic transsphenoidal fenestration of an arachnoid cyst. The anteromedial location in middle fossa, extension toward sphenoid sinus and normal appearance of mesial temporal structures on MRI encouraged us to consider this surgical approach. Case Presentation: A 26-year-old patient with a 13-year history of TLE with uncontrolled symptoms despite taking a combination of AEDs (LTG, CBZ, LEV, CLB) was referred to our clinic. Neuroimaging revealed an arachnoid cyst in anteromedial part of temporal fossa which extended to sphenoid sinus, but showed no abnormality in mesial temporal structures. Endoscopic endonasal transsphenoidal fenestration of the arachnoid cyst was performed, and followed by reconstruction of the skull base. The procedure improved the seizure control during the 9-month follow-up and no sign of radiologic recurrence was observed. Conclusion: Transsphenoidal endoscopic fenestration is a safe and feasible surgical approach for treatment of symptomatic arachnoid cysts in anteromedial part of middle fossa especially when they extend toward lateral wall of sphenoid sinus. This surgical corridor has the privilege of avoiding cortical injury accompanied by transcranial approaches, which is deleterious in epileptic patients.

As otolaryngologists are exposed to high risk of coronavirus disease 2019 (COVID-19) infection, logic and evidence-based prioritization for surgeries is essential to reduce the risk of infection amongst healthcare workers. Several clinical guidelines and surgery prioritizing recommendations have been published during the COVID-19 pandemic. They recommended the surgery in the setting of immediate facial nerve paralysis within 72 hours after trauma, but none of the previous studies in the literature suggests that the optimal timing of operation should be less than 2 weeks from injury.

The main purpose of this study was to investigate the effects of elastic resistance band training (ERBT) and green coffee bean extract (GCBE) supplement on novel cardiometabolic indices in obese women. To this end, a total number of 60 obese women aged 30-50 years with a body mass index of > 30 kg/m2 were selected for inclusion in this study and then they were randomly assigned to one of the following four groups: placebo (n = 15), GCBE supplement (n = 15), GCBE supplement + ERBT (n = 15), and placebo + ERBT (n = 15). Each commercially prepared GCBE supplement capsule used in this study contained 500 mg of GCBE supplement and it was also claimed by the manufacturer to have 50% chlorogenic acid (CGA) (250 mg). The participants in the placebo + ERBT and GCBE supplement + ERBT groups attended an 8-week ERBT program, 3 sessions / week, and 60 min each session. In the GCBE supplement + ERBT group, Framingham risk score (P = 0.018), atherogenic index of plasma (P = 0.003), and metabolic syndrome severity score (P = 0.001) significantly decreased. Taken together, the results of the present study supported the importance of supplemental and resistance-type training in improving obesity and novel cardiometabolic risk scores, despite the fact that longer nutritional and exercise interventions could enhance some cardiometabolic risk scores in obese women.

Background: Exercise training can be effective on cardiac physiological hypertrophy (that is favorable for cardiac function) by changing the concentration of growth factors and their receptors. The aim of this study was to determine the effects of eight weeks of resistance training on activin receptor type II-B (ActRIIβ), as well as plasma levels of growth differentiation factor 11 (GDF11) and growth differentiation factor 8 (GDF8) in cardiac physiological hypertrophy in male Wistar rats. Methods: After the familiarization period, fourteen 3-month-old male Wistar rats were randomly divided into control and training groups (n= 7). Resistance training included 8 weeks and 5 sessions per week climbing from a 1-meter ladder. GDF11 and GDF8 of plasma were measured using enzyme-linked immunosorbent assay (ELISA) method, and ActRIIB of left ventricular myocardium was measured using immunohistochemistry (IHC) method. Data were analyzed using independent t test and Mann-Whitney U at the significance level of P < 0.050. Findings: There was a significant difference between the training and control groups in heart weight (P = 0.004), heart weight/body weight (P =0.045), GDF11 (P = 0.001), and GDF8/GDF11 (P = 0.015). There was not any significant differences between the training and control groups in ActRIIβ (P = 0.768) and GDF8 (P = 0.295) levels. Conclusion: According to the results of the present study, it seems that resistance training with favorable effects on growth factors is an important strategy in cardiac physiological hypertrophy.

