Anemia Status Changes Among Patients With Obesity Following Bariatric Surgery.

Objective This study aims to investigate trends in anemia severity among patients with pre-existing anemia who underwent bariatric surgery due to obesity. It also examines how different bariatric surgery techniques impact anemia outcomes. Methods This prospective study included 280 patients aged 18 to 65 with obesity who underwent bariatric surgery. The patients were categorized into three groups based on the type of surgery: sleeve gastrectomy, one-anastomosis gastric bypass, and Roux-en-Y gastric bypass. Anemia severity was evaluated over a 12-month follow-up period. Chi-square tests were used to assess the homogeneity of baseline factors among the groups, and McNemar tests along with generalized estimating equations were used to compare anemia outcomes. Results Before surgery, the rates of moderate anemia across the three surgical groups ranged from 18.2% to 22.4%, with no cases of severe anemia observed. There was no significant difference among the groups (p=0.949). During the 12-month follow-up, the odds ratio for reducing anemia severity in the sleeve gastrectomy and Roux-en-Y gastric bypass groups were 2.13 and 1.91, respectively, compared to the one-anastomosis gastric bypass group. Additionally, the odds ratio for reducing anemia severity in patients with hypothyroidism was 1.84 compared to those without hypothyroidism. Conclusion The choice of bariatric surgery technique significantly affects anemia outcomes, with sleeve gastrectomy showing a higher success rate in reducing anemia severity. The role of hypothyroidism in anemia management also appears to be significant.

High inflammatory cytokines gene expression can be detected in workers with prolonged exposure to silver and silica nanoparticles in industries.

Occupational health must be strictly considered in industries particularly in nanoparticle factories where workers were exposed to different types of chemicals. We measured the serum levels of inflammatory cytokines in workers who developed skin lesions after exposure to silver and silica nanoparticles. Using a questionnaire in this cross-sectional study, we identified 110 workers in nanoparticle industries who were exposed to silver and silica nanoparticles. We also included 40 healthy subjects as controls from the administrative department of the same factories who were not exposed to nanoparticles. Peripheral blood samples used to measure the mRNA levels of inflammatory cytokines by qRT-PCR. In comparison with the control group, the workers who developed skin lesions had significantly higher levels of interleukin IL4, IL6, IL8, and TNF-α, particularly after two or three decades of exposure to silver and silica nanoparticles. Participants who were exposed to silver had higher levels of IL6 and IL8 compared with those who were exposed to silica. Necessary measures must be considered to protect workers in nanoparticle industries against the potential toxic effects of these compounds. Our network pharmacology study suggests corresponding biochemical pathways for these disorders.

Application of Bandura's social cognitive theory to predict cigarette butt-littering behavior in male smokers: a case study in the parks in Tehran, Iran.

Cigarette butt-littering behavior is common among most smokers. The present study aimed to determine the predictors of butt-littering behavior in a sample of Iranian male current smokers based on the Bandura's social cognitive theory variables. In this cross-sectional study, 291 smokers who throw their cigarette butts in public parks in Tehran city, Iran were selected and completed the study instrument. Finally, the data were analyzed. The average number of butts littered daily by the participants was 8.59 (± 8.661). The results of multiple Poisson regression showed that knowledge, perceived self-efficacy, positive and negative outcome expectations, self-regulation, and observational learning variables were statistically significant predictors of butt-littering behavior among the participants. It is concluded that Bandura's social cognitive theory is a suitable theoretical framework for predicting butt-littering behavior and might be used to develop theory-based environmental education efforts in this field.

The effect of Cornus mas fruit extract on vasomotor symptoms and sex hormones in postmenopausal women: a randomized, double-blind, clinical trial.

