Publications by authors named "Ali Jangjoo"

49 Publications

Elucidated tumorigenic role of MAML1 and TWIST1 in gastric cancer is associated with Helicobacter pylori infection.

Microb Pathog 2021 Nov 21:105304. Epub 2021 Nov 21.

Medical Genetics Research Center, Faculty of Medical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran. Electronic address:

Background: Epithelial-mesenchymal transition (EMT) has a fundamental role in tumor initiation, progression, and metastasis. Helicobacter pylori (HP) induces EMT and thus causes gastric cancer (GC) by deregulating multiple signaling pathways involved in EMT. TWIST1 and MAML1 have been confirmed to be critical inducers of EMT via diverse signaling pathways such as Notch signaling. This study aimed to investigate for the first time possible associations between TWIST1/MAML1 mRNA expression levels, HP infection, and clinicopathological characteristics in GC patients.

Method: TWIST1 and MAML1 mRNA expression levels were evaluated in tumoral and adjacent normal tissues in 73 GC patients using the quantitative reverse transcription PCR (RT-qPCR) method. PCR technique was also applied to examine the infection with HP in GC samples.

Results: Upregulation of TWIST1 and MAML1 expression was observed in 35 (48%) and 34 (46.6%) of 73 tumor samples, respectively. Co-overexpression of these genes was found in 26 of 73 (35.6%) tumor samples; meanwhile, there was a significant positive correlation between MAML1 and TWIST1 mRNA expression levels (P < 0.001). MAML1 overexpression exhibited meaningful associations with advanced tumor stages (P = 0.006) and nodal metastases (P ˂ 0.001). 34 of 73 (46.6%) tumors tested positive for HP, and meanwhile, MAML1 expression was positively related with T (P = 0.05) and grade (P = 0.0001) in these HP-positive samples. Increased TWIST1 expression was correlated with patient sex (P = 0.035) and advanced tumor grade (P = 0.017) in HP-infected tumors. Furthermore, TWIST1 and MAML1 expression levels were inversely linked with histologic grade in HP-negative tumor samples (P = 0.021 and P = 0.048, respectively).

Conclusion: We propose TWIST1 and MAML1 as potential biomarkers of advanced-stage GC that determine the characteristics and aggressiveness of the disease. Based on accumulating evidence and our findings, they can be introduced as promising therapeutic targets to modify functional abnormalities in cells that promote GC progression. Moreover, HP may enhance GC growth and metastasis by disrupting TWIS1/MAML1 expression patterns and related pathways.
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http://dx.doi.org/10.1016/j.micpath.2021.105304DOI Listing
November 2021

Macro- and Micro-nutrient Intake Adequacy in Gastric Bypass Patients after 24 Months: a Cross-sectional Study.

Clin Nutr Res 2021 Oct 22;10(4):341-352. Epub 2021 Oct 22.

Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad 91779-48564, Iran.

Decreased food intake is an effective mechanism for gastric bypass surgery (GBS) for successful weight loss. This cross-sectional study aimed to assess dietary intake, micro-and macro-nutrients in the patients undergoing GBS and determine the possible associations with weight changes. We assessed anthropometric indices and food intake at 24 month-post gastric bypass surgery. Dietary data was evaluated using three-day food records. After the 24 months of surgery, among 35 patients (mean age: 43.5 ± 11.2 years; 82.85% females), with the mean body mass index (BMI) of 30.5 ± 4.5 kg/m, 17 cases were < 50% of their excess weight. The average daily calorie intake was 1,733 ± 630 kcal, with 14.88% of calories from protein. Consumption amounts of protein (0.82 ± 0.27 g/kg of the current weight), as well as fiber, and some micro-nutrients (vitamin B9, E, K, B5, and D3) were lower than recommended amounts. Patients were classified into three groups based on their success in weight loss after surgery. Calorie intake was not significantly different between groups, but successful groups consumed considerably more protein and less carbohydrate than the unsuccessful group (p < 0.05). Based on our findings, the patients undergoing GBS had inadequate macro- and micro-nutrient intake after 24 months. However, protein intake can affect patients' success in achieving better weight loss. Long-term cohort and clinical studies need to be conducted to comprehend this process further.
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http://dx.doi.org/10.7762/cnr.2021.10.4.341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575647PMC
October 2021

The Accuracy of Visceral Adiposity Index for the Screening of Metabolic Syndrome: A Systematic Review and Meta-Analysis.

Int J Endocrinol 2021 26;2021:6684627. Epub 2021 Jul 26.

Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Background And Aims: Visceral adiposity index (VAI) is a novel marker of fat distribution and function which incorporates both anthropometric and laboratory measures. Recently, several studies have suggested VAI as a screening tool for metabolic syndrome (MetS). Here, we aimed to consolidate the results of these studies by performing a systematic review and meta-analysis.

Methods And Results: We searched PubMed and EMBASE online databases for eligible studies that investigated the association of VAI and MetS. After reviewing 294 records, we included 33 eligible papers with a sum of 20516 MetS and 53242 healthy participants. The risk of bias in the included studies was assessed, and the relevant data was extracted. All included studies reported a significant association between VAI and MetS screening, but were highly heterogeneous in their reported effects. We pooled the diagnostic test accuracy metrics of VAI for MetS screening and showed that it has a moderate-to-high accuracy with an area under the summary receiver operating characteristics curve of 0.847, a pooled sensitivity of 78%, and a pooled specificity of 79%. Besides, we pooled the difference in means of VAI between patients with MetS and healthy controls, revealing that VAI was 2.15 units higher in MetS patients.

Conclusions: VAI is an accurate, low-cost, and widely available screening marker for MetS. However, further studies are needed to evaluate its applicability in clinical practice, determine an optimal cut-off, and identify populations that would benefit the most from it.
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http://dx.doi.org/10.1155/2021/6684627DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8331306PMC
July 2021

The Role of Lipid Profile as an Independent Predictor of Non-alcoholic Steatosis and Steatohepatitis in Morbidly Obese Patients.

Front Cardiovasc Med 2021 31;8:682352. Epub 2021 May 31.

Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.

