BACKGROUND:Thrombus formation following flap reconstruction reduces perfusion and can lead to flap compromise. Effective anticoagulation protocols are essential to prevent this complication. PURPOSE:The study's purpose was to measure and compare flap compromise associated with 3 different anticoagulation protocols. STUDY DESIGN, SETTING, SAMPLE:This retrospective cohort study included patients with head and neck cancer who underwent flap reconstruction. Exclusion criteria included patients who did not consent to participate, did not receive the anticoagulation regimen, or had a history of adverse reactions to heparin or aspirin (ASA). EXPOSURE:The primary exposure was the anticoagulation protocol, which was divided into 3 groups: intravenous unfractionated heparin (IV-UFH), subcutaneous UFH (SC-UFH), and SC-UFH plus ASA. MAIN OUTCOME VARIABLE:The outcome variable was postoperative flap outcome coded as compromised or not. COVARIATES:Covariates included patient demographics, cancer type, neoadjuvant therapy, flap type, surgical procedure, intensive care unit stay, medical history, and postoperative complications. ANALYSES:χ2, Mann-Whitney U, and Kruskal-Wallis tests were used for baseline data analysis. Multivariate logistic regression was conducted to examine the adjusted association between anticoagulation protocol and flap outcome. P values < .05 were considered statistically significant. RESULTS:The study sample consisted of 300 patients who met inclusion criteria with a mean age of 48.3 (±17.69) years, 202 (67.3%) of whom were male. There were 28 (9.3%) cases of flap compromise. The unadjusted analysis showed that patients receiving IV-UFH had a significantly higher risk of flap compromise compared to those receiving SC-UFH (relative risk: 3.43 [1.62 to 7.28]). Adding ASA to SC-UFH did not result in a statistically significant reduction in the risk of flap compromise (relative risk: 0.95 [0.35 to 2.61]). After adjusting for confounding factors, the anticoagulant type was not associated with flap compromise (P = .05). However, in the subgroup analysis, compared to SC-UFH, subjects receiving IV-UFH still had higher odds of flap compromise (odds ratio = 2.69, 95% CI [1.003 to 7.205], P = .049) CONCLUSION AND RELEVANCE: Postoperative thrombosis in head and neck microsurgery remains a significant risk factor for poor outcomes. SC-UFH administration may be a practical approach to managing these risks compared to intravenous administration; however, the choice of anticoagulation protocol is not associated with the flap compromise.

Background: Patients with colorectal cancer who undergo surgery face many postoperative problems. These problems include the risk of relapse, side effects, and long-term complications.Objective: This study sought to design and develop a remote monitoring system as a technological solution for the postdischarge care of these patients.Methods: This research was conducted in 3 main steps: system feature extraction, system design, and evaluation. After feature extraction from a systematic review, the necessary features were defined by 18 clinical experts in Iran. In the next step, the architecture of the system was designed based on the requirements; the software and hardware parts of the system were embedded in the architecture, then the software system components were drawn using the unified modeling language diagrams, and the details of software system implementation were identified. Regarding the hardware design, different accessible hardware modules were evaluated, and suitable ones were selected. Finally, the usability of the system was evaluated by demonstrating it over a Skype virtual meeting session and using Nilsen's usability principles.Results: A total of 21 mandatory features in 5 main categories, including patient information registration, periodic monitoring of health parameters, education, reminders, and assessments, were defined and validated for the system. The software was developed using an ASP.Net core backend, a Microsoft SQL Server database, and an Ionic frontend alongside the Angular framework, to build an Android app. The user roles of the system included 3 roles: physicians, patients, and the system administrator. The hardware was designed to contain an Esp8266 as the Internet of Things module, an MLX90614 infrared temperature sensor, and the Maxim Integrated MAX30101 sensor for sensing the heartbeat. The hardware was designed in the shape of a wristband device using SolidWorks 2020 and printed using a 3D printer. The firmware of the hardware was developed in Arduino with the capability of firmware over the air. In evaluating the software system from the perspective of usability, the system received an average score of 3.8 out of 5 from 4 evaluators.Conclusions: Sensor-based telemonitoring systems for patients with colorectal cancer after surgery are possible solutions that can make the process automatic for patients and caregivers. The apps for remote colorectal patient monitoring could be designed to be useful; however, more research regarding the developed system's implementation in clinic settings and hospitals is required to understand the probable barriers and limitations.

