Risk factors for atherosclerotic cardiovascular disease (ASCVD) in healthcare professionals of Azar Cohort Study: A cross-sectional Study.

Background: Atherosclerotic cardiovascular disease (ASCVD) is considered a worldwide health problem associated with high morbidity, mortality, and cost of care. In the present study, we examined risk-enhancing factors for ASCVD in healthcare workers of the AZAR cohort population. Methods: Data from a total of 500 participants were used for this cross-sectional study. Demographic characteristics, anthropometric indices, biochemical factors, and blood pressure were assessed. To evaluate the associations of ASCVD with the parameters mentioned above, univariate and multivariate logistic regression analyses were conducted. Results: The total frequency of subjects with severe (≥7.5) and low (<7.5) ASCVD was 7.6% (95% CI: 5.4-10.3), and 90.6% (95% CI: 87.7-93.0), respectively. The top strongest links were found between ASCVD and atherogenic index of plasma (AIP) (odds ratio [OR]: 12.8, 95% CI: 3.2-49.9), diabetes (OR: 7.6, 95% CI: 2.8-25), and daily smoking (OR: 7.0, 95% CI: 2.8-20). Based on a multivariate logistic regression model, low-density lipoprotein cholesterol (LDL-C)/apolipoprotein B (Apo b), diabetes, hematocrit, age, Triglycerides (TG)/high-density lipoprotein cholesterol (HDL-C), systolic blood pressure, HDL-C, apolipoprotein A-I (Apo A-I), hemoglobin, and Apo B/Apo A-I have significant associations with ASCVD severity. Conclusion: In conclusion, the present study showed significant associations between the severity of ASCVD with some parameters among healthcare workers of AZAR cohort study.

Prognostic factors and survival disparities in right-sided versus left-sided colon cancer.

Right-sided colon cancer (RCC) and left-sided colon cancer (LCC) differ in features and outcomes because of variations in embryology, epidemiology, pathology, and prognosis. This study sought to identify significant factors impacting patient survival through Bayesian modelling. Data was retrospectively analysed from a colorectal neoplasia database. Data on demographics, perioperative risks, treatment, mortality, and survival was analysed from patients who underwent colon cancer surgery from January 2010 to December 2021. This study involved 2475 patients, with 58.7% having RCC and 41.3% having LCC. RCC patients had a notably higher mortality rate, and their overall survival (OS) rates were slightly lower than those with LCC (P < 0.05). RCC stages I-IV consistently exhibited worse OS and relapse-free survival (RFS) than LCC (P < 0.05). Factors like age, BMI, ASA score, cancer stage, and comorbidities had significant associations with OS and RFS. Poor and moderate differentiation, lower lymph node yield, and organ resection were linked to lower survival while receiving chemotherapy; higher BMI levels and elective surgery were associated with better survival (all P < 0.05). Our study reveals key differences between RCC and LCC, emphasising the impact of age, BMI, ASA score, cancer stage, and comorbidities on patient survival. These findings could inform personalised treatment strategies for colon cancer patients.

The efficacy of curcumin supplementation on serum total antioxidant capacity, malondialdehyde, and disease activity in women with rheumatoid arthritis: A randomized, double-blind, placebo-controlled clinical trial.

Oxidative stress plays a crucial role in the physiopathology of rheumatoid arthritis (RA), which is associated with impaired antioxidant defenses. This study aimed to investigate the effects of curcumin supplementation on serum levels of total antioxidant capacity (TAC), malondialdehyde (MDA), and disease activity in women with RA. In this clinical trial, 48 women with RA were treated with one capsule of curcumin (500 mg daily) or placebo for 8 weeks. Anthropometric measurements and fasting blood samples were collected at baseline and end of the study. Finally, we assessed the Disease Activity Score in 28 joints (DAS-28), dietary intake, and physical activity levels. While curcumin supplementation for 8 weeks significantly increased the serum levels of TAC (p < 0.05), it decreased tender joint counts, swollen joint counts, visual analog scale (VAS) for pain, and DAS-28 compared to the placebo at the end of the study (p < 0.001 for all). MDA levels significantly decreased in the curcumin group (p < 0.05). However, changes in MDA concentration were not significant between groups at the end of the trial (p = 0.145). Curcumin supplementation had a beneficial effect on increasing the serum levels of TAC and decreased DAS-28 in women with RA.

A randomized clinical trial: Efficacy of group-based acceptance and commitment therapy program for breast cancer patients with high fear of progression.

