Translational Health Reports

Abstract The global diabetes epidemic continues to rise, with complications extending beyond diabetic retinopathy (DR) and cataracts to include dry eye syndrome (DES), or keratoconjunctivitis sicca. Approximately 54% of individuals with diabetes experience DES, yet the condition remains poorly understood. Diabetes mellitus (DM) disrupts tear film homeostasis through mechanisms such as lacrimal gland dysfunction, Meibomian gland dysfunction, and abnormal tear dynamics. Chronic hyperglycemia, diabetic neuropathy, systemic inflammation, and altered mucin secretion exacerbate these changes, leading to tear instability and ocular surface damage. Risk factors for DES include advanced age, female sex, smoking, and higher glycated hemoglobin (HbA1c) levels. Surgical interventions for diabetes-related ocular complications, such as cataract surgery, intravitreal injections, and pan-retinal photocoagulation, further increase the risk of DES. Treatment strategies for diabetic dry eye (DMDES) include artificial tears, anti-inflammatory drugs like corticosteroids, cyclosporin A, tacrolimus, and autologous blood serum. However, these treatments address symptoms rather than underlying causes, with potential side effects. Emerging therapies, including gene-based approaches, show promise but require further research. Given the high prevalence of DMDES and its potential impact on quality of life, routine ocular surface and tear function assessments are recommended in diabetic care. Early diagnosis, glycemic control, and personalized treatment regimens are critical for preventing complications. Future studies must focus on targeted therapies to better manage DMDES and improve patient outcomes.
 

Abstract Varicocele is the leading cause of male infertility and can often be corrected or improved through a range of surgical and radiological methods. Consequently, it appears logical that varicocele should be treated in infertile men who have this condition. Varicocele, an enlargement of the pampiniform plexus veins affecting 15–20% of men, is more common in those with infertility concerns. Its impact on spermatogenesis is linked to oxidative stress, hypoxia, and immune responses, which may be alleviated by varicocelectomy. Varicocelectomy has been associated with improvements in sexual function, hormonal profiles, and fertility, particularly in men with hypogonadism. This review evaluates its effects on testosterone levels, semen quality, and fertility outcomes, highlighting the advantages of microsurgical varicocelectomy, such as improved sperm quality, higher spontaneous pregnancy rates, and fewer complications. However, patient outcomes depend on surgical indications, pre-existing conditions, and individual expectations.  Emerging evidence suggests that repairing varicoceles before assisted reproductive technology (ART) can enhance fertility outcomes. Further studies are needed to refine treatment criteria and expand options for diverse patient groups, including adolescents and men with pain-related varicoceles. The review also emphasizes the need for standardized diagnostic and treatment protocols.

Abstract Thyroid carcinoma encompasses a heterogeneous group of malignancies, each with distinct biological behaviors, therapeutic strategies, and challenges in pain management and anesthesia. This review delves into the subtypes of thyroid carcinoma—anaplastic, papillary, follicular, Hurthle cell, and medullary—emphasizing the critical interplay between effective pain control and surgical outcomes. Anaplastic thyroid carcinoma (ATC), characterized by rapid progression and local invasion, necessitates multimodal pain management, including systemic analgesics and nerve blocks, to address severe discomfort caused by structural compression. Papillary and follicular thyroid carcinomas, generally indolent but prone to recurrence, require tailored anesthesia and postoperative pain protocols, incorporating techniques like cervical plexus blocks to reduce opioid reliance. Unique challenges are posed by Hurthle cell carcinoma (HCC) and medullary thyroid carcinoma (MTC). HCC, often associated with poor prognosis, demands precise surgical techniques to enhance survival, while MTC involves hereditary and sporadic forms with systemic manifestations complicating pain management. Advanced surgical methods, including transoral and robotic thyroidectomy, are explored for their efficacy in reducing complications and enhancing patient satisfaction. For patients with genetic predispositions, early prophylactic surgeries significantly mitigate risks. Anesthesia considerations are paramount, particularly in advanced ATC, where airway management is crucial. Techniques such as total intravenous anesthesia (TIVA) and regional nerve blocks optimize perioperative outcomes while minimizing systemic side effects. This narrative underscores the importance of interdisciplinary collaboration and individualized care in addressing the multifaceted needs of thyroid carcinoma patients, ultimately aiming to improve survival rates and quality of life.

