A comparison of the effect of Vitamin D and Vitamin E supplementations,alone,and in combination,on reducing the intensity and duration of dysmenorrhea in women:A randomized controlled trial

Objective:The aim of this study is to compare the effect of Vitamin D and Vitamin E supplementations,alone,and in combination,on reducing the intensity and duration of dysmenorrhea in women who were referred to the Kowsar gynecological clinics of Shahid Motahari Hospital of Urmia University of Medical Sciences.Materials and Methods:A double-blinded clinical trial was conducted on 112 women with dysmenorrhea who were randomly allocated into the four study groups.Finally,100 women complete the study and received capsules containing a placebo(n=25),1000 IU of Vitamin D(n=25),400 mg of Vitamin E(n=25),and 1000 IU of Vitamin D+400 mg of Vitamin E(n=25)every 24 h for 2 consecutive months at the beginning of the menstrual period.The pain intensity and duration among groups were compared before and after the intervention.Results:The mean menstrual pain duration in all three experimental groups(Vitamin E,Vitamin D,and the combination of them)was lower than the placebo group(all P<0.05),and the mean pain intensity scores in all three experimental groups were significantly lower than the placebo group(all P<0.05).The results(means)for all of the drugs administered at the end of the 2nd month were better than the 1st month(all P<0.01).Conclusions:Vitamin E and Vitamin D,as well as their combination,are recommended as an effective and safe treatment for the management of the complications of dysmenorrhea.

Risk of inflammatory bowel disease in patients with chronic obstructive pulmonary disease: A nationwide, population-based study

BACKGROUND There is a growing evidence regarding an increased risk of inflammatory bowel disease(IBD)among patients with airway diseases.AIM To investigate the influence of chronic obstructive pulmonary disease(COPD)on the risk of IBD.METHODS A nationwide,population-based study was conducted using data from the National Health Insurance Service database.A total of 1303021 patients with COPD and 6515105 non-COPD controls were identified.The COPD group was divided into the severe and the mild COPD group according to diagnostic criteria.The risk of IBD in patients with COPD compared to controls was analyzed by Cox proportional hazard regression models.The cumulative incidences of IBD were compared between the groups.RESULTS The COPD group had higher incidences of IBD compared to non-COPD controls(incidence rate,9.98 vs 7.18 per 100000 person-years,P<0.001).The risk of IBD in the COPD group was increased by 1.38(adjusted hazard ratio(HR);95%CI:1.25-1.52).The incidence rate of IBD was higher in the severe COPD group than in the mild COPD group(12.39 vs 9.77 per 100000 person-year,P<0.001).The severity of COPD was associated with an increased risk of IBD(adjusted HR 1.70 in severe COPD,95%CI:1.27-2.21 and adjusted HR 1.35 in mild COPD,95%CI:1.22-1.49)CONCLUSION The incidences of IBD were significantly increased in COPD patients in South Korea and the risk of developing IBD also increased as the severity of COPD increased.

Risk factors for the development of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with asymptomatic common bile duct stones

BACKGROUND Previous studies have revealed that patients with asymptomatic common bile duct(CBD)stones are at a high risk of developing post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP).However,no studies to date have addressed the risk factors for PEP in patients with asymptomatic CBD stones.AIM To examine the risk factors for PEP in patients with asymptomatic CBD stones.METHODS Using medical records of three institutions in Japan for 6 years,we identified a total of 1135 patients with choledocholithiasis including 967 symptomatic patients and 168 asymptomatic patients with native papilla who underwent therapeutic ERCP.We performed univariate and multivariate analyses to examine the risk factors for PEP in the 168 patients with asymptomatic CBD stones.RESULTS The overall incidence rate of PEP in all the patients with during study period was 4.7%(53/1135).Of the 168 patients with asymptomatic CBD stones,24(14.3%)developed PEP.In univariate analysis,precut sphincterotomy(P=0.009)and biliary balloon sphincter dilation(P=0.043)were significant risk factors for PEP.In multivariate analysis,precut sphincterotomy(P=0.002,95%CI:2.2-27.8,odds ratio=7.7),biliary balloon sphincter dilation(P=0.015,95%CI:1.4-17.3,odds ratio=4.9),and trainee endoscopists(P=0.048,95%CI:1.01-8.1,odds ratio=2.9)were significant risk factors for PEP.CONCLUSION ERCP for asymptomatic CBD stones should be performed by experienced endoscopists.When performing precut sphincterotomy or biliary balloon sphincter dilation in patients with asymptomatic CBD stones,the placement of a prophylactic pancreatic stent is strongly recommended to prevent PEP.

