Modulatory effect of berberine on plasma lipoprotein (or lipid) profile: a review.

Berberine is a bioactive isoquinoline alkaloid compound extracted from various medicinal plants, such as Barberry. Berberine shows various pharmacological properties that are mainly attributed to its anti-inflammatory and antioxidant effects. A growing body of evidence has shown that berberine influences cholesterol metabolism, and consequently, may ameliorate dyslipidemias and atherosclerosis. Plasma high-density lipoprotein cholesterol (HDL-C) is known to have an independent negative association with incident cardiovascular disease (CVD). However, several outcomes trials and genetic studies have failed to meet expecting the beneficial effects of elevating plasma HDL-C concentrations. Hence, investigations are currently focused on enhancing the functionality of HDL particles, independent of their plasma concentrations. HDL particles show various qualities because of a heterogeneous composition. Consistent with complex metabolism and composition, various biological functions are found for HDL, such as anti-inflammatory, antioxidant, anti-apoptotic, and anti-thrombotic activities. Protective effects of berberine may impact the functionality of HDL; therefore, the present literature review was intended to determine whether berberine can amplify HDL function. It was concluded that berberine may regulate markers of HDL activity, such as apo-AI, cholesterol efflux, LCAT, PON1, and S1P activities and levels. Consequently, berberine may recuperate conditions with dysfunctional HDL and, therefore, have the potential to emerge as a therapeutic agent. However, further human trials of berberine are warranted to evaluate its impact on HDL function and cholesterol metabolism.

Comparing Antegrade and Retrograde Parotidectomy: Surgical Parameters and Complications.

Introduction: Patotidectomy is the treatment of choice for superficial parotid gland lesions. The present study aimed to assess the facial nerve status, as well as peri-and postsurgical complications, in two surgical techniques (antegrade and retrograde) for parotidectomy. Materials and Methods: This study was conducted on 56 patients diagnosed with parotid neoplasms from 2013-2015. The patients were randomly assigned to two groups of antegrade and retrograde. In the retrograde group, the dissection was performed initially to expose the facial nerve branches, while in the antegrade approach, the facial nerve trunk was exposed initially. Different values, such as intraoperative bleeding, mass characteristics, and the time for different sections of the surgery, were noted. The facial nerve was examined after the surgery; moreover, hospital stay and drain removal time was also noted. During the six-month postoperative period, complications and squeals were also noted. Results: Based on the results, antegrade nerve dissection was performed in 24 patients, while retrograde nerve dissection was carried out in 25 patients. The two groups were compared for intraoperative bleeding, drain output, and drain removal time. Hospital stay was found to be statistically higher in the retrograde group (P<0.05). Other complications and morbidities, such as facial nerve trauma, sialoceles, salivary fistulas, Frey's syndrome, skin sensory changes, and surgery time, were not statistically different (P≥0.05). Conclusions: As evidenced by the obtained results, retrograde dissection had higher intraoperative bleeding and longer hospital stay. It seems that skin flap dissection is more extensive in retrograde dissection, leading to more bleeding in this approach. These differences, although statistically significant, are not clinically important; consequently, surgeons' experience and knowledge about the two approaches are of utmost importance.

Assessment of insulin resistance in patients with primary hyperparathyroidism before and after Parathyroidectomy.

BACKGROUND: Primary hyperparathyroidism (PHPT) can lead to renal and skeletal disorders, as well as insulin resistance and impaired glucose metabolism. The current study aimed to assess the effects of parathyroidectomy on insulin resistance in patients with PHPT. MATERIALS AND METHODS: The present study was conducted on 65 patients with PHPT and indications for parathyroidectomy who were referred to the endocrinology clinics of Mashhad University of Medical Sciences. Thereafter, the demographic characteristics of the patients were recorded. Blood tests, including haemoglobin A1c (HbA1c), fasting blood glucose (FBG) and insulin levels, were assessed one week before and three months after the surgery. The insulin resistance score (HOMA-IR) was calculated and compared using the relevant formula. RESULTS: A total of 65 participants with a mean age of 45.44 ± 9.59 years were included in the current study. In one-month postoperative tests, mean scores of FBG (p < .05), insulin level (p < .05) and HbA1c (p < .05) were significantly reduced. Moreover, the HOMA-IR index decreased in 51 patients after the surgery. CONCLUSION: According to our findings, parathyroidectomy can be effective in the reduction of insulin resistance and corresponding complications in patients with PHPT in the present short-term study. However, it has yet to be confirmed as a treatment method for insulin resistance in these patients. Future long-term studies are required to be done to investigate the effect of parathyroidectomy on insulin resistance.

Mucoepidermoid Carcinoma Superimposed on a Warthin's Tumor: A Case Report and Review of the Literature.