Abstract Thyroid carcinoma encompasses a spectrum of malignancies with distinct clinical characteristics, management strategies, and prognoses. This narrative review article provides an in-depth examination of anaplastic thyroid carcinoma (ATC), papillary thyroid carcinoma (PTC), Hurthle cell carcinoma (HCC), and medullary thyroid carcinoma (MTC), offering insights into their epidemiology, diagnostic and treatment modalities. Anaplastic thyroid carcinoma is a highly aggressive and undifferentiated form of thyroid cancer, often associated with poor prognosis. Treatment strategies include combined resection and radiotherapy, but late-stage cases exhibit limited therapeutic options, emphasizing the need for novel therapeutic approaches. Papillary thyroid carcinoma, the most common thyroid cancer, generally carries a favorable prognosis. The article discusses surgical interventions like total thyroidectomy and lobectomy, along with minimally invasive techniques such as transoral endoscopic thyroidectomy vestibular approach (TOETVA) and robotic thyroidectomy. The importance of considering health-related quality of life in the treatment decision-making process is highlighted. Hurthle cell carcinoma, a rare and aggressive subtype, is explored with a focus on factors influencing prognosis. Surgical management, including thyroid lobectomy, completion thyroidectomy, and iodine-131 therapy, is discussed in detail. Medullary thyroid carcinoma is categorized into hereditary and sporadic forms, each requiring specific approaches. The review emphasizes the significance of genetic testing for patients at risk of multiple endocrine neoplasia syndrome (MEN2) and the need for early thyroidectomy in genetic RET mutation carriers. Furthermore, the article evaluates the extent of surgery, the role of radioiodine therapy, and the significance of follow-up in treating differentiated thyroid carcinomas (DTC). Surgical approaches for follicular thyroid carcinoma (FTC) and factors influencing the decision for total thyroidectomy versus lobectomy are elaborated upon. In summary, this narrative review provides a comprehensive overview of thyroid carcinoma subtypes, their epidemiology, surgical interventions, and postoperative management, offering valuable insights for clinicians and researchers in the field.
 

Abstract Background: Hyponatremia, a frequent yet potentially life-threatening electrolyte 
imbalance, poses heightened risks in intensive care contexts. This investigation sought to 
explore contributory factors linked to hyponatremia following linezolid administration in 
critically ill (CI) individuals and to formulate a robust predictive framework. 
Methods: A retrospective evaluation was conducted on clinical records and follow-up data 
from 200 CI patients who received linezolid therapy. To isolate key determinants, logistic 
regression modeling was utilized, followed by validation using Receiver Operating 
Characteristic (ROC) curve analysis. A nomogram-based risk assessment tool was then 
constructed, with calibration tested via the Hosmer-Lemeshow goodness-of-fit approach. 
Findings: Adverse reactions were recorded in 23.5% of the cohort. Statistically significant 
disparities (P < 0.05) emerged between CI and non-CI patients across several variables, 
including linezolid serum levels, therapy duration (DOM), baseline sodium values (BSS), 
estimated glomerular filtration rate (eGFR), white blood cell (WBC) count, total bilirubin 
(TBIL), albumin (ALB), and key biomarkers (NGAL, suPAR, Cystatin C), as well as concurrent 
spironolactone usage. The Z-score presented the highest diagnostic efficacy for 
hyponatremia, with a threshold of -3.24. The model demonstrated an 85.5% predictive 
accuracy, and the nomogram—based on multivariate regression and fit assessment—
 exhibited excellent alignment with actual outcomes. 
Interpretation: Independent predictors of hyponatremia included DOM, drug 
concentration, BSS, eGFR, and TBIL. Incorporation of novel biomarker profiles modestly 
improved model precision, suggesting added value in patient risk stratification. The 
developed tool offers promise for early detection and intervention in vulnerable ICU 
populations. 

Abstract Introduction: Chronic neck pain (CNP) is a common and debilitating condition that significantly impacts quality of life, productivity, and overall well-being. Muscle morphology, particularly in the deep cervical muscles, plays a critical role in the onset, development, and persistence of chronic neck pain. This review investigates the relationship between muscle changes, including atrophy, fat infiltration, and alterations in muscle fiber composition, and their contribution to cervical instability, pain, and functional limitations.

Methods: The review examines existing literature on muscle morphology in CNP, focusing on the role of deep cervical muscles in the pathophysiology of neck pain. It also highlights how factors such as disuse, changes in neural activation, and chronic inflammation exacerbate these muscle alterations. The role of advanced imaging techniques, such as MRI, in identifying these changes is also discussed.

Results: Alterations in muscle morphology, including atrophy and fat infiltration, contribute to weakness and reduced spinal stability, which are key factors in the development and persistence of chronic neck pain. Neural activation changes and chronic inflammation further exacerbate muscle degeneration. Advanced imaging techniques, particularly MRI, play a crucial role in assessing these morphological changes and enabling personalized treatment strategies.