Obesity is one of the major health problems worldwide. Morbid obesity (body mass index >40 kg/m or over 35 with a comorbidity) is associated, apart from other diseases, with an increased risk of non-alcoholic fatty liver disease (NAFLD). Moreover, dyslipidemia is an important comorbidity that is frequently found in NAFLD patients. The aim of this study was to analyze whether serum lipids in morbidly obese patients are associated with the spectrum of NAFLD. Total serum cholesterol, LDL cholesterol, HDL cholesterol, non-HDL cholesterol, VLDL, and triglycerides were analyzed in 90 morbidly obese patients. The association of lipid profile parameters with histopathological, elastographic, and sonographic indices of NAFLD, non-alcoholic steatohepatitis (NASH), and liver fibrosis were explored. The mean levels of serum total cholesterol, LDL-C, and non-HDL cholesterol in patients with positive histology for liver steatosis and NASH were significantly higher than those in patients with negative histology. None of the indices showed a strong association with NAFLD, NASH, or liver fibrosis after adjustment for potential confounders. A slight predictive value of lipid profile is not sufficiently enough to use solely as a non-invasive test in predicting NASH or liver fibrosis.
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http://dx.doi.org/10.3389/fcvm.2021.682352DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8200672PMC
May 2021

The predictive role of parathyroid hormone for non-alcoholic fatty liver disease based on invasive and non-invasive findings in candidates of bariatric surgery.

Eat Weight Disord 2021 May 17. Epub 2021 May 17.

Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: Non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH) and hepatic fibrosis are the most detrimental hepatic abnormalities associated with increased body weight with devastating clinical outcomes. Therefore, there is a substantial necessity for efficient management strategies, including significant weight reduction. Bariatric surgery has been used as a therapeutic approach in a selected obese patient with NAFLD/NASH and other cardiometabolic comorbidities.

Purpose: The study is focused on the predictive role of PTH with the indices of hepatic steatosis/NAFLD and NASH based on liver biopsy, elastography, and sonography in morbidly obese patients.

Methods: Ninety patients with BMI between 35 and 40 kg/m with more than two comorbidities who referred to Imam Reza outpatient clinic from December 2016 to September 2017 were recruited and underwent initial assessments, including demographic profiles, psychological assessment, anthropometric measurements, hepatic biopsy, and basic laboratory tests. Liver stiffness was evaluated using two-dimensional shear wave elastography (2D-SWE) at least two weeks before liver biopsy. The histological analysis of the liver was performed using biopsy samples which obtained from left hepatic lobe during bariatric surgery under direct surgeon observation using a 16-gauge Tru-cut needle. The study was approved by the ethical committee (IR.MUMS.fm.REC.1396.312).

Results: The level of PTH was significantly high in patients with positive histology for hepatic fibrosis, steatosis, and NASH/NAFLD compared to patients with negative histology (p = 0.005, p = 0.009, and p = 0.013, respectively). Also, patients with liver fibrosis confirmed by elastography had significantly higher serum PTH concentration than patients without fibrosis (p = 0.011). PTH was also positively correlated with hepatic fibrosis, NASH, and steatosis (p = 0.007, p = 0.012, p = 0.023, respectively).

Conclusion: High levels of PTH was significantly associated with histological indices of (hepatic fibrosis, steatosis, NAFLD and NASH) and elasticity indices. Therefore, it is imperative to assess for high levels of PTH in the morbidly obese population pre-and post-bariatric surgery. However, for a more robust and comprehensive assessment, a randomized controlled trial is needed. The study was conducted in accordance with the practice guidance in the diagnosis and management of NAFLD from the American association for the study of liver disease (AASLD) 2018.

Level Iii: Evidence obtained from well-designed cohort or case-control analytic studies.
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http://dx.doi.org/10.1007/s40519-021-01151-2DOI Listing
May 2021

Associations between Pre-Bariatric High-Sensitivity C-Reactive Protein and Post-Surgery Outcomes.

Diagnostics (Basel) 2021 Apr 18;11(4). Epub 2021 Apr 18.

Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad 91779-48564, Iran.

Background: Obesity is a chronic inflammatory condition associated with increased circulating levels of C-reactive protein (CRP). Bariatric surgery has been reported to be effective in improving both inflammatory and liver status. Our aims were to elucidate the relationships between pre-surgery high sensitivity-CRP (hs-CRP) values and post-surgery weight loss and liver steatosis and fibrosis in patients with severe obesity undergoing Roux-en-Y gastric bypass.

Methods: We conducted an observational prospective study on 90 individuals with morbid obesity, who underwent gastric bypass. Anthropometric indices, laboratory assessment (lipid panel, glycemic status, liver enzymes, and hs-CRP), liver stiffness and steatosis were evaluated at baseline and 6-months after surgery.

Results: There was a significant post-surgery reduction in all the anthropometric variables, with an average weight loss of 33.93 ± 11.79 kg; the mean percentage of total weight loss (TWL) was 27.96 ± 6.43%. Liver elasticity was significantly reduced (from 6.1 ± 1.25 to 5.42 ± 1.52 kPa; = 0.002), as well as liver aminotransferases, nonalcoholic fatty liver disease fibrosis score (NFS) and the grade of steatosis. Serum hs-CRP levels significantly reduced (from 9.26 ± 8.45 to 3.29 ± 4.41 mg/L; < 0.001). The correlations between hs-CRP levels and liver fibrosis (elastography), steatosis (ultrasonography), fibrosis-4 index, NFS, and surgery success rate were not significant. Regression analyses showed that serum hs-CRP levels were not predictive of liver status and success rate after surgery in both unadjusted and adjusted models.

Conclusions: In patients with morbid obesity, bariatric surgery caused a significant decrease in hs-CRP levels, liver stiffness and steatosis. Baseline hs-CRP values did not predict the weight-loss success rate and post-surgery liver status.
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http://dx.doi.org/10.3390/diagnostics11040721DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8073671PMC
April 2021

Tension pneumothorax in patient with COVID-19 infection.

Radiol Case Rep 2021 Feb 2;16(2):358-360. Epub 2020 Dec 2.

Department of Surgery, Mashhad University of Medical Sciences, Ebne Sina St., Mashhad, 9137913316, Iran.

Corona-virus infection that arose from China is now a global pandemic. It presents with a variety of pulmonary manifestations, most commonly in the form of ground glass pulmonary lesions and opacities. Less common manifestation such as pnuemothorax has been reported by some authors. In this study we report a 56-year-old man with Corona-virus disease presenting with tension pneumothorax, a rare and life-threatening complication of Corona-virus infection that has not been reported previously. In our case, after insertion of thoracostomy tube, the patient's symptoms improved. After about 1 year of Corona-virus pandemic, it still presents with some rare pulmonary and extrapulmonary manifestations, so, familiarity with these manifestations is important for a correct diagnosis and treatment.
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http://dx.doi.org/10.1016/j.radcr.2020.11.044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7709726PMC
February 2021

"Comparison of thyroid volume, TSH, free t4 and the prevalence of thyroid nodules in obese and non-obese subjects and correlation of these parameters with insulin resistance status".

