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BACKGROUND: Dynamic stability is a fundamental goal in standing activities. In this regard, monitoring, analysis, and interventions made to improve stability is a research topic investigated in the biomechanics of human movements. Vision has a major role to play in controlling human movement. Nonetheless, little is known about the effects of visual deprivation, especially from birth on dynamic gait stability. METHODS: The current study was conducted on 20 congenital blind and 10 sighted people (15-38 years). To evaluate the dynamic stability, descriptive data, harmonic ratio (HR), improved harmonic ratio (iHR), and root mean square (RMS), based on trunk acceleration data were measured in three axes: anteroposterior (AP), vertical (V), and mediolateral (ML) while participants walked an eight-meter straight path. RESULTS: In the comparison of blind and sighted people (eyes open), standard deviation, HR, iHR, and RMS indices were found to be significantly different in both AP and V directions. All the mentioned parameters were significantly lower in blind than in sighted participants. In the comparison of blind people and sighted ones with closed eyes, changes were observed in the maximum, range, standard deviation, and RMS only in the AP axis. In the comparison between eyes open and closed in sighted people, a significant difference was found only in the harmonic ratio of the vertical axis. CONCLUSION: Visual deprivation led to a decrease in dynamic stability parameters in the AP and V axes. Even the movement of sighted people in unchallenged conditions is dependent on visual information.
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Equilíbrio Postural , Caminhada , Humanos , Aceleração , Cegueira , Marcha , Adolescente , Adulto Jovem , AdultoRESUMO
BACKGROUND: There is limited and conflicting evidence on the association between selenium and non-alcoholic fatty liver disease (NAFLD). Therefore, the present population-based cross-sectional study aimed to explore the relationship between dietary selenium intake and the risk of NAFLD. METHODS: A total of 3026 subjects from the PERSIAN (Prospective Epidemiological Research Studies in IrAN) Kavar cohort study were included in the analysis. The daily selenium intake was evaluated using a semi-quantitative food frequency questionnaire, and energy-adjusted quintiles of selenium intake (µg/day) were calculated. NAFLD was defined as the fatty liver index (FLI) ≥ 60 or the hepatic steatosis index (HSI) > 36. The association between dietary selenium intake and NAFLD was evaluated using logistic regression analysis. RESULTS: The prevalence rates of NAFLD were 56.4% and 51.9%, based on the FLI and HSI markers, respectively. The odds ratios (ORs) for FLI-defined NAFLD were 1.31 (95% confidence interval (CI): 1.01-1.70) and 1.50 (95% CI: 1.13-1.99) for the fourth and fifth quintiles of selenium intake, respectively, after adjustment for sociodemographic variables, smoking status, alcohol drinking, physical activity, and dietary factors (P trend = 0.002). There was also a similar association between selenium intakes and HSI-defined NAFLD (OR = 1.34 (95% CI: 1.03-1.75) for the fourth quintile and OR = 1.50 (95% CI: 1.12-2.01) for the fifth quintile of selenium intake) (P trend = 0.006). CONCLUSION: In this large sample study, we observed a weak positive association between dietary selenium intake and NAFLD risk.
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Hepatopatia Gordurosa não Alcoólica , Selênio , Humanos , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/etiologia , Estudos Transversais , Estudos de Coortes , Estudos ProspectivosRESUMO
BACKGROUND AND AIMS: Metabolic Syndrome (MetS) is a major risk factor for cardiovascular diseases and type 2 diabetes mellitus. Diet quality has been associated with multiple chronic diseases. We aimed to investigate the association between the quality of diet and the odds of being diagnosed with MetS. METHODS AND RESULTS: This study was conducted cross-sectionally on baseline data of 2225 individuals from the PERSIAN Kavar Cohort Study (PKCS). The quality of diet was measured based on the Diet Quality Index - International (DQI-I), using Food Frequency Questionnaires. The association between DQI-I and MetS and its components was measured via logistic regression models in crude and adjusted models. We did not observe any association between DQI-I and MetS in the overall population. However, after adjustment for potential confounders, we found that male participants with higher DQI-I scores had a lower risk of MetS [adjusted odds ratio (OR) 95% confidence interval CI) = 0.62 (0.42-0.93)]. Moreover, analogous trends were observed with respect to some components of MetS, including elevated triglyceride (TG) [crude OR (95% CI) = 0.89 (0.70-0.98); adjusted OR = 0.82 (0.65-0.93)], lowered high-density lipoprotein cholesterol (HDL-c) [crude OR (95% CI) = 0.79 (0.57-0.99); adjusted OR = 0.76 (0.55-0.97)], and abnormal glucose homeostasis [crude OR (95% CI) = 0.80 (0.55-0.94); adjusted OR = 0.73 (0.51-0.91)] only in male participants, both before and after adjustment for potential confounders. CONCLUSION: In this study, we showed that higher adherence to a high-quality diet was associated with a lower chance of developing MetS in men. Biological gender might be responsible for the observed discrepancies.
