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Background: An unhealthy diet, including low in fruits, vegetables, and dairy products, and high-fat, high-sugar foods and beverages, increases the risk of non-communicable diseases. The main purpose of this study is to investigate the economic inequality of the different food groups in school aged Kurdish children in Iran. Methods: The present cross-sectional study was conducted in 2015 in 10-12 years old students in the west of Iran. The eating diet was evaluated using Food Frequency Questionnaire (FFQ). Thelogistic regression was used to assess the relationship between food groups and the determinants. The concentration curve and concentration index)CI (were used to measure the inequalities. Results: Our findings showed that consumption of milk and dairy products, meat and protein rich foods, vegetables, fruits, and fish was higher among people with high SES. On the contrary, Consumption of fast-food and soft drinks was lower in people with high SES. Our study also showed that girls consumed less milk and dairy products, fruits, vegetables, fast food and soft drinks and more meat and protein rich food and fish than boys. The regression results showed that mother’s high level of education was associated with higher consumption of fruits, vegetables, milk and dairy products, meat and bean, and fish. Therefore, mother’s level of education was protective factor in consuming fast food and soft drinks. We also observed a decrease in fast food consumption as a result of increasing mother’s age while consuming foods with saturated fat was related to the same variable. CI for consumption of dairy products (PConclusions: The consumption of healthy diet e.g., milk and dairy products, meat and protein rich foods, vegetables, fruits, and fish were low in school aged children and it was concentrated in low SES children. Taking action by the national and local governments to reduce inequality in unhealthy choices is necessary.

This study aimed to assess the tissue content of essential and toxic metals including lead (Pb), cadmium (Cd), arsenic (As), silver (Ag), aluminum (Al), chromium (Cr), copper (Cu), iron (Fe), selenium (Se), and zinc (Zn) in the breast cancerous tissues compared to the non-cancerous tissue. The biopsy specimens of 63 breast cancers along with 63 adjacent healthy tissues in Kurdistan Province, Iran, were collected from 2019 to 2020 and assayed using ICP-MS (Agilent 7900). The results of the Mann-Whitney test illustrated that the concentration of Pb, Cd, As, Cr, Cu, and Se were significantly elevated in cancerous tissue (p < 0.05), while Zn was the only trace element with higher levels in healthy subjects (p < 0.05). Moreover, weak to moderate correlations between elements were observed in the cancerous group including Al-Cr (r=0.60), As-Cu (r=0.52), and Cu-Se (r=0.56). In contrast, no correlation over 0.50 was found between trace elements in the non-cancerous group. Raw risk differences (RDs) accounted for a significant effect for Pb, Cd, As, Ag, Cr, Se, and Zn on the development of breast cancer. In conclusion, elevated levels of As, Cd, Cu, Pb, and Se may contribute to enhancing the risk of breast cancer.

Background: The organizational-citizenship behavior and organizational trust change the behaviors and attitudes and can also improve performance and efficiency among nurses as the team working incentives. Numerous environmental and occupational factors can affect the mentioned variables in employees but organizational justice, among other factors, exert a significant impact in this regard. Objectives: The present study aimed to investigate the relationship between perceived organizational justice with organizational-citizenship behavior and organizational trust among Iranian surgical technologists at Iran University of Medical Sciences (IUMS) in 2021. Methods: In this descriptive-analytical and cross-sectional study, 183 surgical technologists of IUMS were investigated, and, therefore, the sampling method was census. Data collection tools were as follows: (1) Demographic characteristics questionnaire; (2) Niehoff and Moorman organizational justice questionnaire; (3) researcher-developed organizational-citizenship behavior scale; and (4) Gary A. Roeder Organizational Trust Questionnaire. Descriptive statistics (mean ± standard deviation; frequency and percentage), Pearson’s correlation coefficient, and multiple regression were performed to analyze the data by using SPSS software version 22. Results: Overall, the perceived organizational justice was poor, whereas the organizational-citizenship behavior and organizational trust were moderate. There was a positive and statistically significant correlation between organizational justice and citizenship-organizational behavior (r = 0.79), (P < 0.001). The same association was also observed between perceived organizational justice and organizational trust (r = 0.87), (P < 0.001). Moreover, 50% of the changes in perceived organizational justice, 67% in organizational trust, and 75% in organizational-citizenship behavior may have been explained and justified by demographic variables. Conclusions: It was concluded that citizenship-organizational behavior and organizational trust in surgical technologists may have been increased by taking appropriate interventions such as increasing the perception of organizational justice as well as improving the performance and quality of services in hospitals.

