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Purpose The Kharameh cohort study (KHCS) is one branch of the ‘Prospective Epidemiological Research Studies in Iran’, located in the south of Iran. The enrolment phase of KHCS spanned from April 2015 to March 2017, during which urban and rural residents of Kharameh were enrolled in the study. KHCS aims to investigate the incidence of non-communicable diseases (NCDs) such as hypertension, diabetes mellitus, cardiovascular diseases and cancer, and its related risk factors in a 15-year follow-up.Participants KHCS was designed to recruit 10 000 individuals aged 40–70 years old from both urban and rural areas of Kharameh. Thus, a total of 10 800 individuals aged 40–70 years of age were invited and, finally, 10 663 subjects were accepted to participate, with a participation rate of 98.7%.Findings to date Of the 10 663 participants, 5944 (55.7%) were women, and 6801 (63.7%) were rural residents. The mean age of the participants was 51.9±8.2 years. 41.8% of the participants were aged 40–49, 35.2% were aged 50–59 and the remaining 23% were 60–70 years old. Until March 2020 (first 3 years of follow-up), the total number of patients diagnosed with NCDs was 1565. Hypertension, type 2 diabetes and acute ischaemic heart disease were the most common NCDs. Furthermore, the total number of deaths during the first 3 years of follow-up was 312, with cardiovascular diseases (38.7%) as the most common cause of death, followed by cerebrovascular diseases (11.8%) and cancer (16.2%).Future plans The remaining 12 years of follow-up will inevitably shed light on the genetic, lifestyle/socioeconomic status, and environmental risk and protective factors of NCDs.

Abstract Background Cardiovascular diseases are the main cause of mortality in the world. This study aimed to estimate the incidence and identify the risk factors of these diseases. Methods This prospective cohort study was performed on 9442 individuals aged 40–70 years in Kharameh, a city in the South of Iran, in 2015–2022. The subjects were followed up for 4 years. The demographic information, behavioral habits, biological parameters, and history of some diseases were examined. The density incidence of cardiovascular disease was calculated. The log-rank test was calculated to assess the cardiovascular incidence difference between men and women. Simple and multiple Cox regression with Firth's bias reduction method were used to identify the predictors of cardiovascular disease. Results The mean ± SD age of the participants was 51.4 ± 8.04 years, and the density incidence was estimated at 1.9 cases per 100,000 person-day. The log-rank test showed that men had a higher risk of cardiovascular disease than women. The Fisher's exact test showed a statistically significant difference between the incidence of cardiovascular diseases in different age groups, education levels, diabetes, and hypertension in men and women. The results of multiple Cox regression revealed that with increasing age, the risk of developing CVDs increased. In addition, the risk of cardiovascular disease is higher in people with kidney disease (HRadj = 3.4, 95% CI 1.3 to 8.7), men (HRadj = 2.3, 95% CI 1.7 to 3.2), individuals with hypertension (HRadj = 1.6, 95% CI 1.3 to 2.1), diabetics (HRadj = 2.3, 95%c CI 1.8 to 2.9), and alcohol consumption (HRadj = 1.5, 95% CI 1.09 to 2.2). Conclusions In the present study, diabetes, hypertension, age, male gender, and alcohol consumption were identified as the risk factors for cardiovascular diseases; three variables of diabetes, hypertension and alcohol consumption were among the modifiable risk factors, so if they were removed, the incidence of cardiovascular disease could greatly reduce. Therefore, it is necessary to develop strategies for appropriate interventions to remove these risk factors.

BackgroundThis study assessed the prevalence of gastroesophageal reflux disease (GERD) in a general adult population in Iran. The association between GERD and various factors was also evaluated.MethodsWe performed a cross-sectional study on 163,018 individuals aged over 35 who were enrolled in the PERSIAN cohort. GERD was defined as the occurrence of heartburn and/or regurgitation symptoms at least several days a month. Survey design analysis for pooled data was performed and multiple regression analysis was conducted to determine the independent risk factors for GERD.ResultsThe prevalence of GERD in our study was estimated at 21.86% (95% confidence interval:17.4%-36.4%). The mean age of the participants was 49.84 years±9.25 (35-70) and 44.75% of the participants were male. Symptoms of heartburn and regurgitation were reported in 18.65% (n: 29,170) and 6.06% (n: 9,717) of participants, respectively. In the multivariate analysis, several factors were found to be associated with a higher prevalence of GERD: female sex, age >50, current smoking, opium use, weekly consumption of fried foods, frequent consumption of hot tea, less than 6 hours of sleep per night, psychiatric disorders, usage of NSAIDs, and poor oral hygiene, were associated with a higher prevalence of GERD. Conversely, higher education levels and average physical activity were found to be less commonly associated with GERD.ConclusionWe found a relatively high prevalence of GERD (21.86%) in this population-based study in Iran. By identifying modifiable risk factors, this research offers opportunities for targeted interventions and lifestyle modifications to reduce the burden of GERD.

Introduction Transanal Endoscopic Microsurgery (TEM) is a minimally invasive method for management of different proctologic conditions. Despite widespread use of this method, it is not used widely in Iran. This report is about to describe the application of TEM in managing different proctologic conditions in a tertiary colorectal referral center in Iran regarding methods and complications.

Introduction: Colorectal cancer remains a significant health challenge, particularly in its advanced Stage III. Timely forecasting of recurrence and metastasis in these patients is crucial for optimizing postoperative care and treatment strategies. The aim of this study is to predict the likelihood of recurrence and metastasis in stage III colorectal cancer patients who have undergone laparoscopic surgery and laparotomy. Material and Methods: In this retrospective analysis, a total of 528 patients with Stage III colorectal cancer were included. Among them, 386 underwent laparoscopy, and 142 underwent laparotomies. logistic regression was employed to assess the influence of the surgical approach on the binary outcomes of recurrence and metastasis. The data were analyzed using SPSS 25, and Odds Ratios along with significance testing were performed with a threshold of p < 0.05 to determine statistical significance. Results: In the laparoscopy group, the recurrence rate was 23.7%, and although older patients (61-98 years) exhibited a higher risk of recurrence (Odds Ratio:1.88, 95% CI:0.92-3.84, p=0.083), this difference did not reach statistical significance. Gender did not significantly impact recurrence. In the laparotomy group, the recurrence rate was 29.6%, and neither age nor gender had a significant influence on recurrence. Notably, in the laparoscopy group, metastasis was significantly associated with age (Odds Ratio:5.044, 95% CI:2.08-12.23, p=0.001), while gender did not play a significant role in metastasis. Similarly, in the laparotomy group, neither age nor gender significantly affected metastasis. Conclusion: This study underscores age's influence on recurrence and metastasis rates in laparoscopic treatment for stage III colorectal cancer, highlighting the need for tailored approaches in elderly patients. In contrast, laparotomy seems to be less affected by age, with tumor size emerging as a crucial predictor of disease progression. Surgical approach significantly impacts outcomes in stage III colorectal cancer, with age affecting laparoscopy outcomes more than laparotomy. These findings emphasize the importance of personalized treatments and call for further research to validate results and enhance patient outcomes in advanced colorectal cancer.

Abstract Background Adaptive cognitive emotion regulation (CER) strategies toward eating play a very important role in obesity and according to schema therapy, patients with obesity learn that don't respond to their emotional stimuli by eating. Thus, this study aimed to evaluate the effectiveness of an online video-based group schema therapy in improvement of the CER strategies and body mass index (BMI) in women who had undergone bariatric surgery. Methods Forty women who had undergone sleeve gastrectomy were selected and randomly divided into two groups of control and experimental. The experimental group received 10 weekly 90-min sessions of group schema therapy, the control group did not receive any intervention at all. Both groups completed the CER strategies questionnaire during pre-test, post-test and follow-up stages, and the data were analyzed using a multivariate analysis of covariance (MANCOVA) through SPSS software (version 20). Results Our results indicated that the experimental group demonstrated significantly higher adaptive CER strategies (P = 0.0001, F = 31.15) and significantly lower maladaptive CER strategies (P = 0.001, F = 9.42), significantly lower BMI (P = 0.001, F = 23.48), as compared to the control condition, following the group schema therapy after the follow-up stage. Conclusion The findings demonstrated that group schema therapy could lead to an increases in adaptive CER strategies and a decrease in maladaptive CER strategies and BMI in women who had undergone bariatric surgery. Trial registration IRCT, IRCT20180523039802N2. Registered 5 August 2020, http://www.irct.com/IRCT20180523039802N2 .

