Investigating the TLR9 mRNA Expression Level in Different Histological Types of Colorectal Polyps

Toll-like receptor 9 (TLR9) is a cellular DNA receptor of the innate immune system which plays a pivotal role ininflammatory response. Recently, changing expression levels of TLR9 has been observed in a wide range of cancercells; however, there is little information about colorectal polyps. Herein, we assessed the mRNA expression of TLR9in different colorectal polyp types compared to normal group in order to investigate its expression level during CRCinitiation. Fifty-four biopsy samples from colorectal polyp patients and from 20 healthy subjects were collected. Themucosal mRNA expression level of TLR9 gene was identified by real time PCR. Fold change of gene expression wasevaluated by 2-ΔΔct method. There was a significant relationship between the lower expression of TLR9 gene in the polypcases compared to normal individuals (P value = 0.0005), Also, decreased TLR9 mRNA expression was obtained inadenomas in contrast to hyperplastic and normal groups (P value = 0.0008). Based on the current results, we hypothesized that aberrant surface expression of TLR9 on tumor cells may promote the growth and invasion of colorectal polyps. Further, TLR9 modulation may have an important impact on the development of novel therapeutic strategies.     

Using Machine Learning Techniques to Predict Factors Contributing to the Incidence of Metabolic Syndrome in Tehran: Cohort Study

BackgroundMetabolic syndrome (MetS), a major contributor to cardiovascular disease and diabetes, is considered to be among the most common public health problems worldwide.ObjectiveWe aimed to identify and rank the most important nutritional and nonnutritional factors contributing to the development of MetS using a data-mining method.MethodsThis prospective study was performed on 3048 adults (aged ≥20 years) who participated in the fifth follow-up examination of the Tehran Lipid and Glucose Study, who were followed for 3 years. MetS was defined according to the modified definition of the National Cholesterol Education Program/Adult Treatment Panel III. The importance of variables was obtained by the training set using the random forest model for determining factors with the greatest contribution to developing MetS.ResultsAmong the 3048 participants, 701 (22.9%) developed MetS during the study period. The mean age of the participants was 44.3 years (SD 11.8). The total incidence rate of MetS was 229.9 (95% CI 278.6-322.9) per 1000 person-years and the mean follow-up time was 40.5 months (SD 7.3). The incidence of MetS was significantly (P<.001) higher in men than in women (27% vs 20%). Those affected by MetS were older, married, had diabetes, with lower levels of education, and had a higher BMI (P<.001). The percentage of hospitalized patients was higher among those with MetS than among healthy people, although this difference was only statistically significant in women (P=.02). Based on the variable importance and multiple logistic regression analyses, the most important determinants of MetS were identified as history of diabetes (odds ratio [OR] 6.3, 95% CI 3.9-10.2, P<.001), BMI (OR 1.2, 95% CI 1.0-1.2, P<.001), age (OR 1.0, 95% CI 1.0-1.03, P<.001), female gender (OR 0.5, 95% CI 0.38-0.63, P<.001), and dietary monounsaturated fatty acid (OR 0.97, 95% CI 0.94-0.99, P=.04).ConclusionsBased on our findings, the incidence rate of MetS was significantly higher in men than in women in Tehran. The most important determinants of MetS were history of diabetes, high BMI, older age, male gender, and low dietary monounsaturated fatty acid intake.     

Hysterosalpingography in the assessment of proximal tubal pathology: a review of congenital and acquired abnormalities

Tubal and peritoneal disease are the main causes of infertility. Tubal pathology can be either congenital malformation or acquired, proximal or distal, unilateral or bilateral and transient or permanent. Several imaging methods such as laparoscopy, fluoroscopy, saline infusion sonography, and hysterosalpingography (HSG) have been used in the assessment of tubal and peritoneal pathology. Although laparoscopy is the modality of choice for investigating tubal patency and pelvic structure in many infertility centers, HSG is usually the initial diagnostic method for infertility workup because of its ease of performance, accuracy, and minimal risk of complications. This method provides useful information about size, contour, and anatomy of the inner surface of the fallopian tubes and is the gold standard for evaluation of tubal lumen. Tubal and peritubal pathology show various imaging manifestations on HSG. This review illustrates the radiographic features of congenital and acquired structural abnormalities of the proximal tubal pathology and along with etiology of proximal obstruction or occlusion will be described.     

Evaluating the Validity and Reliability of PDQ-II and Comparison with DDST-II for Two Step Developmental Screening

Objective

This research was designed to identify the validity and reliability of the Prescreening Developmental Questionnaire 2 (PDQ-II) in Tehran in comparison with the Denver Developmental Screening Test-II (DDST-II).

Methods

After translation and back translation, the final Persian version of test was verified by three pediatricians and also by reviewing relevant literature for content validity. The test was performed on 237 children ranging from 0 to 6 years old, recruited by convenient sampling, from four health care clinics in Tehran city. They were also evaluated by DDST II simultaneously. Interrater methods and Cronbach''s α were used to determine reliability of the test. The Kappa agreement coefficient between PDQ and DDST II was determined. The data was analyzed by SPSS software.