This study was conducted to investigate the association between trace elements including cadmium (Cd), chromium (Cr), cobalt (Co), copper (Cu), iron (Fe), lead (Pb), nickel (Ni), selenium (Se), zinc (Zn), and arsenic (As) in gastrointestinal cancer tissue and non-cancerous tissue (suspected gastrointestinal cancer) in Eastern Iran. The samples of 63 gastrointestinal cancers (stomach (n = 20), esophageal (n = 19), and colorectal (n = 24) along with 63 controls in South Khorasan Province, Iran, were collected and analyzed using ICP-MS (Agilent 7900). Our results indicated that the concentrations of Co (1.3 ± 0.8, 1.3 ± 0.8 μg kg-1), Cr (8.1 ± 7.3, 11.0 ± 14.8 μg kg-1), Ni (29.0 ± 20.1, 39.5 ± 30.2 μg kg-1), Pb (6.9 ± 4.0, 6.1 ± 4.6 μg kg-1), and Zn (867.6 ± 159.1, 935.6 ± 196.2 μg kg-1) were significantly higher among esophagus and colon cancer cases than controls (p < 0.05). Similarly, stomach cancer cases showed higher Co, Cr, Ni, Se, and Zn and lower Cu concentrations than their controls (p < 0.05). Moreover, the Spearman correlation between metals revealed a mostly low to moderate correlation between metals. Our finding illustrated that the significant risk differences of Cr, Ni, Pb, Se, and Zn metals on esophagus cancer when considered the single predictor unadjusted for other metals and covariates RD (95% CI) - Cr: -0.274 (-0.463, -0.086), Ni: -0.288 (-0.457, -0.118), Pb: -0.171 (-0.463, -0.086), Se: -0.243 (-0.434, -0.051), and Zn: -0.094 (-0.143, -0.045) respectively. This study suggests that the trace element's exposure may be associated with gastrointestinal cancer risk. Additional studies are needed to elucidate the mechanisms underlying trace element carcinogenesis further.

The prevalence of gestational diabetes mellitus (GDM) has increased over the recent decades. Exposure to environmental contaminants may be a risk factor for the development of GDM, but this is heavily dependent on particular circumstances. Studies on various areas linking various factors are therefore needed. We examined the associations between serum trace element levels and incidents of GDM among 102 pregnant women (diabetic n = 60 and healthy n = 42) living in Birjand (Iran). Blood serum samples were analyzed for concentrations of elements linked to particulate matter air pollution such as As, Cd, Cu, Hg, Mn, Ni, V, and Zn. Concentrations of As (8.58 vs. 3.15 μg/L), Cd (6.74 vs. 0.52 μg/L), and Hg (2.60 vs. 0.90 μg/L) were significantly higher in women with GDM. Risk difference (RD) estimation showed that As, 0.516 (0.355, 0.677); Cd, 0.719 (0.534, 0.904); and Hg, 0.505 (0.276, 0.735) increase GDM probability, while V lower that risk, -0.139 (-0.237, -0.042). With the principal component analysis, we were able to separate subjects according to their GDM status based on element levels. Such classification revealed very high efficiency with a true positive rate of 93%, according to linear discriminant analysis. GDM subjects presented higher levels of As, Cd, and Hg, indicating that these elements may disturb insulin metabolism and promote the development of GDM. Therefore, we conclude that systematic monitoring of trace elements followed by multivariate modeling in women planning pregnancy should be carried out to prevent the development of GDM.