BACKGROUND:Clear cell renal cell carcinoma (ccRCC) is one of the common subtypes of kidney cancer. Circular RNAs (circRNAs) act as competing endogenous RNAs (ceRNAs) to affect the expression of microRNAs (miRNAs), and hence the expression of genes involved in the development and progression of ccRCC. However, these interactions have not been sufficiently explored.METHODS:The differential expression of circRNAs (DEC) was extracted from the GEO database, and the expression of circRNAs was analyzed by the Limma R package. The interaction of miRNAs with circRNAs was predicted using (cancer-specific circRNA database) CSCD and circinteractome database. The genes affected by the miRNAs were predicted by miRwalk version 3, and the differential expression was retrieved using TCGA. Functional enrichment was assessed and a PPI network was created using DAVID and Cytoscape, respectively. The genes with significant interactions (hub-genes) were screened, and the total survival rate of ccRCC patients was extracted from the Gene Expression Profiling Interactive Analysis (GEPIA) database. To confirm the expression of OS genes we used the Immunohistochemistry (IHC) data and TCGA database. The correlation between gene expression and immune cell infiltration was investigated using TIMER2.0. Finally, potential drug candidates were predicted by the cMAP database.RESULTS:Four DECs (hsa_circ_0003340, hsa_circ_0007836, hsa_circ_0020303, and hsa_circ_0001873) were identified, along with 11 interacting miRNAs (miR-1224-3p, miR-1294, miR-1205, miR-1231, miR-615-5p, miR-940, miR-1283, and miR-1305). These miRNAs were predicted to affect 1282 target genes, and function enrichment was used to identify the genes involved in cancer biology. 18 hub-genes (CCR1, VCAM1, NCF2, LAPTM5, NCKAP1L, CTSS, BTK, LILRB2, CD53, MPEG1, C3AR1, GPR183, C1QA, C1QC, P2RY8, LY86, CYBB, and IKZF1) were identified from a PPI network. VCAM1, NCF2, CTSS, LILRB2, MPEG1, C3AR1, P2RY8, and CYBB could affect the survival of ccRCC patients. The hub-gene expression was correlated with tumor immune cell infiltration and patient prognosis. Two potantial drug candidates, naphazoline and lithocholic acid could play a role in ccRCC therapy, as well other cancers.CONCLUSION:This bioinformatics analysis brings a new insight into the role of circRNA/miRNA/mRNA interactions in ccRCC pathogenesis, prognosis, and possible drug treatment or immunotherapy.

Background: Time management is effective in controlling stress especially for medical residents. Time management in the surgical field and residential education is very important as they are directly involved in treating patients. Proper time management will help decrease work-related stress and increase efficacy, although there is no time management in medical courses. There are few studies in Iran in this field. So, we designed this study to assess the effects of time management on improvement of educational and therapeutic services in surgical residents of Imam Hospital. Methods: This before–after study was done in Imam hospital between February-March 2015. In this before-after study, 18 surgical residents of Imam Hospital (residents of 1-4 years), were enrolled. Their activities were evaluated in 11 scopes. To evaluate the effects of this self-evaluation, 5 scopes were assessed by the staff. The time during two weeks spent on each item was claimed as a percentage of 336 hours in two weeks. The self-assessment results and their effects on their scores were considered. Data regarding age, sex, and marital status were also gathered. Data were analyzed using SPSS software. Results: Eighteen residents were enrolled in this study. Ten residents were male (55.6%) and eight were female. Six (33.3%) were married. The mean age was 30±3.7 years. Resting time and emergency room time were significantly higher in the first-year residents while studying time was higher in the fourth-year residents. Second-year residents spend more time in training classes than others. The mean score at the beginning and the end of the study was highest in the forth-year residents and lowest in the first-year residents. All scores at the end of the study were significantly higher than the beginning except clinical judgment. The increase of the mean overall score was significantly higher in the fourth-year group and lowest in the first-year group. Conclusion: Time management could improve the educational performance of surgical residents.

