Laparoscopic surgery for rectal cancer, specimen extraction: transanal or transabdominal?

BACKGROUND: Comparison of natural orifice specimen extraction (NOSE) and transabdominal specimen extraction (TASE) in colorectal surgery remains controversial. Herein, we aimed to perform a retrospective analysis on surgical outcomes of NOSE and TASE at three hospitals in east of Iran. METHOD: Consecutive locally advanced rectal adenocarcinoma patients who underwent laparoscopic surgery using either NOSE or TASE from 2011 to 2017 were recruited. These patients were followed-up till 2020. Data, including postoperative complications, long-term overall and recurrence-free survival were analyzed retrospectively. RESULTS: 239 eligible patients were included in this study. 169 (70.71%) patients underwent NOSE, and 70 (29.29%) patients underwent TASE. Although this study has achieved similar outcomes in terms of overall and recurrence-free survival, metastasis, circumferential margin involvement as well as complications of intra-operative bleeding, obstruction, anastomosis-fail, rectovaginal-fistula in women and pelvic collection/abscess in both groups, we observed higher rates of locoregional recurrence, incontinency, stenosis and the close distal margins involvement in NOSE group and also obstructed defecation syndrome in TASE cases. CONCLUSION: According to our findings, NOSE laparoscopic surgery showed significantly higher incontinency, impotency, stenosis and involvement of the close distal margins rates. Nevertheless, considering the similarity of long-term overall and recurrence-free survival, metastasis, circumferential margin involvement, NOSE procedure is still could be considered as a second choice for lower rectal adenocarcinoma patients.

Self-care behaviors mediates the relationship between resilience and quality of life in breast cancer patients.

Previous studies have shown that resilience could play an important role in enhancing the quality of life in women with breast cancer; however, the mediating role of self-care behaviors have not been studied. This study aims to explore the mediating role of self-care behaviors in the relationship between resilience and quality of life in breast cancer patients. A sample of 195 women with breast cancer (aged from 21 to 60 years; M = 45.32 ± 8.2) from three hospitals in Tehran, Iran completed online questionnaires measuring resilience, self-care and quality of life. The results of structural equation modeling showed that resilience (ß = 0.546, p < .01) and self-care behaviors (ß = 0.621, p < .01) positively predicted the quality of life in breast cancer patients. The bootstrapping analysis showed that self-care behaviors acted as a partial mediator between resilience and quality of life. The present study brings to light an underlying mechanism of the relationship between resilience and quality of life via the mediating variable of self-care behaviors for patients with breast cancer.

The effect of intra-striatal administration of GPR55 agonist (LPI) and antagonist (ML193) on sensorimotor and motor functions in a Parkinson's disease rat model.

OBJECTIVE: G protein-coupled receptor 55 (GPR55) is an orphan G protein-coupled receptor with various physiological functions. Recent evidence suggests that this receptor may be involved in the control of motor functions. Therefore, in the present study, we evaluated the effects of intra-striatal administration of GPR55 selective ligands in a rat model of Parkinson's disease. METHODS: Experimental Parkinson was induced by unilateral intra-striatal administration of 6-hydroxydopamine (6-OHDA, 10 µg/rat). L-α-lysophosphatidylinositol (LPI, 1 and 5 µg/rat), an endogenous GPR55 agonist, and ML193 (1 and 5 µg/rat), a selective GPR55 antagonist, were injected into the striatum of 6-OHDA-lesioned rats. Motor performance and balance skills were evaluated using the accelerating rotating rod and the ledged beam tests. The sensorimotor function of the forelimbs and locomotor activity were assessed by the adhesive removal and open field tests, respectively. RESULTS: 6-OHDA-lesioned rats had impaired behaviours in all tests. Intra-striatal administration of LPI in 6-OHDA-lesioned rats increased time on the rotarod, decreased latency to remove the label, with no significant effect on slip steps, and locomotor activity. Intra-striatal administration of ML193 also increased time on the rotarod, decreased latency to remove the label and slip steps in 6-OHDA-lesioned rats mostly at the dose of 1 µg/rat. CONCLUSIONS: This study suggests that the striatal GPR55 is involved in the control of motor functions. However, considering the similar effects of GPR55 agonist and antagonist, it may be concluded that this receptor has a modulatory role in the control of motor deficits in an experimental model of Parkinson.

Religious Perfectionism Scale: Assessment of Validity and Reliability Among Undergraduate Students in Iran.