Background: In a laparoscopic surgery team, a surgical technologist as a skillful assistant surgeon is responsible for camera navigation and peg transfer. Objectives: We assessed the effect of the fundamentals of laparoscopic surgery curriculum on improving the skills of surgical technology students in camera navigation, pattern cutting, and peg transfer. Methods: A study was conducted on 30 surgical technology students at the Iran University of Medical Sciences based on Kern's six-step model. After assessing the needs and defining the educational goals, the course content was determined. Afterward, students were trained in a simulation-based learning environment. Then, in the evaluation stage, using the standard task completion time (TCT) tool, their competence in performing the three skills was evaluated. The results of the first comprehensive attempt to perform each skill were recorded as the pretest, and the results of the sixth and 10th repetitions were recorded as the posttest. Data were analyzed using analysis of variance with duplicate data. Results: The TCT score improved in this study. The time of camera navigation decreased from 92.14 to 56.42 s, pattern cutting from 186.07 to 118.21 s, and peg transfer from 93.03 to 54.10 s. Conclusions: This study showed that the fundamentals of laparoscopic surgery curriculum improved the surgical technologists’ competence in performing triple skills essential for performing laparoscopic surgeries. Thus, this learning method could play an essential role in laparoscopic surgery.

Background: The etiology of allergic rhinitis includes an increase in cytokine levels, including IL- 4, IL-13, IL-17, and reduction in B7 homologous 1 (B7-H1) or programmed cell death-1 ligand-1 (PD-L1), a new member of the CD28: B7 stimulant molecule family. The aim of this study was to determine the relationship between cytokines and PD-L1. Methods: In this experimental study, 80 patients with allergic rhinitis were enrolled according to inclusion and exclusion criteria. The severity and stage of the disease were determined by a specialist physician. A 5 cc venous blood sample was collected from the patients. IL-4, IL-17, INFγ and PD-L1 were measured using ELISA technique. Results: There was a significant correlation between SPD-L1 and INFγ, IL-4 and IL-17 in allergic rhinitis patients (P < 0.05). Statistical analysis based on the severity of the disease (Mild, Moderate and Severe) showed a significant positive correlation between the SPD-L1 and INFγ in all three levels (P < 0.001). There was also a significant negative correlation between SPD-L1 and two cytokines IL-4 and IL-17 (P < 0.001). Conclusion: PD-L1 may have a protective role against allergic rhinitis, although the precise mechanism requires further detailed studies.

Objective:One of the most influential natural emotions of anger that affects a person's physical and mental health. Studies have shown that chronic anger and continuous modes of expression and its control over the course of mood and anxiety disorders , as well as the negative impact of leaving. The aims of this study was determine levelincidence and control anger courses at Kurdistan University of Sciences. Methods: This study is descriptive. The study population included 410 students ( 207 males and 203 females) who were selected by multistage random sampling. Spielberger state-trait anger questionnaire 2. Software and test data Spss18, Mann-whitney U,correlation, descriptive statistics , were analyzed. Results: anger and anger control , respectively, with an average of 17/43±3/29and22/01±4/62 highest averages were assigned to. Conclusion: There was no significant relationship between gender and anger , but anger control internal and external gender relations are significant.

The prevalence of gestational diabetes mellitus (GDM) has increased over the recent decades. Exposure to environmental contaminants may be a risk factor for the development of GDM, but this is heavily dependent on particular circumstances. Studies on various areas linking various factors are therefore needed. We examined the associations between serum trace element levels and incidents of GDM among 102 pregnant women (diabetic n = 60 and healthy n = 42) living in Birjand (Iran). Blood serum samples were analyzed for concentrations of elements linked to particulate matter air pollution such as As, Cd, Cu, Hg, Mn, Ni, V, and Zn. Concentrations of As (8.58 vs. 3.15 μg/L), Cd (6.74 vs. 0.52 μg/L), and Hg (2.60 vs. 0.90 μg/L) were significantly higher in women with GDM. Risk difference (RD) estimation showed that As, 0.516 (0.355, 0.677); Cd, 0.719 (0.534, 0.904); and Hg, 0.505 (0.276, 0.735) increase GDM probability, while V lower that risk, -0.139 (-0.237, -0.042). With the principal component analysis, we were able to separate subjects according to their GDM status based on element levels. Such classification revealed very high efficiency with a true positive rate of 93%, according to linear discriminant analysis. GDM subjects presented higher levels of As, Cd, and Hg, indicating that these elements may disturb insulin metabolism and promote the development of GDM. Therefore, we conclude that systematic monitoring of trace elements followed by multivariate modeling in women planning pregnancy should be carried out to prevent the development of GDM.