Conclusion: Muscle degeneration, including atrophy and fat infiltration in the cervical spine, is a significant factor in chronic neck pain. Effective management requires a comprehensive approach, including rehabilitation programs focused on muscle strengthening, postural correction, and ergonomic adjustments. Fat infiltration in cervical muscles is a significant marker of structural and functional impairment in cervical spine disorders. Further research is needed to explore the mechanisms behind muscle changes in CNP and to develop more targeted and effective interventions.

Abstract Introduction: Plantar fasciitis is a prevalent condition characterized by chronic heel pain, primarily caused by inflammation of the plantar fascia. The condition significantly impairs daily activities and quality of life, presenting a challenge for healthcare providers. Numerous treatment modalities, ranging from conservative measures to invasive interventions, have been explored to manage the symptoms and promote healing. However, the effectiveness of these treatments, especially when combined, requires further evaluation.

Methods: This review extracted data from existing studies comparing the effectiveness of corticosteroid injections (CSI) alone versus their combination with needling techniques (such as dry needling and percutaneous needle electrolysis) for chronic plantar fasciitis. The literature was assessed through systematic reviews, randomized controlled trials, and clinical studies that evaluated pain relief, functional recovery, and long-term outcomes. Studies on adjunctive treatments like extracorporeal shockwave therapy (ESWT) were also considered to provide a broader comparison.

Results: Corticosteroid injections provide significant short-term pain relief but are limited in their long-term efficacy, with potential complications like tissue atrophy. Dry needling and other needling therapies, when used in combination with CSI, have shown improved long-term outcomes in terms of pain reduction and functional recovery. ESWT consistently outperformed other treatments in long-term studies for both pain management and functional improvement. Combining treatments appears to yield enhanced results, although conclusive evidence on optimal treatment protocols remains insufficient.

Conclusion: Chronic plantar fasciitis requires a multi-faceted treatment approach. While corticosteroid injections remain a common short-term solution, combining them with needling techniques may offer superior long-term benefits. Extracorporeal shockwave therapy also shows promise for sustained relief. Further research is needed to establish optimal treatment protocols and to better understand the combined effects of these interventions. An individualized treatment strategy that addresses both symptoms and underlying causes is essential for improving patient outcomes.

Abstract  Background: This investigation explored the clinical utility of the Gugging Swallowing 
Screen (GUSS) in identifying swallowing dysfunction following stroke and examined its 
application in designing individualized nutritional interventions. The study also assessed a 
set of physiological markers—brain-derived neurotrophic factor (BDNF), salivary cortisol, 
leptin, and growth differentiation factor-15 (GDF-15)—to determine their relationship with 
dysphagia severity, neural recovery, and clinical prognosis. 
Methods: A cohort of 174 individuals recovering from stroke underwent swallowing 
assessments using both the GUSS protocol and the traditional water swallow test (WST). 
Participants diagnosed with swallowing impairments were randomized into a control group 
(CG), which received standard medical care, and an observation group (OG), which received 
additional GUSS-guided stratified feeding regimens. Comparative analyses focused on 
changes in swallowing ability, emotional well-being, serum and salivary biomarker profiles, 
and occurrence of medical complications. 
Findings: GUSS outperformed WST in sensitivity and responsiveness (P < 0.05), as shown 
by significantly higher effect size (ES) and standardized response mean (SRM). Patients in 
the OG exhibited notably greater improvement in deglutition function and fewer adverse 
outcomes than those in the CG (P < 0.05). Post-treatment nutritional markers—albumin 
(Alb), prealbumin (PA), and transferrin (TNF)—were also more favorable in the OG. BDNF 
and leptin levels showed strong alignment with dysphagia grading, while elevated salivary 
cortisol was associated with stress-related swallowing issues. GDF-15 levels correlated 
significantly with dysphagia-related complications. Moreover, quality of life indicators—
 including mental, physical, and social dimensions—were significantly enhanced in the OG (P 
< 0.05). 
Conclusion: GUSS proves to be a robust tool for early detection of post-stroke swallowing 
disorders and offers added clinical value when used to guide dietary intervention. The 
inclusion of stress, neuroplasticity, and inflammatory biomarkers—particularly salivary 
cortisol and GDF-15—adds depth to severity assessment and supports the development of 
personalized rehabilitation pathways.

Abstract Leptospirosis is a globally distributed zoonotic infection, more prevalent in tropical and low-income regions due to high temperatures, humidity, rainfall, and poor socioeconomic conditions. Individuals in high-risk occupations, such as farmworkers, veterinarians, and slaughterhouse employees, are particularly vulnerable. Early symptoms include fever, headache, myalgia, and conjunctival inflammation. Prompt diagnosis via culture and agglutination tests, along with early antibiotic treatment, can reduce complications and speed recovery. Adhering to hygiene and workplace safety measures is crucial for infection prevention and control.