Context: The uninterrupted dissemination and transmission of COVID-19 brought enormous jeopardy and public-health urgency during past three years. Some patients, who recovered from the infection, develop persistent symptoms and organ dysfunction for weeks or even months; conditions that are called long COVID. Among multiple COVID-related complications, positive individuals suffer from lesser to greater degrees of intrahepatic and extrahepatic complications that principally mediated by ACE2 receptors. Evidence acquisition: We reviewed manuscripts from PubMed, Google Scholar and Web of Science on underlying COVID-19-linked clinical relevance and potential pathogenesis of liver complications during short COVID, as well as long COVID with no time limitation. Results: Liver impairment needs a large-scale and persistent follow-up as it may be multivariate in nature. During COVID-19, physicians must assess whether hepatopathy is associated with hepatic disorders, medications utilized for the COVID-19 therapy, viral antigenic outcomes progression to a complicated course. In the context of COVID-19, physicians report that potential pathophysiological approaches to hepatic failure in critical patients further could be leading to deep vein thrombosis, myocardial infarction, venous thromboembolism, and acute kidney injury. These complications might be either reversible, or irreversible with extended manifestations that mostly occur as a consequence of long COVID in the post-COVID era. Moreover, pre-existing cardiovascular and digestive tract problems tend to be highly correlated with adverse clinical outcomes and the highest fatality rate. Potential drug-disease interactions adversely influencing COVID-19 subjects and persistent comorbidities are also getting a major consideration. Conclusion: The assessment of whether the upshot of hepatic-associated co-morbidities in COVID-19 status can improve an acceptable personalized therapeutic strategy considering these specific tropisms.

Benign anorectal diseases are a spectrum of conditions that involve the anus and rectum. Hemorrhoids, anal fissures, and fistulas are three of the most prevalent benign anorectal disorders that can have a detrimental impact on a patient’s quality of life.

Abstract Background and Aims Hypertension and abnormal liver enzymes are common health issues that frequently coexist, and recent research has suggested a possible association between them, warranting further investigation. Therefore, the aim of this study is to explore the relationship between liver enzymes and hypertension. Methods This prospective cohort study utilized data from the Kharameh cohort study, which is a branch of the Prospective Epidemiological Studies in Iran (PERSIAN) database. The study included 7710 participants aged between 40 and 70 years. Hypertension was defined in accordance with the European guidelines for hypertension management, and the association between liver enzymes and hypertension was modeled and predicted using Firth logistic regression. Results This study investigated the association between liver enzymes and hypertension risk in a cohort of 7710 individuals aged 40–70 years. The results showed that higher levels of alanine aminotransferase (ALT), gamma glutamyl transferase (GGT), and alkaline phosphatase (ALP) were associated with an increased risk of hypertension, and this relationship remained significant even after adjusting for potential confounding factors. Additionally, separate analyses within age subgroups revealed a significant association between ALP concentration and high blood pressure in certain age ranges. Conclusion The study demonstrated a significant association between high levels of ALT, GGT, and ALP and an increased risk of hypertension, regardless of other risk factors. These results suggest that monitoring liver enzymes, specifically ALT, GGT, and ALP, could serve as a useful tool to predict hypertension risk and identify individuals who could benefit from early intervention. Overall, these findings underscore the importance of monitoring liver function in preventing and managing hypertension.

Introduction: Managing nutritional deficiencies is an essential component in the treatment of severe obesity. Vitamin D deficiency is often reported in investigations in severe obese cohorts. However, no prior study has summarized findings on this topic. Consequently, the aim of this systematic review and meta-analysis was to investigate the 25-hydroxyvitamin D [25(OH)D] status in individuals with severe obesity in different regions worldwide. We also evaluated levels of calcium, PTH, and magnesium as secondary outcome measures. Methods: We searched Medline, PubMed, Scopus, the Cochrane Library, and EMBASE for relevant observational studies published in English from 2009 to October 2021. The heterogeneity index among the studies was determined using the Cochran (Q) and I2 tests. Based on the heterogeneity results, the random-effect model was applied to estimate the prevalence of vitamin D deficiency. Results: We identified 109 eligible observational studies. Overall, 59.44% of patients had vitamin D deficiency [25(OH)D

Objective: Gastrointestinal bleeding is one of the surgical emergencies that is routinely visited in emergency departments. Although most of these patients are managed with endoscopic modalities, some of them are managed with surgical interventions. Most of emergency surgical interventions are done via laparotomy. With evolution in minimal invasive surgery, the role of laparoscopic surgeries in emergency settings is on a rise. Case Presentation: In this report we describe a case of lower gastrointestinal bleeding that was presented with melena and during workups no bleeding lesion was detected in colon, stomach or duodenum. Further investigations revealed bleeding of proximal jejunum mass that was resected with the laparoscopic approach which is rarely used in the emergency management of patients with gastrointestinal bleedings. Also, resection and anastomosis of proximal jejunal loop was challenging in this case. Conclusion: This report is intended to describe the feasibility of laparoscopy in proximal small bowel lesion resection in emergency settings as well as the role of CT angiography in detecting the source of obscure gastrointestinal bleeding.

Background and Purpose: Oral health is a critical factor in the quality of life (QoL) of older adults in relation to their nutrition, mental health, and healthy social relationships. This study aimed to investigate oral problems and psychological status of older adults referred to a hospital and its relationship with cognition status, stress, anxiety, and depression. Materials and Methods: This cross-sectional study was conducted among 300 older adults referred to Shahid Beheshti Hospital in Shiraz City, Iran. The “Depression, Anxiety, Stress Scale”, the “Abbreviated Mental Test score”, and the “General Oral Health Assessment Index” were used to collect the required data. The Pearson correlation and multiple linear regression statistical tests were used to analyze the data in SPSS v. 26. P less than 0.05 were considered significant. Results: The Mean±SD age of the participants was 70.1±4.6 years. Their mean±SD score of oral health was 44.83±3.91, and the mean±SD cognitive status was 9.28±0.9. The results of correlation analysis revealed a significant relationship between the dimensions of mental health (cognitive status, stress, anxiety, depression) and oral health (P

Abstract Background Kidney stone is the major cause of morbidity, and its prevalence is increasing in the world. This study aimed to assess the prevalence and risk factors of kidney stone in the adult population of southern Iran based on the data of the Kharameh Cohort Study. Methods This cross-sectional study was conducted on 10,663 individuals aged 40–70 years old, using the baseline data of Kharamah cohort study, which started in 2014. Among all participants, 2251 individuals had a history of kidney stone. The participants’ demographic characteristics, behavioral habits, and the history of underlying diseases were investigated. The crude and Age Standardized Prevalence Rate of kidney stones was calculated. Also, logistic regression was used to identify the predictors of kidney stone. To check the goodness of fit index of the model, we used the Hosmer–Lemeshow test. All analyses were performed in STATA software. Results The prevalence of kidney stone was estimated 21.11%. Also, the Age Standardized Prevalence Rate in men and women was calculated 24.3% and 18.7%, respectively. The mean age of the participants was 52.15 years. Higher prevalence of kidney stone was seen in women aged 40–50 years (40.47%, p = 0.0001) and moderate level of social economic status (31.47%, p = 0.03), men with overweight (44.69%, p

Background Despite the low incidence rate, ureteral injuries can lead to significant morbidity. Urinary organs can be injured during open or laparoscopic surgery. This study aimed to assess whether a ureteral injury exists between laparoscopic and open surgery over 20 years in Shiraz. Methods This is a retrospective study and 779 patients of rectal cancer were evaluated in Shiraz from 2000 to 2021 by collecting data from the patients’ electronic charts. We evaluated the type of surgery, gender, age, body mass index (BMI), stage, appearance and size of the tumor, preoperative (chemo)-radio-therapy, recurrence, and metastasis. Ureteral injury was analyzed and urinary incontinence was recorded.Results A total number of 131 (22.2%) in laparoscopy surgeries and 42 (30.6%) in laparotomy surgeries had abdominoperineal (A-P) resection. The total number of 254 (43%) in laparoscopy surgeries and 61 (44.5%) of patients had low anterior resection in laparotomy surgeries. The incidence of ureteral injuries was 2.2% for open procedures and 1.5% for laparoscopic and 2.2% for conversion procedures. The rate of urinary incontinence was 65 (11.0%) in laparoscopy and 9 (6.6%) in laparotomy group. Conclusion It is concluded that the ureteral injury after laparotomy is more than laparoscopic surgeries. Although the number of side effects of these surgeries is low, it can be concluded that the possibility of damage to the ureter is less in laparoscopic surgery and that of damage to the nerves of the pelvic floor is more.

