Background and purpose: Although the association between obesity and constipation has been increasingly studied, uncertainty remains regarding this relationship. Materials and methods: A comprehensive search was conducted of relevant electronic databases to identify studies evaluating the association between obesity and constipation in adults. Two reviewers independently screened the titles and abstracts of the retrieved records and assessed the full texts of potentially eligible articles. Data extraction and methodological quality assessment were performed using the CASP checklist. The findings of the included studies were synthesized qualitatively, and a random-effects model was used for the quantitative synthesis. Subgroup analyses were conducted according to the diagnostic criteria or tools used to define constipation. Results: Following the screening and eligibility assessment, 10 studies were included in the qualitative synthesis, of which 8 provided sufficient data for meta-analysis. The initial pooled analysis did not demonstrate a statistically significant association between obesity and constipation. However, subgroup analysis revealed a substantial difference according to the diagnostic criteria used to assess constipation. In studies that applied standardized tools, including internationally recognized criteria such as the Rome criteria, obesity was significantly associated with an increased risk of constipation. In contrast, studies using non-standardized or poorly defined criteria showed inverse associations and considerable heterogeneity. The dispersion and asymmetry of the funnel plot appeared to be largely attributable to methodological differences in the definition and assessment of constipation rather than to a consistent underlying association. Conclusion: Although the overall pooled estimate did not show a statistically significant association, the diagnostic approach substantially influenced the findings. When constipation was assessed using standardized and validated criteria, obesity appeared to be associated with an increased risk of constipation. Future studies should adopt internationally validated diagnostic tools and standardized methodological approaches to improve comparability and reduce heterogeneity.
Background and purpose: Colorectal cancer (CRC) exhibits high genetic, epigenetic, and immunological heterogeneity, contributing to variable therapeutic responses. This study introduces a conceptual biological framework, designated as PDS3, which integrates multi-omics data to refine tumor characterization and facilitate personalized treatment strategies. Materials and methods: This systematic review was conducted and reported in accordance with the PRISMA 2020 statement and SWiM guidelines. A comprehensive search was performed in PubMed/MEDLINE, Scopus, Web of Science, Embase, and the Cochrane Library for studies published between January 2015 and December 2025. Two independent reviewers conducted study screening, data extraction, and risk of bias assessment using validated tools (Cochrane RoB 2, ROBINS-I, and the Newcastle-Ottawa Scale). Ultimately, data from 67 eligible studies on integrative multi-omics, epigenetic alterations, the tumor immune microenvironment, liquid biopsy (ctDNA), and combinatorial immunotherapy in CRC were qualitatively synthesized. Results: Aberrant DNA methylation patterns and epigenetic dysregulation of critical cell signaling pathways were found to be closely associated with the establishment of an immunosuppressive and immune-cold tumor microenvironment. This phenotype was associated with poor clinical responses to standard immune checkpoint inhibitors (ICIs). Emerging evidence from preclinical and early-phase clinical studies suggests that the concurrent administration of epigenetic-modifying agents (e.g., DNMT or HDAC inhibitors) alongside immunotherapy may enhance antitumor immune responses and help overcome primary resistance. Furthermore, novel non-invasive modalities, particularly the analysis of circulating tumor DNA (ctDNA) via liquid biopsy, have demonstrated considerable promise as tools for longitudinal molecular profiling of tumors and real-time monitoring of disease dynamics. Conclusion: The conceptual PDS3 framework underscores that the integrative analysis of multi-omics data holds substantial potential to deepen our understanding of CRC complexity and enable more precise treatment tailoring based on individual tumor biology. However, to translate this framework into routine clinical practice, large-scale, prospective interventional studies are imperative to rigorously validate its clinical utility and prognostic value.
Background and purpose: Colorectal cancer (CRC) is a major cause of cancer-related morbidity and mortality, with substantial geographic and demographic variation in incidence. This study aimed to examine trends in CRC incidence in Mazandaran Province, Iran, from 2015 to 2022, stratified by age, sex, county, and urban or rural residence. Materials and methods: This retrospective, population-based study (ethics approval code: IR.MAZUMS.IMAMHOSPITAL.REC.1403.010) used data from the population-based cancer registry of Mazandaran University of Medical Sciences. All newly registered primary malignant CRC cases diagnosed between 2015 and 2022 were included. Data on sex, age, county, and type of residence were analysed using SPSS. Annual case counts, percentages, and age-standardised incidence rates (ASRs) were reported. Differences in age were assessed using analysis of variance (ANOVA) and independent-samples t-tests, as appropriate. Statistical significance was set at P < 0.05. Results: A total of 5,800 cases were included. Annual case counts increased from 397 (6.8% of all cases) in 2015 to 916 (15.8%) in 2021 and 907 (15.6%) in 2022. The ASR increased from 11.3 to 25.8 over the study period. Of the registered cases, 3,162 (54.5%) were male and 2,638 (45.5%) were female. The mean age was 62.37 ± 14.49 years, with no significant difference in mean age across years (P = 0.220). Women were younger than men at diagnosis (61.12 ± 14.53 vs 63.42 ± 14.37 years, P < 0.001). The largest proportion of cases occurred among individuals aged 60-69 years (26.5%), followed by those aged 50-59 years (22.7%) and 70-79 years (19.9%). Residence data were available for 5,343 cases (92.1%); of these, 62.9% were urban residents and 37.1% were rural residents. Rural residents were slightly older than urban residents (P = 0.042). The highest proportions of cases were recorded in Sari (19.6%) and Babol (14.6%), followed by Amol and Qaemshahr (9.3% each). Conclusion: The ASR of CRC in Mazandaran increased between 2015 and 2022, alongside an increase in annual registered case counts. The distribution of cases varied by age, sex, and county, with a higher proportion of cases among men and older adults. These findings support the need to strengthen CRC prevention and evaluate appropriate age-targeted screening strategies, while improving the completeness of residence data in cancer registration systems.