Treatment of Benzene,Toluene and Xylene Contaminated Air in a Bioactive Foam Emulsion Reactor

A novel bioactive foam emulsion bioreactor for benzene,toluene and xylene(BTX)contaminated air streams treatment has been developed.The gas-liquid interfacial area by biocompatible foam and driving force for mass transfer by a water immiscible organic phase were increased in this reactor.The effect of several parameters such as gas residence time,oxygen content,and organic phase concentration on bioreactor performance was studied. Experimental results showed an average elimination capacity(EC)of 220 g·m3·h -1with removal efficiency(RE) of 89.59%for BTX inlet concentration of 1 g·m3at 15 s gas residence time in the bioreactor.The statistical developed model predicted that the maximum elimination capacity of the reactor for BTX could be reached to 423.45 g·m3·h -1.Continues operation of the bioreactor with high EC and RE was demonstrated by optimizing the operational parameters of the bioreactor.Overall the results suggest that the bioreactor developed can be very effective systems to treat BTX vapors.

Endoscopic retrograde cholangiopancreatography for bile duct stones in patients with a performance status score of 3 or 4

BACKGROUND As the aging population grows worldwide,the rates of endoscopic retrograde cholangiopancreatography(ERCP)for common bile duct stones(CBDS)in older patients with a poor performance status(PS)have been increasing.However,the data on the safety and efficacy of ERCP for CBDS in patients with a PS score of 3 or 4 are lacking,with only a few studies having investigated this issue among patients with poor PS.AIM To examine the safety and efficacy of ERCP for CBDS in patients with a PS score of 3 or 4.METHODS This study utilized a retrospective multi-centered design of three institutions in Japan for 8 years to identify a total of 1343 patients with CBDS having native papillae who underwent therapeutic ERCP.As a result,1113 patients with a PS 0-2 and 230 patients with a PS 3-4 were included.One-to-one propensity-score matching was performed to compare the safety and efficacy of ERCP for CBDS between patients with a PS 0-2 and those with a PS 3-4.RESULTS The overall ERCP-related complication rates in all patients and propensity score-matched patients with a PS 0-2 and 3-4 were 9.0%(100/1113)and 7.0%(16/230;P=0.37),and 4.6%(9/196)and 6.6%(13/196;P=0.51),respectively.In the propensity score-matched patients,complications were significantly more severe in the group with a PS 3-4 than in the group with a PS 0-2 group(P=0.042).Risk factors for complications were indications of ERCP and absence of antibiotics in the multivariate analysis.Therapeutic success rates,including complete CBDS removal and permanent biliary stent placement,in propensity score-matched patients with a PS 0-2 and 3-4 were 97.4%(191/196)and 97.4%(191/196),respectively(P=1.0).CONCLUSION ERCP for CBDS can be effectively performed in patients with a PS 3 or 4.Nevertheless,the indication for ERCP in such patients should be carefully considered with prophylactic antibiotics.