This report presents the case of a 45-year-old male with fever, jaundice, and multiple systemic symptoms, with a history of chronic kidney disease and recent rice paddy exposure. He was admitted to Razi Hospital in Qaemshahr, where his condition rapidly deteriorated, requiring multidisciplinary intervention from nephrology, infectious disease, pulmonology, and psychiatry specialists. Initial findings revealed severe thrombocytopenia (platelet count: 8,000) and elevated creatinine levels (6 mg/dL), prompting treatment with dexamethasone, ceftriaxone, fluid therapy, and dialysis. However, his worsening respiratory distress and alveolar bleeding led to ICU admission.

Leptospirosis was suspected based on occupational exposure and was confirmed by positive IgM antibodies in urine PCR. Despite intensive interventions—including dialysis, pleural fluid drainage, and Shaldon catheter placement—the patient developed progressive pulmonary complications and eventually succumbed.

This case highlights the diagnostic and management challenges of leptospirosis in a patient with preexisting comorbidities. It underscores the importance of a multidisciplinary approach in recognizing and addressing the complexities of infectious diseases in critical care settings.

Abstract Background: The optimal radiation dose for stage III non-small cell lung cancer (NSCLC) remains unclear. This study aimed to investigate the radiation dose-response relationship in patients with stage III NSCLC treated with definitive radiation therapy.

Methods: This retrospective cohort study analyzed 376 patients with stage III NSCLC treated with definitive radiation therapy between 2010 and 2019. The study population had a median age of 68 years, with 64.9% being male and 89.4% having a performance status of ECOG 0-1. The median radiation dose was 66 Gy, with 74.5% of patients receiving conventional fractionation and 25.5% receiving hypofractionated radiation.

Results: The median overall survival (OS) was 24.5 months, with a 95% confidence interval (CI) of 13.1-32.9 months. For every 1 Gy increase in radiation dose, the hazard of death decreases by 6% (HR = 0.94, p < 0.001). Older age is associated with a higher hazard of death (HR = 1.02, p = 0.002). Poorer performance status (ECOG 2-3) is associated with a higher hazard of death compared to good performance status (ECOG 0-1) (HR = 1.63, p = 0.009). Histology other than adenocarcinoma is associated with a higher hazard of death (HR = 1.55, p = 0.02). The results of the PCA suggest that the 15 dosimetric variables can be reduced to 5 components that explain 88.4% of the variance in the data suggesting that higher doses to smaller tumor volumes may be associated with better treatment outcomes.

Conclusion: Higher radiation doses may be associated with improved OS, but in patients with smaller tumor size. Further studies are needed to confirm these findings and to determine the optimal radiation dose for this patient population.

Abstract Background and purpose: Pressure ulcers are common postoperative complications that increase morbidity, mortality, and healthcare costs. Operating room (OR) technologists play a critical role in preventing pressure ulcers through proper skin care. This study aimed to assess the knowledge, attitude, and performance of OR technologists regarding skin care and pressure ulcer prevention.
Materials and methods: This descriptive-analytical, cross-sectional study was conducted from September to December 2022. Using a census sampling method, we included 58 operating room technologists from the educational hospitals affiliated with Zahedan University of Medical Sciences. Data were collected using a researcher-made questionnaire assessing knowledge, attitude, and performance. The data were analyzed using SPSS version 21, employing descriptive statistics, independent t-tests, and ANOVA.
Results: The mean and standard deviation of knowledge, attitude, and performance scores were 38.00 ± 15.00, 33.00 ± 6.00, and 23.00 ± 4.00, respectively. Most operating room technologists demonstrated a positive attitude, relatively good knowledge, and average performance toward pressure ulcer prevention. There was a significant relationship between knowledge scores and the age of operating room technologists (p < 0.0001).
Conclusion: The results of this study highlight the importance of knowledge, attitude, and performance among operating room professionals in reducing the risk of pressure ulcers in patients surgical candidates.. It can be suggested that in the field of skincare and prevention of pressure ulcers in the operating room, basic pressure ulcer training should be included at the beginning of the operating room courses and in the in-service training of operating room experts.

Abstract Background: Oligometastatic lung cancer is a clinical entity characterized by a limited number of metastases, and stereotactic body radiation therapy (SBRT) has emerged as a promising treatment option for this condition. However, the relationship between SBRT dose and adverse events in this population is not well understood.


Objectives: To evaluate the treatment outcomes and adverse events associated with SBRT in patients with oligometastatic lung cancer, and to investigate the relationship between radiation dose and adverse events.