Lower gastrointestinal cancer patients, like other immunosuppressed patients, are vulnerable to develop more severe infections. Iran is one of the countries with a high incidence of COVID-19, and some modifications are needed to adjust international protocols to deal with this pandemic. Therefore, our cancer institute has implemented some changes in the current treatment guidelines. In each specialty, all members agreed to choose the minimal intervention. The members know that some recommendations may interfere with the routine best-practice recommendations and decrease the quality measures in the patient's outcome. Therefore, these recommendations are valid just in the epidemic COVID-19 situation in the country. According to the consensus of colorectal and cancer surgery professors, if a patient is a new case of rectal cancer, he or she should be referred to undergo neoadjuvant chemoradiotherapy. But if the patient comes eight to twelve weeks after receiving chemoradiotherapy in accordance with the COVID-19 epidemic phase, it may be possible to delay surgery. A stent can be implanted in a patient with rectal cancer who presents with obstructive symptoms, and surgery can be postponed until resolving the crisis of the COVID-19 epidemic or its downward trend. For colon cancer, we will request a thoracic spiral CT scan. If there was no evidence of pulmonary involvement with COVID-19, the patient would undergo open surgery considering the patient's health and protection tips.

Background Distant metastasis of Gastric Cancer (GC) causes more than 700 000 deaths worldwide. Cancer Stem Cells (CSCs) are a subpopulation of cancer cells responsible for aggressiveness and chemoresistance in clinical settings. MicroRNAs (miRNAs) emerge as important players in regulating self-renewal and metastasis in CSCs. Understanding the role of miRNAs in CSCs offer a potential diagnostic tool for GC patients. This study is aimed to identify miRNAs that target both stemness and metastasis in gastric cancer stem cells (GCSCs) and differentially expressed in metastatic GC patients as diagnostic biomarkers for GC metastasis. Methods We investigate the gene expression profile of patients using the GEO database and Rstudio software. To obtain the regulatory networks and miRNAs, the STRING and miRwalk database used. The gastric cancer tissues were obtained from Iranian National Tumor Bank (INTB) to validate the results. Results Our results indicated three important regulatory cores affecting the immune system’s regulation, tumor progress, and metastasis. Based on the bioinformatics results, four miRNAs miR-17-5p, miR-24-3p, miR-124-3p, and miR-145-5p, were selected, and their expression pattern was evaluated in 10 patients’ metastatic tumors compared to 10 nonmetastatic tumors by real-time PCR. The expression level of mir-17, −24, and −124 was upregulated about 8, 10, 60 folds, respectively, and miR-145 was down-regulated 4.5 folds in metastatic tumors compared to nonmetastatic tumors. Conclusion the high expression level of miR-17, −24, −124, and low level of miR-145 in GC patients’ samples could be a potential biomarker for the presence of GCSCs and the diagnosis of metastasis.