Background and purpose: Cancer can be accompanied by psychological distress, fear of death, and diminished hope, in addition to its physical consequences. Death anxiety refers to fear and apprehension concerning death, whereas, within Snyder’s framework, hope encompasses the motivation to pursue goals and the perceived ability to identify pathways towards achieving them. This study aimed to assess death anxiety and hope and examine their associations with demographic and clinical characteristics in patients with cancer. Materials and methods: This descriptive-analytical, cross-sectional study involved a secondary analysis of baseline data from a larger study. A total of 64 patients were assessed at IranMehr Oncology Center in Birjand, Iran, between December 2023 and June 2024. Data were collected using a demographic and clinical questionnaire, the 15-item Templer Death Anxiety Scale (score range, 0-15), and the 12-item Snyder Hope Scale (score range, 12-60). Following assessment of normality using the Shapiro-Wilk test, the Mann-Whitney U test, Kruskal-Wallis test, and Spearman’s rank correlation were used, with statistical significance set at P < 0.05. Results: The mean age of participants was 44.94 ± 11.66 years. Mean death anxiety and hope scores were 7.45 ± 0.85 and 25.27 ± 3.64, respectively; neither variable was normally distributed. Death anxiety was not significantly associated with sex, age, residence, marital status, educational attainment, occupation, economic status, cancer stage, cancer type, or illness duration. Similarly, hope scores were not significantly associated with these characteristics, except for analgesic or narcotic use, which was associated with lower hope scores (U = 392, P = 0.024). Death anxiety and hope were not significantly correlated (ρ = 0.124, P = 0.330). Conclusion: This study underscores the necessity of enhancing supportive psychological care for cancer patients. Given the psychological challenges inherent in this population, integrating routine psychological screening into clinical practice, particularly for patients with a high symptom burden, is a vital step toward improving their psychological well-being and overall quality of life.
Background and purpose: Pain and anxiety associated with local anaesthetic injections remain important challenges in paediatric dentistry, particularly during palatal injections. Given the inconsistent evidence regarding the comparative effectiveness of topical anaesthetic agents, this study aimed to compare the effectiveness of 2.5% lidocaine/2.5% prilocaine gel and 20% benzocaine gel in reducing injection-related pain and to compare their taste acceptability in children aged 9-12 years. Materials and methods: This randomised, double-blind, crossover trial included 50 children aged 9-12 years. Each participant received both topical anaesthetic gels in a randomised sequence during two separate treatment sessions, with a one-week washout period between sessions. Pain associated with needle insertion during palatal injection was assessed immediately after injection using the visual analogue scale (VAS). Taste acceptability was assessed based on the children's reported responses to each gel. Data were analysed using SPSS version 22. Between-treatment differences in pain scores were analysed using a paired t-test, while taste acceptability was compared using the generalised McNemar test. Statistical significance was set at P < 0.05. Results: The mean VAS pain scores were 46.28 ± 10.15 for 20% benzocaine gel and 42.38 ± 8.55 for 2.5% lidocaine/2.5% prilocaine gel. Although the mean pain score was numerically lower with lidocaine/prilocaine gel, the difference between treatments was not statistically significant (reported 95% CI: -0.06 to 7.86; P = 0.054). Taste acceptability differed significantly between the two gels (P < 0.001), with unfavourable taste reported more frequently following the use of benzocaine gel. Conclusion: The 2.5% lidocaine/2.5% prilocaine gel and 20% benzocaine gel did not differ significantly in their effectiveness in reducing pain associated with palatal injections in children aged 9-12 years. However, lidocaine/prilocaine gel had better taste acceptability and may therefore be a useful alternative to benzocaine gel in paediatric dentistry. (Clinical Trials Registry Number: IRCT20250715066500N1)