Feasibility of gastric endoscopic submucosal dissection in elderly patients aged≥80 years

BACKGROUND Endoscopic resection,especially endoscopic submucosal dissection(ESD),is increasingly performed in elderly patients with early gastric cancer,and lesions beyond the expanded indications are also resected endoscopically in some patients.It is essential to assess whether gastric ESD is safe and suitable for elderly patients and investigate what type of lesions carry an increased risk of ESD-related complications.AIM To assess the efficacy and feasibility of gastric ESD for elderly patients,and define high-risk lesions and prognostic indicators.METHODS Among a total of 1169 sessions of gastric ESD performed in Kanagawa Cancer Center Hospital from 2006 to 2014,179 sessions(15.3%)were performed in patients aged≥80 years,and 172 of these sessions were done in patients with a final diagnosis of gastric cancer.These patients were studied retrospectively to evaluate short-term outcomes and survival.The short-term outcomes included the rates of en bloc resection and curative resection,complications,and procedurerelated mortality.Curability was assessed according to the Japanese Gastric Cancer Treatment Guidelines 2010.Fisher’s exact test was used to statistically analyze risk factors.Clinical characteristics of each group were compared using Fisher’s exact test and Mann-Whitney U test.Survival rates at each time point were based on Kaplan-Meier estimation.Overall survival rates were compared between patients with gastric cancer in each group with use of the log-rank test.To identify prognostic factors that jointly predict the hazard of death while controlling for model overfitting,we used the least absolute shrinkage and selection operator(LASSO)Cox regression model including factors curative/noncurative,age,gender,body mass index,prognostic nutritional index,Charlson comorbidity index(CCI),Glasgow prognostic score,neutrophil-to-lymphocyte ratio,and antithrombotic agent use.We selected the LASSO Cox regression model that resulted in minimal prediction error in 10-fold cross-validation.P<0.05 was considered statistically significant.RESULTS The en bloc dissection rate was 97.1%,indicating that a high quality of treatment was achieved even in elderly patients.As for complications,the rates of bleeding,perforation and aspiration pneumonitis were 3.4%,1.1%and 0.6%,respectively.These complication rates indicated that ESD was not associated with a particularly higher risk in elderly patients than in nonelderly patients.A dissection incision>40 mm,lesions associated with depressions,and lesions with ulcers were risk factors for post-ESD bleeding,and location of the lesion in the upper third of the stomach was a risk factor for perforation in elderly patients(P<0.05).Location of the lesion in the lower third of the stomach tended to be associated with a higher risk of bleeding.The overall survival(OS)did not differ significantly between curative and noncurative ESD(P=0.69).In patients without additional surgery,OS rate was significantly lower in patients with a high CCI(≥2)than in those with a low CCI(≤1)(P<0.001).CONCLUSION Gastric ESD is feasible even in patients aged≥80 years.Observation without additional surgery after noncurative ESD is reasonable,especially in elderly patients with CCI≥2.

The Effects of Cupping Therapy on Skin’s Biomechanical Properties in Wistar Rats

Cupping therapy has been widely used for clinical treatment of soft tissue lesions. The current study investigated the effects of cupping therapy on biomechanical properties of the skin in Wistar rats. 20 rats were divided into two groups: 10 in experimental and 10 in control group. Either the right or the left lower quadrants of the lumbar regions in the experimental group underwent 10 minutes daily cupping therapy for 12 days. The skin stiffness and ultimate tensile strength of all the rats were measured using tensiometer. The skin stiffness and ultimate tensile strength were decreased significantly in cupping side of the experimental group as compared with the non-cupping side and the control group. There were no significant differences between the non-cupping side of the experimental group and the control group. In conclusion, cupping therapy can be useful as a treatment method to reduce the skin stiffness and ultimate tensile strength.