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Diabetes Mellitus Tipo 2 , Síndrome Metabólica , Adulto , Masculino , Humanos , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/prevenção & controle , Irã (Geográfico)/epidemiologia , Estudos de Coortes , Diabetes Mellitus Tipo 2/complicações , Dieta/efeitos adversos , Fatores de RiscoRESUMO
Nonalcoholic fatty liver disease is the hepatic sign of metabolic syndrome. Here, we aimed to assess the effects of garlic and its major components on fasting plasma glucose, fasting insulin, and lipid profile levels in animal models of nonalcoholic fatty liver disease. A systematic search in PubMed, Scopus, ProQuest, and Web of Science was performed. After the screening process and data extraction, the pooled effect sizes were estimated using a random-effect model and stated as standardized mean differences and a 95% confidence interval. Out of 839 reports, 22 articles were included in the present study. The pooled results revealed that garlic and its components significantly decreased fasting plasma glucose (standardized mean difference: - 0.77, 95% confidence interval: - 1.42 to - 0.12, I2 : 58.85%), fasting insulin (standardized mean difference: - 1.88, 95% confidence interval: - 3.07 to - 0.69, I2 : 70.42%), serum triglyceride (standardized mean difference: - 1.01, 95% confidence interval: - 1.43 to - 0.59, I2 : 61.41%), cholesterol (standardized mean difference: - 1.00, 95% confidence interval: - 1.39 to - 0.60, I2 : 52.12%), and low-density lipoprotein cholesterol (standardized mean difference: - 0.98, 95% CI: - 1.63 to - 0.32, I2 : 71.58%) and increased high-density lipoprotein cholesterol (standardized mean difference: 1.05, 95% confidence interval: 0.52 to 1.58, I2 : 59.39%) levels. The type of animal, nonalcoholic fatty liver disease induction model, kind and duration of intervention, study model, and risk of bias were detected as possible sources of heterogeneity across studies. We conclude that garlic and its major components have a favorable impact on glycemic control and lipid profile in diet-induced nonalcoholic fatty liver disease animal models.
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Alho , Resistência à Insulina , Hepatopatia Gordurosa não Alcoólica , Animais , Hepatopatia Gordurosa não Alcoólica/tratamento farmacológico , Hepatopatia Gordurosa não Alcoólica/metabolismo , Glicemia , Controle Glicêmico , Colesterol , Insulina , AntioxidantesRESUMO
BACKGROUND: MicroRNAs (miRNAs) are non-coding, endogenous, single-stranded, small (21-25 nucleotides) RNAs. Various target genes at the post-transcriptional stage are modulated by miRNAs that are involved in the regulation of a variety of biological processes such as embryonic development, differentiation, proliferation, apoptosis, inflammation, and metabolic homeostasis. Abnormal miRNA expression is strongly associated with the pathogenesis of multiple common human diseases including cardiovascular diseases, cancer, hepatitis, and metabolic diseases. METHODS AND RESULTS: Various signaling pathways including transforming growth factor-ß, apoptosis, and Wnt signaling pathways have also been characterized to play an essential role in kidney diseases. Most importantly, miRNA-targeted pharmaceutical manipulation has represented a promising new therapeutic approach against kidney diseases. Furthermore, miRNAs such as miR-30e-5p, miR-98-5p, miR-30d-5p, miR-30a-5p, miR-194-5p, and miR-192-5p may be potentially employed as biomarkers for various human kidney diseases. CONCLUSIONS: A significant correlation has also been found between some miRNAs and the clinical markers of renal function like baseline estimated glomerular filtration rate (eGFR). Classification of miRNAs in different genetic renal disorders may promote discoveries in developing innovative therapeutic interventions and treatment tools. Herein, the recent advances in miRNAs associated with renal pathogenesis, emphasizing genetic kidney diseases and development, have been summarized.