OBJECTIVES: Cornus mas fruit has various antioxidants and anti-inflammatory properties, so this study aims at assessing its effect on menopausal symptoms and sex hormones in postmenopausal women. METHODS: In the current randomized, double-blind clinical trial, 84 individuals (42 per group) were participated. C mas hydroalcoholic extract was prepared, and participants received 300 mg C mas extract or placebo three times a day (900 g in total) for 8 weeks. The demographic, dietary intake, and physical activity information were gathered. Anthropometric indices were measured by standard methods. Furthermore, menopause symptoms were assessed by Greene Climacteric Scale. Also, sex hormones were measured by enzyme-linked immunosorbent assay. RESULTS: Based on the results, there was a significant difference in total Greene score reduction between the intervention and placebo groups (-3.19 ± 0.54, -0.76 ± 0.32, and P < 0.001). In addition, vasomotor symptoms had a remarkable decrease in the C mas extract group (P < 0.001). Also, the intervention group demonstrated a decreasing trend in the number and duration of hot flushes. Moreover, follicle-stimulating hormone remarkably decreased and estradiol increased in the intervention group (P = 0.016 and P = 0.018). CONCLUSIONS: It has been found that the extract of C mas fruit has a favorable effect on vasomotor symptoms, sex hormones, and related complications in women experiencing menopausal symptoms.

Artificial intelligence, BI-RADS evaluation and morphometry: A novel combination to diagnose breast cancer using ultrasonography, results from multi-center cohorts.

PURPOSE: To develop and validate a machine learning (ML) model for the classification of breast lesions on ultrasound images. METHOD: In the present study, three separate data cohorts containing 1288 breast lesions from three countries (Malaysia, Iran, and Turkey) were utilized for MLmodel development and external validation. The model was trained on ultrasound images of 725 breast lesions, and validation was done separately on the remaining data. An expert radiologist and a radiology resident classified the lesions based on the BI-RADS lexicon. Thirteen morphometric features were selected from a contour of the lesion and underwent a three-step feature selection process. Five features were chosen to be fed into the model separately and combined with the imaging signs mentioned in the BI-RADS reference guide. A support vector classifier was trained and optimized. RESULTS: The diagnostic profile of the model with various input data was compared to the expert radiologist and radiology resident. The agreement of each approach with histopathologic specimens was also determined. Based on BI-RADS and morphometric features, the model achieved an area under the receiver operating characteristic (ROC) curve (AUC) of 0.885, which is higher than the expert radiologist and radiology resident performances with AUC of 0.814 and 0.632, respectively in all cohorts. DeLong's test also showed that the AUC of the ML protocol was significantly different from that of the expert radiologist (ΔAUCs = 0.071, 95%CI: (0.056, 0.086), P = 0.005). CONCLUSIONS: These results support the possible role of morphometric features in enhancing the already well-excepted classification schemes.

Tumor Microenvironment, Radiology, and Artificial Intelligence: Should We Consider Tumor Periphery?

OBJECTIVES: The tumor microenvironment (TME) consists of cellular and noncellular components which enable the tumor to interact with its surroundings and plays an important role in the tumor progression and how the immune system reacts to the malignancy. In the present study, we investigate the diagnostic potential of the TME in differentiating benign and malignant lesions using image quantification and machine learning. METHODS: A total of 229 breast lesions and 220 cervical lymph nodes were included in the study. A group of expert radiologists first performed medical imaging and segmented the lesions, after which a rectangular mask was drawn, encompassing all of the contouring. The mask was extended in each axis up to 50%, and 29 radiomics features were extracted from each mask. Radiomics features that showed a significant difference in each contour were used to develop a support vector machine (SVM) classifier for benign and malignant lesions in breast and lymph node images separately. RESULTS: Single radiomics features extracted from extended contours outperformed radiologists' contours in both breast and lymph node lesions. Furthermore, when fed into the SVM model, the extended models also outperformed the radiologist's contour, achieving an area under the receiver operating characteristic curve of 0.887 and 0.970 in differentiating breast and lymph node lesions, respectively. CONCLUSIONS: Our results provide convincing evidence regarding the importance of the tumor periphery and TME in medical imaging diagnosis. We propose that the immediate tumor periphery should be considered for differentiating benign and malignant lesions in image quantification studies.

The effect of a nutrition education intervention on knowledge, attitude, and intake of foods high in fats in women.