Caspian J Intern Med 2020 May;11(3):278-282

Background: To compare thyroid volume, thyroid stimulating hormone (TSH), free t4 and the prevalence of thyroid nodules between obese and non-obese subjects. Also, the association between BMI and insulin resistance status with various parameters of thyroid gland was evaluated.

Methods: Fifty-two patients with obesity and 38 volunteers aged 20-50 years with normal body mass index (BMI), were enrolled in this cross-sectional study. Patients with diabetes, history of thyroid disorders, and patients, who were taking medications that influence their blood glucose or insulin levels or modified thyroid function tests, were excluded. TSH, free t4, insulin and glucose and thyroid sonography were carried out and the results compared between two groups. P<0.05 was considered as significant.

Results: Thyroid volume was higher (p<0.001) and free t4 was lower (p<0.001) in patients with obesity but there was no difference in TSH between groups. Prevalence of thyroid nodules was 15.7% and 10.8% in obese and non-obese groups, respectively (p=0.51). Frequency of nodules was significantly higher in insulin resistant than non- insulin resistant subjects (22% vs.2%, p=0.01). BMI was associated with thyroid volume (r=0.44, p<0.001) and free t4 (r=-0.35, p=0.001). HOMA-IR (homeostatic model assessment for insulin resistance) had no correlation with thyroid volume (p=0.38), but associated with free t4 (r=-0.25, p=0.01).

Conclusion: Free T4 was lower and volume of thyroid was higher in obese subjects, but TSH and frequency of thyroid nodules had no significant difference between obese and non-obese counterparts. Insulin resistant individuals had more nodules but thyroid volume was mainly associated with BMI.
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http://dx.doi.org/10.22088/cjim.11.3.278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442458PMC
May 2020

Evaluation of serum level of substance P and tissue distribution of NK-1 receptor in colorectal cancer.

Mol Biol Rep 2020 May 10;47(5):3469-3474. Epub 2020 Apr 10.

Department of Clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Colorectal cancer (CRC) is known as the most common form of malignancies in the world and its occurrence is annually increasing. Due to the relatively high death rates in patients, finding better diagnostic and prognostic factors are required. Substance P (SP) belongs to the tachykinin family that acts as an immunomodulator by binding to the neurokinin-1 receptor (NK1R). The interaction of SP with NK1R might be involved in tumor cell proliferation, angiogenesis, and migration. Hence, this study was aimed to evaluate the serum SP level and tissue distribution of NK1Rs in CRC. Also, we assessed the relationship between tissue distribution of NK1R and some different tumor characteristics, including tumor size, and lymph node status. Recruiting 38 patients primarily diagnosed with CRC, the tissue distribution of NK1R was immunohistochemically evaluated in tumor tissues and their adjacent normal tissue. The serum level of SP was measured using an ELISA method in both cases and healthy control group. The SP value was significantly increased in the serum of patients in comparison with the healthy group (p = 0.001). Tumor tissues expressed a higher number of NK1R than adjacent normal tissues (p = 0.01) considering both the percentage of stained cells and intensity of staining. However, there was not any statistically significant relevance between NK1R distribution and tumor characteristics. The SP/NK1R system is involved in tumorigenesis of CRC, and might be suggested as a potent prognostic or diagnostic factor, or a new target in the treatment of CRC.
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http://dx.doi.org/10.1007/s11033-020-05432-4DOI Listing
May 2020

Hepatic Function and Fibrosis Assessment Via 2D-Shear Wave Elastography and Related Biochemical Markers Pre- and Post-Gastric Bypass Surgery.

Obes Surg 2020 06;30(6):2251-2258

Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: Nonalcoholic fatty liver disease (NAFLD) exhibits a worldwide distribution and encompasses a wider range of hepatic abnormalities that can culminate in serious clinical outcomes. The growing incidence of NAFLD necessitates more efficient management strategies particularly in clinically severe obese patients. Weight reduction is the cornerstone of NAFLD treatment; therefore, bariatric surgery could be a therapeutic approach in selected obese patients afflicted with NAFLD and other cardiometabolic comorbidities.

Objective: The present study focused on the potential role of bariatric surgery on hepatic function and NAFLD-related histopathological features measured through a noninvasive method.

Method: Ninety patients entered to this study and underwent initial preoperative assessments including demographic profile, anthropometric measurements, standard laboratory tests, and hepatic biopsy. Liver stiffness was also evaluated via two-dimensional shear wave elastography (2D-SWE). All assessments were repeated over the subsequent 6 months following surgery except for liver biopsy.

Results: Postoperative hepatic elasticity was lessened after 6 months (p = 0/002).The levels of alanine aminotransferase, gamma-glutamyl transferase, total protein, lipid indices, glucose, and platelet count were also improved following surgery (p < 0/001). Further progression of fibrosis was observed in 25% of patients after surgery.

Conclusion: Bariatric surgery was associated with a favorable impact on anthropometric and hepatic elasticity indices as well as metabolic parameters. The ideal target population for bariatric surgery should be thoroughly addressed, and the underlying risk factors for fibrosis progression need to be controlled before surgery. However, expanded research designed as comprehensive randomized controlled trials are recommended to confirm these findings.
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http://dx.doi.org/10.1007/s11695-020-04452-0DOI Listing
June 2020

Measurement of Liver Stiffness with 2D-Shear Wave Elastography (2D-SWE) in Bariatric Surgery Candidates Reveals Acceptable Diagnostic Yield Compared to Liver Biopsy.

Obes Surg 2019 08;29(8):2585-2592

Department of Radiology, Faculty of Medicine, Islamic Azad University-Mashhad Branch, Mashhad, 9137714639, Iran.

Background: Nonalcoholic fatty liver disease (NAFLD) is common among severely obese patients. Two-dimensional shear wave elastography (2D-SWE) has been validated as a noninvasive diagnostic tool for liver stiffness measurement. However, the technical feasibility and accuracy of this method in severely obese patients are still under debate.

Objective: We aimed to assess the diagnostic accuracy of 2D-SWE in bariatric surgery candidates in comparison with the gold standard liver biopsy.

Methods: Ninety severely obese candidates for bariatric surgery were included. Liver stiffness was measured using 2D-SWE 14 days before liver biopsy. Liver biopsy was taken on the day of surgery. The area under the receiver operating curve (AUROC) was calculated for the staging of liver fibrosis.