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Nefropatias , MicroRNAs , Biomarcadores , Perfilação da Expressão Gênica , Taxa de Filtração Glomerular , Humanos , Rim/metabolismo , Nefropatias/genética , MicroRNAs/genética , MicroRNAs/metabolismoRESUMO
BACKGROUND: Colorectal cancer (CRC) is the second most common cancer in women and the third most common cancer in men worldwide, with an increasing trend in its incidence in Asian countries. In the present study, we aimed to describe the 13-year results of patients with CRC based on the Shiraz Colorectal Cancer Surgery (SCORCS) registry system in patients with a pathologically confirmed diagnosis of colon cancer (CC) and rectal cancer (RC) undergoing surgery. METHODS: Between 2007 and 2020, 811 patients, including 280 patients with CC and 531 patients with RC, registered in SCORCS, were included in the present study. The information collected for this study included demographic characteristics of the patients, primary clinical presentations, laboratory findings before surgery, radiologic and colonoscopy results, and surgical procedures. Death was confirmed by the physician as "CRC-related". The data were analyzed by SPSS software version 21; life table and Kaplan-Meier curve were used for evaluating the overall survival, recurrence, and metastasis rates and Log-Rank test or Breslow test to check significant differences between the subgroups. The Cox proportional regression model was fitted to evaluate the prognostic factors of survival recurrence and metastasis. RESULTS: Laparoscopy was performed in 60% of patients (66% in RC and 51% in CC), laparotomy in 32% (27% in RC and 41% in CC), and 7% required conversion. The median time of follow-up was 29 months in all patients; 28 months in patients with RC, and 33 months in patients with CC; 1, 3, and 5 years' survival rate was 90, 70, and 63% for all the patients, 89%, 67%, and 58% for RC and 90%, 74%, and 71% for CC, respectively (P = 0.009). The Cox regression analysis revealed tumor stages II, (P = 0.003, HR:2.45, 95% CI;1.34-4.49), III, (P ≤ 0.001, HR:3.46, 95% CI;1.88-6.36) and IV, (P ≤ 0.001, HR:6.28, 95% CI;2.73-14.42) in RC and stage IV, (P = 0.03, HR:9.33, 95% CI;1.1-76.37) in CC were the significant survival prognostic factors. The metastasis and recurrence of the tumors occurred earlier in patients with RC than CC (P = 0.001 and 0.03, respectively). CONCLUSIONS: Long-term follow-up of patients with CRC in an Iranian population indicated the significance of screening for diagnosis of early stages and improved survival of the patients.