Methods: This retrospective chart review included 81 patients with oligometastatic lung cancer who underwent SBRT at a single institution between 2015 and 2023. Patients received SBRT with a dose of 30-60 Gy in 3-10 fractions. Data on patient demographics, tumor characteristics, treatment details, and adverse events were collected and analyzed.


Results: The study found that 37% of patients experienced adverse events of grade ≥2, with fatigue, dermatitis, and cough being the most common. Multivariate analysis revealed that higher radiation dose was significantly associated with increased risk of adverse events (OR 1.05, 95% CI 1.01-1.09, p=0.01). Other factors, including age, sex, ECOG performance status, and previous chemotherapy, were not significantly associated with adverse events.


Conclusion: This study demonstrates that SBRT higher radiation doses are associated with increased risk of adverse events with no other risk factor predicting adverse event occurrence. These findings highlight the importance of careful treatment planning and dose optimization to minimize toxicity while maintaining treatment efficacy.

Abstract Background: Early-stage laryngeal squamous cell carcinoma (T1-T2) can be treated with either radiation therapy or surgery, but the cost-effectiveness of these treatments is unclear.

Methods: This study is a cost-effectiveness analysis comparing radiation therapy and surgery as treatments for early-stage laryngeal squamous cell carcinoma (T1-T2) at a university hospital's tertiary care center. A consecutive sampling method was used to select 86 patients (43 per group) diagnosed with early-stage laryngeal squamous cell carcinoma (T1-T2) between January 2018 and December 2020. Demographic, clinical, and cost data were collected, and quality of life data were collected using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30).

Results: The mean total cost for patients treated with radiation therapy was ¥123,419, which was significantly lower than the mean total cost for patients treated with surgery (¥153,219, p=0.012). The mean QALYs for patients treated with radiation therapy was 4.21 (± 1.23), which was slightly higher than the mean QALYs for patients treated with surgery (3.92 ± 1.35), but the difference was not statistically significant (p=0.142). The incremental cost-effectiveness ratio (ICER) was ¥24,011 per QALY gained, indicating that radiation therapy was associated with a lower cost per QALY gained compared to surgery. At a willingness-to-pay (WTP) threshold of ¥50,000 per QALY, the probability that radiation therapy is cost-effective is 72.1%.

Conclusion: Radiation therapy is a cost-effective treatment option for early-stage laryngeal squamous cell carcinoma (T1-T2) compared to surgery, with a lower ICER and a higher probability of cost-effectiveness at various WTP thresholds. These findings can inform treatment decisions and resource allocation in the management of early-stage laryngeal squamous cell carcinoma.

Abstract Introduction: Osteoporosis is a widespread bone disease characterized by low bone mineral density (BMD), structural bone deterioration, and an increased risk of fractures. It primarily affects postmenopausal women and the elderly, representing a significant global health burden. The management of osteoporosis involves pharmacological treatments aimed at preventing fractures, alleviating symptoms, and improving overall quality of life.
Methods: This review analyzes the pharmacology of current osteoporosis treatments, including bisphosphonates, selective estrogen receptor modulators (SERMs), monoclonal antibodies, and newer agents such as sclerostin inhibitors. It also examines pain management strategies, particularly those targeting fracture-related pain, and explores the intersection between bone therapies and analgesia.
Results: The current pharmacological treatments for osteoporosis have shown significant efficacy in reducing fracture risk. However, managing pain in osteoporosis, particularly post-fracture pain, remains a complex challenge. This review highlights the need for a multidimensional approach that integrates both bone-targeted therapies and effective pain management strategies.
Conclusion: While osteoporosis therapies have greatly reduced fracture risk, pain management in osteoporosis patients remains an area requiring further research. This review synthesizes current literature on osteoporosis treatments and pain management, offering insights into best practices and identifying future research directions to improve patient outcomes.

Abstract Background: Neoadjuvant chemotherapy is a common treatment approach for breast cancer, but its impact on disease-free survival, quality of life, and recurrence rates is not well understood.

Objectives: To evaluate the association between neoadjuvant chemotherapy and disease-free survival, quality of life, and recurrence rates in patients with breast cancer.

Methods: This retrospective cohort study included 350 patients with breast cancer who underwent surgery at a university clinic between 2015 and 2022. Patients were divided into two groups: those who received neoadjuvant chemotherapy (n=105) and those who did not (n=245). Demographic, tumor, and treatment characteristics were compared between groups. Disease-free survival, quality of life, and recurrence rates were analyzed using Cox proportional hazards models, multivariate analysis of variance, and logistic regression models. 1 year follow ups were made.