Results: 2D-SWE was performed in 97.3% of patients successfully. Histologic stages of fibrosis (F0-F4) were detected in 34.2%, 36%, 6.3%, 3.6%, and 0.9% of patients, respectively. The AUROC for 2D-SWE was 0.77 for F1, 0.72 for F2, 0.77 for F3, and 0.70 for F4. In univariate analysis, 2D-SWE values were correlated with BMI, waist circumference, NAFLD activity score (NAS), and steatosis, whereas these components did not affect liver stiffness in multivariate analysis.

Conclusion: Two-dimensional shear wave elastography of the liver can be feasible and has good accuracy in severely obese candidates for bariatric surgery. Therefore, 2D-SWE may be a good option for assessing liver fibrosis, especially in the early stages of fibrosis to lessen complications of surgery in this population. However, this method should be applied on a larger scale for late stage of fibrosis.
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http://dx.doi.org/10.1007/s11695-019-03889-2DOI Listing
August 2019

Isolation and identification of chemotherapy-enriched sphere-forming cells from a patient with gastric cancer.

J Cell Physiol 2018 10 10;233(10):7036-7046. Epub 2018 May 10.

Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Gastric cancer (GC) is the third and fifth cause of cancer-associated mortality for men and women throughout the world, respectively. Despite the use of surgery and chemotherapy for GC therapy, there are no efficient therapeutic protocols for it to date. Cancer stem cells (CSCs) due to their pivotal role in tumor initiation, growth, progression, invasion, distant metastasis, recurrence and resistance to anticancer drugs are very appealing targets for cancer therapies. Here, we isolated and identified CSCs from a chemotherapy-treated patient. Small subpopulation of dissociated cells after tissue digestion formed spheroid colonies in serum-free media under the non-adherent condition. These spheroid colonies differentiated into epithelial like cells in serum-containing medium. Few sphere-forming cells carried CD44 and CD54 markers overexpressed DLL4 that is responsible for tumor growth and angiogenesis. Subcutaneous injections of sphere-forming cells in different passages conferred tumorigenicity in nude mice. Sphere-forming cells upregulated CD44 polymorphisms CD44v3, -v6, and -v8 -10, stemness factors OCT4, SOX2, SALL4 and Cripto-1, self-renewal molecules IHh, Wnt, β-catenin and BMI1, and epithelial mesenchymal transition (EMT) markers Twist1 and Snail1 in vitro and in vivo. Moreover, these cells similar to sphere-forming cells isolated from a chemotherapy-free patient expressed Oct-4 and β-catenin proteins. However, the Twist1 protein was only expressed by sphere-forming cells derived from the chemotherapy-treated patient. Thus, these cells have all the characteristics of stationary and migratory CSCs, including tumorigenicity, self-renewal, pluripotency, invasion and metastasis. Taken together, targeting chemotherapy-enriched CSCs as chemo-resistance cells observed in GC patients can provide more effective therapeutic strategies compared to untreated patients.
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http://dx.doi.org/10.1002/jcp.26627DOI Listing
October 2018

Effect of oral ginger on prevention of nausea and vomiting after laparoscopic cholecystectomy: a double-blind, randomized, placebo-controlled trial.

Electron Physician 2018 Feb 25;10(2):6354-6362. Epub 2018 Feb 25.

M.D., Cardiac Anesthesiologist, Assistant Professor, Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: Postoperative nausea and vomiting (PONV) are among the most frequent complications following laparoscopic cholecystectomy. Recently, some studies have shown ginger, as an herbal medicine, to be effective and safe in PONV prevention; however, there is no evidence of its efficacy in the Iranian population.

Objective: The aim of this study was to determine the effect of oral ginger on PONV prevention after laparoscopic cholecystectomy.

Methods: This double-blind, randomized, placebo-controlled clinical trial was performed on women who were undergoing laparoscopic cholecystectomy in Imam Raza Hospital, Mashhad, Iran between April and November, 2016. Patients were divided randomly into two groups of G) intervention group (n=75, received 2 capsules containing 250 mg ginger) and P) placebo group (n=75, received 2 placebo capsules) one hour before surgery. Nausea severity and vomiting frequency were evaluated at 2, 4, 6, and 12 hours after the operation. Data analysis was done by SPSS version 16.0 software with Chi-square test, Independent-sample-t-test, repeated measure ANOVA and Mann-Whitney U test.

Results: The two groups were homogenous in terms of age, gender and surgery duration. The severity of nausea was lower in the ginger group at the 2, 4, 6, and 12 hours after the operation; however, these differences were statically significant only at 2 (p=0.034) and 12 hours (p=0.043). Although the incidence of vomiting was higher in the placebo group in the 2nd and 12th hours after surgery, the number of vomiting episodes in 2, 4, 6 and 12 hours after surgery was statistically similar in the two groups (p>0.05). The nausea severity was significantly changed during 12 hours of study in both groups (p=0.001), however the nausea severity was always lower in the ginger group (p=0.078).

Conclusion: This study demonstrated that 500mg oral ginger one hour before surgery in women who were undergoing laparoscopic cholecystectomy is effective in decreasing severity of PONV.

Trial Registration: The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2016122222218N2.

Funding: The study was financially supported by Deputy of Research of Mashhad University of Medical Sciences.
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http://dx.doi.org/10.19082/6354DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878030PMC
February 2018

The relation between pro-oxidant antioxidant balance and glycolipid profile, 6 months after gastric bypass surgery.

Surg Obes Relat Dis 2018 03 11;14(3):361-367. Epub 2017 Dec 11.

Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Electronic address:

Background: Morbid obesity is a chronic disease that contributes to increased oxidative stress. Gastric bypass surgery is the gold standard method in treating co-morbidities.

Objectives: The objective of this study was to evaluate the relation between pro-oxidant antioxidant balance (PAB) as one measure of oxidative stress and glycolipid profile 6 months after gastric bypass surgery.

Setting: Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

Methods: Thirty-five morbidly obese patients with body mass index ≥35 kg/m with co-morbidities or ≤40 kg/m were randomly recruited. The PAB assay was used to estimate oxidative stress. Anthropometrics and glycolipid profile were collected at recruitment and 6 months after surgery. Statistical analysis was performed using SPSS 16 software.