Plasma Concentrations of Some Trace Element and Heavy Metals in Patients with Metastatic Colon Cancer

Purpose: It is well known that trace elements and heavy metals play a significant role in human health and disease. These elements play an important role in different metabolic pathways of cells and tissues. Trace element deficiency or excess is implicated in the development or progression of some cancers. We present a study which investigates serum/ plasma levels of trace-heavy elements in metastatic colon cancer patients and healthy subjects. Methods: Blood samples were collected from 29 healthy subjects and 40 patients with metastatic colon cancer in Oncology Department of Medical School of Yuzuncu Yil University. In both groups, the serum levels of copper (Cu), magnesium (Mg), lead (Pb), chromium (Cr), zinc (Zn) selenium (Se), manganese (Mn), and cadmium (Cd) were determined. Results: Higher levels of Cu, Mg, Pb, Cr, Zn, Mn and Cd were seen in patients with metastatic colon cancer compared to healthy subjects and these findings were statistically significant (p 0.05). Se levels were noted to be lower in patients with colon cancer in comparison to healthy subjects and this finding was also statistically significant (p 0.05). Conclusions: According to our findings there was significant diffence in trace elements and heavy metals levels between healthy subjects and metastatic colon cancer patients. Therefore heavy metal and trace elements may have prognostic significance in complex disorders including colon cancer. However, further comprehensive studies are needed in order to advance our understanding of the relationship between heavy metal and trace elements and their role in cancers.

Comparison of Sexual Function in Primiparous Women Pre-Pregnancy and Postpartum: Difference of the Sexual Function after the Normal Vaginal Delivery and the Cesarean Section

Introduction: Sexual function is undoubtedly an important dimension of adult life. Due to all the conflicting results with regard to sexual function after the normal vaginal delivery (NVD) or the Cesarean Section (CS), in the present study, we aimed to compare the sexual function in women pre-pregnancy and postpartum and also after the NVD and CS. Materials and Methods: In this cohort study, two groups of healthy women, with antenatal normal pregnancies, who underwent NVD (n = 90) and CS (n = 113), were prospectively studied. The sexual function of the participants was assessed through a Female Sexual Function Index (FSFI) questionnaire in two stages: once before pregnancy and then within 3 to 6 months after delivery, which lasted from June 2011 to September 2012. The data were analyzed by descriptive and inferential statistics. Data were analyzed using chi-square test, Mann-Whitney test, and T Test. Results: Based on the data gathered from 206 women who completed the FSFI questionnaire in two stages, the mean (±SD) self-reported timing of the resumption of sexual activity was 8.9 ± 1.3. There was no significant statistical difference found between the two groups by timing of the resumption of sexual activity in NVD and CS groups. There was also no statistically significant difference found in the overall sexual function scores between the two groups (NVD vs. CS). The average score for female sexual function in desire, arousal, orgasm, and satisfaction within 3 to 6 months after delivery was significantly lower than that of their pre-pregnancy period (p < 0.004). The mean coitus in postpartum period was 1.84 ± 1.20 per week. Conclusion: Based on the findings of this study, there was no significant relationship between the mode of delivery and changes in sexual function. Therefore, it can be claimed that CS is not preferred to NVD with regard to preserving normal sexual functioning.

Renal function after laparoscopic cholecystectomy and analgesia with tramadol and dipyrone or ketorolac

Background: Laparoscopic cholecystectomy (LC) reduces surgical trauma and hospital stay, but requires effective and safe postoperative analgesia. This prospective and double-blind study investigated the effects of analgesia with tramadol combined with either dipyrone or ketorolac on the postoperative renal function of patients submitted to LC. Methods: Pre-and post-operatively (PO), estimated glomerular filtration rates (GFR), obtained by two formulas dependent on blood Cr and one on blood cystatin C values, and tubular enzymuria—alkaline phosphatase (AP), γ-glutamiltransferase (γ-GT)— were determined in well hydrated patients who underwent LC and analgesia with tramadol combined with either dipyrone (Dipyrone, n = 63) or ketorolac (Ketorolac, n = 63). Upon discharge from the post-anesthetic care unit (PACU), pain (through Verbal Numerical Scale—VNS) and need for rescue analgesia with morphine were evaluated. Results: There was hemodilution PO, which made GFR profile analysis more difficult—those dependent on Cr increased and statistically correlated, but those dependent on cystatin C did not change. There was a significant PO increase in AP in the Dipyrone and Ketorolac groups, and in the product of the both enzymes in the Ketorolac group. Upon PACU discharge, the Dipyrone group showed signifi cantly higher VNS scores than the Ketorolac group. All patients received morphine PO, and the total dose needed for pain control differed between groups, but without statistical significance. Conclusions: The association of tramadol with dipyrone or ketorolac in well hydrated patients submitted to LC had similar analgesic effectiveness in the PACU. Postoperatively, the effect on GFR may have been masked by hemodilution, and enzymuria was discreetly enhanced when ketorolac was used.