INTRODUCTION: Warthin's tumor (WT) is the second most common neoplasm of the parotid gland and consists of two components, including lymphoid stroma and glandular epithelium. The malignant transformation of this tumor occurs most often in the lymphoid component; however, the carcinomatous transformation of the epithelial component is rare. CASE REPORT: We present a patient who had a mass in the right mandibular angle two years before referral. A cystic mass was reported on sonography, and the patient underwent superficial parotidectomy with a pre-operative impression of lymphangiomatouse-like lesions. In the microscopic view, the sections revealed salivary gland neoplastic lesion with the diagnosis of WT. On the periphery of the neoplasm, another neoplastic lesion was observed along with infiltrative borders and diagnosis of mucoepidermoid carcinoma. CONCLUSION: The WT is one of the most common tumors of the salivary glands. Malignancy transformation of the WT is a rare event. However, due to the importance of the treatment type, the surgeon should consider this issue in cystic lesions suspected of WT.

Evaluation of Serum Level of FGF23 and 1,25(OH)2D3 in Primary Hyperparathyroidism Patients Before and After Parathyroidectomy.

PURPOSE: Parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23) play critical roles in phosphate homeostasis. To the best of our knowledge, there are limited data on the impact of FGF23 and PTH on serum calcium, 1,25(OH)2D3, and phosphate in patients with primary hyperparathyroidism (PHPT). We examined these parameters and their correlations in PHPT patients before and after parathyroidectomy (PTX). PATIENTS AND METHODS: In this prospective cohort study, 29 PHPT patients who met the inclusion criteria were selected. The patient's blood samples were taken three times: before the operation, 24 h after the operation, and 1 week after the operation. The concentrations of serum calcium, FGF23, 1,25(OH)2D3, phosphate, PTH, and alkaline phosphatase were measured in a referral laboratory at each of the three steps. Moreover, 25(OH)D was primarily measured just before the surgery. RESULTS: Of 29 patients included in this study with a mean age of 52.37±12.3 years, majority were females (75.8%). Serum FGF23 and 1,25(OH)2D3 levels were high before PTX and decreased after the operation; however, the difference was not statistically significant. FGF23 levels were significantly correlated with 1,25(OH)2D3 at each of the three steps (r=0.964, P <0.01; r=0.985, P <0.0; and r=0.976, P <0.05). The variations in calcium, phosphate, creatinine, and PTH were preoperatively and postoperatively significant. CONCLUSION: Although 1,25(OH)2D3 and FGF23 levels were preoperatively higher in PHPT, their variations were not meaningful. There was a statistically direct significant relationship between 1,25(OH)2D3 and FGF23 preoperatively and postoperatively; however, the correlations between FGF23 and calcium, phosphate, and PTH were not significant.

Oral verrucous carcinoma and ameloblastoma: a rare coincidence.

INTRODUCTION: Oral verrucous carcinoma (OVC) is a rare malignancy of the oral cavity that was first described by Ackerman. This tumor is a well-differentiated low-grade, slow growing cancer that is locally invasive without metastasis. Ameloblastoma is one of the most common odontogenic tumors, which originates from the odontogenic epithelium. Verrucous carcinoma along with central ambloblastoma is a rare phenomenon. CASE REPORT: A case of verrucous carcinoma along with central ambloblastoma in a 49-year-old man, which was referred with a painless exophytic lesion with a verrucous and granular surface, is reported. Panoramic radiography revealed a well-defined radiolucency with sclerotic borders. To the best available knowledge, this phenomenon has not yet been reported. CONCLUSION: Verrucous carcinoma could occur in the wall of odontogenic cysts and tumors and should be considered during the differential diagnosis of a radiolucency, which is observed in the jaws with rapid growth or which presents some changes from its previous appearance.

Secondary Involvement of the Mandible due to Basal Cell Carcinoma: A Case Report.

Basal cell carcinoma (BCC) is the most common cutaneous malignancy among Caucasians. Rare examples of aggressive and neglected BCC have been reported. Here we report a unique case of a neglected BCC with significant jaw involvement. A 50-year-old female, referred by an otorhinologist, presented with a large ulcer on her chin, which was extended to her mandibular vestibule. The ulcer was 9×5.5 cm in size, and tissue destruction, necrosis was observed in the central portion, and the mandibular bone was exposed. On intraoral examination, tooth mobility and severe bone loss were evident. Due to the primary cutaneous origin of the lesion, BCC was considered as preliminary diagnosis. Biopsy was performed and diagnosis of BCC was confirmed. The diseased mandibular bone was resected and reconstructed with a surgical plate. The soft tissue defect was reconstructed with deltopectoral flap. The patient refused secondary stage plastic surgery. Although BCC is not a lethal malignancy, if left untreated and neglected, it can result in severe destruction, disfigurement, and even mortality.

Mandibular metastasis from follicular thyroid carcinoma: a rare case after twelve years.

Metastatic tumor of the mandible is a rare lesion and differentiated carcinomas of the thyroid as the primary site of origin are even more uncommon. A case of late metastasis of follicular thyroid carcinoma (FTC) to the mandible is presented here. The metastasis arose 12 years after thyroidectomy. Although relatively rare, thyroid tumors metastasis to the mandible should be born in mind, as in rare cases this metastasis may be the only presentation of the original malignancy.