BACKGROUND: Given that many Iranian were interested in the consumption of foods that are high in fats, the present study was done to determine the effect of a nutrition education intervention on knowledge, attitude, and intake of foods high in fat among a sample of women in Tehran. MATERIALS AND METHODS: In this quasi-experimental study, 92 female referrals to the health houses affiliated to Tehran municipal were selected and assigned to either intervention (n = 46) or control (n = 46) groups. Information (data) regarding women's knowledge, attitude, and practice in terms of foods rich in fat intake was collected by three questionnaires. Then, a nutrition education intervention included four 40-60 min training sessions over 4 weeks was designed and conducted to the study participants in the intervention group. Two groups were followed up 2 months after the intervention. Finally, all data were analyzed by using the independent-samples t-tests, Student's paired-samples t-test, and Pearson correlation analysis on the R software (version 6.3.2). RESULTS: The results showed that there were significant reductions in a positive attitude towards food with high fat content and intake of these foods in the intervention group compared with the control group after the intervention (P < 0.001). Furthermore, following the intervention, the intervention group reported a significant increase in dietary fat nutrition knowledge than the control group (P < 0.001). CONCLUSION: Developing nutrition education interventions is an effective strategy for reducing the consumption of foods rich in fat in Iranian women.

The effect of Cornus mas extract consumption on bone biomarkers and inflammation in postmenopausal women: A randomized clinical trial.

The drastic decrease in estrogen levels in menopausal women can elevate bone resorption and osteoporosis. Cornus mas extract (C. mas extract) is a potential candidate for treating menopausal-related bone complications because of its phytoestrogen and anti-inflammatory contents. It was an interventional double-blind placebo-controlled randomized study. Eighty-four women aged 45-60 years old were randomly allocated to either the extract group receiving 3 capsules of 300 mg C. mas extract or the placebo group receiving 3 capsules of 300 mg of starch powder per day for 8 weeks. Then, venous blood was used to measure bone-specific alkaline phosphatase (BAP), osteocalcin (OC), C-terminal telopeptide (TC) as well as serum levels of PTH and hsCRP. Our results indicated the decrease in alkaline phosphatase, PTH, and as an inflammation biomarker, hsCRP, between two groups at the end of the study. No statistically significant difference was observed in telopeptide C, osteocalcin, and calcium between the placebo and extract groups after 8 weeks of intervention. In conclusion, the results indicate that the C. mas extract supplement of 900 mg/day may decrease levels of BAP, PTH, and hsCRP. However, this intervention had no beneficial effect on OC and TC in healthy postmenopausal women.

The effect of occupational noise exposure on systolic blood pressure, diastolic blood pressure and salivary cortisol level among automotive assembly workers.

Introduction. Both auditory and non-auditory health can be affected by exposure to occupational noise. The aim of this study was to evaluate the association of high occupational noise (at three levels) with systolic blood pressure (SBP), diastolic blood pressure (DBP) and salivary cortisol concentration in an automotive factory. Methods. This study was carried out on 78 male workers from a factory who worked in the warehouse unit (control group: 60-70 dB(A)) and assembly units (two test groups: 75-85 and 85-95 dB(A)). Data were collected through questionnaires and measurement of SBP, DBP, saliva cortisol concentration and body mass index (BMI), prior to and post occupational noise exposure. The measurements were performed twice/day and repeated after 10 days. Results. For each occupational noise level group, there was no significant association between cortisol level with age and BMI. The SBP and DBP in all groups increased significantly. Also, the average cortisol levels were similar in different groups before noise exposure, but were statistically different after occupational noise exposure. Conclusions. High occupational noise exposure increases the cortisol level and blood pressure, which are the major risk factors of cardiovascular disease.

Effect of lymphedema self-management group-based education compared with social network-based education on quality of life and fear of cancer recurrence in women with breast cancer: a randomized controlled clinical trial.