BACKGROUND: Fear of progression (FOP) is a common and significant concern among cancer patients, encompassing worries about cancer progression during active treatment. Elevated levels of FOP can be dysfunctional. This study aims to assess the efficacy of an Acceptance and Commitment Therapy (ACT)-based intervention on FOP, anxiety sensitivity (AS), and quality of life (QOL) in breast cancer patients. METHODS: A clinical trial was conducted involving 80 stage I-III active-treatment breast cancer patients with a score greater than 34 on the Fear of Progression Questionnaire-Short Form scale. These patients were randomly assigned in a 1:1 ratio to either an intervention group, which received weekly 70-min sessions of 5-ACT-bsed group-therapy, or a control group that received usual treatment. Variables including FOP, AS, QOL, and ACT-related factors were assessed using ASQ, QLQ-C30, Cognitive Fusion Questionnaire, and Acceptance and Action Questionnaire-II at three time points: baseline, post-intervention, and 3-month follow-up. The efficacy of the intervention was evaluated using mixed model analysis across all time-points. RESULTS: The fidelity and acceptability of the ACT-based manual were confirmed using significant methods. A significant reduction in FOP was observed only in the ACT group at post-intervention (P-valueACT < 0.001; Cohen dACT = 1.099). Furthermore, the ACT group demonstrated a more significant reduction in FOP at follow-up. Furthermore, all secondary and ACT-related variables, except for the physical symptoms subscale, showed significant improvement in the ACT group compared to the control group. CONCLUSIONS: Our ACT-based manual showed promise for reducing FOP, AS, and improving QOL, and ACT-related variables in breast cancer patients 3 months following the intervention.

A Human Homozygous HELQ Missense Variant Does Not Cause Premature Ovarian Insufficiency in a Mouse Model.

Disruption of meiosis and DNA repair genes is associated with female fertility disorders like premature ovarian insufficiency (POI). In this study, we identified a homozygous missense variant in the HELQ gene (c.596 A>C; p.Gln199Pro) through whole exome sequencing in a POI patient, a condition associated with disrupted ovarian function and female infertility. HELQ, an enzyme involved in DNA repair, plays a crucial role in repairing DNA cross-links and has been linked to germ cell maintenance, fertility, and tumour suppression in mice. To explore the potential association of the HELQ variant with POI, we used CRISPR/Cas9 to create a knock-in mouse model harbouring the equivalent of the human HELQ variant identified in the POI patient. Surprisingly, Helq knock-in mice showed no discernible phenotype, with fertility levels, histological features, and follicle development similar to wild-type mice. Despite the lack of observable effects in mice, the potential role of HELQ in human fertility, especially in the context of POI, should not be dismissed. Larger studies encompassing diverse ethnic populations and alternative functional approaches will be necessary to further examine the role of HELQ in POI. Our results underscore the potential uncertainties associated with genomic variants and the limitations of in vivo animal modelling.

Predicting mortality and recurrence in colorectal cancer: Comparative assessment of predictive models.