Results: Patients who received neoadjuvant chemotherapy had a significant reduction in the risk of disease recurrence (HR=0.65, p=0.02) and local recurrence (OR=0.42, p=0.01). However, they had lower physical and social functioning scores compared to those who did not receive neoadjuvant chemotherapy (p=0.04 and p=0.02, respectively). Neoadjuvant chemotherapy was also associated with a higher survival rate at 12 months (92.5% vs. 85.1%, p=0.03).

Conclusions: Neoadjuvant chemotherapy is associated with improved disease-free survival and reduced local recurrence rates in patients with breast cancer. However, it may have a negative impact on quality of life, particularly physical and social functioning. These findings have implications for the management of breast cancer and highlight the need for further research on the optimal use of neoadjuvant chemotherapy.

Abstract This forward-looking clinical investigation explored the prognostic utility of four distinct 
biomarkers—high-sensitivity cardiac troponin T (hs-cTnT), N-terminal pro b-type 
natriuretic peptide (NT-proBNP), Copeptin, and Mid-regional pro-Adrenomedullin (MR
proADM)—in forecasting significant cardiovascular complications among 120 individuals 
presenting with symptoms suggestive of acute coronary syndrome (ACS) in an emergency 
care setting. Across a 12-month observation window, occurrences of major adverse 
cardiovascular events (MACE)—encompassing myocardial infarction, stroke, and 
cardiovascular mortality—were systematically tracked and correlated with both initial and 
serial biomarker measurements. 
Multivariate analysis using Cox proportional hazards modeling, adjusted for demographic 
and behavioral risk factors such as age, sex, and smoking, revealed a robust association 
between elevated biomarker levels and MACE incidence. Diagnostic accuracy for each 
marker—individually and collectively—was assessed through ROC curve analysis, 
demonstrating favorable area under the curve (AUC) values indicative of strong predictive 
performance. Survival outcomes stratified by median biomarker thresholds were estimated 
using Kaplan-Meier methodology, showing pronounced differences in MACE-free survival 
between high- and low-risk groups. 
The findings affirm the clinical value of hs-cTnT, NT-proBNP, Copeptin, and MR-proADM in 
early cardiovascular risk stratification. Moreover, the integrative use of these markers was 
shown to outperform any single biomarker alone, emphasizing their combined role in 
refining diagnostic precision and guiding therapeutic decisions. These results support 
incorporating such biomarker panels into routine evaluation protocols for patients 
undergoing assessment for suspected ACS.

Abstract Background: Glioblastoma multiforme (GBM) is a highly aggressive brain tumor with a poor prognosis. Radiation therapy (RT) and temozolomide (TMZ) are standard treatments, but their impact on cognitive function is not well understood.

Objective: To investigate the effects of radiation dose and TMZ dose on cognitive function in patients with GBM treated with RT and TMZ.

Methods: This retrospective study included 162 patients with GBM treated with RT and TMZ between 2018 and 2023. Cognitive function was assessed using a comprehensive battery of neuropsychological tests, and MRI-based measures of cognitive function were obtained. Patients were categorized into three groups based on radiation dose received: low dose (< 50 Gy), moderate dose (50-60 Gy), and high dose (> 60 Gy). Follow ups were made up to 8 to 12 months after chemoradiotherapy.

Results: Patients in the high dose group performed significantly worse on executive function and memory tests, and had reduced white matter integrity and increased white matter hyperintensity volume compared to the low dose group. Higher TMZ doses were associated with poorer cognitive outcomes in executive function, memory, and reduced hippocampal volume. Linear regression analysis showed that higher radiation doses were associated with poorer cognitive outcomes in memory, and higher TMZ doses were associated with poorer cognitive outcomes in executive function, memory, and reduced hippocampal volume.

Conclusion: This study suggests that higher radiation doses and TMZ doses are associated with poorer cognitive outcomes in patients with GBM. These findings have important implications for the management of GBM, highlighting the need to minimize radiation dose and TMZ dose to prevent cognitive decline. Future studies are needed to confirm these findings and to explore strategies to mitigate the cognitive effects of RT and TMZ in patients with GBM.

Abstract Urosepsis is a severe, life-threatening condition caused by the rapid dissemination of urinary-tract pathogens into the bloodstream and an uncontrolled host inflammatory response. The emergence of multidrug-resistant organisms and the variability of immune activation in critically ill patients have made its management increasingly complex. Targeted antimicrobial therapy (TAT)—defined as the selection of antibiotics based on microbiological identification and susceptibility testing—embodies the principles of precision medicine, aiming to optimize treatment effectiveness while minimizing broad-spectrum exposure and the spread of resistance.