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Neoplasias do Colo , Neoplasias Colorretais , Procedimentos Cirúrgicos do Sistema Digestório , Neoplasias Retais , Neoplasias do Colo/cirurgia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/cirurgia , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Prognóstico , Neoplasias Retais/patologia , Sistema de Registros , Estudos RetrospectivosRESUMO
BACKGROUND: Neuroendocrine tumors (NETs), as a rare and heterogeneous category of solid tumors, feature various morphologies and behaviors. In recent years, the incidence of NETs has continued to increase. Endoscopic mucosal resection (EMR) is one of the therapeutic modalities for the treatment of gastric and rectal NETs. METHODS: We evaluated patients with well-differentiated NETs of the stomach, duodenum, or rectum between 2011 and 2018. In this study, all cases with tumors confined to the mucosal or submucosal layers and smaller than 20 mm were resected using the EMR technique. We used EUS, CT scan, or MRI to exclude patients with advanced disease. All patients were actively monitored for recurrence according to the recommended protocols. RESULTS: A total of 36 patients with NETs entered the study; 17 (47.2%) were female and the remaining 19 (52.8%) were male, with a total age range of 20-74 years (mean: 52.47 ± 13.47 years). Among the tumors, 31 cases (86.1%) were G1 and the remaining 5 (13.9%) were G2. Based on the pathology reports, 22 tumors (61.1%) were smaller than 1 cm, while the remaining 14 (38.9%) were between 1-2 cm. Twenty-two patients (61.1%) had a margin of specimen involved with the tumor. No recurrence was observed during the mean follow-up time of 63.5 ± 19.8 months (range: 39-103 months). All 36 cases survived during the study period. CONCLUSION: Conventional EMR procedure provides low chance of R0 (complete resection) achievement in gastrointestinal NETs smaller than 20 mm and limited to the mucosa or sub mucosa. However, it could be an option if patients are closely followed. Postoperative marginal involvement is not a reliable predictor of disease recurrence, which may be explained by the deleterious effect of heat coagulation and cauterization applied during tumor removal.
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Ressecção Endoscópica de Mucosa , Tumores Neuroendócrinos , Neoplasias Retais , Adulto , Idoso , Dissecação , Feminino , Humanos , Mucosa Intestinal , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/cirurgia , Neoplasias Retais/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Changes in the enteric microbiota have been suggested to contribute to gastrointestinal diseases, including irritable bowel syndrome. Most of the published work is on bacterial dysbiosis with meager data on the role of the virome in irritable bowel syndrome and other gastrointestinal diseases. In the current study, we therefore aimed to investigate the viral community composition of the gut and test for potential dysbiosis linked to irritable bowel syndrome. RESULTS: A metagenomics analysis on fecal samples of 50 individuals - 30 of whom met the Rome IV criteria for IBS and 20 healthy controls- was conducted. There was a noticeable alteration in viral taxa observed in association with irritable bowel syndrome when compared to healthy individuals - where some eukaryotic viral taxa noticeably prevail over others. We observed a significant decrease in the diversity and abundance of enteric virome particularly in eukaryotic viruses of Megavirales in patients with irritable bowel syndrome. CONCLUSIONS: These findings shed light on a new hypothesis that the alteration of the viral taxa contributes to the pathogenesis of irritable bowel syndrome and related symptoms, and therefore, pave the way for developing a new diagnostic biomarker or anti-viral drugs for the treatment of irritable bowel syndrome.
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Síndrome do Intestino Irritável/virologia , Metagenômica/métodos , Vírus/classificação , Adulto , Estudos de Casos e Controles , Fezes/virologia , Feminino , Humanos , Masculino , Filogenia , Vírus/genética , Vírus/isolamento & purificação , Sequenciamento Completo do GenomaRESUMO
BACKGROUND: Overweight and obesity are major health concerns worldwide, with adverse health consequences during the life span. This study measured socioeconomic inequality in overweight and obesity among Iranian adults. METHODS: Data were extracted from 129,257 Iranian adults (aged 35 years and older) participated in the Prospective Epidemiologic Research Studies in IrAN (PERSIAN) in 14 provinces of Iran in 2014. Socioeconomic-related inequality in overweight and obesity was estimated using the Concentration Index (Cn). The Cn further decomposed to find factors explaining the variability within the Socioeconomic related inequality in overweight and obesity. RESULTS: Of the total number of participants, 1.98, 26.82, 40.76 and 30.43% had underweight, normal weight, overweight and obesity respectively. The age-and sex standardized prevalence of obesity was higher in females than males (39.85% vs 18.79%). People with high socioeconomic status (SES) had a 39 and 15% higher chance of being overweight and obese than low SES people, respectively. The positive value of Cn suggested a higher concentration of overweight (0.081, 95% confidence interval [CI]; 0.074-0.087) and obesity (0.027, 95% CI; 0.021-0.034) among groups with high SES. There was a wide variation in socioeconomic-related inequality in overweight and obesity rate across 14 provinces. The decomposition results suggested that SES factor itself explained 66.77 and 89.07% of the observed socioeconomic inequalities in overweight and obesity among Iranian adults respectively. Following SES, province of residence, physical activity, using hookah and smoking were the major contributors to the concentration of overweight and obesity among the rich. CONCLUSIONS: Overall, we found that overweight and obesity is concentrated among high SES people in the study population. . Accordingly, it seems that intersectional actions should be taken to control and prevent overweight and obesity among higher socioeconomic groups.