Background and Aim: The purpose of this study was to investigate the effect of endurance training intensity (low, moderate and high) on the expression of skeletal muscle ATGL protein and serum levels of insulin and glucose in male diabetic rats. Material and Method: 40 streptozotocin induced diabetic male Wistar rats were randomly assigned to five groups of eight, including low (DL , moderate (DM) and high intensity (DH) endurance training diabetic groups, diabetic control group (D), and healthy control group (Con). Three sessions of endurance training with low intensity (DL( equivalent to 5-8 m / min, moderate intensity (DM) equivalent to 17-14 m / min and high intensity (DH) equivalent to 25-22 m / min were performed every week for eight weeks. The relative expression of ATGL protein was measured with western blot technique. Serum insulin and glucose levels were measured by ELISA method. To determine the difference between the groups we used one way ANOVA test. Result: The results showed a significant difference in the expression of ATGL between the control and training groups (with low, moderate and high intensity) (p=0.0002). This difference was significant between DH and D (p=0.0049), DH and DL (p = 0.0053) and also between DH and DM (P = 0.0136) groups. Serum glucose levels were also significantly different between the DH group with the groups D (p = 0.002) and DL (p = 0.039), also, the DM group with groups D (p = 0.0018) and DL (p = 0.0165). There was a significant difference in the amount of insulin in the DH group compared to the groups DL (p = 0.011), D (p = 0.0002), and the DM group with D (p = 0.014). Conclusion: Moderate and high intensity endurance training can to some extent compensate for diabetes-induced reduction in the expression of ATGL protein and cause reduction of serum insulin and glucose levels in diabetic rats. It seems higher intensity of endurance training can lead to greater increase in expression of ATGL in diabetic rats. Keywords: Diabetes, ATGL, Endurance training intensity, Insulin, Glucose. Received: Oct 17, 2017 Accepted: Jan 29, 2018

Introduction: Fatty liver is a condition in people with type 2 diabetes mellitus (T2DM). The purpose of this study is to examine the effects of combined training on novel hepatic steatosis indices (fatty liver index (FLI), accumulation product (LAP), hepatic steatosis index (HSI), and Framingham steatosis index (FSI)) in women with type 2 diabetes. Methods: 35 female with type 2 diabetes were assigned to combined training (n = 17) and control (n = 18). Intervention consisted of combined (aerobic-strength training) for 10 weeks. Data were analyzed using dependent t test to compare pretest and posttest in each group. The Analysis of covariance (ANCOVA) was used to compare the amount of changes in experimental and control training groups after 10 weeks. Results: The results of the analysis of covariance showed that 10 weeks of combined training caused a non-significant decrease in HSI (P = 0.596), FSI (P = 0.312), FLI (P = 0.327) and a significant decrease in LAP (P = 0.334) compared to the control group. Conclusion: The results show that 10-week combined training results in a significant decrease in LAP index and a non-significant reduction in FSI, HSI, and FLI indices of women with type 2 diabetes. Therefore, combined training recommended for improve the fatty liver in women with type 2 diabetes.

IntrodutionThe purpose of this study was investigating the effect of endurance training on protein expression of CGI-58, ATGL and serum levels of insulin and glucose in streptozotocin-induced diabetic rats. Methods: 24 male Wistar rats were randomly assigned to three groups of eight, including diabetic group with endurance exercise (D-E), diabetic (D) and healthy control groups (Con). After induction of diabetic rats by injection streptozotocin was administered intraperitoneal , endurance exercise was applied for eight weeks, three sessions pre week in diabetic rats. Exercise intensity was equal to a speed of 21-25 m / min. The relative expression of CGI-58 and ATGL protein was measured with western blot technique and serum insulin and glucose levels were measured with a specialized kit. One-way ANOVA test was performed using SPSS-20 software and at a significance level less than 5%. Results: Results showed that ATGL and CGI-58 values were significantly different between the three groups (p

Papillary thyroid carcinoma (PTC) is one of the most commonly diagnosed types of differentiated carcinoma of the thyroid. It is stated that lung is the most common site of metastasis followed by bone. The incidence of paranasal sinus (PNS) metastasis is fairly uncommon in case of thyroid carcinoma. To the best of our knowledge, no case of metastatic PTC to nasal cavity has been reported. In this case report, we present the first case of papillary carcinoma of the thyroid with nasal cavity metastases in a 55-year-old female. The patient underwent surgical treatment and the mass was completely removed and sent for pathology. The pathology report revealed that it was metastatic papillary cell carcinoma. Surgical approach is usually difficult in view of the cosmetic and functional concerns, but may be considered in selected cases. As described herein, this rare type of metastasis was successfully removed and the patient was symptoms free after 1-year follow-up.