Religious perfectionism is a construct that may help to either improve mental health or cause mental health difficulties. The Religious Perfectionism Scale (RPS; Wang in J Relig Health 59: 318-333, 2020) is a useful tool for assessing religious perfectionism around the world, but its psychometric properties have yet to be tested in Iran. The sample in the present study consisted of 300 Iranian undergraduate students (180 females) from Azad University who completed the RPS, the Depression Anxiety Stress Scale-2, and the Moral Perfectionism Scale. The impact score was used to determine face validity, and the values of the impact score for all translated items were greater than 1.5, meaning that the items had satisfactory face validity. The Content Validity Index (CVI) values were above the acceptable cutoff score of 0.7, indicating the acceptable content validity of items. The Content Validity Ratio (CVR) scores were greater than the cutoff score of the Lawshe table (.78), indicating the satisfactory essentiality of the items. To measure construct validity, the results of a confirmatory factor analysis (CFA) using AMOS software confirmed the scale with two subscales (zealous religious dedication and religious self-criticism). No item was removed from the scale as all factor loading values were greater than 0.49. The findings support the psychometric properties of the scale for measuring religious perfectionism among undergraduate students in Iran.

Effects of Death Anxiety on Perceived Stress in Individuals With Multiple Sclerosis and the Role of Self-Transcendence.

Stress is a commonly reported concern of individuals with chronical diseases, including multiple sclerosis (MS). This study sought to investigate the relationships between self-transcendence, death anxiety, and perceived stress among individuals with MS from Iran. A second aim of the study was to assess the buffering effect of self-transcendence in the relationship between death anxiety and perceived stress. Two hundred and fifteen participants with MS from four hospitals completed measures assessing self-transcendence, death anxiety, and perceived stress. Using structural equation modeling, death anxiety was found to be positively related to perceived stress. In addition, there was a negative relationship between self-transcendence and perceived stress. Results of the study suggest that self-transcendence is a buffer in the link between death anxiety and perceived stress for individuals with MS. The findings demonstrate the importance of self-transcendence in decreasing the effects of death anxiety on perceived stress and have clinical implications for health professionals.

Self-compassion moderates the perceived stress and self-care behaviors link in women with breast cancer.

OBJECTIVE: Women with breast cancer are exposed to various stressors, and self-care behaviors play an important role in their recovery. However, very few studies have investigated self-care behaviors specifically for women with breast cancer. The current study examined the relationship between perceived stress and self-care behaviors, and explored whether self-compassion moderated this relationship. METHODS: A sample of 210 women with breast cancer aged 27 to 60 years old from three hospitals in Tehran, Iran completed online self-report questionnaires of self-care behaviors, self-compassion, and perceived stress. RESULTS: Data analyses with structural equation modeling showed that perceived stress (ß = -.37, P < .01) and self-compassion (ß = .38, P < .01) were significant predictors of self-care behaviors. The interaction-moderation analysis showed that self-compassion acted as a moderator between perceived stress and self-care behaviors. CONCLUSIONS: The findings enhance our understanding about the protective role of self-compassion in the relationship between perceived stress and self-care behaviors in women with breast cancer.

The effects of perceived stress on hope in women with breast cancer and the role of psychological hardiness.

OBJECTIVE: Diagnosis and treatment of breast cancer are psychologically stressful events, and hope and hardiness have been found to be important constructs for women with breast cancer. Therefore, this research sought to examine the relationships of perceived stress and hardiness with hope, and the buffering role of hardiness in the link between perceived stress and hope among Iranian women with breast cancer. METHODS: Two hundred and twenty Iranian women with breast cancer from three hospitals completed online measures evaluating perceived stress, hardiness, and hope. RESULTS: Using structural equation modelling, perceived stress was found to be negatively related to hope. Additionally, there was a positive relationship between hardiness and hope. The findings indicate that hardiness is a buffer in the link between perceived stress and hope for women with breast cancer. CONCLUSIONS: These findings demonstrate the importance of hardiness in reducing the effects of perceived stress on hope and have clinical implications for health professionals.

ErbB1 and ErbB3 co-over expression as a prognostic factor in gastric cancer.