Results: The study showed a significant postoperative reduction in serum PAB values compared with the baseline (P<.001). All anthropometric and several glycolipid parameters significantly reduced after surgery (P<.001), while serum high-density lipoprotein cholesterol was unaffected. Repeated measures analysis of variance showed that postoperative PAB values were affected by gastric bypass surgery (F = 12.51, P = .001). Regression analysis demonstrated medication usage controlling co-morbidities (β^ = -.6, P = .002) and fasting blood glucose (β^ = .41, P = .04) as independent factors in predicting PAB values 6 months after surgery.

Conclusions: Gastric bypass surgery can reduce PAB values in favor of antioxidants 6 months after the operation. Accordingly, fasting blood glucose after gastric bypass surgery can be an independent factor in predicting PAB values.
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http://dx.doi.org/10.1016/j.soard.2017.12.002DOI Listing
March 2018

Three Anastomotic Techniques Following Laparoscopic Rectal Cancer Resection: Our Experience in 155 Patients.

Surg Innov 2018 Feb 9;25(1):57-61. Epub 2017 Dec 9.

4 Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Purpose: This study aimed to assess the impact of 3 anastomotic techniques after laparoscopic rectal cancer resection.

Methods: In a cross-sectional study, the data of 155 patients who underwent surgery for rectal cancer were retrieved. An anastomosis was created between the left colon and anal canal with 3 different methods: coloanal anastomosis with protective ileostomy (group A), coloanal anastomosis without ostomy (group B), and delayed coloanal anastomosis (group C). The rates of anastomotic problems (leakage, peritonitis, and collection) were calculated for each treatment method. Multivariate analysis was used to verify the effect of anastomosis techniques.

Results: In 5 (3.2%) patients, peritonitis was observed in which 3 (9.7%) of them belonged to group B and 2 (4.1%) belonged to group C. In 9 (5.8%) patients, presacral collection and anastomotic leakage were observed; 4 (8.2%) patients belonged to group C, 4 (12.9%) patients to group B, and 1 (1.3%) patient to group A. Postoperative obstructions occurred in 5 (10.2%) patients of group C, 2 (6.5%) patients of group B, and 2 (2.7%) patients of group A. Rectovaginal fistula was detected in 2 patients from group B.

Conclusions: Laparoscopic surgery of rectal cancer with transanal method is reliable and acceptable in terms of oncologic and surgical results. This study showed the best results in patients who had protective ostomy.
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http://dx.doi.org/10.1177/1553350617745976DOI Listing
February 2018

A Comparative Study on the Results of Estimating Children's Weights Based on Arm Circumference, Height, and Body Habitus against Estimated Weight Broselow on 2-24 Months Children in Isfahan.

Adv Biomed Res 2017 28;6:104. Epub 2017 Aug 28.

Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Resuscitation of children in different treatment wards is a challenge. Given that the pediatric drug dosing is based on weight and weighing is not practical in emergency situations, it is critical to employ a fast, easy, and reliable technique. Hence, this study attempted to evaluate the real weight children against Broselow estimation.

Materials And Methods: This cross-sectional study involved 1500 children of 2-24 months referred to Isfahan urban and rural health centers in 2015. Children's estimated weights were measured based on the standard Broselow tape and real weights through a digital scale. The factors such as age, sex, height, arm circumference, head circumference, and living place of children were recorded. The collected data were analyzed through independent -test, ANOVA, and linear regression using SPSS (version 20).

Results: The weight difference of children through Broselow estimation was 0.019 kg, and the correlation coefficient was 0.893 ( > 0.05). The difference sorted by age ranges was significant only in >12 months ( < 0.05). It was estimated at error of 10% to be 68.9% correctly. The mean weight estimation error was significant sorted by weight, sex, habitus, and living place of children ( < 0.001).

Conclusion: Although Broselow tape has been proved to be accurate it led to a significant error at different age ranges. Hence, the present study estimated the age, arm circumference, and height of Iranian children based on new formulas providing more successful tool through controlling the confounding factors in estimating the real weight.
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http://dx.doi.org/10.4103/abr.abr_171_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5590395PMC
August 2017

Effect of bariatric surgery on adiposity and metabolic profiles: A prospective cohort study in Middle-Eastern patients.

World J Diabetes 2017 Jul;8(7):374-380

Mohsen Mazidi, Key State Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing 100049, China.

Aim: To investigate changes in adiposity and cardio-metabolic risk profile following Roux-en-Y gastric bypass in patients of Middle Eastern ethnicity with severe obesity.

Methods: This prospective cohort study involved 92 patients who met the indications of bariatric surgery. Post-procedure markers of obesity and cardiometabolic profile were monitored regularly for a year.

Results: Mean body mass index decreased by 29.5% from 41.9 to 29.5 kg/m between baseline and 12-mo follow-up, while mean fat mass decreased by 45.9% from 64.2 kg to 34.7 kg. An improvement was also observed in the gluco-metabolic profile with both fasting glucose and HbA1c substantially decreasing ( < 0.001).

Conclusion: The present study shows the short to medium term (1 year) health benefits of bariatric surgery for patients of Middle Eastern ethnicity.
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http://dx.doi.org/10.4239/wjd.v8.i7.374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5507835PMC
July 2017

Minimally invasive radioguided parathyroid surgery using low-dose Tc-99m-MIBI - comparison with standard high dose.

Endokrynol Pol 2017 29;68(4):398-401. Epub 2017 May 29.

Surgical Oncology Research Centre, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran, Iran, Islamic Republic Of.

Introduction: Surgery remains the most effective treatment for primary hyperparathyroidism (PHPT). Minimally invasive radioguided parathyroidectomy (MIRP) is a common technique for detecting and excising abnormal parathyroid glands. The aim of this study was to compare injections of low-dose and high-dose (99m) Tc methoxy isobutyl isonitrile (MIBI) for intraoperative localisation of parathyroid adenomas by means of a gamma probe in patients with primary hyperparathyroidism (PHPT).

Material And Methods: Thirty patients with PHPT and a preoperative diagnosis of parathyroid adenoma were enrolled between 2010 and 2012. They were considered as Group B and underwent MIRP using 5 mCi Tc-99m MIBI, and their perioperative data were compared with twenty patients treated with conventional 20 mCi Tc-99m MIBI previously (Group A).

Results: Group A was made up of 20 patients (mean age, 41.55 years; 14 women and 6 men), and group B included 30 patients (mean age, 40.43 years; 19 women and 11 men). The mean serum parathyroid hormone (PTH) and calcium values were recorded pre- and postoperatively. The mean follow-up period for the patients in the two groups was 18.4 and 16.5 months, respectively. Pre-operative evaluation demonstrated that the groups were statistically similar. Intraoperative data and success rate of surgery showed no difference between the two groups. No significant complication was detected after surgeries and no recurrence happened in either of the two groups during the follow-up period.