Background: Circular RNAs (circRNAs) are a new kind of non-coding RNA(ncRNA). Throughout research, we see an increase in the number of studies demonstrating that circRNAs occupy a pivotal role in the growth and advancement of human tumors. Nevertheless, hsa_circ_001787's role in the evolution of colorectal cancer (CRC) remains unclear. This current study ascertained the expression level of circRNA001787 in CRC specimens and neighboring healthy tissues, and investigated the miRNAs associate with hsa_circ_001787, as well as the relationship between hsa_circ_001787 and pathological factors. Method: First, the expression level of hsa_circ_001787 was measured in 43 matched Tissues from CRC and normal tissues through using real-time quantitative reverse transcription PCR (qRT-PCR). Second, based on circular RNA-microRNA and microRNA-mRNA pairs, a circRNA-miRNA-mRNA network was created. The survival rate of mRNAs was investigated through the GEPIA in the network. Regarding the elucidated function analysis of hsa_circ_001787, The biological, molecular, cellular function (GO) and pathway (KEGG) enrichment was obtained. Result: We detected that hsa_circ_001787 expression level was significantly down expressed in CRC tissue versus paired CRC histological normal tissue. The area under the curve (AUC) was 0.83. The expression level of hsa_circ_001787 was significantly associated with pathological factors such as tumor grade and the primary site of the tumor. Based on the hsa_circ_001787, a novel circRNA/miRNA/mRNA network has been built up, four miRNAs, and 24 mRNA. The pathway of mRNAs analyzed in the pathogenesis of CRC. Four genes distinguished via the GEPIA database were positively linked to the overall survival of CRC patients. Conclusion: Our study suggested that hsa_circ_001787 was significantly down-regulated in CRC. We might be able to use this as a new biomarker in the screening of CRC. Furthermore, our finding achieves a broader understanding of the regulatory mechanisms by which hsa_circ_001787 acts as ceRNA in colorectal cancer. (C) 2021 The Authors. Published by Elsevier B.V. on behalf of King Saud University.

INTRODUCTION:Colorectal cancer (CRC) is a type of cancer in humans that leads to high mortality and morbidity. CD166 and CD326 are immunoglobulins that are associated with cell migration. These molecules are included in tumorigenesis of CRC and serve a great marker of CRC stem cells. In the present study, we devised a novel chimeric protein including the V1-domain of the CD166 and two epitopes of CD326 to use in diagnostic or therapeutic applications.METHODS:In silico techniques were launched to characterize the properties and structure of the protein. We have predicted physicochemical properties, structures, stability, MHC class I binding properties and ligand-receptor interaction of this chimeric protein by means of computational bioinformatics tools and servers. The sequence of chimeric gene was optimized for expression in prokaryotic host using online tools and cloned into pET-28a plasmid. The recombinant pET28a was transformed into the E. coli BL21DE3. Expression of recombinant protein was examined by SDS-PAGE and Western blotting.RESULTS:The designed chimeric protein retained high stability and the same immunogenicity as of the original proteins. Bioinformatics data indicated that the epitopes of the synthetic chimeric protein might induce B-cell- and T-cell-mediated immune responses. Furthermore, a gene was synthesized using the codon bias of a prokaryotic expression system. This synthetic gene expressed a bacterial expression system. The recombinant protein with molecular weights of 27kDa was expressed and confirmed by anti-his Western blot analysis.CONCLUSION:The designed recombinant protein may be useful as a CRC diagnostic tool and for developing a protective vaccine against CRC.

BACKGROUND AND AIM:Cancer stem cells (CSCs), a subpopulation of tumor cells, assess the capacity of self-renewal, metastasis, and therapeutic resistance. Regulation of CSCs and their epithelial to mesenchymal transition (EMT) potential is one of the promising strategies to eliminate cancer or to inhibit metastasis. Micro-RNAs (miRNAs) as regulators of several cell properties, such as self-renewal, metastasis, and resistance to the drug, could be proper targets in cancer diagnosis and therapy. The aim of the present study is to select common miRNAs targeting both self-renewal and metastasis in gastric cancer.METHODS:Stemness-related and EMT-related genes were selected by literature mining. The common miRNAs targeting genes were chosen using different databases and r programming language. The expression pattern of selected miRNAs and genes was evaluated in gastrospheres-as a gastric CSC model-and gastric tumor biopsies.RESULTS:Based on the integrated analysis, six miRNAs common to both stemness and metastasis were identified. miR-200c-3p and miR-520c-3p overexpressed in MKN-45 gastrospheres and grade III tumors. In AGS spheres, however, miR-520c-3p and miR-200c-3p upregulation and miR-34a-5p downregulation were similar to grade II tumors. Interestingly, miR-200c-3p and miR-520c-3p indicated a positive correlation with OCT4 and NOTCH1 expression in grade III tumors and MKN-45 spheres. Protein-protein network revealed that the EMT acquisition can be induced by stemness activation through intermediated core-regulatory genes, including CTNNB1, CTNND1, MAML1, KAT2A, and MAML3.CONCLUSION:The upregulation of mir-200c-3p and mir-520c-3p could effect on stemness and metastasis in gastric cancer as well as gastric CSCs. Therefore, they can be used as diagnosis and prognostic factors.