Introduction: Colorectal cancer (CRC), also known as colorectal cancer, is a significant disease marked by high fatality rates, ranking as the third leading cause of global mortality. The main objective of this study was to assess the accuracy of predictive models in predicting both mortality events and the probability of disease recurrence. Method: A retrospective analysis was conducted on a cohort of 284 individuals diagnosed with colorectal cancer between 2001 and 2017. Demographic and clinical data, including gender, disease stage, age at diagnosis, recurrence status, and treatment details, were meticulously recorded. We rigorously evaluated various predictive models, including Decision Trees, Random Forests, Random Survival Forests (RSF), Gradient Boosting, mboost, Deep Learning Neural Network (DLNN), and Cox regression. Performance metrics, such as sensitivity, positive predictive value (PPV), specificity, area under the receiver operating characteristic curve (ROC area), and overall accuracy, were calculated for each model to predict mortality and disease recurrence. The analysis was performed using R version 4.1.3 software and the Python programming language. Results: For mortality prediction, the mboost model demonstrated the highest sensitivity at 96.9% (95% CI: 0.83-0.99) and an ROC area of 0.88. It also exhibited high specificity at 80% (95% CI: 0.59-0.93), a positive predictive value of 86.1% (95% CI: 0.70-0.95), and an overall accuracy of 89% (95% CI: 0.78-0.96). Random Forests showed perfect sensitivity of 100% (95% CI: 0.85-1) but had low specificity at 0% (95% CI: 0-0.52) and poor overall accuracy (50%). On the other hand, DLNN had the lowest performance metrics for mortality prediction, with a sensitivity of 24% (95% CI: 0.222-0.268), specificity of 75% (95% CI: 0.73-0.77), and a lower positive predictive value of 42% (95% CI: 0.38-0.45). The Gradient Boosting model showed the best performance in predicting recurrence, achieving perfect sensitivity of 100% (95% CI: 0.87-1) and high specificity at 92.9% (95% CI: 0.76-0.99). It also had a high positive predictive value of 93.3% (95% CI: 0.77-0.99). Gradient Boosting, with an ROC area of 96.4%, and mboost, with an ROC area of 75%, demonstrated remarkable performance. DLNN had the lowest performance metrics for recurrence prediction, with sensitivity at 1.75% (95% CI: 0.01-0.02), specificity at 98% (95% CI: 0.97-0.98), and a lower positive predictive value at 52.6% (95% CI: 0.39-0.65). Conclusion: In summary, the mboost model demonstrated outstanding performance in predicting mortality, achieving exceptional results across various evaluation metrics. Random Forests exhibited perfect sensitivity but showed poor specificity and overall accuracy. The DLNN model displayed the lowest performance metrics for mortality prediction. In terms of recurrence prediction, the Gradient Boosting model outperformed other models with perfect sensitivity, high specificity, and positive predictive value. The DLNN model had the lowest performance metrics for recurrence prediction. Overall, the results emphasize the effectiveness of the mboost and Gradient Boosting models in predicting mortality and recurrence in colorectal cancer patients.

Exploring the impact of stage and tumor site on colorectal cancer survival: Bayesian survival modeling.

Colorectal cancer is a prevalent malignancy with global significance. This retrospective study aimed to investigate the influence of stage and tumor site on survival outcomes in 284 colorectal cancer patients diagnosed between 2001 and 2017. Patients were categorized into four groups based on tumor site (colon and rectum) and disease stage (early stage and advanced stage). Demographic characteristics, treatment modalities, and survival outcomes were recorded. Bayesian survival modeling was performed using semi-competing risks illness-death models with an accelerated failure time (AFT) approach, utilizing R 4.1 software. Results demonstrated significantly higher time ratios for disease recurrence (TR = 1.712, 95% CI 1.489-2.197), mortality without recurrence (TR = 1.933, 1.480-2.510), and mortality after recurrence (TR = 1.847, 1.147-2.178) in early-stage colon cancer compared to early-stage rectal cancer. Furthermore, patients with advanced-stage rectal cancer exhibited shorter survival times for disease recurrence than patients with early-stage colon cancer. The interaction effect between the disease site and cancer stage was not significant. These findings, derived from the optimal Bayesian log-normal model for terminal and non-terminal events, highlight the importance of early detection and effective management strategies for colon cancer. Early-stage colon cancer demonstrated improved survival rates for disease recurrence, mortality without recurrence, and mortality after recurrence compared to other stages. Early intervention and comprehensive care are crucial to enhance prognosis and minimize adverse events in colon cancer patients.

Unraveling atherosclerotic cardiovascular disease risk factors through conditional probability analysis with Bayesian networks: insights from the AZAR cohort study.

This study aimed at modelling the underlying predictor of ASCVD through the Bayesian network (BN). Data for the AZAR Cohort Study, which evaluated 500 healthcare providers in Iran, was collected through examinations, and blood samples. Two BNs were used to explore a suitable causal model for analysing the underlying predictor of ASCVD; Bayesian search through an algorithmic approach and knowledge-based BNs. Results showed significant differences in ASCVD risk factors across background variables' levels. The diagnostic indices showed better performance for the knowledge-based BN (Area under ROC curve (AUC) = 0.78, Accuracy = 76.6, Sensitivity = 62.5, Negative predictive value (NPV) = 96.0, Negative Likelihood Ratio (LR-) = 0.48) compared to Bayesian search (AUC = 0.76, Accuracy = 72.4, Sensitivity = 17.5, NPV = 93.2, LR- = 0.83). In addition, we decided on knowledge-based BN because of the interpretability of the relationships. Based on this BN, being male (conditional probability = 63.7), age over 45 (36.3), overweight (51.5), Mets (23.8), diabetes (8.3), smoking (10.6), hypertension (12.1), high T-C (28.5), high LDL-C (23.9), FBS (12.1), and TG (25.9) levels were associated with higher ASCVD risk. Low and normal HDL-C levels also had higher ASCVD risk (35.3 and 37.4), while high HDL-C levels had lower risk (27.3). In conclusion, BN demonstrated that ASCVD was significantly associated with certain risk factors including being older and overweight male, having a history of Mets, diabetes, hypertension, having high levels of T-C, LDL-C, FBS, and TG, but Low and normal HDL-C and being a smoker. The study may provide valuable insights for developing effective prevention strategies for ASCVD in Iran.