Background. Omentin-1, a novel adipokine expressed in visceral adipose tissue, is negatively correlated with insulin-resistance and obesity. Objective(s). The aim of this study was to investigate the effect of eight weeks of high-intensity interval training on omentin-1 gene expression in visceral adipose tissue and insulin-resistance in male wistar rats. Methods. A total of 26 male Wistar rats (mean weight = 110±10 gr) were purchased from Pasteur Institute in Iran. At first, six rats were separated as base control group and, after eight weeks of feeding with normal diet, were dissected and their visceral adipose tissues were sampled. The remaining rats were given a high-fat diet for eight weeks. After this, seven rats were separated into the non-diabetic fat group (obese HIIT). Then, diabetes was induced on the remaining animals After eight weeks, diabetic rats were divided into two groups—diabetic control group (n=6) and diabetic HIIT exercise group (n=7). The exercise group ran on treadmill for eight weeks—five days a week with a speed of 29–36 m/min and intensity of 90% of VO2Max. The activity was repeated five times in the first week, which increased to 12 times in the last week. A total of 48 hours after last session, fasting blood glucose and insulin were measured. Omentin gene expression was measured from visceral adipose tissue. Results. Results showed that omentin-1 gene expression was increased significantly after eight weeks of HIIT. Blood glucose and insulin-resistance decreased significantly in training groups (p=0.001). Conclusion. It can be concluded that eight weeks of HIIT induce high omentin-1 gene expression and reduce fasting glucose level and insulin-resistance in diabetic male wistar rats.

Introduction: Aging is associated with elevated levels of some proinflammatory factors and exercise is a non-invasive intervention to improve immune function among older adults .The aim of the study was to compare resistance training effects on interlukine-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) levels in older-aged women. Methods: The study was quasi-experimental and forty healthy females were selected and randomly assigned to one of four groups: strength after endurance training (endurance + strength (E + S), n = 9), strength prior to endurance training (strength + endurance (S + E), n = 10), interval resistance-endurance training (Int, n = 12), and control (n = 9) groups. The training program was performed for eight weeks, three times per week. Human TNF-α and IL-6 sandwich ELISA Kit were used. Within-group differences were analyzed using a paired samples t-test and between-group differences were analyzed using one-way analysis of variance. Results: The intra-session order had not significantly influence on the adaptive response of waist-to-hip ratio (p = 0.55), IL-6 (p = 0.55) and hs-CRP (p = 0.55) throughout the study. However, significant differences were shown following combined training between the S + E, E + S and Int groups for Vo2 max (p = 0.029), body mass (p = 0.016) and BMI (p = 0.023) when comparing pre and posttests. Conclusion: This study confirmed that adaptations to a combination of endurance and resistance training appear to be independent of whether resistance training occurs prior to or following endurance training.

Background: A clear association between allergy and nasal polyposis (NP) is not determined and the role of food intolerance in patients with NP is not investigated by oral food challenge (OFC). Objective: To investigate the relation of salicylate food intolerance and atopy in patients with NP according to recurrence and aspirin sensitivity. Methods: A cross sectional multicenter study was done in two tertiary centers for allergy in Iran. Adult patients with NP were selected for the study that had been referred to allergy clinics. The oral aspirin challenge (OAC) test was performed to identify aspirin exacerbated respiratory disease (AERD) and the OFC test was used to investigate food intolerance. Atopic evaluation was performed by skin-prick tests, nasal smear and blood eosinophil count as well as serum total IgE. Results: One hundred and nineteen Iranian patients (female to male ratio 1.05) with NP were enrolled (mean age, 38 ± 11 years). Recurrence of nasal polyposis was 64.7%. OAC was performed in all cases; 43.79% cases had aspirin hypersensitivity. In addition, OFC tests determined that 69.9% of patients had salicylate food allergy. Salicylate food intolerance was significantly higher in NP cases with AERD than in aspirin tolerant patients (p

Introduction: The lenticular process of the incus succumbs to necrosis in chronic otitis media. Few researchers have addressed the issue of autograft incus preservation in the soft tissue of the tragus or mastoid cavity. Nonetheless, preservation of the incus in this method during the second stage of ossiculoplasty is a subject that is still up for debate. This study was carried out to demonstrate the hearing outcome after a modification of the incus interposition technique, which involved preserving it in the periauricular soft tissue. Materials and Methods: In the primary operations, tympanoplasty was performed with a postauricular incision. At the end of the surgery, a small pocket was created to preserve the incus beneath the temporalis fascia. The second stage of ossiculoplasty was performed 6 to 18 months after the primary operation. Post-operative pure tone audiometry was analyzed after at least 12 months and was considered successful after achieving an air-bone gap (ABG) within 20 dB. Results: In this paper, we analyzed 199 ears. The mean duration of follow up was 2.5 years. We achieved post-operative ABG within 20 dB in 157 patients (78.9% of patients). Conclusion: This study indicates the efficacy and safety of incus interposition when it is preserved in the postauricular soft tissue.

