Iranian Journal of

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Background: Type II diabetes is a chronic inflammatory condition that is associated with a combination of genetic and environmental factors. Tumor necrosis factor alpha or TNF-α as an adipocyte cytokine, which affects the signaling pathway of insulin, can contribute to insulin resistance in type 2 diabetes patients. Considering the importance of epigenetic changes in multifactorial diseases, this study aimed to investigate TNF-α promoter methylation in patients with type 2 diabetes.
Methods: This study was performed on 61 patients with type 2 diabetes and 31 non-diabetic patients. The Groups were matched in terms of demographic characteristics. The lipid profiles were measured by standard kits. TNF-α promoter methylation levels were measured by bisulphite treatment method, Nested PCR and sequencing.
Results: There was no association between TNF-α promoter methylation gene promoter and type 2 diabetes in the studied groups. Also, there was no association between TNF-α promoter methylation in diabetic and non-diabetic groups between males and females.
Conclusion: The epigenetic changes in cytokines that contribute to insulin resistance in type 2 diabetic patients seem to be ineffective in peripheral blood samples, and other tissues may need to be investigated in this regard.

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Background: Peripheral neuropathy is one of the most common problems in diabetic patients. The increased risk of Diabetic Foot Ulceration (DFU) and amputation would be a complication of diabetic neuropathy. The aim of this study was to compare the DFU healing in different severity classification of neuropathy.
Methods: This is a retrospective study that was conducted over a two-year period from April 2016 to March 2018 according to the information of patients records with Diabetes Mellitus (DM) referred to clinic of diabetes and metabolic disorders of Endocrinology and Metabolism Research Institute of Tehran University of Medical Sciences. Wound healing criteria including area, depth and healing duration were studied. Accordingly, changes in the area and depth of wounds were evaluated and reported during the first, third and sixth months after baseline. Data were analyzed using descriptive and inferential statistics using SPSS software version 16.
Results: The results of the study of patients with neuropathic ulcer showed that males and age group of 56 to 65 years had the highest frequencies. In addition, most of these patients suffered from type 2 DM (79%). The rate of wound healing, which was measured by area and depth of wound in three time periods, differed in different severity classification of neuropathy; at mild level of neuropathy the area and depth of wound decreased faster but in severe neuropathy, duration of wound healing in both mentioned criteria has increased. Regarding to the increase in the duration of DM, the healing time increased too. However the rate of wound healing decreased with increased age (p-value = 0.001).
Conclusion: Evidence suggests that early identification of neuropathy can reduce the incidence of DFU and amputation. Due to the slow healing of the size and depth of the wound in diabetic patients with severe neuropathy, it is necessary to prevent DFU by conducting preventive care and educational interventions.

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Background: Nowadays, thinness is generally considered as a standard of women's beauty, and high BMI is associated with negative physical and psychological consequences among women, including negative body image and eating disorders. Therefore, identifying the effective factors in reducing these outcomes seems necessary. The purpose of this study was to determine the moderating role of self-compassion in the relationship between body mass index, body image and symptoms of eating disorders.
Methods: The research method was correlation and the statistical population was all female students of Tehran in 2018 that Among them, 345 students were selected by convenient sampling. Measurement tools included Eating Disorders Diagnostic Scale (EDDS), Self-compassion Measurement Scale (SCS) and Body Appreciation Scale (BAS-2). Data were analyzed using Pearson correlation coefficient and multiple regression analysis (hierarchical method).
Results: The results showed that there was a significant positive correlation between body mass index and eating disorder (P<0.01), and a significant negative correlation with body appreciation and self-compassion (P <0.01). On the other hand, the results of hierarchical regression analysis showed that self-compassion moderates the relationship between body mass index and symptoms of eating disorders (P<0.01), but it did not moderate the relationship between body mass index and body appreciation (P>0.05).
Conclusion: These findings showed that self-compassion may protect women against negative consequences of a high body mass index. As a result, self-compassion can be beneficial in improving mental health and preventing disorders.

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Background: The purpose of this study was to evaluate the effect of six weeks of endurance training with sour lemon consumption on plasma levels of endolin-1 and nitric oxide in streptozotocin-induced diabetic rats.
Methods: In this experimental study, 72 male Wistar rats (Weight; 200 ± 12 g) were selected and randomly divided into eight groups after becoming diabetic. Endurance training protocol was performed on rats for 6 weeks. Lemon essential oil (50 mg/kg) was administered using gavage. Plasma endolin-1 levels were measured by ELISA and serum nitrite levels were measured as a major metabolite of nitric oxide. One-way analysis of variance and Tukey's post hoc test were used for statistical analysis.
Results: The results showed that the mean levels of endothelin-1 in the endurance training + lemon group and diabetes + endurance training + lemon were significantly lower than the control group (p<0.05). Also, the mean nitric oxide levels in the diabetes + lemon group were significantly lower compared to the control group, but in the endurance + lemon training group and the diabetes + endurance training + lemon group was significantly higher than the control group (p<0.05).
Conclusion: According to the results of this study, it can be concluded that endurance training with consumption of lemon may improve endothelial function and vascular occlusion in diabetic patients by reducing the concentration of endothelin-1 levels and increasing nitric oxide levels.