Intraoperative dexamethasone and chronic postsurgical pain: a propensity score-matched analysis of a large trial.

BACKGROUND: Dexamethasone has been shown to reduce acute pain after surgery, but there is uncertainty as to its effects on chronic postsurgical pain (CPSP). We hypothesised that in patients undergoing major noncardiac surgery, a single intraoperative dose of dexamethasone increases the incidence of CPSP. METHODS: We devised a propensity score-matched analysis of the ENIGMA-II trial CPSP dataset, aiming to compare the incidence of CPSP in patients who had received dexamethasone or not 12 months after major noncardiac surgery. The primary outcome was the incidence of CPSP. We used propensity score matching and inverse probability weighting to balance baseline variables to estimate the average marginal effect of dexamethasone on patient outcomes, accounting for confounding to estimate the average treatment effect on those treated with dexamethasone. RESULTS: We analysed 2999 patients, of whom 116 of 973 (11.9%) receiving dexamethasone reported CPSP, and 380 of 2026 (18.8%) not receiving dexamethasone reported CPSP, unadjusted odds ratio 0.76 (95% confidence interval 0.78-1.00), P=0.052. After propensity score matching, CPSP occurred in 116 of 973 patients (12.2%) receiving dexamethasone and 380 of 2026 patients (13.8%) not receiving dexamethasone, adjusted risk ratio 0.88 (95% confidence interval 0.61-1.27), P=0.493. There was no difference between groups in quality of life or pain interference with daily activities, but 'least pain' (P=0.033) and 'pain right now' (P=0.034) were higher in the dexamethasone group. CONCLUSIONS: Dexamethasone does not increase the risk of chronic postsurgical pain after major noncardiac surgery. CLINICAL TRIAL REGISTRATION: Open Science Framework Registration DOI https://doi.org/10.17605/OSF.IO/ZDVB5.

Quality of life amongst patients with diverting umbilical stomas in rectal surgery: a single centre prospective randomized controlled pilot study.

BACKGROUND: The umbilical stoma (umbistoma) has been proposed as a viable alternative site for a temporary defunctioning stoma. Suggested advantages of the umbistoma include decreased number of surgical incisions required, improved cosmesis and ease of reversal surgery. This study aimed to assess the patient experience of umbilical loop ileostomies in rectal surgery, with the primary outcome being patient reported quality of life (QoL). METHODS: A total of 20 patients undergoing laparoscopic rectal cancer surgery were randomly allocated to have a defunctioning ileostomy at a conventional site (right iliac fossa) or at the umbilicus. Patient-reported QoL was assessed at 6 weeks using the Stoma-QoL questionnaire. Secondary outcomes were number of stomas reversed, length of time awaiting stoma reversal surgery, duration of operative time for stoma reversal, length of hospital stay following stoma reversal and rate of parastomal or post reversal incisional hernias. RESULTS: Patients who had an umbilical stoma scored significantly lower on the Stoma-QoL questionnaire compared to the conventional group, particularly on questions regarding feelings of tiredness, body insecurity and anxiety. No significant differences were observed between the two groups in relation to secondary outcomes. CONCLUSION: There may be potential disadvantages to the umbilical stoma with negative impacts on body image and subsequent increased social anxiety. Patient selection and adequate counselling will be important when considering an umbilical stoma. Further larger scale prospective studies are required to further validate the feasibility and longer-term safety of umbilical stomas in both clinical outcomes as well as patient QoL.

Compensation based on work relative value unit for cardiovascular surgeons in Iran: A mixed method study.