Background: The prevalence of obesity is an increasing public health problem. Objectives: The present study aimed at estimating the prevalence of unhealthy diet among children aged 10 - 12 years in Kurdistan, west of Iran and assessing the association of unhealthy diet with socioeconomic inequality. Methods: The present cross-sectional study was conducted on 2506 children living in Sanandaj city, west of Iran in 2015. The subjects were selected from the schools by multistage sampling method. The required data were collected using the food frequency questionnaire. The socioeconomic status (SES) was calculated by measuring household asset by using principal component analysis technique. The inequality was measured using concentration index, and Blinder-Oaxaca decomposition method was utilized to determine the proportion of different determinants causing inequality. Results: The prevalence of unhealthy diet was 50.75% (95% confidence interval (CI): 48.79 - 52.71). The concentration index for unhealthy diet was -0.14 (95% CI: -0.18, -0.09), indicative of concentration of unhealthy diet in the group with low SES (P < 0.001). The Blinder-Oaxaca decomposition analysis showed that the poor-rich gap in the prevalence of unhealthy diet was 27.77%, while 59.41% of the observed gap attributed to the explained component. The major causes of inequality were mother’s level of education and place of residence, respectively. Conclusions: The obtained results showed that the prevalence of unhealthy diet was higher in children with low SES. Increasing mothers’ awareness of health literacy and performing place-based interventions can be effective in decreasing socioeconomic inequalities in unhealthy diet and prevention of chronic diseases in children.

Ethnopharmacological relevance Undesired effects of synthetic antidiabetic agents have made researchers to seek for safer and healthier resources. With this aspect, herbal materials have attracted substantial research interest and are being extensively investigated. Considering that herb-drug interactions can be a double-edged sword presenting both risks and benefits, investigation of such interactions is greatly in demand. Aim of the study to investigate possible beneficial effects of hydroalcoholic extract of Securigera Securidaca seed (HESS) on antioxidant capacity, fibroblast growth factor 21 (FGF21) and insulin resistance in Streptozotocin (STZ)-induced diabetic rats, alone and in combination with glibenclamide. Materials and methods Forty male Wistar rats were randomly divided in to eight equal groups including healthy and diabetic controls and six treated groups with a various doses of HESS alone and in combination with glibenclamide, for 35 consecutive days. Serum samples were taken and analyzed for biochemical profile, HOMA indexes, FGF21, oxidative/nitrosative stress and inflammatory biomarkers as compared with the controls. Moreover, total phenolic and flavonoid contents of herbal extract were assessed. Results The herbal extract was found to be rich in flavonoid and phenolic components. Both of glibenclamide and the HESS decreased glucose and insulin resistance, as well as increased body weight and insulin sensitivity. Moreover, the extract could mitigate oxidative/nitrosative stress and inflammation dose-dependently, however, the standard drug was less effective than HESS. Induction of diabetes increased FGF21 levels and both of the treatments could reduce its contents, however, glibenclamide was more effective than HESS. Conclusions The results clearly show that there is no contradiction between HESS and glibenclamide. Moreover, the herbal extract could augment antioxidant and anti-inflammatory properties of the standard drug.

There are a paucity and contradicted data about the impact of concurrent heredity of polymorphic genes and risk of chronic myeloid leukemia (CML). In the present study, the concurrent effects of three polymorphisms affecting the integrity of DNA consist of ABCB1 C3435T, ABCG2 C421A, and XRCC1 Arg194Trp on development of chronic myeloid leukemia were studied. Furthermore, the role of these polymorphisms in clinical and laboratory outcomes of patients was evaluated. In this case-control study, 70 CML patients and 140 healthy individuals were enrolled in the study. The clinical features of patients such as phase of disease and response to treatment and laboratory data before and after treatment with imatinib mesylate were collected. ABCB1 C3435T, ABCG2 C421A, and XRCC1 Arg194Trp single nucleotide polymorphisms were evaluated by restriction fragment length polymorphism-polymerase chain reaction. The T allele of ABCB1 C3435T, T allele of XRCC1 Arg194Trp, and C allele of ABCG2 C421A polymorphisms were significantly higher in patients than controls. TT genotype of ABCB1 and TT genotype of XRCC1 were associated with higher risk of chronic myeloid leukemia development. CC421 ABCG2/TT3435 ABCB1 and CC421 ABCG2/TT27157 XRCC1 were also correlated with a higher risk of CML. Patients with C allele of ABCB1 had poor cytogenetic response, and correlation of CC421 ABCG2/TT3435 ABCB1 diplotype with accelerated phase of CML was significant. Patients with CC421 ABCG2/TT3435 ABCB1 and CC421 ABCG2/TT27157 XRCC1 diplotypes might be at higher risk to rapid and severe development of CML and have weaker response to treatments with imatinib.