BACKGROUND: Breast cancer-related lymphedema (BCRL) and its associated symptoms harm the quality of life (QoL) of cancer survivors and can stimulate fear of cancer recurrence (FCR). Self-management education for lymphedema has been introduced as an effective method in controlling FCR. This study investigates the effect of lymphedema group-based education compared to the social network-based and control group on QoL and FCR in breast cancer patients. METHODS: This three-arm clinical trial studied 105 patients with breast cancer-related lymphedema referred to Seyed_Khandan rehabilitation center. Sampling was done by random allocation method in blocks of 3 with 35 subjects in each group. All subjects received routine lymphedema treatments. The group-based education (GE) and social network-based education (SNE) groups received self-management education in the clinic and Telegram™ messenger channel, respectively. Impairment in QoL and mean score of FCR were assessed before, immediately after, and three months after the intervention by using the Persian version of Lymphedema Life Impact Scale (LLIS) and Fear of Progression Questionnaire-Short Form (FoPQ-SF), respectively. Mixed-model ANOVA was applied for statistical analysis. RESULTS: There was a significant time effect on total LLIS (P = 0.007), psychosocial (P = 0.038) and functional (P = 0.024) subscale changes in three groups of study. Interaction between the main effect of group and time on psychosocial subscale changes was statistically significant (P = 0.017). The multicomparison results illustrated that the main effect of time, the main effect of group, and interaction of them on the mean score of FCR were P = 0.084, P = 0.380, and P = 0.568, respectively. CONCLUSION: Despite no significant reduction in the FCR score, results showed the improvement of most QoL aspects after three months of intervention. Although the social network-based education method was effective, the group-based education method was more beneficial. Applying these educational methods in lymphedema treatment protocols needs cost-effectiveness studies. TRIAL REGISTRATION: This study was registered at the Iranian Registry of Clinical Trials (IRCT2017052834176N1).

The effect of saffron supplement on clinical outcomes and metabolic profiles in patients with active rheumatoid arthritis: A randomized, double-blind, placebo-controlled clinical trial.

Rheumatoid arthritis (RA) is a systemic autoimmune and inflammatory disease. Our study aimed to determine the effect of saffron supplement on clinical outcomes and metabolic profiles in patients with active RA. In this randomized, double-blind, placebo-controlled trial, 66 women older than 18 years old received 100 mg/day either saffron supplement in the intervention group (n = 33) or matched placebo in the placebo group (n = 33) for a period of 12 weeks. Sixty-one patients (30 in the control and 31 in the saffron group) remained for the final analysis. No adverse effects were reported by the patients. Saffron supplementation significantly decreased the number of tender (-1.38 ± 1.66 vs. 0.10 ± 0.40, p < .001) and swollen (-2.12 ± 2.34 vs. 0.63 ± 2.79, p < .001) joints, pain intensity based on visual analogue scale (-18.36 ± 15.07 vs. -2.33 ± 5.04), p < .001), and disease activity score (DAS28) (-0.75 ± 0.67 vs. 0.26 ± 0.77, p < .001) at the end of intervention between the two groups and in saffron group compared with baseline values. Physician Global Assessment (p = .002) and erythrocyte sedimentation rate were significantly improved after intervention (24.06 ± 12.66 vs. 32.00 ± 14.75, p = 0.028). High-sensitivity C-reactive protein reduced at the end of the intervention in the saffron group compared with baseline values (12.00 ± 7.40 vs. 8.82 ± 7.930, p = .004). Tumor necrosis factor alpha, interferon gamma, and malondialdehyde were decreased, and total antioxidant capacity were increased, but their differences between the two groups were not significant (p > .05). According to the results, saffron supplements could positively and significantly improve clinical outcomes in RA patients.

A Hybrid Multilayer Filtering Approach for Thyroid Nodule Segmentation on Ultrasound Images.

OBJECTIVES: Speckle noise is the main factor that degrades ultrasound image contrast and segmentation failure. Determining an effective filter can reduce speckle noise and improve segmentation performances. The aim of this study was to define a useful filter to improve the segmentation outcome. METHODS: Twelve filters, including median, hybrid median (Hmed), Fourier Butterworth, Fourier ideal, wavelet (Wlet), homomorphic Fourier Butterworth, homomorphic Fourier ideal, homomorphic wavelet (Hmp_Wlet), frost, anisotropic diffusion, probabilistic patch-based (PPB), and homogeneous area filters, were used to find the best filter(s) to prepare thyroid nodule segmentation. A receiver operating characteristic (ROC) analysis was used for filter evaluation in the nodule segmentation process. Accordingly, 10 morphologic parameters were measured from segmented regions to find the best parameters that predict the segmentation performance. RESULTS: The best segmentation performance was reached by using 4 hybrid filters that mainly contain contrast-limited adaptive histogram equalization, Wlet, Hmed, Hmp_Wlet, and PPB filters. The area under the ROC curve for these filters ranged from 0.900 to 0.943 in comparison with the original image, with an area under the curve of 0.685. From 10 morphologic parameters, the area, convex area, equivalent diameter, solidity, and extent can evaluate segmentation performance. CONCLUSIONS: Hybrid filters that contain contrast-limited adaptive histogram equalization, Wlet, Hmed, Hmp_Wlet, and PPB filters have a high potential to provide good conditions for thyroid nodule segmentation in ultrasound images. In addition to an ROC analysis, morphometry of a segmented region can be used to evaluate segmentation performances.