BACKGROUND: Work relative value unit (wRVU) is a tool for assessing surgeons' performance, compensation, and productivity. It appears that wRVU for cardiovascular procedures does not consider complexity and its value for lengthy operations is low. The aim of the study is to determine wRVU for cardiovascular procedures in Iran according to the proposed approach. MATTERIALS AND METHODS: This study was conducted as a mixed method in teaching hospitals in Tabriz in the period of September 2020 to December 2021. According to Hospital Information System and expert opinions, six procedures in cardiovascular surgery were included in the study. They were compared with 18 procedures in neurosurgery, orthopedics, and otorhinolaryngology in terms of the operation time and wRVU/min. Then, we calculated new wRVUs for the selected procedures based on surgeons' opinions, time measurements, and anesthetists' points of view by content analysis in qualitative and statistical analysis in quantitative parts. RESULTS: Among the six cardiac procedures, the wRVU for five was under-estimated. The wRVU/min value ranged from 0/28 to 1/15 in the studied procedures. Findings demonstrate no significant relationship between the length of operations and the wRVU announced by the Ministry of Health and Medical Education (P value >0/05). Compared to studied procedures in four specialties, thoracoabdominal aortic aneurysm repair has the longest surgery time at 417 minutes. According to anesthesiologists, cardiovascular; orthopedics; ear, nose, and tongue; and neurosurgery specialties obtained 4/2, 2/9, 2/8, and 4, respectively, in terms of surgery duration, complexity, risk, and physical effort. CONCLUSION: Despite policymakers' attempts to bring justice to payments, it seems that there has been little progress in paying cardiovascular surgeons. Improper payment to cardiovascular surgeons will affect the future of the workforce in this specialty. Today, the need to reconsider the wRVUs in heart specialty is felt more than before.

Psychometric Properties of the Persian Version of Cystic Fibrosis Questionnaire: Revised in Children with Cystic Fibrosis.

Background: Cystic fibrosis is a progressive, fatal disease affecting the quality of life. The cystic fibrosis questionnaire-revised (CFQ-R) is an efficient tool to monitor health-related quality of life in patients. The aim of this study was to explore the psychometric properties of the child and parent versions of the Persian version of the CFQ-R in the Iranian population. Methods: Fifty children with cystic fibrosis (6-11 years) and their parents were allocated in this methodological study to examine convergent validity, discriminant validity, test-retest reliability (n = 30), internal consistency, ceiling and floor effects, and agreement between two versions of the CFQ-R. Results: Convergent validity was confirmed for parent proxy (P < 0.05). CFQ-R discriminated patients among stages of disease severity based on lung function, age, and BMI (P < 0.05). Test-retest analysis revealed good to excellent reliability (inter-class correlation coefficient (ICC) = 0.78-0.97). In most domains, lower quality of life scores was obtained in the parent proxy compared to the child version (P < 0.05). Domain-specific correlations were found between the child version and parent proxy (P < 0.05). Internal consistency was generally confirmed (α = 0.13-0.83 in child version and α = 0.25-0.87 in parent proxy). There were no floor effects. Ceiling effects were mostly seen for physical, digestion, and body image domains in the child version and for eating, weight, and school domains in the parent proxy. Conclusions: The child version and parent proxy of the Persian CFQ-R are valid and reliable measures and can be applied in clinical trials to monitor the quality of life in children with cystic fibrosis. It is recommended to use both versions in conjunction to better interpret the quality of life aspects of children with cystic fibrosis.

Predicting mortality in brain stroke patients using neural networks: outcomes analysis in a longitudinal study.

In this study, Neural Networks (NN) modelling has emerged as a promising tool for predicting outcomes in patients with Brain Stroke (BS) by identifying key risk factors. In this longitudinal study, we enrolled 332 patients form Imam hospital in Ardabil, Iran, with mean age: 77.4 (SD 10.4) years, and 50.6% were male. Diagnosis of BS was confirmed using both computerized tomography scan and magnetic resonance imaging, and risk factor and outcome data were collected from the hospital's BS registry, and by telephone follow-up over a period of 10 years, respectively. Using a multilayer perceptron NN approach, we analysed the impact of various risk factors on time to mortality and mortality from BS. A total of 100 NN classification algorithm were trained utilizing STATISTICA 13 software, and the optimal model was selected for further analysis based on their diagnostic performance. We also calculated Kaplan-Meier survival probabilities and conducted Log-rank tests. The five selected NN models exhibited impressive accuracy ranges of 81-85%. However, the optimal model stood out for its superior diagnostic indices. Mortality rate in the training and the validation data set was 7.9 (95% CI 5.7-11.0) per 1000 and 8.2 (7.1-9.6) per 1000, respectively (P = 0.925). The optimal model highlighted significant risk factors for BS mortality, including smoking, lower education, advanced age, lack of physical activity, a history of diabetes, all carrying substantial importance weights. Our study provides compelling evidence that the NN approach is highly effective in predicting mortality in patients with BS based on key risk factors, and has the potential to significantly enhance the accuracy of prediction. Moreover, our findings could inform more effective prevention strategies for BS, ultimately leading to better patient outcomes.