Abstract Background and Aim Prehypertension and hypertension are important risk factors for cardiovascular diseases. This study was carried out to evaluate the effect of prehypertension and hypertension on the development of cardiovascular diseases. Methods This prospective cohort study was performed on 9442 people aged 40−70 in Kharameh, southern Iran. Individuals were divided into three groups: normal blood pressure (N = 5009), prehypertension (N = 2166), and hypertension (N = 2267). In this study, demographic data, disease histories, behavioral habits, and biological parameters were studied. At first, the incidence density was calculated. Then Firth's Cox regression models were used to investigate the association between prehypertension and hypertension with the incidence of cardiovascular diseases. Results The incidence density in the three groups of individuals with normal blood pressure, prehypertension, and hypertension was 1.33, 2.02, and 3.29 cases per 100,000 person‐days, respectively. The results of multiple Firth's Cox regression by controlling all factors showed that the risk of occurrence of cardiovascular disease in people with prehypertension was 1.33 times (hazard ratio [HR] = 1.32, 95% confidence interval [CI]: 1.01−1.73, p = 0.03) and those with hypertension were 1.85 times higher (HR = 1.77, 95% CI: 1.38−2.29, p

Abstract Background The prevalence of cardiovascular disease (CVD) is rapidly increasing in the world. The present study aimed to assess the prevalence and Predictors factors of CVD based on the data of Kherameh cohort study. Methods The present cross-sectional, analytical study was done based on the data of Kherameh cohort study, as a branch of the Prospective Epidemiological Studies in Iran (PERSIAN). The participants consisted of 10,663 people aged 40–70 years. CVD was defined as suffering from ischemic heart diseases including heart failure, angina, and myocardial infarction. Logistic regression was used to model and predict the factors related to CVD. Additionally, the age-standardized prevalence rate (ASPR) of CVD was determined using the standard Asian population. Results The ASPR of CVD was 10.39% in males (95% CI 10.2–10.6%) and 10.21% in females (95% CI 9.9–10.4%). The prevalence of CVD was higher among the individuals with high blood pressure (58.3%, p

Abstract Background and Aim Multimorbidity is one of the problems and concerns of public health. The aim of this study was to estimate the prevalence and identify the risk factors associated with multimorbidity based on the data of the Kherameh cohort study. Methods This cross‐sectional study was performed on 10,663 individuals aged 40–70 years in the south of Iran in 2015 to 2017. Demographic and behavioral characteristics were investigated. Multimorbidity was defined as the coexistence of two or more of two chronic diseases in a person. In this study, the prevalence of multimorbidity was calculated. Logistic regression was used to identify the predictors of multimorbidity. Results The prevalence of multimorbidity was 24.4%. The age‐standardized prevalence rate was 18.01% in males and 29.6% in females. The most common underlying diseases were gastroesophageal reflux disease with hypertension (33.5%). Multiple logistic regression results showed that the age of 45–55 years (adjusted odds ratio [ORadj]] = 1.22, 95% confidence interval [CI], 1.07–1.38), age of over 55 years (ORadj = 1.21, 95% CI, 1.06–1.37), obesity (ORadj = 3.65, 95% CI, 2.55–5.24), and overweight (ORadj = 2.92, 95% CI, 2.05–4.14) were the risk factors of multimorbidity. Also, subjects with high socioeconomic status (ORadj = 1.27, 95% CI, 1.1–1.45) and very high level of socioeconomic status (ORadj = 1.53, 95% CI, 1.31–1.79) had a higher chance of having multimorbidity. The high level of education, alcohol consumption, having job, and high physical activity had a protective role against it. Conclusion The prevalence of multimorbidity was relatively high in the study area. According to the results of our study, age, obesity, and overweight had an important effect on multimorbidity. Therefore, determining interventional strategies for weight loss and control and treatment of chronic diseases, especially in the elderly, is very useful.

Abstract Background: Oxidative stress contributes to the development of cardiovascular disease. Tools for evaluating the anti-inflammatory and antioxidative characteristics of an individual’s diet as a whole may be valuable for assessing the combined effects of dietary antioxidants on health. This population-based study aimed to investigate the association between dietary antioxidants and cardiac disease. Methods: In this population-based cross-sectional study, 10439 individuals aged 40-70 years were recruited during 2014-2017 in Kherameh cohort study which is a part of the Prospective Epidemiological Research Studies in Iran (PERSIAN). The food frequency questionnaire (FFQ) with 130 food items was used to assess the dietary intakes. Vitamin A, E, C, selenium, zinc and Manganese intakes were used to compute dietary antioxidant index (DAI) and dietary antioxidant quality score (DAQs). Results: The participants’ mean age was 52.1± 8.3 years. Among all, 4356 (41.7%) were overweight and 1892 (18.1%) were obese. According to the results, odds of cardiac diseases decreased by increasing DAI score (OR=0.80, Pvalue

Introduction: SARS-CoV-2 infection (COVID-19) pandemic may influence the weight outcomes of bariatric surgeries (BS). Here, we intended to compare the weight outcome of patients who underwent bariatric surgery before and during the pandemic time. Methods: In a retrospective, single-center study, the information of two groups of patients; first COVID-19_Group (n=51) consisted of those that underwent BS during the pandemic and completed a year of follow-up, second NonCOVID-19_Group included 50 patients who underwent BS and were followed up before the pandemic. All the patients’ anthropometric and obesity-related disease data were compared between groups. Results: Weight loss and the decrease of body mass index (BMI) one year after the surgery, as well as excess weight loss and total weight loss, were significantly higher in the NonCOVID-19_Group compared to the COVID-19_Group (p 0.05). Conclusion: We showed a significantly poorer weight outcome at the one-year follow-up of the BS during the pandemic compared to the pre-pandemic. These results need further investigations to determine the preventive measures and management by evaluating the associated factors.

Statement of the Problem: Oral health is one of the most important public health problems. The DMF index is used to assess oral health status. Purpose: This study was performed to evaluate oral health status based on DMF index in adults in Fars province. Materials and Method: This cross-sectional study was performed on 8911 people aged 40 to 70 years under the Kharameh cohort study in 2020. Demographic and oral health factors were collected during interviews and clinical evaluation. T test, ANOVA, and linear regression tests were used for data analysis. Results: The mean and standard deviation of DMF index was 18.06±8.7in all individuals under study. Multiple linear regression results showed that diabetes (OR=1.1 95%CI: 0.9-1.9 p= 0.0001), smoking (OR=4.4 95%CI: 4-4.9 p= 0.0001) and underweight (OR=2.1 95%CI: 1.1-3.1 p= 0.0001) are the factors affecting the increase in DMF index. Other factors such as high level of education, economic and social class, flossing, and living in a village have been inversely related to the DMF index. Conclusion: The results of this study are a warning about the importance of reducing dental costs to increase the level of access of people with low economic and social levels and increase health literacy in relation to oral health.

Abstract Background: Cancer stem cells (CSCs) have critical roles in tumor initiation, progression, metastasis, resistance to chemoradiotherapy, and recurrence in various cancers such as colon cancer. Therefore, extensive studies are required to understand the CSCs mechanism of action and design novel cancer therapies. Successful isolation and characterization of CSCs from tumor tissues or cancer cell lines provide the proper opportunity for these kinds of studies. This study aimed to isolate and characterize CSCs from HT29 colon cancer cell lines. Methods: Sphere formation assay was used to isolate CSCs from the HT29 cell line. The expression of four stemness genes, including LGR5, SOX2, c-Myc, and Oct4, was assessed by real-time PCR. The CSC markers, CD 44 and CD 24, were also evaluated and compared between the parental HT29 cell line and HT29-derived spheres by flow cytometry. Statistical analysis was performed using GraphPad Prism version 6.0 and the Mann-Whitney U test. Results:HT29-derived sphere cells were successfully formed in serum-free media. The proportion of CD 24 and CD 44-expressing cells and the expression of LGR5, SOX2, c-Myc, and Oct4 stemness genes were significantly higher in CSCs isolated from HT29 spheres compared with parental HT29 cells. Conclusion:Sphere formation assay is a proper method for the isolation of CSCs from the HT29 cell line. The stemness markers LGR5, SOX2, c-Myc, Oct4,CD 44,andCD 24are suitable for the characterization of these cells.