Conclusions: A new protocol of MIRP using low doses of Tc-99m-MIBI resulted in an excellent success rate. Comparing results of the study, we conclude that low-dose Tc-99m-MIBI may be preferred for identification of parathyroid adenomas intraoperatively by means of a gamma probe in PHPT patients because it appears to be as effective as high-dose Tc-99m-MIBI.
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http://dx.doi.org/10.5603/EP.a2017.0031DOI Listing
January 2018

Evaluation of laparoscopic sleeve gastrectomy compared with laparoscopic Roux-en-Y gastric bypass for people with morbid obesity: A systematic review and meta-analysis.

Med J Islam Repub Iran 2016 12(3):354. Epub 2016 Apr 12.

Associate Professor of Surgery, Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: Prevalence of obesity in the world, in both developed and developing countries, is growing rapidly. Bariatric surgery is now accepted as the treatment for morbid obesity.

Objective: This study compares laparoscopic sleeve gastrectomy's effectiveness (LSG) with the most common bariatric surgery, laparoscopic Roux-en-Y (LRYGB) gastric bypass.

Methods: A systematic review was performed using relevant search data bases, including Cochrane library, PubMed, Magi ran, Iranmedex, SID and Trip database, with no time limit. Data bases were searched until July 2014 for randomized control trials. The studied population included people aged between 18-60 years, with BMI≥35 and at least one obesity-related disease, or people with BMI≥40. BMI change, as the research outcome, was investigated at least in one-year follow-up period. Cochrane criteria were used to assess quality of studies. The results were extracted from the articles.

Results: In total, 384 articles were obtained in the search; six RCTs were included in this study. There was no significant difference between the two laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass procedures in BMI, and both groups were similar in weight loss CI [-.1.31, 0.43], p=0.32.

Conclusion: The two procedures of bariatric surgery are effective and reliable treatments. Performing more trial studies with greater sample size and longer follow-up period for making final decision in selecting a certain surgical procedure is essential.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934447PMC
July 2016

An Evaluation of the Effect of Hypnosis on Postoperative Analgesia following Laparoscopic Cholecystectomy.

Int J Clin Exp Hypn 2016 Jul-Sep;64(3):365-72

a Mashhad University of Medical Sciences , Iran.

Little attention has been paid to the effectiveness of hypnosis in improving the results of surgery in Iran. One hundred and twenty patients scheduled for laparoscopic cholecystectomy were randomly divided into either control (standard care) or experimental (hypnosis) groups. Prior to surgery and again after surgery, abdominal pain, nausea, and vomiting were assessed. The results suggest that hypnosis could effectively reduce pain after laparoscopic cholecystectomy and significantly reduce hospitalization time.
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http://dx.doi.org/10.1080/00207144.2016.1171113DOI Listing
February 2018

Consequences of Lost Gallstones During Laparoscopic Cholecystectomy: A Review Article.

Surg Laparosc Endosc Percutan Tech 2016 Jun;26(3):183-92

Surgical Oncology Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: Laparoscopic cholecystectomy (LC) has become a popular and widespread procedure for the treatment of gallstone disease. There is still an increasing concern about specific complications of LC due to gallbladder perforation and spillage of bile and stones. Although unretrieved intraperitoneal gallstones rarely become symptomatic, their infective complications may cause serious morbidities even after a long interval from LC.

Methods: We performed a review of the literature on the diagnosis, prevention, consequences, and management of lost gallstones. All studies with a focus on lost gallstones or perforated gallbladder were analyzed to evaluate the postoperative complications.

Results: Between 1991 and 2015, >250 cases of postoperative complications of spilled gallstones were reviewed in the surgical literature. The most common complications are intraperitoneal abscesses and fistulas. Confusing clinical pictures due to gallstones spreading in different locations makes diagnosis challenging. Even asymptomatic dropped gallstones may masquerade intraperitoneal neoplastic lesions.

Conclusions: Every effort should be made to prevent gallbladder perforation; otherwise, they should be retrieved immediately during laparoscopy. In cases with multiple large spilled stones or infected bile, conversion to open surgery can be considered. Documentation in operative notes and awareness of patients about lost gallstones are mandatory to early recognition and treatment of any complications.
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http://dx.doi.org/10.1097/SLE.0000000000000274DOI Listing
June 2016

Evaluation and Comparison of the Early Outcomes of Open and Laparoscopic Surgery of Liver Hydatid Cyst.

Surg Laparosc Endosc Percutan Tech 2015 Oct;25(5):403-7

*Surgical Oncology Research Center, Mashhad University of Medical Sciences †Department of Statistics, Faculty of Mathematical Sciences, Ferdowsi University of Mashhad, Mashhad, Iran.

Background And Aim: Surgery is the mainstay for treatment of liver hydatid cyst. Different surgical procedures have been suggested, but it is important to select the most appropriate treatment to obtain the best results with the lowest rate of recurrence and minimal morbidity and mortality. The aim of this study was to evaluate the early outcomes of open and laparoscopic surgery of hydatidosis.

Materials And Methods: In this study, 75 patients with uncomplicated liver hydatid cyst were assigned prospectively to either groups of laparoscopic surgery (37, 50.68%) or open procedure (36, 49.32%) during the period of 2007 to 2012. Conversion to open surgery was required in 2 patients (2.67%), who were excluded from the study. Patients were followed for about 17.86±17.64 months.

Results: Participants included 73 patients: 49 (67.12%) female and 24 (32.88%) male patients, with the mean age of 38.97±16.48 years. There was no statistically significant difference between the 2 groups with regard to the sex, the occupation, and the mean diameter of the cysts. Bilious staining of the cyst content was observed in 23 (35.94%) patients during surgery, and a maximum diameter of 91 mm was considered as a cut point for predicting postoperative fistula with 69.2% sensitivity and 41.1% specificity. The mean duration of operation, postoperative pain, the hospitalization time, and the time to return to work were significantly lower in the laparoscopic group. Postoperative biliary fistula, cyst cavity infection, and wound infection were not different between the 2 groups.

Conclusions: Laparoscopic surgery seems to be effective and safe, with low morbidity rates for uncomplicated cysts in accessible segments of the liver.
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http://dx.doi.org/10.1097/SLE.0000000000000199DOI Listing
October 2015

Differentiation of adipocytes and osteocytes from human adipose and placental mesenchymal stem cells.