BACKGROUND: Epidermal growth factor receptor family members such as ErbB1 and ErbB3 are involved in tumor progression and metastasis. Although, there are various reports about the prognostic value of EGFR members separately in gastric cancer, there is not any report about the probable correlation between ErbB1 and ErbB3 co-expression and gastric cancer prognosis. In present study, we assessed the correlation between ErbB1 and ErbB3 co-overexpression (in the level of mRNA and protein expression) and gastric cancer prognosis for the first time. METHODS: ErbB1 and ErbB3 expressions were analyzed by immunohistochemistry and real-time PCR in 50 patients with gastric cancer. Parametric correlations were done between the ErbB1 and ErbB3 expression and clinicopathological features. Multivariate and logistic regression analyses were also done to assess the roles of ErbB1 and ErbB3 in tumor prognosis and survival. RESULTS: There were significant correlations between ErbB1/ErbB3 co-overexpression and tumor size (p = 0.026), macroscopic features (p < 0.05), tumor differentiation (p < 0.05), stage of tumor (p < 0.05), and recurrence (p < 0.05). Moreover, ErbB1/ErbB3 co-overexpression may predict the survival status of patients (p < 0.05). CONCLUSION: ErbB1 and ErbB3 co-overexpression is accompanied with the poor prognosis and can be used efficiently in targeted therapy of gastric cancer patients.

A lentiviral vaccine expressing KMP11-HASPB fusion protein increases immune response to Leishmania major in BALB/C.

Hydrophilic acylated surface protein B (HASPB) is an immunogenic Leishmania-specific protein that antibodies are produced against it in the sera of Leishmania-infected individuals. Kinetoplastid membrane protein 11 (KMP11) is another Leishmania antigen and considered as the suitable candidate for vaccine development Leishmaniasis. It is a highly conserved surface protein expressed in both promastigotes and amastigotes. In this study, KMP11 and HASPB coding sequences were cloned into a pCDH-cGFP lentiviral vector as a fusion protein to be used as a DNA vaccine against L. major. The KMP11-HASPB fusion protein was successfully expressed as evidenced by RT-PCR and Western blot assays. The effect of the vaccine was determined by evaluating the level of IFN-γ, IL-10, IgG1, and IgG2a performed using ELISA as well as determining the parasite load after challenge with L. major in vaccinated mice. The results revealed that IFN-γ, IL-10, IgG1, and IgG2a significantly increased after vaccination using KMP11-HASPB-expressing lentiviruses in BALB/c mice. It is noteworthy that the level of IFN-γ and IgG2a was higher than that of IL-10 and IgG1, respectively, which indicates the activation Th1 cells, macrophages, and cellular immunity. Moreover, the parasite load in the spleen and lymph node of vaccinated mice after challenge was significantly lower than that of controls.

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

PURPOSE: This study aimed to assess the impact of 3 anastomotic techniques after laparoscopic rectal cancer resection. METHODS: In a cross-sectional study, the data of 155 patients who underwent surgery for rectal cancer were retrieved. An anastomosis was created between the left colon and anal canal with 3 different methods: coloanal anastomosis with protective ileostomy (group A), coloanal anastomosis without ostomy (group B), and delayed coloanal anastomosis (group C). The rates of anastomotic problems (leakage, peritonitis, and collection) were calculated for each treatment method. Multivariate analysis was used to verify the effect of anastomosis techniques. RESULTS: In 5 (3.2%) patients, peritonitis was observed in which 3 (9.7%) of them belonged to group B and 2 (4.1%) belonged to group C. In 9 (5.8%) patients, presacral collection and anastomotic leakage were observed; 4 (8.2%) patients belonged to group C, 4 (12.9%) patients to group B, and 1 (1.3%) patient to group A. Postoperative obstructions occurred in 5 (10.2%) patients of group C, 2 (6.5%) patients of group B, and 2 (2.7%) patients of group A. Rectovaginal fistula was detected in 2 patients from group B. CONCLUSIONS: Laparoscopic surgery of rectal cancer with transanal method is reliable and acceptable in terms of oncologic and surgical results. This study showed the best results in patients who had protective ostomy.

Iatrogenic injuries of the extrahepatic biliary system.