The aim of this study was to assess the socioeconomic inequalities in obesity and overweight in children aged 10 to 12 yr old.A cross-sectional study.This study was conducted on 2506 children aged 10 to 12 yr old in the city of Sanandaj, western Iran in 2015. Body mass index (BMI) was calculated. Considering household situation and assets, socioeconomic status (SES) of the subjects was determined using Principal Component Analysis (PCA). Concentration Index was used to measure inequality and Oaxaca decomposition was used to determine the share of different determinants of inequality.The prevalence of overweight was 24.1% (95% CI: 22.4, 25.7). 11.5% (95% CI: 10.0, 12.0) were obese. The concentration index for overweight and obesity, respectively, was 0.10 (95% CI: 0.05, 0.15), and 0.07 (95% CI:0.00, 0.14) which indicated inequality and a higher prevalence of obesity and overweight in higher SES. The results of Oaxaca decomposition suggested that socioeconomic factors accounted for 75.8% of existing inequalities. Residential area and mother education were the most important causes of inequality.To reduce inequalities in childhood obesity, mother education must be promoted and special attention must be paid to residential areas and children gender.

BACKGROUND: Rheumatoid arthritis (RA) is the most common chronic disease involving joints. Anti-cyclic citrullinated peptide (anti-CCP) as a specific antibody is a reliable index to early diagnosis of RA. Disease-modifying anti-rheumatic drugs (DMARDs) can reduce progression of RA joint destruction. The present study aimed to investigate the effects of DMARDs in reducing serum anti-CCP. METHODS: A cross-sectional study was performed on 30 patients including 22 females and 8 males RA patients according to the American College of Rheumatology (ACR) classification criteria, who referred to the Rheumatology Clinic. Treatment with DMARD group started at the beginning of the study (May 2009). At 1st and 6th month of the study, clinical findings and disease activities were recorded and anti-CCP was measured. RESULTS: At the beginning and the end of the study, morning stiffness for more than 1 h and involvement of three areas were, 28 (93%) and 12 (40%), respectively. Indicators of disease severity in patients, the mean ± SD serum levels of erythrocyte sedimentation rate at the beginning and end, were 40.7 (30-59) mm/1 h and 13.4 (9-86) respectively. Anti-CCP at the beginning and end of the study was 141.83 (65.8-101.09) U/ml and 65.8 (62-92) U/ml respectively (P < 0.05). Disease Activity Score in 28 joints and rheumatoid factor positive and C-reactive protein positive were significantly different at the onset and at the end of the study (P < 0.05). CONCLUSION: Measurement of serum anti-CCP is a helpful index of treatment response and monitoring of treatment efficacy in patients with RA.

Summary Background: This study aimed to determine adenosine deaminase (ADA) activity as a possible screening tool in lung cancer patients. Methods: Blood samples were collected from 30 subjects with positive pathological tests and 62 patients with negative pathological tests as a control group. The enzymatic activity of total ADA and its isoenzymes was determined. Results: tADA and ADA2 isoenzyme activity was significantly higher in cancerous patients compared to benign controls in serum and BAL fluid. Using a cut-off level of respectively 35.22 U/L and 31.80 U/L for BAL total ADA and ADA2, sensitivity and specificity were 100% and 81% for total ADA and 95% and 98% for ADA2. Conclusions: Adenosine deaminase may play important roles in the pathophysiology of lung cancer and because of its might be considered as a useful screening tool among the other markers in lung cancer diagnosis.