Iran J Basic Med Sci 2015 Mar;18(3):259-66

Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Objectives: Mesenchymal stem cells (MSC) can be isolated from adult tissues such as adipose tissue and other sources. Among these sources, adipose tissue (because of easy access) and placenta (due to its immunomodulatory properties, in addition to other useful properties), have attracted more attention in terms of research. The isolation and comparison of MSC from these two sources provides a proper source for clinical experimentation. The aim of this study was to compare the characteristics of MSC isolated from human adipose tissue and placenta.

Materials And Methods: Adipose and placental MSC were isolated from the subcutaneous adipose tissues of 10 healthy women (25 to 40 years) and from a fresh term placenta (n= 1), respectively. Stem cells were characterized and compared by flow cytometry using CD29, CD31, CD34, CD44, CD45, CD105, CD166 and HLA-DR markers. Osteocytes and adipocytes were differentiated from isolated human mesenchymal stem cells (HMSC).

Results: Adipose and placenta-derived MSC exhibited the same morphological features. ADSC differentiated faster than placenta; however, both were differentiated, taking up to 21 days for osteocyte and 14 days for adipocyte differentiation. About 90% of PLC-MSC and ADSC were positive for CD29, CD44, CD105, and CD166; and negative for CD31, CD34, CD45, and HLA-DR.

Conclusion: The two sources of stem cells showed similar surface markers, morphology and differentiation potential and because of their multipotency for differentiating to adipocytes and osteocytes, they can be applied as attractive sources of MSC for regenerative medicine.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4414992PMC
March 2015

The role of prophylactic cefazolin in the prevention of infection after various types of abdominal wall hernia repair with mesh.

Asian J Surg 2015 Jul 14;38(3):139-44. Epub 2015 Mar 14.

Surgical Oncology Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Electronic address:

Objective: There are controversies about the benefits of prophylactic antibiotics in the prevention of postoperative surgical site infection (SSI) in mesh herniorrhaphy for a long time. This study aimed to evaluate the effectiveness and efficacy of systemic prophylactic cefazolin in prevention of wound infection in various types of hernia repair with mesh materials.

Methods: This is a prospective randomized control study. We evaluated wound infection rates in 395 patients with various kinds of hernia who underwent elective mesh repair using polypropylene mesh from 2007 to 2011. A total of 237 (60.0%) patients received prophylactic cefazolin (study group) and the remaining 158 (40.0%) patients did not receive any prophylactic antibiotics (control group). Patients were followed for infection at the following periods after the operation by an independent surgeon: 10 days, 30 days, 12 months, and then annually for at least 2 years.

Results: Eight (2.03%) patients had infection in the site of surgery [2 (1.27%) in the control group and 6 (2.53%) in the study group]. The distribution of infection was not significantly different between the two groups (p = 0.364). The superficial infections were managed by drainage and irrigation. One patient from the study group developed deep SSI and was readmitted and subsequently received antibiotic therapy, drainage, and debridement.

Conclusion: Preoperative administration of single-dose cefazolin for prosthetic hernia repairs did not markedly decrease the risk of wound infection. Our results do not support the use of cefazolin as a prophylactic antibiotic for various kinds of abdominal wall hernia repair with mesh.
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http://dx.doi.org/10.1016/j.asjsur.2015.01.006DOI Listing
July 2015

Pre-operative rectal indomethacin for reduction of postoperative nausea and vomiting after laparoscopic cholecystectomy: a double-blind randomized clinical trial.

J Coll Physicians Surg Pak 2015 Jan;25(1):56-9

Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.

Objective: To evaluate the effect of pre-operative indomethacin suppository on postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy.

Study Design: A double blind placebo-controlled randomized clinical trial.

Place And Duration Of Study: Hazrat Rasoul Akram Hospital, Tehran, Iran, from February 2010 to September 2012.

Methodology: One hundred and thirty patients, scheduled for laparoscopic cholecystectomy, were randomly divided into case and control groups. Sixty-five patients received indomethacin suppository and 70 patients received rectal placebo in the case and control groups respectively. All patients underwent the same protocol in laparoscopic surgery and anesthesia, then nausea and vomiting was recorded after 1, 6, 12 and 24 hours postoperatively and compared between the two groups. Independent-sample t test or Mann-Whitney tests were used for statistical analysis. Level of statistical significance was set at P ² 0.05.

Results: Patients' nausea was statistically lower in the case group at the 1st hour (43.1 vs. 92.9%), 6th hour (20.0 vs. 68.6%) and 12th hour (7.7 vs. 24.3%) after surgery (for all periods, P < 0.001). Fewer patients in the case group experienced vomiting at the first (13.8 vs. 51.4%) and 6th hour (0 vs. 20%) after surgery (for both P < 0.001). The use of pethidine was also statistically less in the case group in the same hours after surgery (for all of them, P < 0.001).

Conclusion: Rectal indomethacin before laparoscopic cholecystectomy led to lower postoperative nausea and vomiting.
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http://dx.doi.org/01.2015/JCPSP.5659DOI Listing
January 2015

Sexual function after Stoppa hernia repair in patients with bilateral inguinal hernia.

Med J Islam Repub Iran 2014 17;28:48. Epub 2014 Jun 17.

6. MD, Assistant Professor, Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: This study was performed to evaluate the effect of Stoppa hernia repair on sexual function of the patients with bilateral inguinal hernia.

Methods: In a prospective follow-up study, 50 patients with bilateral inguinal hernia were investigated to assess sexual function before and 1 and 6 months after standardized Stoppa hernioplasty using the International Index of Erectile Function (IIEF) questionnaire. The mean scores obtained on pre- and postoperative visits for all domains of sexual function were analyzed and compared with the Friedman and paired Wilcoxon tests.

Results: The mean score of IIEF at the first month after surgery was significantly declined compared to that before surgery and 6 months after surgery (P< 0.001), while the difference between preoperative score and the score at 6 months after surgery was not significant

Conclusion: Bilateral inguinal mesh repair with Stoppa technique can decreased sexual activity of the patients at one month after surgery, nevertheless it returns to its initial condition at 6 months after surgery. This suggests that the Stoppa technique does not affect the sexual function of patients with bilateral inguinal hernia.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4219880PMC
November 2014

Sentinel node mapping in papillary thyroid carcinoma using combined radiotracer and blue dye methods.

Endokrynol Pol 2014 ;65(4):281-6

Introduction: In the current study, we evaluated the accuracy of sentinel node mapping in thyroid cancer patients using both radiotracer and blue dye.