Introduction:Different types of prosthesis are available for stapes replacement. Because there has been no published report on the efficacy of the titanium soft-clip vs the fluoroplastic Causse loop Teflon piston, we compared short-term hearing results of both types of prosthesis in patients who underwent stapedotomy due to otosclerosis.Materials and Methods:A total of 57 ears were included in the soft-clip group and 63 ears were included in the Teflon-piston group. Pre-operative and post-operative air conduction, bone conduction, air-bone gaps, speech discrimination score, and speech reception thresholds were analyzed.Results:Post-operative speech reception threshold gains did not differ significantly between the two groups (P=0.919). However, better post-operative air-bone gap improvement at low frequencies was observed in the Teflon-piston group over the short-term follow-up (at frequencies of 0.25 and 0.50 kHz; P=0.007 and P=0.001, respectively).Conclusion:Similar post-operative hearing results were observed in the two groups in the short-term.

با وجود همه‌ی روش‌های پیش‌گیری، ویروس هپاتیت B (HBV یا Hepatitis B virus)، که می‌تواند عامل ایجاد هپاتیت حاد و مزمن، سیروز و سرطان کبد باشد، همچنان در بسیاری از مناطق به صورت اندمیک باقی مانده است و بیش از 350 میلیون نفر در جهان ناقل مزمن این ویروس هستند. بروز عفونت هپاتیت B در بیماران با نارسایی مزمن کلیه در طول چند دهه‌ی گذشته، به دنبال اقداماتی نظیر غربال‌گری خون از نظر Hepatitis B surface antigen (HBsAg) و Anti-Hepatitis B core total antibodies (Anti-HBc)، کاهش نیاز به انتقال خون پس از پیدایش اریتروپویتین واکسیناسیون هپاتیت B و انجام اقدامات کنترل عفونت در واحدهای همودیالیز به طور قابل توجهی کاهش یافته است. به نظر می‌رسد که در اکثر بیماران مبتلا به بیماری مرحله‌ی پایانی کلیه، آزمایش HBsAg برای تشخیص عفونت ویروس هپاتیت B کافی است. با این وجود، با توجه به این که علایم بیوشیمیایی اغلب نمی‌تواند به طور قابل اعتمادی وضعیت بافت‌شناسی کبد را نشان دهد، بیوپسی کبدی بهترین روش برای ارزیابی فعالیت هپاتیت B و درجه‌ی سیروز می‌باشد. بیوپسی کبد، اغلب هنگامی توصیه می‌شود که درمان آنتی‌ویروس و قبل از آن، انجام پیوند کلیه برای ارزیابی شدت بیماری کبدی ناشی از HBV مد نظر باشد. با توجه به عوارض جانبی اینترفرون آلفا در بیماران تحت دیالیز، آنالوگ‌های نوکلئوزیدی، انتخاب‌های بهتری در درمان هپاتیت B این بیماران می‌باشند. در پایان، باید اشاره شود که انتکاویر خوراکی، اولین خط درمان توصیه شده برای هپاتیت B در این بیماران می‌باشد.

Background: Aging is a process in which the body’s physiological capacity continuously decreases after the age of 30. However, interventions such as physical activity can play an important role in the prevention of aging. Objectives: The purpose of this study was to compare the effects of eight weeks of combined training (endurance and resistance) in different orders on inflammatory factors and adipokines among elderly females. Patients and Methods: The design of this study was quasi-experimental. Forty healthy females were selected purposely and randomly assigned to one of four groups including strength after endurance training (E + S, n = 9), strength prior to endurance training (S + E, n = 10), circulation combined (CI, n = 12), and control (n = 9) groups. The training program was performed for eight weeks, three times per week. Within-group differences were analyzed using a paired samples t-test and between-group differences were analyzed using one-way analysis of variance (ANOVA). Results: The data analysis showed that the between group comparison did not influence the adaptive response of tumor necrosis factor (TNF)-α (P = 0.80), high sensitivity-C reactive protein (hs-CRP) (P = 0.55), adiponectin (P = 0.33), chemerin (P = 0.56), omentin (P = 0.51), leptin (P = 0.10) and vaspin (P = 0.70) levels, yet the within group comparison showed a significant difference in the chemerin concentration in the E+S group (P = 0.03). Conclusions: The results indicated that three different combined trainings (strength and endurance) had no positive effect on inflammatory factors and adipokines among aged females. However, the different combined trainings, independent of order, were effective training methods in reducing body fat and body mass index (BMI) in aged females.