BACKGROUND: Iatrogenic traumatic extrahepatic biliary tract injuries though rarely occur; they can lead to exceedingly morbid complications. The aim of this study was to evaluate the management strategies and outcomes of patients presented with iatrogenic bile duct injuries. METHODS: This is a retrospective study. Over 19 y, 124 patients were managed for iatrogenic biliary injuries at our institution. The data related to the etiology of biliary tract injury, symptoms of injury, laboratory and radiologic studies, injury-to-diagnosis time, type of biliary tract injury, injury management, hospitalization time, and postoperative complications were reviewed. RESULTS: The main clinical presentations were jaundice or recurrent cholangitis in 64 (51.61%) patients, followed by bile peritonitis in 34 (56.67%) and biliary fistula in 26 (43.33%) patients. Only in 23 (18.54%) cases, the injury was recognized intraoperatively. The most frequent surgical procedure was open cholecystectomy in 81 (65.32%) of 124 patients. The remaining patients were operated on laparoscopically. Good results were achieved in 99 of 101 patients with direct suture repair including hepaticojejunostomy, choledocoduodenostomy, and choledochocholedochostomy (98.02% success rate) at the first attempt. Three cases (2.97%) of biliary strictures after direct suture technique and four (3.96%) cases of postoperative mortalities were detected. The mortality rate was mostly affected by male gender, advanced age, and existence of bile peritonitis. Totally, 111 (89.52%) patients are still alive with a mean follow-up time of 78 ± 38 (2-230) mo. CONCLUSIONS: Biliary injuries can be sometimes life-threatening complications. A successful repair may provide patients with a lifelong relief from symptoms, whereas a failed repair may result in recurrent biliary obstruction, reoperation, and even death.

Spirituality Moderates Hopelessness, Depression, and Suicidal Behavior among Malaysian Adolescents.

Suicide is an important public health problem for adolescents, and it is essential to increase our knowledge concerning the etiology of suicide among adolescent students. Therefore, this study was designed to examine the associations between hopelessness, depression, spirituality, and suicidal behavior, and to examine spirituality as a moderator between hopelessness, depression, and suicidal behavior among 1376 Malaysian adolescent students. The participants completed measures of depression, hopelessness, daily spiritual experience, and suicidal behavior. Structural equation modeling indicated that adolescent students high in hopelessness and depression, but also high in spirituality, had less suicidal behavior than others. These findings reinforce the importance of spirituality as a protective factor against hopelessness, depression, and suicidal behavior among Malaysian adolescent students.

Self-esteem, body-esteem, emotional intelligence, and social anxiety in a college sample: the moderating role of weight.

To examine the relationships between self-esteem, body-esteem, emotional intelligence, and social anxiety, as well as to examine the moderating role of weight between exogenous variables and social anxiety, 520 university students completed the self-report measures. Structural equation modeling revealed that individuals with low self-esteem, body-esteem, and emotional intelligence were more likely to report social anxiety. The findings indicated that obese and overweight individuals with low body-esteem, emotional intelligence, and self-esteem had higher social anxiety than others. Our results highlight the roles of body-esteem, self-esteem, and emotional intelligence as influencing factors for reducing social anxiety.

Problem-Solving Skills and Suicidal Ideation Among Malaysian College Students: the Mediating Role of Hopelessness.

OBJECTIVE: Recent evidence suggests that suicidal ideation has increased among Malaysian college students over the past two decades; therefore, it is essential to increase our knowledge concerning the etiology of suicidal ideation among Malaysian college students. This study was conducted to examine the relationships between problem-solving skills, hopelessness, and suicidal ideation among Malaysian college students. METHODS: The participants included 500 undergraduate students from two Malaysian public universities who completed the self-report questionnaires. RESULTS: Structural equation modeling estimated that college students with poor problem-solving confidence, external personal control of emotion, and avoiding style were more likely to report suicidal ideation. Hopelessness partially mediated the relationship between problem-solving skills and suicidal ideation. CONCLUSION: These findings reinforce the importance of poor problem-solving skills and hopelessness as risk factors for suicidal ideation among college students.

Sedentary behaviour and social anxiety in obese individuals: the mediating role of body esteem.

Given that the prevalence of social anxiety in obese individuals is high, it is necessary that we increase our knowledge about the related factors that cause social anxiety in obese individuals. The present study sought to examine the role of body esteem as a mediator between sedentary behaviour and social anxiety. The participants were 207 overweight and obese individuals who completed the self-report measures. The structural equation modelling displayed that obese individuals with sedentary behaviour and poor body esteem were more likely to show social anxiety. Body esteem partially mediated between sedentary behaviour and social anxiety. Our results highlight the role of sedentary behaviour and body esteem as promising avenues for reducing social anxiety in obese individuals.

Hardiness, spirituality, and suicidal ideation among individuals with substance abuse: the moderating role of gender and marital status.