Material And Methods: 30 patients with a diagnosis of papillary thyroid carcinoma (PTC) were included in the study; 2-3 hours before surgery, 0.5 mCi 99m-Tc-Antimony Sulfide Colloid was injected intra-tumourally. 15 minutes post-injection, lymphoscintigraphy images of the neck were obtained. Immediately after anaesthesia induction, 0.5 mL patent blue V was also injected in the same fashion. Sentinel lymph nodes were detected intraoperatively using gamma probe and blue dye. Total thyroidectomy was performed for all patients with dissection of central neck lymph nodes as well as sampling of the lateral neck lymph nodes.

Results: At least one sentinel node could be identified during surgery in 19 patients (63.3%). The median number of sentinel nodes per patient was 1. Sentinel nodes in 12 patients were pathologically involved. No false negative case was noted. Upstaging occurred in six patients (20%).

Conclusions: Sentinel node mapping in papillary thyroid carcinoma is a feasible technique with high accuracy for the detection of lymph node involvement. This technique can guide surgeons to perform central lymph node dissection only in patients with pathologically involved sentinel nodes. Although SLN detection in the lateral neck lymph nodes increases the extension of lymphadenectomy, SLN mapping can result in upstaging in older patients (> 45 years of age) or treatment plan change in younger patients (< 45 years of age) by the detection of lateral lymph node involvement.
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http://dx.doi.org/10.5603/EP.2014.0038DOI Listing
October 2016

Treatment of life-threatening wounds with a combination of allogenic platelet-rich plasma, fibrin glue and collagen matrix, and a literature review.

Exp Ther Med 2014 Aug 29;8(2):423-429. Epub 2014 May 29.

UCL Centre for Nanotechnology and Regenerative Medicine, Division of Surgery and Interventional Science, University College London, Royal Free Hampstead NHS Trust Hospital, London, UK.

Currently there is no ideal procedure for the treatment of recalcitrant ulcers that are unresponsive to the majority of common treatments. However, several novel approaches have been proposed, including bone marrow stem cells, platelets, fibrin glue and collagen matrix. For the first approach treatment of a chronic wound, a non-invasive method is highly desirable. The present study was undertaken with the aim of evaluating the effect of a combination of platelets, fibrin glue and collagen matrix (PFC) in one treatment. A total of ten patients with aggressive, refractory, life-threatening wounds were recruited for the study and their treatment effects were evaluated. Initially, the ulcers were extensively debrided, measured and photographed at weekly intervals. The PFC combination was applied topically to the wound every two days. Following treatment, the wound was completely closed in nine patients and was markedly reduced in the other patient. The mean 100% healing time for the nine patients was 11.3±5.22 weeks. There was no evidence of local or systemic complications or any abnormal tissue formation, keloid or hypertrophic scarring. Therefore, the results of the present study indicate that in the first approach, the combination of PFC components may be used safely in order to synergize the effect of chronic wound healing.
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http://dx.doi.org/10.3892/etm.2014.1747DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4079439PMC
August 2014

Accuracy of prognostic and predictive markers in core needle breast biopsies compared with excisional specimens.

Breast Care (Basel) 2014 May;9(2):107-10

Surgical Oncology Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: Core needle biopsy (CNB) is widely accepted for preoperative diagnosis of breast cancer and sometimes can be the only way of providing a suitable specimen for prognostic and predictive marker studies prior to neoadjuvant treatment. The purpose of this study was to evaluate the accuracy of CNB by comparing histological tumor type and grade as well as estrogen receptor (ER), progesterone receptor (PR), p53, and HER2/ neu status by immunohistochemistry in CNB and excisional surgical specimens.

Patients And Methods: During a 2.5-year study period, we identified 30 patients with breast cancer, who underwent CNB and definitive surgery. To evaluate the accuracy of CNB, tumor grade, ER, PR, HER2, and p53 status were immunohistochemically determined in both the CNB and the surgical specimens, and concordance of results between the 2 specimens was assessed.

Results: The concordance rate was 100% for histological type, 66.6% for histological grade, and 96.7, 90, 76.7 and 93.3% for ER, PR, p53 and HER2/neu, respectively.

Conclusion: Our study showed that CNB has an excellent accuracy for tumor type, ER, and HER2/ neu; however, it should be used cautiously for tumor grade, PR, and p53 status. Thus, excisional biopsy is recommended for the determination of these factors.
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http://dx.doi.org/10.1159/000360787DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4038314PMC
May 2014

Evaluation of the incidence of complications of lost gallstones during laparoscopic cholecystectomy.

Surg Laparosc Endosc Percutan Tech 2014 Jun;24(3):213-5

Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background And Aim: Recently, an increasing number of reports in the literature have shown various complications of lost gallstones. This study aimed to evaluate patients with lost stones in the peritoneal cavity for any related complications for at least 12 months after the operation.

Materials And Methods: In a 3-year prospective study, of 900 patients with laparoscopic cholecystectomy, 50 patients with lost stones in the peritoneal cavity were enrolled as the case group. On the same day or the day after, an uncomplicated case was assigned to the control group. Postoperative complications were checked on the 10th day and 1, 6, and 12 months after surgery. They were also visited if they had any complaints at any time. All suspicious cases and also all patients in the last follow-up visit underwent abdominal ultrasonography and were observed for signs of abdominal and port site collections, abdominal and port site stone, abscess, and mass.

Results: In 50 cases (34 female and 16 male with a mean age of 59 y), the surgeon was doubtful about proper stone extraction. The mean duration of operation for patients with a ruptured gall bladder was 49.6+30.3 minutes, and in others, it was 27.9+11.7 minutes. During the early postoperative period, fever was detected in 3 (6%) patients in the case group and in 1 (2%) patient in the control group, which was resolved spontaneously. Postoperative pain on the 10th and the 30th days, unrelated to the lost stone, was resolved with analgesics. Abdominal collection was found in 8 (16%) patients in the case group and 5 (10%) patients in the control group, which was not significant. All these patients underwent ultrasonography-guided percutaneous aspiration. The aspirate was serous, and the patients' clinical findings were not clinically significant.

Conclusions: According to the study, serious complications related to the lost stones indicate prophylaxis as the best therapeutic approach for such patients. The patients should be informed about lost stones and their possible complications. Also, conversion to open surgery is not advised.
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http://dx.doi.org/10.1097/SLE.0b013e31828fc09eDOI Listing
June 2014
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