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Disparidades nos Níveis de Saúde , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Classe Social , Adulto , Idoso , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores SocioeconômicosRESUMO
BACKGROUND: The level of socioeconomic-related inequality in physical activity in Iran is largely unknown. This study investigates socioeconomic-related inequality in poor-physical activity (PPA) among Iranian adults. METHODS: A total of 129,257 adult participants enrolled in the PERSIAN (Prospective Epidemiological Research Studies in IrAN) Cohort were included in this study. Physical activity of adults was measured using metabolic equivalent rates (METs). Physical activity less than 41 METs/hour/day was considered PPA. The Concentration index (C) was used to quantify socioeconomic-related inequality in PPA. Moreover, the C was decomposed to identify the relative contribution of explanatory variables to inequality in PPA. RESULTS: There were significant regional variations in physical activity level among Iranian adults (29.8-76.5%). The positive value of C (0.098, 95% CI = 0.092 to 0.104) suggested that the higher concentration of PPA among higher socioeconomic status (SES) adults in Iran which was consistently observed in all cohort sites. CONCLUSIONS: The higher prevalence of PPA among Iranian adults, especially, women and older adults, warrant further public health attention. Since PPA is concentrated more among the high-SES population in Iran, strategies for the promotion of physical activity should focus more on economically well-off population.
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Exercício Físico , Classe Social , Adulto , Idoso , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores SocioeconômicosRESUMO
OBJECTIVES: Ulcerative Colitis (UC) follows a natural clinical course of relapses and remissions. The aim of this study was to construct a risk-scoring formula in order to enable predicting relapses in patients with UC. METHODS: From October 2012 to October 2013, 157 patients from Shiraz, southern Iran who were diagnosed with UC and in remission were enrolled. At 3-month intervals, multiple risk factors of hemoglobin, complete blood counts, serum iron and albumin, erythrocyte sedimentation rate, and faecal calprotectin levels, sex, age, cigarette smoking, positive family history of inflammatory bowel diseases, past history of appendectomy, extra-intestinal accompanying diseases, extent of disease at the beginning of study, number of previous relapses, duration of disease and duration of remission before the study were assessed. Univariate and multivariate logistic regression were applied to fit the final model. The new risk-scoring system accuracy was assessed using receiver-operating-characteristics (ROC) curve analysis. RESULTS: Seventy four patients (48.1%) experienced a relapse. Multivariate analysis revealed that relapses could significantly be predicted by the level of fecal calprotectin (OR=8.1), age (OR=9.2), the Seo activity index (OR=52.7), and the number of previous relapses (OR=4.2). The risk scoring formula was developed using the regression coefficient values of the aforementioned variables. CONCLUSION: Four predictor variables were significant in the final model and were used in our risk-scoring formula. It is recommended that patients who achieve high scores are diligently observed, treated, and followed up.
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OBJECTIVE: To evaluate the outcomes of jejunal serosal patch and jejunal pedicled flap procedures for the repair of duodenal injuries. METHODS: The experimental animal-model study was conducted at Shiraz University of Medical Sciences, Iran, in February 2013. Ten mixed-breed male dogs were selected and randomly divided into groups A and B. After general anaesthesia, a large duodenal defect was created in all animals. The defect was repaired with jejunal pedicled flap in group A and jejunal serosal patch in group B. Microscopic healing was scored according to epithelialisation, collagenisation, inflammation, ulcer and necrosis of samples. Kolmogorov-Smirnov and independent t-test were used to indicate normal distributions of data and statistical differences between the two groups respectively. RESULTS: The weight of the animals ranged between 23 and 37 kg and the age range was 12-16 months. All dogs survived the procedures. Anastomotic leakage, intra-abdominal abscess or intestinal obstructions were not detected in gross examination. Healing score was significantly higher in the group A than group B (p < 0.011). However, in terms of surgical findings, no significant difference was detected between the groups (p > 0.05). CONCLUSION: Applying jejunal pedicled flap for repairing large duodenal defects would lead to better histologic outcomes compared to jejunal serosal patch in dogs.