Background: Rectal cancer is a malignant tumor of the digestive tract and as it is a widespread condition it demands comprehensive research. At the time of the writing of the present study, COVID-19 infection rates are rising rapidly in Iran and the study attempts to make an evaluation of the country’s rectal cancer management during the pandemic. Methods: 83 patients were divided into two groups and closely studied. The first group underwent rectal cancer surgery during a 9 month period in 2019, while the second group underwent the same process during the same amount of time in 2020. Demographic data, surgery and outcomes after surgery were assessed and compared between the two groups. The data were analyzed by SPSS (statistical analyzer software, ver. 22). Results: The age, weight, height, BMI, size of tumor, and numbers of involved lymph nodes were not different between the two groups. The radiotherapy techniques were significantly different between two groups (p=0.012). Neoadjuvant long course chemoradiation therapy was changed to short-course radiation therapy during the pandemic and hospital stay for the patients was significantly longer during the pandemic (p=0.010). There is no difference in the recurrence or overall survival between the two groups. Metastasis was seen in six patients in the 2019 group,, whereas this phenomenon was not observed in the 2020 group. . The size of tumors were larger in the 2020 group, but it was not statistically different (p=0.064).Conclusion: Cancer is a highly complicated and problematic decease which stresses the importance of immediate diagnosis and treatment; however during the COVID-19 pandemic, medical centers may need to take additional measures to protect their cancer patients.

Background: Autophagy and unfolded protein response (UPR) are mechanisms with dual roles in both maintaining the cellular homeostasis and progression of various diseases such as cancer. Therefore, identification of different molecules and proteins involved in the regulation of these pathways may contribute to find new therapeutic targets. A member of the M28 family of the metallopeptidases, Endoplasmic Reticulum Metallo Protease 1 (ERMP1), is overexpressed in cancers such as colorectal cancer. The role of this protein in the UPR activation was previously reported in breast cancer. We aimed to evaluate the role of ERMP1 in the activation of autophagy and apoptosis in colorectal cancer. Methods: ERMP1 Gene silencing was performed using specific small hairpin RNA (shRNA) in HCT-116 colorectal cancer cell line. Then, autophagy associated protein markers including Beclin 1, p62 and LC3II were evaluated using western blot. The effect of ERMP1 knockdown on cellular apoptosis was also assessed by propidium iodide staining flow cytometry analysis. Statistical analysis was performed using SPSS software version 20. Results: All three autophagy markers were increased significantly in the ERMP1-silenced HCT116 cell lines compared with negative control cells (P < 0.05). It seems that ERMP1 silencing inhibits autophagy at the flux stage. However, ERMP1 knockdown had no significant effect on HCT-116 apoptotic cell death (P > 0.05). Conclusion: The oncogenic protein, ERMP1, activates autophagy in colorectal cancer cell line. Targeting of ERMP1 may be considered as a proper approach in colorectal cancer therapy. Further investigations are required to confirm these results.

The purpose of this study is the effects of perceived organizational support and psychological empowerment of employees on job performance. The statistical population of this research is the employees of the Communication Design Consulting Engineers Company. The statistical sample was determined using Cochran's sampling and placement formula for a limited number of 113 people. To determine the validity of this study, experts in this field, including the supervisor and professors of the management group, were asked about the questionnaire and its questions, which confirmed the validity of the questionnaire, and Cronbach's alpha coefficient was used to determine the reliability of the questionnaire. Cronbach's alpha coefficient for Perceived Organizational Support (0.815), Psychological Empowerment (0.945) and Job Performance (0.903) questionnaire was found to prove an acceptable percentage of reliability. Hypotheses tests showed that perceived organizational support and psychological empowerment have a positive and significant effect on employees' job performance.

The present study has been carried out to optimize three machining parameters in the milling process to achieve minimum surface roughness and tool wear along with the maximum material removal rate. A specific tool wear factor has been defined to evaluate both tool wear and material removal rate parameters simultaneously and the surface roughness was considered as the second output parameter. A set of experiments was designed using a DOE technique and conducted on a milling machine. The experimental data then was applied to develop different mathematical models and the best model was chosen based on analysis of variance (ANOVA). Three proposed methods of optimization with different natures were used to determine optimal output parameters based on selected models. The comparison between these methods showed that Regression-response optimization was superior to Simulated Annealing (SA) algorithm and Goal-attainment method. The Simulated Annealing (SA) algorithm also represented less error function compared to goal-attainment methods. The results of optimization revealed that optimum values for cutting speed and feed rate were ranged from 312 to 314 m/min and 0.085 to 0.12 mm/rev⸱tooth, respectively, while all optimization methods reached the same value of 1.0 mm for depth of cut parameter.

Background and Aim: Colorectal cancer is a chronic disease that reduces the patients’ quality of life. Therefore, it is essential to have self-care ability. This study aimed to investigate the effect of the family-centered empowerment model on the self-care ability of patients with colorectal cancer. Materials and Methods: This randomized controlled study consisted of all patients who referred to the surgery ward of the colorectal clinic affiliated to Shahid Faghihi Hospital, Shiraz, Iran, during 2018. A total of 72 patients were selected by convenience sampling method and randomly allocated into control and experimental groups. A researcher-made questionnaire was used to collect data. It is worth mentioning that this study lasted nine months. Results: The results showed a significant increase in the mean score of total self-care ability and its components in the experimental group, compared to the baseline after the intervention (P

Background: Transanal Total Mesorectal Excision (TaTME) presented in recent years as a novel technique to achieve better outcome in circumferential margin (CRM) and distal margin (DRM) in lower rectal cancer operation. The current study aimed to assess the perioperative and pathological characteristics of TaTME in comparison with laparoscopic total mesorectal excision (LaTME) in patients with mid- and low-rectal cancer. Methods: From January 2016 to December 2018, we enrolled all consecutive patients with rectal cancer, who underwent TaTME and LaTME. Primary endpoints like circumferential rectal margin (CRM) status, distal rectal margin (DRM) status, and pathological outcomes, as well as secondary endpoints including perioperative outcomes (total blood loss, duration of hospitalization, anastomosis leakage, as well as 30-day mortality) were evaluated and compared statistically (α=0.05). Results: 11 patients with distal rectal adenocarcinoma which was biopsy-proven, underwent TaTME, and 19 patients operated on using LaTME. Both groups were similar in the baseline characteristics. Also, the perioperative outcomes were similar in both groups. Regarding pathological outcomes, no patients with CRM Conclusion: TaTME is a reasonable procedure in patients with low rectal cancer. But no remarkable superiority was observed in this method compared to laparoscopy with respect to the pathological outcomes.

In this paper, retrofitting of a hydroxy (HHO) cell which is coupled to a gasoline engine is performed by investigating the effects of electrodes’ shape and distances and the impacts of improvement technologies ultrasonic waves, DC pulsed power with various frequencies and magnetic field on the cell’s bubble pumping efficiency and rate of HHO gas production. Subsequently, an energy analysis was performed to provide a comparison between different improvement technologies. As a result, by applying DC pulsed power with 300 kHz frequency to the HHO cell, highest HHO gas production rate, energy efficiency and lowest energy intensity is achieved among other technologies, however, it will allocate lowest surface intensity which leads to requiring more electrode surface area. In addition, employment of ultrasonic waves improves HHO gas production rate from approximately 6.4% to 52.4%, and it is possessed the highest surface intensity which result in requiring lowest electrode surface among other methods. Finally, the effects of superior improvement methods on the overall cost and weight of an HHO generator and its impacts on engine parameters are studied.