Survival prediction and prognostic factors in colorectal cancer after curative surgery: insights from cox regression and neural networks.

Medical research frequently relies on Cox regression to analyze the survival distribution of cancer patients. Nonetheless, in specific scenarios, neural networks hold the potential to serve as a robust alternative. In this study, we aim to scrutinize the effectiveness of Cox regression and neural network models in assessing the survival outcomes of patients who have undergone treatment for colorectal cancer. We conducted a retrospective study on 284 colorectal cancer patients who underwent surgery at Imam Khomeini clinic in Hamadan between 2001 and 2017. The data was used to train both Cox regression and neural network models, and their predictive accuracy was compared using diagnostic measures such as sensitivity, specificity, positive predictive value, accuracy, negative predictive value, and area under the receiver operating characteristic curve. The analyses were performed using STATA 17 and R4.0.4 software. The study revealed that the best neural network model had a sensitivity of 74.5% (95% CI 61.0-85.0), specificity of 83.3% (65.3-94.4), positive predictive value of 89.1% (76.4-96.4), negative predictive value of 64.1% (47.2-78.8), AUC of 0.79 (0.70-0.88), and accuracy of 0.776 for death prediction. For recurrence, the best neural network model had a sensitivity of 88.1% (74.4-96.0%), specificity of 83.7% (69.3-93.2%), positive predictive value of 84.1% (69.9-93.4%), negative predictive value of 87.8% (73.8-95.9%), AUC of 0.86 (0.78-0.93), and accuracy of 0.859. The Cox model had comparable results, with a sensitivity of 73.6% (64.8-81.2) and 85.5% (78.3-91.0), specificity of 89.6% (83.8-93.8) and 98.0% (94.4-99.6), positive predictive value of 84.0% (75.6-90.4) and 97.4% (92.6-99.5), negative predictive value of 82.0% (75.6-90.4) and 88.8% (0.83-93.1), AUC of 0.82 (0.77-0.86) and 0.92 (0.89-0.95), and accuracy of 0.88 and 0.92 for death and recurrence prediction, respectively. In conclusion, the study found that both Cox regression and neural network models are effective in predicting early recurrence and death in patients with colorectal cancer after curative surgery. The neural network model showed slightly better sensitivity and negative predictive value for death, while the Cox model had better specificity and positive predictive value for recurrence. Overall, both models demonstrated high accuracy and AUC, indicating their usefulness in predicting these outcomes.

The Effect of Decision Aid on Satisfaction With Decision and Anxiety Among Women With Abnormal Cervical Screening Results.

BACKGROUND: Most women in the face of stressful situations such as risk of a cancer diagnosis (abnormal Papanicolaou smear results) need guidance to choose the appropriate method to follow the diagnosis process, but few studies have identified appropriate interventions to support these women. OBJECTIVE: To determine the effect of decision aid on anxiety and satisfaction with decisions (SWD) regarding the type of follow-up method after receiving an abnormal Papanicolaou smear result. METHODS: This interventional study was conducted on women referred to the oncology clinic in Tabriz, Iran. Women were assigned to the intervention (n = 27) and control groups (n = 27) in a ratio of 1:1 using blocked randomization. The intervention group received a decision aid booklet. Participants in both groups completed questionnaires assessing demographic and obstetric characteristics, anxiety, SWD, and shared decision-making before and after the intervention. RESULTS: The mean score for SWD in the intervention group was significantly higher than that in the control group after the intervention (median, 6.43 with 95% confidence interval of 3.11-7.76; P = .03). There was no significant difference between groups in the mean score of anxiety after intervention (median, 1.14; 95% confidence interval, -0.5 to 2.70; P = .19). CONCLUSION: A decision aid can increase SWD among women with abnormal results in their cervical cancer screening. IMPLICATIONS FOR PRACTICE: It is recommended that healthcare providers use decision aid tools to support and guide patients.

Recurrence and Postoperative Death in Patients with Colorectal Cancer: A New Perspective via Semi-competing Risk Framework.