Vaccination as an alternative to non-drug interventions to prevent local resurgence of COVID-19

Background:While a COVID-19 vaccine protects people from serious illness and death,it remains a concern when and how to lift the high-cost and strict non-pharmaceutical interventions(NPIs).This study examined the joint efect of vaccine coverage and NPIs on the control of local and sporadic resurgence of COVID-19 cases.Methods:Between July 2021 and January 2022,we collected the large-scale testing information and case number of imported COVID-19 patients from the website of the National Health Commission of China.A compartment model was developed to identify the level of vaccine coverage that would allow safe relaxation of NPIs,and vaccination strategies that can best achieve this level of coverage.We applied Monte Carlo simulation 50000 times to remove random fuctuation efects and obtain ftted/predicted epidemic curve based on various parameters with 95% confdence interval at each time point.Results:We found that a vaccination coverage of 50.4% was needed for the safe relaxation of NPIs,if the vaccine efectiveness was 79.3%.The total number of incidence cases under the key groups frstly strategy was 10^(3) times higher than that of accelerated vaccination strategy.It needed 35 months to fully relax NPIs if the key groups frstly strategy was implemented,and 27 months were needed with the accelerated vaccination strategy.If combined the two strategies,only 8 months are needed to achieve the vaccine coverage threshold for the fully relaxation of NPIs.Sensitivity analyses results shown that the higher the transmission rate of the virus and the lower annual vaccine supply,the more difcult the epidemic could be under control.When the transmission rate increased 25% or the vaccination efectiveness rate decreased 20%,33 months were needed to reduce the number of total incidence cases below 1000.Conclusions:As vaccine coverage improves,the NPIs can be gradually relaxed.Until that threshold is reached,however,strict NPIs are still needed to control the epidemic.The more transmissible SARS-CoV-2 variant led to higher resurgence probability,which indicates the importance of accelerated vaccination and achieving the vaccine coverage earlier.

闪光对于减轻静脉置管痛的作用：一项前瞻性随机安慰剂对照研究

背景尽管静脉置管时的疼痛经常让人备受困扰，但通常都是在没有任何镇痛措施下进行静脉置管的。临床上曾尝试用一些药物和非药物方法来减轻静脉置管的疼痛，但结果各异。本研究拟评价一次闪光对于减轻静脉置管痛的效果。方法90例拟择期行腹腔镜胆囊切除术的ASAⅠ～Ⅱ级的成年患者（15～60岁），随机分为3组，每组30例，组1为对照组；组2为分散注意力组，即在非优势手的手背静脉进行置管前给患者照相而不使用闪光；组3为闪光组，静脉置管前照相并且使用闪光；在照相后立即使用18G的穿刺针进行静脉置管。结果每组均有2例患者首次静脉穿刺失败，在数据分析中即予以剔除，闪光组疼痛的发生率为50％（28例中14例发生），其他2组为100％（28例全部发生），通过视觉模拟评分评估的疼痛严重程度分散注意力组和闪光组显著低于对照组，而闪光组也显著低于分散注意力组。结论静脉置管前使用闪光是一种减轻疼痛的安全而简单有效的方法。