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Duodeno/lesões , Jejuno/transplante , Retalhos Cirúrgicos , Animais , Modelos Animais de Doenças , Cães , Irã (Geográfico) , Masculino , Complicações Pós-Operatórias , Distribuição Aleatória , CicatrizaçãoRESUMO
BACKGROUND: Considering the anti-oxidant properties of Pistacia atlantica and lack of data regarding its efficacy in the treatment of ulcerative colitis, this study aims at investigating the effect of the Pistacia atlantica fruit extract in treating experimentally induced colitis in a rat model. METHODS: Seventy male Sprague-Dawley rats (weighing 220±20 g) were used. All rats fasted 24 hours before the experimental procedure. The rats were randomly divided into 7 groups, each containing 10 induced colitis with 2ml acetic acid (3%). Group 1 (Asacol), group 2 (base gel) and group 7 (without treatment) were assigned as control groups. Group 3 (300 mg/ml) and group 4 (600 mg/ml) received Pistacia atlantica fruit orally. Group 5 (10% gel) and group 6 (20% gel) received Pistacia atlantica in the form of gel as enema. Macroscopic, histopathological examination and MDA measurement were carried out. RESULTS: All groups revealed significant macroscopic healing in comparison with group 7 (P<0.001). Regarding microscopic findings in the treatment groups compared with group 7, the latter group differed significantly with groups 1, 2, 4 and 6 (P<0.001). There was a significant statistical difference in MDA scores of the seven treatment groups (F(5,54)=76.61, P<0.001). Post-hoc comparisons indicated that the mean±SD score of Asacol treated group (1.57±0.045) was not significantly different from groups 4 (1.62±0.024) and 6 (1.58±0.028). CONCLUSION: Our study showed that a high dose of Pistacia atlantica fruit oil extract, administered orally and rectally can improve colitis physiologically and pathologically in a rat model, and may be efficient for ulcerative colitis.
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BACKGROUND: The gold standard of the management of rectal cancer in the middle and lower parts is low anterior resection with coloanal anastomosis. About 50% of the patients undergoing this procedure might experience some complications because of the low capacity of the neorectum. The aim of this study was to evaluate ileal J-pouch interposition as a neorectum between the anal canal and the remaining colon in comparison to coloanal anastomosis and transverse coloplasty. METHODS: Twelve dogs, weighing 23-27 kg, were divided into three groups. After laparotomy, the volume of the primary rectum was measured so that it could be compared with that of the neorectum at the end of the study. After rectal resection in Group A, the colon was directly anastomosed to the anus. In Group B, a 5-cm longitudinal incision was made 2 cm proximal to the anastomosis and was sutured transversely (coloplasty). In Group C, a 5-cm ileal J-pouch was interposed between the colon and anus. After 8 weeks, the neorectum was evaluated for volume, radiology, and pathology. RESULTS: All the samples were alive until the end of the study. The healing of the anastomotic lines was acceptable (pathologically) in all. The mean volume expansion was 20.9% in Group A, 21.7% in Group B, and 118.2% in Group C, with the latter being significantly higher than that of the other groups (P=0.03). Colon J-pouch and coloplasty after proctectomy in some situations have not been performable. This study evaluated the performance of ileal J-pouch interposition. CONCLUSION: This study showed that ileal J-pouch interposition might produce an acceptable reservoir function and that it seems feasible and safe in selected cases.