Parastomal Hernia (PSH) is a common complication of patient who undergone ostomy especially end colostomy. Presence of hernia defect is associated with the risk of strangulation and obstruction so understanding the potential risk factor such as patient’s factor and technical issues is important. This study is evaluating the incidence of PSH hernia in patients who undergone end colostomy due to Abdominoperineal Resection (APR) in a tertiary colorectal surgery referral center and explore the possible risk factors of this complication.The study was designed as a retrospective cross sectional study on 41 patients who undergone end colostomy due to APR. Three patient lost the follow up and 13 patients died and 25 patients were enrolled in study. Demographic data, history of smoking, steroid administration, Diabetes, obstructive pulmonary disease, transfusion, Neoadjuvant therapy, wound infection and Body mass Index (BMI) were gathered.The mean age of participants was 58.8 and the mean BMI was 25.04 kg/m2. The incidence of PSH was 40% and 68% of operations were done with Laparoscopy. This study could not find statistically significant risk factor for PSH.The 40% incidence of PSH is noticeable and specific strategies should be applied to reduce such complications. Larger studies is essential to investigate the possible etiologies of this complication. Resumo: A hérnia paraestomal é uma complicação comum em pacientes submetidos a estomia, especialmente a colostomia terminal. A presença de defeito de hérnia está associada ao risco de estrangulamento e obstrução, portanto, é importante compreender o potencial fator de risco, como o fator do paciente e questões técnicas. Este estudo avalia a incidência de hérnia paraestomal em pacientes submetidos à colostomia terminal devido à ressecção abdominoperineal em um centro terciário de referência em cirurgia colorretal e explorar os possíveis fatores de risco dessa complicação. O desenho do estudo foi transversal retrospectivo de 41 pacientes submetidos à colostomia terminal devido à ressecção abdominoperineal. Três pacientes foram perdidos no seguimento, 13 pacientes morreram, e 25 pacientes foram incluídos no estudo. Dados demográficos, história de tabagismo, administração de esteroides, diabetes, doença pulmonar obstrutiva, transfusão, terapia neoadjuvante, infecção de ferida operatória e Índice de Massa Corporal foram coletados. A média de idade dos participantes foi 58,8 e o índice de massa corporal médio foi 25,04 kg/m2. A incidência de hérnia paraestomal foi de 40% e 68% das cirurgias foram realizadas por laparoscopia. Este estudo não encontrou fator de risco estatisticamente significativo para hérnia paraestomal. A incidência de 40% de hérnia paraestomal é perceptível e estratégias específicas devem ser aplicadas para reduzir tais complicações. Estudos maiores são essenciais para investigar as possíveis etiologias dessa complicação.

Background: Understanding the prognostic factors affecting the recurrence-free survival (RFS) of patients with rectal cancer (RC) is the mainstay of care. The present study aimed to identify factors affecting both short- and long-term RFS of patients with RC using semiparametric mixture cure models. Methods: The data were obtained from the database of the Colorectal Research Center of Shiraz University of Medical Sciences, Shiraz, Iran, which was collected during 2007-2017. To determine the factors affecting recurrence, cure models were applied to short-term and long-term RFS of patients with RC separately. The cure rate was calculated using the smcure package in R 3.5.1 (2018-07-02) software. P

Background: Fecal incontinence is an embarrassing problem and decreases the woman’s quality of life. The literature has shown that women with obstetric trauma especially by episiotomy had damaged anal sphincter (Internal and External). We aimed to find the role of episiotomy in the fecal incontinence in women after delivery. Methods: In this study, 71 females with previous vaginal deliveries were investigated by endoanal ultrasonography. The degree of FI was measured using the incontinence score of Wexner. The number of episiotomies was measured for each patient. Results: The mean Wexner score was 9.0±0.7 in the incontinent patients. The mean of normal vaginal delivery was 3.48±0.3 and 33.8% of the patients whom had a history of hemorrhoidectomy. Of patients, 70% had undergone one or more prior episiotomies during their deliveries. Conclusion: Episiotomy could be one of the risk factors in fecal incontinence but we did not find any significant difference in Wexner score between patients with or without episiotomy. Endoanal sonography seems an effective tool to evaluate and prediction of anal injury during episiotomy in some critical cases.

Abstract Background ARID1A has been described as a tumor suppressor gene, participating in chromatin re-modeling, epithelial-mesenchymal-transition and many other cellular and molecular processes. It has been cited as a contribute in tumorigenesis. The role of ARID1A in CRC is not yet defined. Aim To investigate the role of ARID1A methylation and CNV in its expression in CRC cell lines and to examine the relationship between ARID1A status with survival and clinicopathologic characteristics in patients with CRC. Methods We used RT-PCR to determine both CNV and expression of ARID1A from six CRC cell lines. We used MSP to evaluate methylation of ARID1A. IHC was used to assess ARID1A protein expression. We also evaluated MSI and EMAST status in 18 paired CRC and adjacent normal tissues. 5AzadC was used to assess effect of DNA demethylation on ARID1A expression. Statistical analysis was performed to establish correlations between ARID1A expression and other parameters. Results Among the 18 CRC tumors studied, 7 (38.8%) and 5 tumors (27.7%) showed no or low ARID1A expression, respectively. We observed no significant difference in ARID1A expression for overall patient survival, and no difference between clinicopathological parameters including MSI and EMAST. However, lymphatic invasion was more pronounced in the low/no ARID1A expression group when compared to moderate and high expression group (33% VS. 16.6% respectively. ARID1A promoter methylation was observed in 4/6 (66%) cell lines and correlated with ARID1A mRNA expression level ranging from very low in SW48, to more pronounced in HCT116 and HT-29/219. Treatment with the methyltransferase inhibitor 5-Azacytidine (5-aza) resulted in a 25.4-fold and 6.1-fold increase in ARID1A mRNA expression in SW48 and SW742 cells, respectively, while there was no change in SW480 and LS180 cells. No ARID1A CNV was observed in the CRC cell lines. Conclusion ARID1A expression is downregulated in CRC tissues which correlates with it being a tumor suppressor protein. This finding confirms ARID1A loss of expression in CRC development. Our in-vitro results suggest high methylation status associates with reduced ARID1A expression and contributes to CRC tumorigenesis. However, there was no significant association between ARID1A loss of expression and clinicopathological characteristics. Future in-vivo analysis is warranted to further establish ARID1A role in colorectal neoplastic transformation.

Abstract: 1. Context Endoplasmic reticulum stress (ER stess) is associated with endoplasmic reticulum perturbation homeostasis. Prolonged ER stress conditions may induce cell death. Unfolded protein response (UPR) attempts to restore normal cell conditions. 2. Evidence Acquisition There now exists an emergent body of evidence identifying the WNT signaling network as a regulator of cancer cell metabolism. Given that existing findings show that the WNT pathway and ER stress regulates changes in metabolic activities of cancer cells suggesting these signaling pathways represent critical nodes in the regulation of central metabolism in tumors. 3. Results Findings suggest that the molecular cross-talks between hypoxic ER stress, Wnt/βcatenin signaling, may represent an important mechanism that enables some tumor subtypes to survival and grow in hypoxic conditions. 4. Conclusions The present article disuses differential effects of the activation of the three arms of UPR, namely endoplasmic reticulum kinase (PERK), activation transcription factor -6 (ATF-6), and inositol –requiring enzyme (IRE-1) on cancer. This review also highlights regulators and downstream effectors of Wnt cascade and addresses the increasingly apparent crosstalk of Wnt with other tumorigenic signaling pathways.

Abstract Background: Zataria multiflora Boiss is a well-known medicinal plant and its’ essential oil (EO) is traditionally used for treatment of respiratory and digestive disorders and/or bacterial, viral, fungal, and parasitic infections. Objective: This study was undertaken to evaluate the effect of long-term consumption of Z. multiflora EO on hematological and biochemical parameters in patients infected with liver hydatid disease. Materials and Methods: Fifteen patients were administered orally with Z. multiflora EO (60 mg daily) for six months. Hematological and biochemical analysis were performed on the blood samples of patients before the start of treatment and after completion of the treatment course. In hematological analysis, WBC, RBC, Hb, hematocrit, MCV, MCH, MCHC and platelets were measured. In biochemical analysis, FBS, BUN, creatinine, cholesterol, triglycerides, HDL, LDL, Na, K, Cl, AST, ALT, and ALK were assessed. Results: No apparent changes were observed in the values of hematological parameters of the patients after treatment. No significant changes also occurred in the values of FBS, BUN, creatinine, cholesterol, triglycerides, HDL, LDL, Na, and K. The mean values of AST, ALT and ALK enzymes decreased significantly after treatment (P ˂ 0.05). No adverse clinical event was noticed in the patients during the course of study. Conclusions: Long-term consumption of Z. multiflora EO induced no adverse effect on the hematological and biochemical parameters of patients infected with liver hydatid disease. Since Z. multiflora EO reduced the level of liver transaminases (AST, ALT and ALK), this herbal product may be considered as a hepatoprotective agent in human beings.