Background: Screen time (ST), including watching television and playing electronic games are the leading cause of a growing obesity epidemic. This study aimed to evaluate ST and its association with physical activity, overweight and socioeconomic status (SES) in children 10 to 12 years of age in Sanandaj. Methods: This study was designed as a cross-sectional study, which was conducted in Sanandaj in 2015. ST and physical activity data were collected using the Modifiable Activity Questionnaire (MAQ). Overweight indices are defined based on BMI age- and gender-specific percentiles, as proposed by WHO criteria. Considering household assets data, SES was calculated using principal component analysis (PCA). The relationship between ST and different determinants was assessed using logistic regression analysis. Results: Based on the results obtained in our study, 47.28% (95% CI: 45.33-49.24) of the participants spent more than two hours a day on television and video watching and electronic games playing. People who spend greater time on ST activities, independent of their physical activities, are more susceptible to overweight and obesity (p=0.002). People in higher socioeconomic groups spent more time on watching TV and video and playing electronic games (p=0.001). There was a direct relationship between the residential area and ST (P=0.052). ST in male was found to be greater (p=0.033). In addition, ST was also lower in school-aged children whose mothers had a greater education (p=0.56). Conclusion: Based on the results of this study, it is recommended to increase the education level and knowledge of mothers and design interventions consistent with children gender and residential location so that to reduce ST and its associated outcomes in children.

Aims : Given the growing rate of patients with type 2 diabetes mellitus, uncovering the effects of gene polymorphism on diabetes pathogenesis has attracted a lot of attention. Because glucose transporter 1 is involved in glucose uptake, the polymorphism of this gene may be an important risk factor in type 2 diabetes mellitus or in the progression of diabetes complications such as diabetic nephropathy. As far as the authors are concerned, this study is the first one aiming at evaluating the probable effects of solute carrier family 2 facilitated glucose transporter member 1 (SLC2A1) HaeIII polymorphism on clinical and laboratory outcomes of Kurdish patients with type 2 diabetes mellitus. Methods : This study was conducted involving 126 diabetic nephropathy patients and 150 diabetic patients without renal involvement. Serum levels of Cystatin C, fasting blood glucose, creatinine and urinary albumin; levels of glycated hemoglobin and estimated glomerular filtration rate were measured. Moreover, the Hae III polymorphism of SLC2A1 gene was determined by PCR-restriction fragment length polymorphism (RFLP). Results : The rate of CC genotype was higher (37%) in patients with diabetic nephropathy compared with controls. There were a significant correlation between the CC genotype and risk of diabetic nephropathy. There were significant correlations between genotypes, serum Cystatin C and estimated glomerular filtration rate in patients with diabetic nephropathy. Conclusions : The results demonstrated the high frequency of C allele of SLC2A1 HaeIII in Kurdish patients with diabetic nephropathy. It was also found that this polymorphism is a significant risk factor for diabetic nephropathy. The effect of this polymorphism on clinical and laboratory characteristics of diabetic nephropathy patients was significant.

Methods for assaying lysosomal diseases in dried blood samples are very useful today due to its several advantages related to the stability of samples, its transportation, handled and analysis, and its potential use for newborn screening compared to traditional methods in leucocytes samples. For this reason, it is important to validate these assays before being used in routine laboratory. Because of different in biological markers based on ethnicity, we aimed this study to validation a DBS-based fluorometric assay for measurement of α-l-Iduronidase activity for diagnosis of MPS I patients in Iran. DBS samples were collected from 15 MPS I patients and 60 healthy age matched subjects. Diagnostic value, biological variance and α-l-Iduronidase activity were determined. DBS α-l-Iduronidase activity was significantly higher in male subjects than in female group. Using a cut-off level of 1.08 µmol/spot 20 h, sensitivity and specificity were 100 and 98 %. The linearity of test was proved and we showed that within-run and between run precision were 5.6 and 14.66 %. Measurement of α-l-Iduronidase activity in DBS samples is an accurate test for diagnosis of MPS I and because of its rapid shipping and simplicity to keeping, DBS-based enzyme activity could be considered as a useful diagnostic tool in this disease.

BACKGROUND Finding a suitable marker with high sensitivity and specificity for early diagnosis of cancer is very desirable. This study was aimed to determine the diagnostic value of serum CYFRA21-1, carcinoembryonic antigen (CEA), and neuron-specific enolase (NSE) for screening of lung cancer patients in western Iran. METHODS This descriptive analytical case-control study was performed on 30 subjects with malignant and 81 with benign lung cancer. Serum levels of CYFRA21-1, CEA, and NSE were determined. RESULTS The concentration of serum tumor markers was significantly higher in the malignant group than in the benign subjects. The highest sensitivity was obtained by measurement of serum NSE (73%). The highest specificity was obtained by measurement of serum CYFRA21-1 (95%). CONCLUSIONS Our results demonstrate the usefulness of measuring CYFRA21-1 and NSE together for early screening of lung cancer in western Iran.