Findings

All of the questions in PDQ had satisfactory content validity. The total Cronbach''s α coefficient of 0–9 months, 9–24 months, 2–4 years and 4–6 years questionnaires were 0.951, 0.926, 0.950 and 0.876, respectively. The Kappa measure of agreement for interrater tests was 0.89. The estimated agreement coefficient between PDQ and DDST II was 0.383. Based on two different categorizing possibilities for questionable scores, that is, "Delayed" or "Normal", sensitivity and specificity of PDQ was determined to be 35.7–63% and 75.8–92.2%, respectively.

Conclusion

PDQ has a good content validity and reliability and moderate sensitivity and specificity in comparison with the DDST-II, but by considering their relatively weak agreement coefficient, using it along with DDST-II for a two-stage developmental screening process, remains doubtful.     

The relationship between self-efficacy,coping skill and substance use in adolescent: based on structural equation modeling

Background: This study was aimed to investigate interrelationships between the self-efficacy and coping skill in relation to substance use behavior in adolescent.

Method: A self-administered questionnaire was completed by 720 girls and boys, aged between 14 and 18, involved in the cross-sectional study in Iran. In the first step, first-order measurement models were examined to assess how well the observed measures could reflect the latent constructs and in the second step, the structural component consisting of relationships between the latent factors was examined to determine the theoretical factors of the coping and self-efficacy predicted substance use behavior, as hypothesized.

Result: The results of the first step revealed stable assessment of four confirmed factors in the first-order measurement model. In second step, the structural model of coping and self-efficacy showed an acceptable adequacy in predicting substance use behavior in the second-order model. Direct and indirect path analysis demonstrated that relationship between refusal self-efficacy and substance use would be mediated by the coping skill, and this relationship could significantly predict substance use behavior in our study.

Conclusion: The results of our hypothesized model of coping self-efficacy (CSE) had an acceptable adequacy in predicting substance use behavior in adolescents.     

Cholangiocarcinoma and liver transplantation: What we know so far?

Cholangiocarcinoma (CCA) is a type of cancer with increasing prevalence around the world that originates from cholangiocytes, the epithelial cells of the bile duct. The tumor begins insidiously and is distinguished by high grade neoplasm, poor outcome, and high risk for recurrence. Liver transplantation has become broadly accepted as a treatment option for CCA. Liver transplantation is expected to play a crucial role as palliative and curative therapy for unresectable hilar CCA and intrahepatic CCA. The purpose of this study was to determine which cases with CCA should be subjected to liver transplantation instead of resection, although reported post-transplant recurrence rate averages approximately 20%. This review also aims to highlight the molecular current frontiers of CCA and directions of liver transplantation for CCA.     

Prevalence of and Risk Factors for Genito-Pelvic Pain/Penetration Disorder: A Population-Based Study of Iranian Women

IntroductionTo date, few studies have investigated the prevalence of sexual pain in the context of the new diagnostic concept of genito-pelvic pain/penetration disorder (GPPPD).AimTo evaluate the prevalence of GPPPD and its associated factors.MethodsThis was a population-based, cross-sectional study of 590 healthy married women age 18–70 years conducted between May and October 2017 in Tehran, Iran.Main Outcome MeasuresResearch tools included demographic characteristics checklist, factors affecting GPPPD, sexual distress and self-reporting of pain during intercourse, 2 standard questionnaires on depression (Patient Health Questionnaire 9) and Binik’s guideline for the diagnosis of GPPPD.Results196 women (33%) reported pain or fear in answer to self-report questions. Administration of Binik’s guideline yielded a GPPPD prevalence of 16% (n = 94 women); however, this number decreased to 62 women (10.5%) when sexual distress was taken into account; thus, the final prevalence of GPPPD was considered to be 10.5%. However, if the threshold in Binik’s guideline was lowered to also include those reporting “somewhat” pain in addition to the group reporting “moderate” and “quite a bit or always,” then the prevalence of GPPPD increased to 25.8%. The results of backward logistic regression identified a strong aversion to looking at or touching the genitalia (odd ratio [OR] = 4.3), low sexual satisfaction (OR = 3.1), and severe depression (OR = 6.6) as independent risk factors for a diagnosis of GPPPD and secure financial status (OR = 0.3) and a high level of marital satisfaction (OR = 0.2) as protective factors against a diagnosis of GPPPD.Clinical ImplicationsReliable diagnosis of GPPPD is crucial. Application of validated tools may mitigate the overestimation of GPPPD prevalence. Simultaneously, clinicians’ judgment is essential in assessing a reasonable threshold and preventing underestimation that leads to the exclusion of women suffering from pain.Strengths & LimitationsThe present study is one of the few evaluating the prevalence of GPPPD according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) definition and Binik’s guideline. The study also aims to point out some new perspectives on merging the 2 concepts of vaginismus and dyspareunia. Study limitations include the evaluation of factors affecting GPPPD based on self-reporting and possible recall bias.ConclusionFurther research is needed to determine the appropriate threshold for a diagnosis of GPPPD. We suggest that a woman with mild to moderate pain or fear of vaginal penetration is under sexual distress and cannot be neglected. In addition, problems may arise following the DSM-5 merging of the 2 disorders of vaginismus and dyspareunia, owing to the significant prevalence and distress of lifelong vaginismus in some cultures.Alizadeh A, Farnam F, Raisi F, et al. Prevalence of and Risk Factors for Genito-Pelvic Pain/Penetration Disorder: A Population-Based Study of Iranian Women.J Sex Med 2019;16:1068–1077.