Background and Aims. Nonalcoholic fatty liver disease (NAFLD) is common in severely obese individuals undergoing bariatric surgery. Assessing the prevalence and severity of NAFLD seems crucial since it may affect the prevention or development of more severe forms of fatty liver. Methods. This cross-sectional study was conducted on 228 severely obese individuals undergoing bariatric surgery. Abdominal ultrasonography was done, and clinical and biochemical factors (liver enzymes, lipid profile, and fasting blood sugar (FBS)) were assessed. Results. The mean body mass index (BMI) was 43.45±5.92 kg/m2. The prevalence of NAFLD was 49.12% (mild steatosis: 37.5%, moderate steatosis: 36.6%, and severe steatosis: 25.8%). The main risk factors of NAFLD were weight (p=0.002), BMI (p=0.003), alanine aminotransferase (ALT) (p

Background: Bariatric surgery is an appropriate treatment for obese patients with metabolic syndrome. Adipose tissue is an active endocrine tissue secreting leptin and adiponectin that affect body metabolism. Nowadays, a high incidence of metabolic syndrome with an increased risk of serious diseases has been detected in Shiraz. This study aimed to assess the levels of leptin and adiponectin as well as the adiponectin-to-leptin ratio in three different bariatric surgeries among obese patients in Shiraz. The results will play an important role in physicians' choice of surgery by distinguishing the effects of these three bariatric surgeries. Materials and Methods: The serum adiponectin and leptin levels were measured using enzyme-linked immunosorbent assay. Blood glucose, lipid profile, weight, and liver enzyme level were measured before and 7 months after surgery. Results: This clinical trial was conducted on 81 obese patients who underwent sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and single anastomosis sleeve ileal (SASI) bypass surgeries. The results revealed a decrease in fasting blood sugar and triglyceride (TG) levels 7 months after the surgeries. In addition, decrease of body mass index (BMI) was more significantly in the SASI group (12.8 ± 3 4.95) compared to the Roux-en-Y gastric group (8.56 ± 4.61) (P = 0.026). Besides, a more significant improvement in liver function was observed in SG (P < 0.05). Furthermore, the results revealed a significant difference among the three groups regarding the increase in the adiponectin level (P = 0.039). Decrease in the leptin level and increase in the adiponectin level were more significant after the RYGB surgery compared to the SG group (P < 0.05). Conclusion: The three bariatric surgeries were effective in increasing the adiponectin level and decreasing the leptin levels. The surgeries also changed the metabolic risk factors including TGs, high-density lipoprotein, fasting blood glucose, and BMI.

Background: Cancer research is highly dependent of large amount of data and high quality samples which can be provided by networks to enable large-scale multi-center research projects. Biologic materials, such as blood, tissue samples, DNA, body fluids and the related data obtained in cohorts and clinical trials are valuable sources for research which should be managed by policies and standard operating procedures as biorepositories or biobanks. Methods and evidence acquisition: The authors investigated and summarized pubmed database articles using biobanks and describing the policies. Conclusion: biobanking as a young discipline in different countries needs new technologies, standards and harmonization. In this review article, we have an overview on biorepository, cancer biobanking and the emerging registry in Iran. Background: Cancer research is highly dependent of large amount of data and high quality samples which can be provided by networks to enable large-scale multi-center research projects. Biologic materials, such as blood, tissue samples, DNA, body fluids and the related data obtained in cohorts and clinical trials are valuable sources for research which should be managed by policies and standard operating procedures as biorepositories or biobanks. Methods and evidence acquisition: The authors investigated and summarized pubmed database articles using biobanks and describing the policies. Conclusion: biobanking as a young discipline in different countries needs new technologies, standards and harmonization. In this review article, we have an overview on biorepository, cancer biobanking and the emerging registry in Iran.

Abstract Background: Colorectal cancer causes many deaths worldwide and rectal cancer includes one-third of them. Surgical mesorectal excision along with preoperative neoadjuvant chemoradiotherapy is known as the standard treatment for rectal cancer. However, inaccurate preoperative staging is a main concern which leads to large number of patients not being treated with neoadjuvant therapy. Selection of the best treatment approach for these patients is controversial. Although significant better survival was observed is patients who received postoperative adjuvant chemoradiation compared with patients who treated with surgery alone, other studies did not find such results. Due to these contradictory results, this study was designed to further evaluate the survival outcomes in rectal cancer patients who received adjuvant chemoradiotherapy without neoadjuvant therapy. Methods: Totally 197 rectal cancer patients who received adjuvant chemoradiation were included in this study. The demographic and clinico-pathological characteristics of the patients were evaluated by statistical analysis. Results: Based on the univariate cox regression, poor disease free survival (DFS) was significantly associated with male sex and T3 stage. Poor overall survival (OS) was also associated with stage II/III, T3/T4, NI/NII, grade II/III, positive node number (> 3), perineural invasion, lymphovascular invasion, and margin involvement. According to the multivariate cox regression, independent predictive factors for DFS were T3 andT4 stage, and for OS were also T3/ T4 stage, grade II/ III and lymphovascular invasion. Conclusions: Taken together, obtained results indicated that combined adjuvant chemoradiation contributes to improve survival outcomes in the rectal cancer patients who did not received neoadjuvant therapy.

Background: Pelvic organ prolapse recurrence rate is an important issue which impacts the patient's quality of life and results in a new surgical procedure. We use a new technique of laparoscopic pelvic organ suspension (rectal suspension) for pelvic organ prolapse treatment in our center. We evaluated the results of this technique, three months after surgery and at the time of study reporting. Methods: All patients with pelvic organ prolapse for whom laparoscopic pelvic organ prolapse had been done were evaluated. Data were collected from the patient's charts and their short term follow up 3 months after the surgery and their last follow up visit. Demographic, history, physical examination, Wexner's fecal incontinence score and Altomare's Obstructed Defecation Syndrome score, post-operation complications and patient's satisfaction were analyzed, retrospectively. Results: All patients were female with a mean age of 57 ± 11.43 years (range 32–86 years). Mean BMI was 26.1 ± 3.73. Nine patients had rectal bleeding (31%), 18 had prolonged or difficult defecation (62%), 16 had rectal prolapse (55.2%), 11 had gas incontinence (37.9%), 9 had liquid stool incontinence (31%), 5 had stool incontinence (17.2%), 9 had vaginal prolapse (31%), 23 had constipation (79.3%), 9 complaint of pelvic pain (31%), 9 had urge or stress urinary incontinence (31%) and 13 had dyspareunia (44.8%). Conclusions: In conclusion, we believe this procedure has good results in short term follow up (3 months after surgery), but a high recurrence rate in the middle term follow up. Therefore, this procedure is no longer recommended. Resumo: Introdução: A taxa de recorrência do prolapso de órgãos pélvicos é uma questão importante que afeta a qualidade de vida do paciente, resultando em um novo procedimento cirúrgico. Os autores adotaram uma nova técnica de suspensão laparoscópica de órgãos pélvicos (suspensão retal) no tratamento de prolapso de órgãos pélvicos. Os resultados dessa técnica foram avaliados três meses após a cirurgia e no momento do relato do estudo. Métodos: Todos os pacientes com prolapso de órgão pélvico submetidos a suspensão laparoscópica foram avaliados. Os dados foram coletados do prontuário do paciente, na visita de acompanhamento três meses após a cirurgia e na última visita de acompanhamento. Os dados demográficos, histórico médico, avaliação física, escore de incontinência fecal de Wexner, escore da síndrome da defecação obstruída de Altomare, complicações pós-operatórias e satisfação do paciente foram analisados retrospectivamente. Resultados: Todos os pacientes eram do sexo feminino, com média de idade de 57 ± 11,43 anos (variação de 32 a 86 anos). O índice de massa corporal médio foi de 26,1 ± 3,73. Nove (31%) pacientes apresentaram sangramento retal; 18 (62%), defecação prolongada ou difícil; 16 (55,2%), prolapso retal; 11 (37,9%), incontinência gasosa; nove (31%), incontinência fecal líquida, cinco (17,2%), incontinência fecal; nove (31%), prolapso vaginal; 23 (79,3%), constipação; nove (31%), queixa de dor pélvica; nove (31%), incontinência urinária de urgência ou esforço e 13 (44,8%), dispareunia. Conclusões: Os autores acreditam que este procedimento apresenta bons resultados no seguimento de curto prazo (três meses após a cirurgia), mas uma alta taxa de recorrência no acompanhamento a médio prazo. Portanto, esse procedimento não é mais recomendado. Keywords: Pelvic organ prolapsed, Incontinence, Mesh, Wexner's score, Altomare's ODS score, Palavras-chave: Prolapso de órgãos pélvicos, Incontinência, Malha, Pontuação de Wexner, Escore da SDO de Altomare