OBJECTIVE: Substance abuse is a serious and major public health problem in Iran and potentially increases the risk of suicidal behavior; therefore, it is essential to increase our knowledge concerning the etiology of suicide among individuals with substance use disorders. The present study sought to examine the associations among hardiness, spirituality, and suicidal ideation in Iranian individuals with substance abuse. METHODS: This cross-sectional study was conducted in 2012, and participants comprised 450 individuals seeking substance abuse treatment at 10 addiction treatment centers in Tehran, Iran. All data were collected via self-report questionnaires. RESULTS: Sixty-seven percent of participants were male, 47% were married, and 59% were working. Structural equation modeling (SEM) suggested that, as expected, spirituality and hardiness were positively associated with each other. Findings also showed that spirituality and hardiness were negatively associated with suicidal ideation among this group of individuals with substance abuse, explaining 46% of the variance in suicidal ideation. That is, those with low levels of spirituality and low levels of hardiness were more likely to report suicidal ideation. There was a moderating effect of gender, such that greater hardiness predicted a lower likelihood of suicidal ideation for males but not for females. CONCLUSIONS: These findings reinforce the importance of spirituality and hardiness as protective factors against suicidal ideation in individuals with substance abuse, as well as the particular role of hardiness for men.

Spirituality Moderates Hopelessness, and Suicidal Ideation among Iranian Depressed Adolescents.

To examine the moderating role of spirituality between hopelessness, spirituality, and suicidal ideation, 202 Iranian depressed adolescent inpatients completed measures of patient health, suicidal ideation, hopelessness, and core spiritual experience. Structural equation modelling indicated that depressed inpatients high in hopelessness, but also high in spirituality, had less suicidal ideation than others. These findings reinforce the importance of spirituality as a protective factor against hopelessness and suicidal ideation.

Problem-solving skills and hardiness as protective factors against stress in Iranian nurses.

Nursing is a stressful occupation, even when compared with other health professions; therefore, it is necessary to advance our knowledge about the protective factors that can help reduce stress among nurses. The present study sought to investigate the associations among problem-solving skills and hardiness with perceived stress in nurses. The participants, 252 nurses from six private hospitals in Tehran, completed the Personal Views Survey, the Perceived Stress Scale, and the Problem-Solving Inventory. Structural Equation Modeling (SEM) was used to analyse the data and answer the research hypotheses. As expected, greater hardiness was associated with low levels of perceived stress, and nurses low in perceived stress were more likely to be considered approachable, have a style that relied on their own sense of internal personal control, and demonstrate effective problem-solving confidence. These findings reinforce the importance of hardiness and problem-solving skills as protective factors against perceived stress among nurses, and could be important in training future nurses so that hardiness ability and problem-solving skills can be imparted, allowing nurses to have more ability to control their perceived stress.

Can methylene blue dye be used as an alternative to patent blue dye to find the sentinel lymph node in breast cancer surgery?

BACKGROUND: Sentinel lymph node biopsy (SLNB) is standard care to evaluate axillary involvement in early breast cancer. It has fewer complications than complete lymph node dissection; however, using blue dye in SLNB is controversial. We have evaluated the detection rate and local complications associated with methylene blue dye (MBD) used in SLNB in early breast cancer patients and compared these results to patent blue dye (PBD). MATERIALS AND METHODS: In a cohort prospective study, 312 patients with early breast cancer without axillary lymph node involvement were divided into two groups according to dye type. All of the patients received radiotracer and one type of blue dye. We filled out a checklist for the patients that contained demographic data, size of tumor, stage, detection of sentinel lymph node, and complications and then analyzed the data. RESULTS: Demographic and histopathologic characteristics were not significantly different in both groups. Mean (standard deviation [SD]) tumor size in all patients was 2.4 (0.8) cm. Detection rate in the MBD group was 77.5% with dye alone and 94.2% with dye and radioisotope; and in the PBD group it was 80.1% and 92.9% respectively (P > 0.05). We had blue discoloration of the skin in 23.7% in the PBD and 14.1% in the MBD group (P < 0.05) local inflammation was detected in one patient in the PBD and five in the MBD group (P < 0.05). Skin necrosis and systemic complications were not observed. CONCLUSION: Methylene blue has an acceptable detection rate, which may be a good alternative in SLNB. Complication such as blue discoloration of the skin was also lower with MBD.