BACKGROUND/AIMS: Cancer studies suffer from an overestimation of prediction of survival when both recurrence and death are of interest. This longitudinal study aimed to mitigate this problem utilizing a semi-competing risk approach evaluating the factors affecting recurrence and postoperative death in patients with colorectal cancer. MATERIALS AND METHODS: This longitudinal prospective study was conducted in 284 patients with resected colorectal cancer who were referred to the Imam Khomeini Clinic in Hamadan, Iran, during 2001-2017. Primary outcomes were postoperative outcomes and patient survival, including time to recurrence (of colorectal cancer), time to death, and time to death after recurrence. All patients who were alive at the end of the study were censored for death and who did not experience recurrence of colorectal cancer were also censored for recurrent colorectal cancer. The relationship between underlying demographics and clinical factors and the outcomes was assessed using a semicompeting risk approach. RESULTS: The results of the multivariable analysis showed that having metastasis to other sites (hazard ratio = 36.03; 95% CI = 19.48- 66.64) and higher pathological node (pN) stage (hazard ratio = 2.46; 95% CI = 1.32-4.56) were associated with a raised hazard of recurrence. The fewer chemotherapies (hazard ratio = 0.39; 95% CI = 0.17-0.88) and higher pN stages (hazard ratio = 4.32; 95% CI = 1.27-14.75) showed significantly higher hazards of death without recurrence. Having metastasis to other sites (hazard ratio = 2.67; 95% CI = 1.24-5.74) and higher pN stages (hazard ratio = 1.91; 95% CI = 1.02-3.61) were linked with the higher hazard of death after recurrence. CONCLUSION: Considering findings on death /recu rrenc e-spe cific predictors obtained in this study to manage the outcomes in patients with colorectal cancer, tailored strategies for preventive and interventional plans should be deliberated.

Machine learning framework for atherosclerotic cardiovascular disease risk assessment.

Introduction: Atherosclerotic cardiovascular disease (ASCVD) is the first leading cause of mortality globally. To identify the individual risk factors of ASCVD utilizing the machine learning (ML) approaches. Materials & methods: This cohort-based cross-sectional study was conducted on data of 500 participants with ASCVD among Tabriz University Medical Sciences employees, during 2020. The data with ML methods were developed and validated to predict ASCVD risk with naive Bayes (NB), spurt vesture machines (SVM), regression tree (RT), k-nearest neighbors (KNN), artificial neural networks (ANN), generalized additive models (GAM), and logistic regression (LR). Results: Accuracy of the models ranged from 95.7 to 98.1%, with a sensitivity of 50.0 to 97.3%, specificity of 74.3 to 99.1%, positive predictive value (PPV) of 0.0 to 98.0%, negative predictive value (NPV) of 68.4 to 100.0%, positive likelihood ratio (LR +) of 13.8 to 96.4%, negative likelihood ratio (LR-) of 3.6 to 51.9%, and area under ROC curve (AUC) of 62.5 to 99.4%. The ANN fit the data best with an accuracy of 98.1% (95% CI: 96.5-99.1), a specificity of 99.1% (95% CI: 97.7-99.9), a LR + of 96.4% (95% CI: 36.2-258.8), and AUC of 99.4% (95% CI: 85.2-97.0). Based on the optimal model, sex (females), age, smoking, and metabolic syndrome were shown to be the most important risk factors of ASCVD. Conclusion: Sex (females), age, smoking, and metabolic syndrome were predictors obtained by ANN. Considering the ANN as the optimal model identified, more accurate prevention planning may be designed.

Survival and prognostic factors among hospitalized pancreatic cancer patients in northwestern Iran.