Wallflower (Erysimum cheiri (L.) Crantz) is a common medicinal plant in Persian medicine and nowadays some traditional products from wallflower are consumed on global markets. The aim of the present study was to study the phytochemical constituents of wallflower and discuss safety evaluations related to the traditional wallflower preparations. Major Persian scholars (e.g. Avicenna) books, Persian manuscripts (e.g. Makhzan-al-advia) and Arabic medical manuscripts (e.g Alshamel-fi alsanaat altebya) of the medieval Islamic era as well as current search engines including Pubmed, Scopus, Siencedirect, and Google Scholar were included in the study from 1700 up to 2018 A.D. In traditional medicine manuscripts, various topical and oral dosage forms of wallflower were administered in low doses. After renaissance, phytochemical investigations reported cardiac steroids in wallflower and it might be the reason that next medical investigations on the herb have been interrupted. According to in vivo studies, topical indications of cardiac steroids in doses lower than their inhibitory concentration 50 (IC50) should be safe and effective in some cutaneous disorders. Wallflower is reported to have several different classes of compounds including: 11 types of cardenolides (such as strophanthidin, bipindogenin, uzarigenin, cannogenol and digitoxygenin derivatives), two flavonoids, a cyanidin and two glucosinolates. Therefore, for safety guarantee, wallflower products require dose adjustment based on IC50 and probable cardenolide soluble content in that dosage forms.

Background: Morbid obesity (body mass index≥40 kg/m2 or >35 kg/m2 with co-morbidity) is an important factor in reducing the quality of life which is influenced by the characteristics of the individual, his social, cultural, and environmental conditions; also, each disease has unique effects on it. Although most of the studies have been conducted on obesity (25>BMI>40), how to prevent it and improve life quality, there is lack of knowledge about what morbid obese people really experience about their life quality. Thus, this qualitative study aimed to explore the viewpoints of morbid obese people about life quality. Methods: In this conventional content analysis, data were collected using semi-structured interviews with 20 morbid obese patients who were referred to nutrition and obesity clinics of Shiraz and Ahvaz Jundishapur University of Medical Sciences. Purposeful sampling was processed from May 2016 to January 2017. The sampling continued until data saturation. Each interview was recorded by audio recorder and typed in the MAXQDA10 software. Data were analyzed after each interview. The meaning units were encoded and the codes were categorized. This trend continued until the main and sub-categories emerged. Results: Data analysis indicated 1835 codes, 76 sub-subcategories, 26 subcategories and 6 main categories including physical changes, psychological experiences, socio-personal dysfunction, negative body image, financial pressure, and change in the spirituality. Conclusion: Final results indicated that life quality had a special definition in morbid obesity and includes very different dimensions. This study can promote health care providers’ knowledge (nurses) for supporting obese people and improving their quality of life by community-based care approaches.

Abstract The current study aimed at investigating the impact of disclosure quality and voluntary disclosure on Information asymmetry of the companies listed in Tehran Stock Exchange. Accordingly, statistical sample including 84 companies listed in Tehran Stock Exchange were studied in a time period of 2006 to early 2016 using Panel regression. In this study, the relationship between voluntary disclosure and Information asymmetry criteria including the domain of difference of bid and offer prices, cash stock and the error of predicting interest as well as the relationship between the rate of disclosure quality and Information asymmetry were examined. In order to examine the normality of data, Kolmogorov-Smirnov Test was used. Significance level of the test for the variables of the domain of difference of bid and offer prices, the error of predicting interest, growth, return on assets and financial leverage was normalized using Johnson Method. Finally, the model was estimated and the results of the study showed a meaningful relationship between voluntary disclosure of information and the rate of disclosure quality with cash stock, but there was not a meaningful relationship between voluntary disclosure of information and the rate of disclosure quality with two other criteria. Based on the results obtained, the released information from companies should be presented orally so that investors could have more tendencies to invest in Stock Exchange. Therefore, the role of Stock Exchange in compelling companies to present clear information gets more and more important Introduction The availability of appropriate information is one of the factors influencing the decision making process. The distribution of required information asymmetrically among individuals can produce different results. Therefore, although information can be important to the decision maker, however, we need to carefully assess the quality of information distribution (Diamond and Verechia, 1991). Hence, the information asymmetry leads to various adverse consequences such as increased transaction costs, market weakness, low liquidity, and, in general, a reduction in the profits from transactions in the capital market. These undesirable outcomes can be modulated by disclosing and clarifying the financial information to reduce the information asymmetry. With regard to the information disclosure process, investors (traders) face the problem of information asymmetry. This problem arises when one of the parties to the transaction has more information than the other party (Davani and Moini, 2007). The improper information issues result from information asymmetry and conflicting incentives for the investors and managers. This will bring about chaos to the capital market performance. Some of the measures taken to reduce these issues are as follows: First, optimal contracts between companies and investors increase the incentive for managers to fully disclose information and leads to a reduction in the misleading evaluations. Secondly, establishing the regulations to bind the managers to fully disclose information will reduce the problem of information asymmetry. Thirdly, these unfavorable issues may be diminished through effective intermediary information such as the views of analysts and the institutions determining the credit rating of the companies (Izadinia and Soroush Yar, 2009). Case study The study statistical population included all the companies listed in Tehran Stock Exchange. Materials & Methods This research was an applied and correlational study. The research project was a quasi-experimental one, which was conducted by using a retrospective approach (through previous information). In this research, we used Tehran Stock Exchange databases, audited financial statements and Rahavard Novin software to collect data and information. Data analysis and testing the research hypotheses along with their results were done according to the outputs obtained from the Eviews software Ver. 9. Discussion and Results This research was aimed to answer the following question: What is the effect the quality of information disclosed by companies on the information asymmetry in Tehran Stock Exchange Companies? In this regard, six sub-hypotheses were developed by using the voluntary disclosure criterion and the quality rating of information disclosure to answer the research questions. The summary of the results is as follows: The first sub-hypothesis of this study examined the relationship between the score of voluntary disclosure of information and the range of the proposed price difference for the purchase and sale of shares. According to the regression results, the significance of the coefficient related to the independent variable of information disclosure was 0.7877, suggesting a lack of significant relationship between these two variables. As a result, the first sub-hypothesis is not verified, which is consistent with the results of Khajavi and Alizadeh Talatapeh research (2014) and contradicts the results of Gao and Zhou (2015) study. The second sub-hypothesis evaluated the relationship between the score of voluntary disclosure of information and the liquidity of the stock shares with the criterion of frequency of transactions. The coefficient of the independent variable of disclosure rating in this test was negative and significant (equal to 0.000). As a result, the second sub-hypothesis was accepted. It should be noted that the initial assumption about the relationship between the disclosure of information and liquidity of shares was the presence of a positive relationship between these two variables, while the test results proved the opposite. One of the possible reasons for this issue may be the inefficiency even at a weak level of the Tehran Stock Exchange. The studies conducted in relation to the efficiency of the Tehran Stock Exchange market confirm its ineffectiveness. The third sub-hypothesis of the study was to investigate the relationship between the score of voluntary information disclosure and the earnings forecast error. Regarding the regression test and the significance of the coefficients, this hypothesis was not accepted and no significant relationship was found between the score of voluntary information disclosure and the earnings forecast error. The fourth sub-hypothesis of this study examined the relationship between the score of voluntary information disclosure and the range of the proposed price difference for the purchase and sale of shares. Based on the results of regression, the significance of the coefficient of the independent variable of disclosure of information was equal to 0.003, suggesting the lack of significant relationship between these two variables. As a result, the fourth sub-hypothesis was not confirmed. The fifth sub-hypothesis of the study was to investigate the relationship between the score of voluntary information disclosure and the stock liquidity. The independent variable coefficient of disclosure rank in this test was negative and significant (equal to 0.000). Accordingly, the fourth sub-hypothesis was accepted. This result was similar to that of the second sub-hypothesis. Finally, the sixth sub-hypothesis of the research investigated the relationship between the score of voluntary information disclosure and the earnings forecast error. Due to the regression test and the significance of the coefficients, this hypothesis was not also accepted and no significant relationship was seen between the information disclosure rate and the earnings forecast error. Since no similar studies have been done on the relationship between disclosure quality and information asymmetry by the above computational approach, consequently, no comparison can be made with other studies. Comparing the results of the two variables of voluntary disclosure score and the rating of information disclosure quality revealed that these two variables have had the same effects on the three dependent variables in this study. The effect of both variables on the stock liquidity is inverse and significant, while their effect on the earnings forecast error is positive and insignificant. The effect of these two variables on the difference range of the proposed price is positive but not significant. According to the obtained results, the information provided by the companies should be presented in a transparent manner so that the investors will be more willing to invest in the securities. Hence, the role of the Stock Exchange Organization becomes increasingly important in requiring the companies to provide transparent information. In addition, more serious laws should be established by the government to bind the companies for providing early and more accurate information. Along with regarding the financial statements and internal information of the companies, the investors should also pay further attention to the outsourcing information and consider such information in their analyses.