Purpose: Long non-coding RNAs (LncRNAs) are thought as tumorigenic factors in cancer progression. We investigated the clinical significance of arylsulfatase D (ARSD) and ARSD antisense in breast cancer patients. Methods: Eighty breast cancer tumors were obtained from the Tumor Bank of Cancer Institute, Imam Khomeini Hospital. The expression level of ARSD and ARSD-AS1 were examined in breast tumors in comparison to the margin of normal tissues using quantitative real-time PCR. Demographic information and the clinicopathologic characteristics including tumor grade, presence of cell receptors, lymph node and vascular invasion were also evaluated. Bioinformatics databases were used for identification of ARSD and ARSD-AS1 molecular targets and their association with cancer. Results: Significant up-regulation of ARSD was observed in tumor tissues in comparison with its antisense (p<0.05). Both ARSD and ARSD-AS1 expression in tumor specimens were notably lower than those in adjacent normal tissue. High expression of ARSD was associated to lower tumor grade (p<0.05). Bioinformatics results revealed the interaction of ARSD with STS and SUMF1 proteins was attributed to the inhibiting of sulfates activity. Also, ARSD co-expressed genes were associated with oncogenic transcription factors, MAF and GATA. TP53 transcription factor site was identified as a target of ARSD-AS1 mRNA. The interaction of this antisense with microRNA (miR-618) could explain its participation in tumor cell proliferation. Conclusion: Low expression of ARSD was associated with higher tumor grade. The evidence from this study enhance our understanding of ARSD and ARSD-AS1 function in cancer gene therapy. Accordingly, they could be introduced as great potential targets for breast cancer treatment.

Gastric cancer (GC) is the fifth most frequent cancer and the third-leading cause of cancer-related death worldwide. It is a highly heterogeneous disease regarding the morphological and molecular viewpoints. Since it is curable in primary stages, early detection could improve the survival rate. Long noncoding RNAs contribute to a variety of cellular mechanisms, and their dysregulation is reported in various diseases such as cancer. Thus, they have a great potential to be used as diagnostic and prognostic biomarkers and therapeutic targets as well. In the current study, ANRIL and ANRASSF1 expression levels were compared between GC tumors and the adjacent normal tissues collected from 39 Iranian patients using the quantitative real-time polymerase chain reaction method. Correlation between ANRIL and ANRASSF1 expression levels and other clinical parameters was also evaluated. ANRIL and ANRASSF1 were significantly overexpressed in GC tumors compared with adjacent tissues ( P < 0.0001 and P = 0.001, respectively). No significant correlation between ANRIL and ANRASSF1 expression levels and demographic information was found. This study suggests that ANRIL and ANRASSF1 may play a critical role in GC progression and can be considered as a potential diagnostic or therapeutics biomarkers.

Cancer is one of the most complex diseases that has resulted in multiple genetic disorders and cellular abnormalities. Globally, cancer is the most common health concern disease that is affecting human beings. Great efforts have been made over the past decades in biology with the aim of searching novel and more efficient tools in therapy. Thus, small interfering RNAs (siRNAs) have been considered one of the most noteworthy developments which are able to regulate gene expression following a process known as RNA interference (RNAi). RNAi is a post-transcriptional mechanism that involves the inhibition of gene expression through promoting cleavage on a specific area of a target messenger RNA (mRNA). This technology has shown promising therapeutic results for a good number of diseases, especially in cancer. However, siRNA therapeutics have to face important drawbacks in therapy including stability and successful siRNA delivery in vivo. In this regard, the development of effective siRNA delivery systems has helped addressing these issues by opening novel therapeutic windows which have allowed to build up important advances in Nanomedicine. In this review, we discuss the progress of siRNA therapy as well as its medical application via nanoparticle-mediated delivery for cancer treatment.