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Background: A key aspect of Scientific collaboration increases scientific productivity. This study aimed to draw up a scientific collaboration network of the Endocrinology and Metabolism Research Institute (EMRI) at Tehran University of Medical Sciences.
Methods: A Descriptive Cross-Sectional Study was conducted by the Scientometrics method. Data collection from the Scopus and Web of Science Core collection databases between 2002 until 30 October 2020. MS-Excel, HistCite, VOSviewer, and ScientoPy were used for descriptive statistics and data analysis.
Results: A total of 4190 records with the affiliation of the EMRI are indexed in two international databases. All of the records received a sum of 89480 citations. The EMRI Researchers were published in 1118 journals. The annual growth rate of publication and citation of the scientific output of the EMRI was 20.3% and 22.7%, respectively. A total of 17662 authors from 186 countries participated in the publication. The co-authorship pattern shows. The next section of the Study was classified and visualized based on authorship (institutes and country of affiliation), keywords (co-occurrence and trend).
Conclusion: Overall, these results indicate that the pattern of collaborations in the authorships' articles increases the flow of knowledge among the institute's researchers as a result of international collaborations, interaction with leading countries, and interdisciplinary collaborations. To develop a full picture of co-authorship, additional studies will need a comprehensive picture of network cooperation to analyze the situation with other social network analysis indicators.

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Background: Adipulin is a hormone secretd by fat cells that acts as a metabolic regulator with anti-inflammatory properties and is reduced through obesity, diabetes and inflammation. Therefore, the aim of this study was to compare the effect of high and moderate intensity aerobic exercise on serum adipolin levels and some indicators of metabolic syndrome in obese women.
Methods: In this quasi-experimental study, 36 people were randomly divided into three groups of 12 people (2 experimental groups and one control group). Aerobic exercise group with an intensity of 85-95% of maximum heart rate performed intermittent walking and running on the treadmill for 33 minutes per session and exercise group with an intensity of 50-70% of maximum heart rate walked continuously for 41 minutes. (Training duration for 2 groups was 8 weeks and 3 sessions per week, The control group was not active during this period). One-way analysis of variance statistical and Bonferroni post hoc tests were used at the significant level (P> 0.05).
Results: High intensity aerobic exercise significantly increased serum adipolin levels (P= 0.001) and decreased total cholesterol (P= 0.020), triglyceride (P= 0.021) and insulin resistance (P= 0.001). The results also showed no significant differences in the levels of high-density lipoprotein (P= 0.615), low-density lipoprotein (P= 0.604), and blood pressure (P= 0.269) in the three groups. Medium-intensity aerobic exercise had no effect on serum adipoline levels (P= 0.192), only glucose, (P= 0.025), triglycerides (P= 0.010), systolic blood pressure (P= 0.028) and insulin (P= 0.043) decreased and the levels of cholesterol, low-density lipoprotein and high-density lipoprotein did not change significantly.
Conclusion: In the end, it can be said that it seems that individuals can use high-intensity aerobic exercise to increase the amount of adipolin as an indicator of improving insulin sensitivity and also improving the indicators of metabolic syndrome.

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Background: Unc-51 Like Autophagy Activating Kinase-1 (ULK1) and FAK Family Kinase-Interacting Protein of 200 kDa (FIP200) play an essential role in controlling autophagy and muscle volume. The aim of this research is to investigate the effect of endurance training on the intracellular content of ULK1 and FIP200 proteins in the left ventricular of rats with type 1 diabetes.
Methods: In this experimental study, 18 rats 2-month-old male Sprague-Dawley rats with a mean weight of 300±20g were selected. 12 rats became diabetic by intraperitoneal injection of Streptozotocin solutions. These rats were randomly divided into 2 groups: diabetic training and diabetic control (6 heads per group); A healthy control group (6 heads)was also considered. The training group practiced endurance training 4 days a week for 6 weeks. Data were analyzed using SPSS software version 23 and one-way ANOVA and Tukey post hoc tests.
Results: The content of ULK1 (increase) and FIP200 (decrease) after endurance training showed a significant change among the research groups in the left ventricular (P=0.0001). Tukey's post hoc test showed that this change is significant between the pair of diabetic training groups to diabetic control, diabetic training to healthy groups, and also diabetic control to healthy groups (P≤0.05).
Conclusion: Endurance training showed that it can have a dual nature to control autophagy in diabetic subjects by increasing ULK1 and decreasing FIP200. There is a need for more investigations in the field of exercise physiology on the proteins responsible for autophagy, especially in type 1 diabetes subjects.