Combined Effect of Noise and Smoking on the Cognitive Performance of Automotive Industry Workers.

INTRODUCTION: Noise is an environmental stressor and can cause or exacerbate mental disorders, and affect the individual performance in certain conditions. This study aimed to evaluate the combined effects of noise and smoking on the cognitive performance of the workers in the automotive industry. METHODS: This research is a descriptive-analytical study with a cross-sectional design conducted on 300 workers randomly assigned into two groups of noise-exposed and nonexposed. They were examined using computerized tests, including the Tower of London test (TOL), Continuous Performance test (CPT), and Stroop test. The sound pressure levels were measured based on an 8-hour equal-loudness contour in each group according to ISO 9612 standard, using the Testo CEL-815 sound level meter. RESULTS: The study of combined effects of noise and smoking on 12 CPT indicators using the 2-way Analysis of Variance (ANOVA) indicate that noise and smoking factors had a significant impact on the mean number of errors and correct responses in the third 50-stimuli stage, the mean number of errors and correct responses in the second 50-stimuli stage with P<0.001, P<0.001, P=0.012 and P<0.001 for smoking respectively, but only noise affected the other 7 indicators (P<0.001). CONCLUSION: Smoking and noise have negative impacts on concentration, attention, and cognitive processing speed, which can lead to an individual's mistakes and delayed decision making at the workplace.

Barriers to Health Service Utilization Among Iranian Female Sex Workers: A Qualitative Study.

OBJECTIVES: In most countries around the world, sex work is an illegal activity. Female sex workers (FSWs) in Iran hide their identities, and they are known to be a hard-to-reach population. Despite free access to HIV testing, fewer than half of FSWs receive HIV testing. The purpose of this study was to characterize the reasons for which FSWs do not seek testing at drop-in centers (DICs) and voluntary counseling and testing (VCT) centers in Iran. METHODS: A qualitative study was conducted in 2016. The participants were 24 FSWs who received services at VCT centers and DICs for vulnerable females in the north of Iran and 9 males who were the clients of FSWs. In this study, we made use of purposive sampling and carried out a thematic analysis. RESULTS: We found 4 major and 6 minor themes. The major themes were: fear of being infected (with HIV), stigma, indifference, and knowledge. CONCLUSIONS: Despite the significant efforts made by the government of Iran to establish and expand DICs for vulnerable females, the number of FSWs receiving services at these centers has not been very considerable. Consequently, by introducing and implementing training programs for peer groups, it may be possible to take steps toward establishing strategic programs for the control and prevention of HIV/AIDS.

Assessment of Kidney Function After Allograft Transplantation by Texture Analysis.

INTRODUCTION: Ultrasonography is the preferable imaging technique for monitoring and assessing complications in kidney allograft transplants. Computer-aided diagnostic system based on texture analysis in ultrasonographic imaging is recommended to identify changes in kidney function after allograft transplantation. MATERIALS AND METHODS: A total of 61 biopsy-proven kidney allograft recipients (11 rejected and 50 unrejected) were assessed by a computer-aided diagnostic system. Up to 270 statistical texture features were extracted as descriptors for each region of interest in each recipient. Correlations of texture features with serum creatinine level and differences between rejected and unrejected allografts were analyzed. An area under the receiver operating characteristic curve was calculated for each significant texture feature. Linear discriminant analysis was employed to analyze significant features and increase discriminative power. Recipients were classified by the first nearest neighbor classifier. RESULTS: Fourteen texture features had a significant correlation with serum creatinine level and 16 were significantly different between the rejected and unrejected allografts, for which an area under the curve values were in the range of 0.575 for difference entropy S(4,0) to 0.676 for kurtosis. Using all 16 features, linear discriminant analysis indicated higher performance for classification of the two groups with an area under the curve of 0.975, which corresponded to a sensitivity of 90.9%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 98.0%. CONCLUSIONS: Texture analysis was a reliable method, with the potential for characterization, and can help physicians to diagnose kidney failure after transplantation on ultrasonographic imaging.