Background: Pancreatic cancer (PC) is associated with a poor prognosis, with various modifiable risk factors affecting the survival of patients. Our aim was to evaluate the survival rate and the prognostic factors influencing survival in PC patients in northwestern Iran. Materials and Methods: All the PC patients admitted to the Imam Reza Hospital of Tabriz, Iran, from 2016 to 2020, were enrolled in this study. The survival rate and time were calculated, and the risk factors related to survival were evaluated by Cox regressions. The data were analyzed using the Cox proportional hazards model using STATA software. Results: Of 110 patients, 12-, 24-, 36-, and 48-month survival rates were 29.1%, 19.8%, 14.1%, and 8.5%, respectively, with the median survival time of seven months. The mean age was 65.5 years. The results showed that a higher age (hazard ratio [HR] [95% confidence interval (CI)] = 2.04 [1.20-3.46]), lower education (1.72 [1.03-2.89]), delayed diagnosis (1.03 [1.02-1.05]), hypertension (1.53 [1.01-2.31]), concomitant heart disorders (2.67 [1.50-4.74]), COPD (4.23 [1.01-17.69]), consanguineous marriage (1.59 [1.01-2.50]), and the presence of icterus complications (adjusted HR = 3.64 [1.56-8.49]) were directly associated with a worse survival. On the contrary, radiotherapy (0.10 [0.01-0.85]), chemotherapy (0.57 [0.36-0.89]), and surgical therapy (AHR = 0.48 [0.23-0.99]) were directly related to a good prognosis. Conclusion: Surgery, chemotherapy, and radiotherapy were the best predictors of survival in PC patients. Moreover, it seems that resolving jaundice can improve survival in these patients. It seems that increasing social awareness, treating underlying diseases, and employing an appropriate therapeutic method may promise a better outlook, improve the survival rate of patients, and reduce PC risk.

Sex-specific association of exposure to air pollutants and Nrf2 gene expression and inflammatory biomarkers in exhaled breath of healthy adolescents.

Studies investigating the nuclear factor erythroid 2-related factor 2 (Nrf2) expression levels in the respiratory system of healthy subjects are scarce. Moreover, separate studies on the health-related outcomes of air pollution for each sex are limited. The current panel study investigated sex-specific Nrf2 expression levels and related oxidative stress and inflammatory responses among healthy adolescents exposed to PM2.5, PM10, O3, and PM2.5-bounded metals in a high traffic region. Forty-nine healthy nonsmoking subjects participated in the study for five consecutive months (Nov. 2019 to Feb. 2020). Each subject was asked to provide 1 mL of exhaled breath condensate (EBC). Data were analyzed using linear mixed-effects models. The results showed that PM10, PM2.5, O3, and PM2.5-bounded metals were negatively linked to Nrf2 expression level in EBC of females with -58.3% (95% CI: 79.5, -15.4), -32.1% (95% CI: -50.3, -7.1), -76.2% (95% CI: -92.6, -23.9), and -1.9 (95% CI: -3.4, -0.4), respectively. While our results presented no significant association between the studied pollutants and Nrf2 gene expression in males, significant associations were observed between the pollutants and total nitric oxide (NOx), interleukins 6 (IL-6), and tumor necrosis factor-alpha (TNF-α) in the EBC of females. In the case of males, only EBC cytokines showed a significant association with air pollutants. Overall, this study suggests that exposure to ambient air pollutants may affect the respiratory system with biologically different mechanisms in males and females. PM2.5 concentration had a positive correlation with exhaled TNF-α and IL6 values in females while positive correlation with TNF-α and negative correlation with IL6 values in males. O3 had a negative correlation with TNF-α in males.

Factors affecting the post-operative outcomes in patients aged over 80 following colorectal cancer surgery.

PURPOSE: In 2019, in Australia, there were 500,000 people aged 85 and over. Traditionally, clinicians have adopted the view that surgery is not desirable in this cohort due to increasing perioperative risk, perceived minimal clinical benefit, and shortened life expectancy. This cohort study is aimed at investigating postoperative outcomes from elective and non-elective colorectal cancer surgery in patients aged 80 and over. METHODS: A retrospective analysis was conducted on patients from 2010 to 2020 on a prospectively maintained colorectal database. Patients aged over 80 who underwent surgical resection for colorectal cancer were reviewed. Oncological characteristics, short-term outcomes, overall survival, and relapse-free survival rates were analysed. RESULTS: A total of 832 patients were identified from the database. Females comprised 55% of patients aged 80 and above. The median age was 84 for octogenarians and 92 for nonagenarians. Most patients were ASA 2 (212) or ASA 3 (501). ASA 3 and 4 and stage III pathology were associated with higher postoperative complications. Fifty percent of over 80 s and 37% of over 90 s were surgically discharged to their own home. Overall survival at 30, 180, and 360 days and 5 years was 98.1%, 93.1%, 87.2%, and 57.2% for the over 80 s and 98.1%, 88.9%, 74.9%, and 24.4% for the over 90 s. CONCLUSION: Our results demonstrate that surgical treatment of older patients is safe with acceptable short-, medium-, and long-term survival. Nonetheless, efforts are needed to reduce the rates of complications in older patients, including utilisation of multi-disciplinary teams to assess the optimal treatment strategy and postoperative care.