This review synthesizes the current evidence regarding the role of TAT in urosepsis, highlighting its effects on systemic inflammation, organ function, and clinical outcomes. Special attention is given to novel biomarkers such as Presepsin, neutrophil CD64 index, and Copeptin, examined alongside classical inflammatory mediators including tumour necrosis factor-α (TNF-α), interleukin-6 (IL-6), and C-reactive protein (CRP). Collectively, these markers provide valuable insights into the interplay between pathogen control and immune modulation. The review also discusses diagnostic and operational barriers to implementing TAT, the variability of antimicrobial stewardship across institutions, and future research directions aimed at integrating biomarker-guided targeted therapy into individualized sepsis management.

Abstract Background: Renal colic is a common and severely painful emergency condition often caused by ureteral stones. Rapid pain management is critical. This study evaluates the efficacy of inhaled salbutamol, a β2-agonist with smooth muscle relaxant properties, as an adjunct therapy in reducing pain severity in patients with acute renal colic.

Methods: In this double-blind randomized controlled trial, 204 patients with moderate renal colic pain (based on the Visual Analog Scale, VAS) referred to the emergency department of Imam Khomeini Hospital in Sari, Iran, were randomly assigned to two groups. The intervention group received 30 mg intravenous ketorolac and inhaled salbutamol (5 puffs), while the control group received ketorolac and a placebo inhalation. Pain intensity, vital signs, and symptoms such as nausea and vomiting were recorded at baseline and at intervals of 10, 20, 30, 45, 60, and 120 minutes after treatment.

Results: Pain intensity significantly decreased over time in both groups (p

Abstract Brain tumor-related epilepsy (BTRE) is a prevalent complication, affecting 25-60% of patients with primary or metastatic brain tumors, significantly impacting quality of life and complicating oncologic management. This narrative review examines factors influencing the effectiveness of levetiracetam (LEV), lamotrigine (LTG), and lacosamide (LCS) in BTRE. By analyzing epidemiological data, pathophysiological mechanisms, pharmacological profiles, and clinical evidence, we study how tumor characteristics (type, location, molecular profile), patient-specific factors (age, comorbidities), drug interactions, and pharmacodynamic properties modulate seizure control. LEV is often the first-line choice due to its favorable tolerability and minimal drug interactions, achieving seizure freedom in 65-80% of patients in some studies. LTG and LCS, effective as monotherapy or add-on therapies with response rates of 50-70%, vary in efficacy based on tumor histology and peritumoral microenvironment. Challenges include drug resistance linked to glutamate excitotoxicity, sodium channel dysregulation, and tumor-driven molecular changes. Research gaps, such as long-term comparative trials and personalized dosing strategies, highlight the need for further investigation. Optimizing AED selection in BTRE requires a multidisciplinary approach to balance seizure control, antitumor therapy efficacy, and adverse effect minimization, emphasizing personalized medicine.

Abstract Background: Spinal injuries are a significant cause of morbidity and mortality globally. Trauma-related spinal fractures contribute to the burden on healthcare systems and significantly affect the quality of life. Although substantial progress has been made in trauma care, spinal fractures, particularly those associated with spinal cord injuries (SCI), remain a leading cause of long-term disability. The epidemiology of spinal fractures varies regionally due to demographic, trauma mechanisms, and healthcare factors. In Iran, motor vehicle accidents and falls from heights are prominent causes of spinal injuries, but regional data on the epidemiology of these injuries, particularly from smaller cities, is scarce.


Materials and Methods: This retrospective cohort study was conducted at Imam Khomeini Hospital in Sari, Mazandaran province, Iran, reviewing the records of 288 patients with spinal fractures treated between March 2014 and March 2018. Data collected included demographic characteristics (age and gender), injury mechanisms, fracture locations, fracture types, presence of spinal cord injuries, and clinical outcomes. The analysis also included the association between injury mechanisms and fracture types using statistical tests.


Results: The study included 288 patients, with 75% being male and a mean age of 39.21 years. The most common mechanisms of injury were motor vehicle accidents (47.2%) and falls from height (35.4%). Cervical spine fractures were the most common, accounting for 49% of cases. Burst fractures were the most prevalent type of fracture (40.5%). Spinal cord injuries were present in 21.2% of the patients, with a higher incidence in those injured by vehicle accidents. The mortality rate was 3.1%, and 42.4% of patients underwent surgical intervention. The average hospital stay was 7.53 days.


Conclusion: This study provides a comprehensive epidemiological profile of spinal fractures in a regional Iranian hospital. It highlights the high incidence of spinal fractures due to motor vehicle accidents and falls from height, with cervical spine fractures and burst fractures being the most common. The presence of spinal cord injury is significant and underscores the need for early diagnosis and effective treatment. . Further studies, particularly prospective ones, are needed to better understand the long-term outcomes of spinal injuries and SCI in Iran.