Background: Breast cancer is the most common type of cancer among women, and is among the five most prevalent cancer types among Iranian women. Advanced-stage breast cancer is often correlated with distant metastases. Alterations in gene expression affect general cytoskeleton changes during differentiation and oncogenesis, and can be considered an important factor in tumor progression. Gelsolin plays a significant role in actin assembly and has been introduced as a tumor activator. The aim of this study was to evaluate the expression of Gelsolin in breast cancer as well as its correlation with patients’ clinical parameters. Methods: In this study, 70 breast cancer patients, who had been referred to Imam Khomeini Complex Cancer Institute for surgery were randomly selected. Normal and tumor tissues were prepared and stored at -80°C. Gelsolin gene expression was measured using real-time polymerase chain reaction (PCR). Results: The results showed that Gelsolin gene expression had increased in 68.6% of the tumor samples. In addition, there was a significant association between increased levels of gene expression and tumor progression stages (P < 0.05). However, there was no significant association between increased levels of gene expression and other clinical findings, such as tumor grade, tumor size or patient age. Conclusion: The results revealed that Gelsolin gene expression had increased in the tumor samples. Gelsolin overexpression also resulted in increased lymph node involvement in breast cancer. The expression of this gene also increased significantly during advanced stages of breast cancer; however, there was no significant relation between Gelsolin expression and tumor grade or tumor size.

Spinal cord injury (SCI) has a number of severe and disabling consequences including chronic pain. Approximately 40% of patients experience neuropathic pain, which appears to be persistent. Previous studies have demonstrated the neuroprotective effects of magnesium sulfate (MgSO4). We aimed to investigate the effect of MgSO4 on neuropathic pains following SCI in male rats. Thirty-two adult male rats (weight 300-350 g) were used. After laminectomy, a complete SCI was induced by compression of the spinal cord for 1 min with an aneurysm clip. A single dose of 300 or 600 mg/kg MgSO4 was injected intraperitoneally. Tail-flick latency and acetone drop test scores were evaluated before surgery and once a week for 4 weeks after surgery. Rats in groups SCI + Mg300 and SCI + Mg600 showed significantly higher mean tail-flick latencies and lower mean scores in the acetone test compared with those in the SCI + veh group 4 weeks after surgery (P < 0.05). These findings revealed that systemic single-dose administration of MgSO4 can attenuate thermal hyperalgesia and cold allodynia induced by SCI in rats. Behavioural Pharmacology 26:315-320 Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.

Oral cancer is considered a great threat to public health. Tongue cancer accounts for nearly 30% of all oral cancers and usually seen in 50 to 60 year old men. Oropharyngeal cancers account for 3% of all cancers in Iran; as reported in 2003. The present study was designed to assess the epidemiologic and clinicopathologic characteristics of tongue cancer patients in two Tehran's referral university hospital between the years 2003 and 2008. In a retrospective study 87 files of pa¬tients, diagnosed with tongue cancer who were referred to Imam Khomeini and Loghman Hospitals and Iranian Cancer Iinstitute in Tehran-Iran from 2003 to 2008 were reviewed. Participants were selected from all the patients who had a record of their specimens in the pathology ward registry and their tongue cancer diagnosis was confirmed by a expert pathologist. Patients characteristics (age, gender and presence of risk factors) and chief complain at the time of diagnosis and their tumor related data (type of cancer, staging, grading, morphology and location of tumor) were recorded. Tongue cancer was most frequently seen in the eighth decade of life among both men and women, but had the lowest frequency among patients with less than 40 years of age. Squamous cell carcinoma had the highest prevalence in our patients. Tongue cancer was the most common cancer of oral cavity among Iranian patients and similar epidemiologic and clnicopathological characteristics of the disease were found in our patients. Assessing variables such as socioeconomic levels and religious believe require further studies with large sample sizes.