Background: In this study, we investigated several socioeconomic, clinical, and psychological factors associated with medication adherence in a sample of Iranian patients with inflammatory bowel disease (IBD). Materials and Methods: This study was conducted on 110 IBD patients from 2013 to 2014 in Isfahan, Iran. The patients were invited to complete three anonymous questionnaires including the Hospital and Anxiety Depression Scale (HADS) for assessing the levels of anxiety and depression; IBD Questionnaire-Short Form (IBDQ-9) for the quality of life; and a visual analog scale assessing the medication adherence. A self-assessment adherence rate of more than 80% was considered “appropriate adherence.” Results: Overall, 99 patients completed the questionnaires. Among them, 77.8% reportedly adhered to their medications. There was no statistical difference between adherence and nonadherence rates in terms of gender, educational status, disease type, disease severity, and family history of IBD. Conversely, single patients (100% vs. 74.1%; P = 0.03), nonsmokers (79.4% vs. 0.0%; P = 0.04), patients receiving immunosuppressive drugs (100% vs. 71.9%; P = 0.01), and corticosteroids (95.1% vs. 65.5%; P = 0.01) were more likely to be adhered than their counterparts. No differences emerged in terms of the mean HADS scores in either of the sexes. The mean IBDQ-9 score was significantly higher in adhered patients only in females (31.08 ± 11.6 vs. 24.7 ± 9.1; P = 0.04) but not in males. Conclusion: The adherence rate in our study is almost similar to developed countries. Single marital status, not smoking, receiving corticosteroids and immunosuppressive drugs, and higher IBDQ-9 score in females are associated with higher adherence rate.

Introduction: Even though modern technology progresses so rapidly, annals of otology are replete with so many challenging article, which often compare various types of prosthesis. Since there has not been a prospective randomized clinical trial study which compares the hearing result of total ossicular replacement prosthesis made of Titanium with omega connector and Polycel in the literature, we decided to perform a study encompassing this issue. Materials and Methods: 105 patients, who were in the 2nd stage of their operation and who needed total ossicular replacement prosthesis, were included in this prospective single blind randomized clinical trial study. Patients were classified in two groups: titanium Kurz (TTP™ -Vario system, Kurz GmbH, Dusslingen, Germany) with omega connector and Polycel (Sheehy Plastipore Polycel, Medtronic Xomed Inc). The duration of the follow up was 6-12 months. In order to evaluate hearing results, pure tone audiometric in 0.5, 1, 2, and 4 kHz were checked. In addition, speech reception threshold was recorded. A successful surgery was defined as having a postoperative air–bone gap within 20 dB. Results: We accomplished successful hearing in 64.4% of patients with titanium and 65% of patients with a Polycel prosthesis.Improvement in speech reception threshold was 11.5 dB in the titanium group and 13 dB in the Polycel group. In other words, there was no significant difference between the two groups. In addition, air-bone gap improvement after ossiculoplasty was 11.2 dB in the patients with a titanium prosthesis and 12.4 dB in the Polycel group. In fact, the difference was not significant. Conclusion: We found that both the titanium and the Polycel prosthesis improve speech reception threshold and air-bone gap closure in a similar manner.

Introduction: In developing countries, chronic otitis media (COM) and cholesteatoma are relatively prevalent. Within the field of otology, COM surgery remains one of the most common surgical treatments. Most recent studies evaluating the potential prognostic factors in COM surgery have addressed graft success rate and types of middle ear and mastoid pathology. There has been much controversy about this issue until the present time. This study evaluated the effect of cholesteatoma on the GSR in COM surgery. Materials and Methods: The present retrospective, study-controlled study investigated 422 ears undergoing COM surgery. The minimum and maximum postoperative follow-up periods were 6 and 48 months, respectively. The study group consisted of patients with cholesteatomatous COM, while the control group included patients with non-cholesteatomatous COM, who had undergone ear surgery. Postoperative graft success rate and audiological test results were recorded and the effect of cholesteatoma on graft success rate was investigated. Results: The overall GSR was 92.4%. In the study group (COM with cholesteatoma),the postoperative GSR, mean speech reception threshold improvement, and mean air-bone gap gain were 95.3%, 2.1 dB, and 3.2 dB, respectively. In the control group (COM without cholesteatoma), however, these measurements were 90.9%, 9.4 dB, and 9.1 dB, respectively. The difference between the two groups was not statistically significant. Conclusion: The study results suggest that cholesteatoma is not a significant prognostic factor in graft success rate.