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Background: Due to the novel advanced screening methods, the number of patients diagnosed with stage I colorectal cancer (CRC) is increasing. This retrospective cohort study aimed to identify recurrence and survival risk factors of patients with stage I CRC after surgery. Materials and methods: Patients with stage I CRC were evaluated, and their demographic and clinicopathologic variables were recorded. The log-rank test assessed the association of variables with overall survival (OS), recurrence-free survival (RFS), local recurrence, and distant metastasis. Results: The median overall survival period was 51 months. The recurrence rate was 13.7%: 7.2% local and 9.3% distant recurrence. One-, two-, three-, and five-year RFS were 92%, 89%, 87%, and 83%, respectively, and OS were 96%, 93%, 90%, and 89%, respectively. Local and distant recurrence rates were higher in patients with higher tumor grades. Additionally, RFS and OS were worse in patients with higher tumor grades, and perforation was associated with worse OS. Conclusions: The determinants of survival and recurrence identified in the present study can be used to improve patient outcomes by early diagnosis and appropriate management of high-risk patients.
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INTRODUCTION: Biliary complications (BCs) are a well-documented post-liver transplantation concern with potential implications for patient survival. This study aims at identifying risk factors associated with the development of BCs in recipients after liver transplantation (LT) and exploring strategies for their management. METHODS: We conducted a retrospective analysis of 1595 adult patients (age > 18 years) who underwent LT surgery between 2019 and 2021. The study assessed the incidence of BCs in this cohort. RESULTS: Of 1595 patients, 178 (11.1%) experienced BCs, while 1417 (88.8%) did not exhibit any signs of such complications. Patients who developed BCs were found to have a significantly lower average age (p < 0.001) and longer cold ischemic times (p < 0.001) compared to those without BCs. Variables such as sex, body mass index (BMI), model for end-stage liver disease (MELD) score, primary diagnosis, type of anastomosis, hepatectomy technique, type of transplanted liver and mortality did not demonstrate statistically significant differences between the two groups (p > 0.05). Univariate logistic regression analysis revealed that a cold ischemic time exceeding 12 hours and duct-to-duct anastomosis were positive predictors for BC development (odds ratios of 6.23 [CI 4.29-9.02] and 1.47 [CI 0.94-2.30], respectively). Conversely, increasing age was associated with a protective effect against BC development, with an odds ratio of 0.64 (CI 0.46-0.89). CONCLUSION: Our multi-variate analysis identified cold ischemia time (CIT) as the sole significant predictor of post-liver transplantation biliary complications. Additionally, this study observed that advancing patient age had a protective influence in this context. Notably, no significant disparities were detected between hepatectomy techniques and the etiology of liver disease types in the two study groups.
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Doenças Biliares , Transplante de Fígado , Complicações Pós-Operatórias , Humanos , Transplante de Fígado/efeitos adversos , Fatores de Risco , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Doenças Biliares/etiologia , Doenças Biliares/epidemiologia , Isquemia Fria/efeitos adversos , Estudos de Coortes , Fatores Etários , IncidênciaRESUMO
Human papillomavirus (HPV) is a circular, double-stranded DNA virus and recognized as the most prevalent sexually transmitted infectious agent worldwide. The HPV life cycle encompasses three primary stages. First, the virus infiltrates the basal cells of the stratified epidermis. Second, there is a low-level expression of viral genes and preservation of the viral genome in the basal layer. Lastly, productive replication of HPV occurs in differentiated cells. An effective immune response, involving various immune cells, including innate immunity, keratinocytes, dendritic cells, and natural killer T cells, is instrumental in clearing HPV infection and thwarting the development of HPV-associated tumors. Vaccines have demonstrated their efficacy in preventing genital warts, high-grade precancerous lesions, and cancers in females. In males, the vaccines can also aid in preventing genital warts, anal precancerous lesions, and cancer. This comprehensive review aims to provide a thorough and detailed exploration of HPV infections, delving into its genetic characteristics, life cycle, pathogenesis, and the role of high-risk and low-risk HPV strains. In addition, this review seeks to elucidate the intricate immune interactions that govern HPV infections, spanning from innate immunity to adaptive immune responses, as well as examining the evasion mechanisms used by the virus. Furthermore, the article discusses the current landscape of HPV vaccines and common treatments, contributing to a holistic understanding of HPV and its associated diseases.