Abstract Objective To integrate the latest evidence regarding inherited genetic risk factors for esophageal cancer while emphasizing contrasting susceptibility profiles between esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC)/Barrett’s esophagus as this integration also allows assessment of how genome-wide association studies (GWAS) together with new trans-ancestry genomic methods have advanced the discovery of risk loci and their potential clinical application.

Results More than 30 reliable risk loci are now recognized for ESCC mostly identified in East Asian populations with major signals located in PLCE1 alcohol/aldehyde metabolism genes ADH/ALDH2 (showing strong interaction with alcohol consumption) CHEK2 and HLA-region immune pathways whereas recent trans-ancestry studies have validated shared loci such as PLCE1 while uncovering novel African-enriched variants that highlight population-specific genetic architecture. By comparison EAC and Barrett’s esophagus present a separate genetic profile shaped largely by European-ancestry consortia featuring risk loci near BARX1 FOXP1 CRTC1 (involved in mucosal development) as well as CFTR MSRA BLK (linked to barrier function and oxidative stress) and although fewer loci have been found overall EAC exhibits considerable shared heritability with Barrett’s esophagus which supports the value of genetically guided surveillance.

Conclusion ESCC and EAC display strikingly different inherited risk patterns that closely reflect their distinct environmental risk factors as this difference now permits the construction of polygenic risk scores that incorporate subtype-specific GWAS findings together with emerging rare-variant and functional genomic information thereby enabling personalized risk assessment and more targeted screening in high-risk families and populations.

Abstract Background: Physical inactivity is a key risk factor for coronary heart disease (CHD). This systematic review explores the role of exercise in cardiac rehabilitation for CHD patients, emphasizing the integration of nuclear stress tests and tumor imaging techniques to assess heart function.

Materials and Methods: A systematic review was conducted, analyzing randomized controlled trials (RCTs) indexed in the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and EMBASE. Studies were selected based on criteria related to exercise-based cardiac rehabilitation, including outcomes such as cardiovascular mortality, hospitalization, and quality of life. Imaging methods, such as nuclear stress tests and tumor imaging, were also considered. The quality of the studies was assessed using the Cochrane Risk of Bias tool.

Results: Five RCTs were included in the final analysis. The reviewed literature consistently reported that exercise-based cardiac rehabilitation led to reductions in cardiovascular mortality and hospital admissions, alongside notable improvements in patient quality of life. The inclusion of nuclear stress tests was found to improve diagnostic accuracy for identifying myocardial ischemia and assessing heart function during exercise. Tumor imaging techniques were successfully used to identify cardiac tumors and monitor post-surgical heart function.

Conclusion: This systematic review supports the integration of exercise as a core component of cardiac rehabilitation programs for CHD patients. The findings indicate significant benefits in reducing cardiovascular mortality and improving quality of life. The use of nuclear stress tests and tumor imaging techniques enhances the precision of rehabilitation strategies, offering a more personalized approach to care.

Abstract Introduction: The global prevalence of obesity has spurred interest in alternative therapies beyond conventional diet, exercise, and pharmacotherapy. Acupuncture, a staple of Traditional Chinese Medicine, is one such intervention, though its efficacy and mechanisms of action, particularly on fat distribution, warrant further synthesis of existing evidence.



Objective: This review aims to critically appraise and summarize the current literature on the efficacy and safety of acupuncture for weight loss, with a special focus on insights provided by MRI and CT scan imaging regarding its impact on visceral and subcutaneous fat distribution.



Methods: A narrative review of scientific literature was conducted. Key databases, including PubMed, Google Scholar, and ISI Web of Science, were searched for relevant clinical trials, reviews, and meta-analyses published up to September 2024. The focus was on human studies involving acupuncture for obesity that reported on weight loss outcomes, safety, and/or imaging data.



Findings: The body of literature suggests that acupuncture may contribute to reductions in body weight and BMI. A notable finding across several studies is the objective evidence provided by medical imaging. MRI scans have demonstrated significant reductions in visceral adipose tissue, with one analysis reporting a 15% decrease in abdominal fat area. Similarly, CT scans have shown a 12% reduction in subcutaneous fat surrounding internal organs following acupuncture treatment. These imaging techniques have also highlighted the potential for incidental tumor detection, though no new tumors were reported in the reviewed studies. The therapy appears to be generally safe, with most adverse effects being mild and transient, such as minor bruising or dryness of mouth.



Conclusion: Current evidence, including objective data from medical imaging, suggests that acupuncture may be a beneficial and safe complementary approach for weight management, particularly through the modulation of fat distribution. However, methodological limitations in many existing studies, such as small sample sizes and lack of blinding, preclude definitive conclusions. More rigorous, large-scale, and long-term studies are recommended to confirm these findings and elucidate the underlying mechanisms.