Background: Stapled hemorrhoidopexy is a safe and acceptable alternative to traditional hemorrhoidectomy with shorter hospital stay, better satisfaction, and less postoperative pain. There have, however, been reports on early and late complications. Therefore, the present study was designed to assess the impact of stapled hemorrhoidopexy on anorectal function and continence. Methods: Sixty-one patients with rectal prolapse and/or symptomatic circumferential hemorrhoidal disease, as validated by the Wexner incontinence score, were included. Anal manometric indices were measured. The Wexner scores and anal manometric measures were compared pre- and postoperatively using the Mann–Whitney U test. (A P

A multi-fidelity micro combustor design approach is developed for a small-scale combined heat and power CHP system. The approach is characterised by the coupling of the developed preliminary design model using the combined method of 3D high-fidelity modelling and experimental testing. The integrated multi-physics schemes and their underlying interactions are initially provided. During the preliminary design phase, the rapid design exploration is achieved by the coupled reduced-order models, where the details of the combustion chamber layout, flow distributions, and burner geometry are defined as well as basic combustor performance. The high-fidelity modelling approach is then followed to provide insights into detailed flow and emission physics, which explores the effect of design parameters and optimises the design. The combustor is then fabricated and assembled in the MGT test bench. The experimental test is performed and indicates that the designed combustor is successfully implemented in the MGT system. The multi-physics models are then verified and validated against the test data. The details of refinement on lower-order models are given based on the insights acquired by high-fidelity methods. The shortage of conventional fossil fuels and the continued demand for energy supplies have led to the development of a micro-turbine system running renewable fuels. Numerical analysis is then carried out to assess the potential operation of biogas in terms of emission and performance. It produces less NOx emission but presents a flame stabilisation design challenge at lower methane content. The details of the strategy to address the flame stabilisation are also provided.

Background: Previous studies have reported that gastrectomy and fundectomy can induce osteopenia. Body fat index is a new index of obesity that shows central obesity and other risks of obesity. Sleeve gastrectomy (SG) is a bariatric surgery and a new technique introduced as subsleeve, which only resected fundus of the stomach. In this study, it has been shown the effect of subsleeve and SG on fat index and bone densitometry in an animal model. Materials and Methods: Rabbits were underlined SG, fundectomy (surgical removal of fundus), or sham-operated (controls without any resection), and after 12 weeks, fat index and bone densitometry were obtained. Results: Our study showed that there was no significant difference between SG and fundectomy groups in bone mass density and fat mass after surgery in comparison with presurgery condition. SG group were associated with lower fat index and bone density, and it showed significantly decrease in weight after 1.5 months. Conclusion: Sub-SG did not show any significant effect on fat index and bone densitometry in comparison with SG. However, we found lower fat index in sleeve group of rabbits, but it was not statistically significant.

Background: Perianal fistula is a complicated disorder and most difficult to manage. New treatment methods would help surgeons to achieve a better outcome in patients with perianal fistula. Human amniotic membrane (HAM) has positive effects on wound healing in several conditions. The present study aimed to further determine the effect of HAM on wound healing of perianal fistula in rabbits. Methods: In a prospective experimental study, 14 male rabbits (aged 4-6 months and weighing 3-4 kg) were randomly divided into 2 groups. After 12 weeks, the high type perianal fistula was repaired with endorectal flap (ERF) and ERF plus HAM in the control and case groups, respectively. In all rabbits of the case group, a 1×1 cm width wrap of HAM was applied and fixed around the ERF site. Three weeks later, the repaired site of the perianal fistula was sent for pathologic wound healing scoring. The results were analyzed with the SPSS 21.0 software using Mann-Whitney test. Results: Six rabbits of each group survived the study period. There was a statistically significant difference in wound healing between the case and control groups (P

Background: In recent years, single-port laparoscopic colectomy (SPLC) has been introduced as a new technique for colorectalsurgery. Despite several studies, available results are too sparse to accurately identify differences between SPLC and conventionalmultiport laparoscopic colectomy (MPLC). In a continuing effort, the aim of this study was to compare these two techniques in coloncancer patients.Methods: 76 patients with colon cancer who underwent either SPLC or MPLC took part in this study. Demographic data and complicationssuch as age, gender, operative time, hospital stay, intra-operative blood volume loss, and internal organ injury were assessed.The patients were followed up for 6 months. Statistical analysis was performed by SPSS software using Student’s t-test, Chi-squaretest, or Fisher’s exact test.Results: The complications were similar in both SPLC and MPLC groups. Operative time was significantly lower in SPLC (P = 0.003).No significant differences were observed in other factors (P > 0.05).Conclusions: According to studies conducted so far, it seems that the difference in the surgeon’s experience, types of the colorectaldiseases, and types of the colorectal resection may affect the outcomes like operative time and hospital stay. Therefore, furthercoherent investigations with larger datasets are essential for a detailed comparison.

Background: Bariatric surgery is the most effective intervention for treatment of severe obesity and patient’s adherence to self management behaviors are essential to reduce complications after surgery. The purpose of this study was to investigate the validity and reliability of bariatric surgery self-management behaviors questionnaire (BSSQ) in Iranian population. Methods: From December 2016 till June 2016, all obese patients who underwent laparoscopic obesity surgery in Shiraz Ghadir Mother and Child Hospitalwere were enrolled. Their demographic characteristics, BSSQ, General Adherence Scale (GAS), and the Specific Adherence Scale (SAS) questionnaires were collected. The content, structural and simultaneous validity and factor analysis were determined using GAS and SAS questionnaires. Results: According to psychometric factors including eating behaviors, fluid intake, vitamin and mineral supplement intake, fruits, vegetables, whole grain and protein intake, physical activity and dumping syndrome management, 6 factors could explain 61.5% of BSSQ. Total score of correlation matrix BSSQ with GAS and SAS were 0.36 and 0.70. For reliability, the Cronbach’s alpha coefficient was found 0.90 and Guttmann split-half coefficient was 0.78. Conclusion: BSSQ was shown to have an acceptable validity and reliability to be used for assessing the bariatric surgery self-management behaviors in Iranian population.

Background: Since studies have demonstrated that morbid obesity can exponentially impair quality of life, the measurement of quality of life is paramount to monitoring the effects of treatment and influences the development of clinical pathways, service provision, healthcare expenditures, and public health policy. Accordingly, clinicians, researchers, and policy makers must rely on valid instruments. Aim: This study aimed to review and critique the psychometric properties of some specific tools by COSMIN checklist and their application among morbidly obese individuals. Method: We searched PubMed, Web of Science, PsycINFO, Ovid, Elsevier, and ScienceDirect by using the keywords related to the Quality of Life Questionnaire, namely “morbid obesity”, “tool”, and “scale”, to retrieve articles published during 1989-2017. Then, the psychometric properties of the selected tools were assessed using the COSMIN checklist. Results: Most of the tools had not reported complete and desirable psychometrics properties. Demonstration of responsiveness from independent randomized controlled trials was not available in two of the eight questionnaires. These tools also did not report proper definition of interpretability. However, the data obtained by COSMIN checklist showed that Laval questionnaire is a proper scale for measuring quality of life in obese individuals, which can be recommended to researchers. Implications for Practice: Although Laval questionnaire was found a proper tool for measuring the quality of life among morbid obese patients, developing an instrument suitable for different societies with varied cultural and social characteristics is suggested because socio-cultural factors can influence the quality of life.