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Background: This review study aims to shade light on the effects of carrying out interventions and policies in order to reduce the incidence and prevalence of non-communicable diseases (NCDs) and their behavioral risk factors (i.e., unhealthy diet, insufficient physical activity and smoking) and strategies and approaches to reduce their attributed burden.
Method: In this research, the documents and reports available in the Ministry of Health, developed action plans, recommendations of national and international organizations, evidence gathered from monitoring and evaluations and the "National Action Plan and Control of Non-Communicable Diseases and Related Risk Factors in the Islamic Republic of Iran, 2015-2025" were investigated with respect to  each of the three main risk factors of NCDs, including unhealthy diet, insufficient physical activity, and smoking (harmful consumption of alcohol has been reviewed in another article). Each risk factor has been discussed separately in the sections describing the current situation, policies and implemented interventions, findings, and future plans.
Results: The implemented interventions and policies to achieve the goals stated in the "National Action Plan and Control of Non-Communicable Diseases and Related Risk Factors in the Islamic Republic of Iran, 2015-2025" in the field of unhealthy nutrition, resulted in revising the food standards. Interventions in the field of physical activity have caused a 1.5% reduction in the relative prevalence of sedentary behavior in the society. Our research also revealed that interventions in the field of tobacco consumption have led a total decrease of 7.44% among Iranian people over 18 years of age, but a decrease in the use of hookah is not recorded, and its consumption has increased by 28% in 2021 compared to 2011.
Conclusion: According to the findings, the goals stated in the aforementioned document have not been fully achieved, so new interventions and policies should be used by those involved.

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Background: CTRP3 is known to be an adipose tissue-derived anti-inflammatory hormone that leads to improved insulin resistance. However, the effects of exercise training on this adipokine are poorly understood. Therefore, the aim of the present meta-analysis was to investigate the effect of exercise training on circulating CTRP3 levels in adults with metabolic disorders.
Methods: A comprehensive search was conducted in PubMed and Web of Science databases through October 2022 using the keywords "exercise training" and "CTRP3". The inclusion criteria for the current research included human studies with metabolic disorders, exercise training intervention, and circulating CTRP3 values. Standardized mean difference (SMD) and 95% confidence interval were calculated using random method.
Results: A total of 9 studies including 12 intervention arms and 365 participants with metabolic disorders were included in the meta-analysis. The results of data analysis showed that exercise training led to a significant increase in CTRP3 [0.57, (CI: 1.10 to 0.03) P=0.03]. Also, the results of the I2 test showed that there is a high and significant heterogeneity (I2 =84.59, P=0.001) and the results of the Egger test showed a significant publication bias (P=0.001).
Conclusion: Exercise training with a moderate effect size leads to a significant increase in circulating CTRP3 levels in individual with metabolic and cardiovascular diseases, which may be a mediator of the beneficial effects of exercise training.

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Background: Diabetic nephropathy is the main cause of end-stage kidney disease in diabetic patients. Several inflammatory markers related with diabetic nephropathy have been investigated so far. It is necessary to identify easily available and cost-effective indices. We aimed to determine the relationship between the neutrophil to lymphocyte ratio and mean platelet volume with diabetic nephropathy.
Methods: This cross-sectional study was performed from 2021 to 2022 in diabetes clinic of Ghaem hospital, Mashhad.  Patients with type II diabetes were categorized into two groups: without and with nephropathy (urinary albumin excretion greater than 30 mg/24h or GFR less than 60). Patients’ data, including demographic data, past medical and drug history and lab data were gathered and analyzed.
Results: In total, 100 diabetic patients including 50 with (mean age=64.04±7.40 years) and 50 without nephropathy (mean age=56.06±6.36 years), were studied. Patients with nephropathy were older, had a longer history of diabetes and a higher blood pressure (P < 0.05). However, the distribution of gender, weight, height, and BMI was not significantly different the two groups (P>0.05). The absolute neutrophil count was not significantly different between the two groups (P>0.05), while the mean platelet volume, neutrophil% and neutrophil/lymphocyte ratio were significantly higher in patients with nephropathy (P<0.05).
Conclusion: According to our findings, patients with diabetic nephropathy had higher mean platelet volume, neutrophil%, and neutrophil/lymphocyte ratios compared to diabetic patients without nephropathy.

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Background: Fetuin-A, as a hepatokine, plays an important role in the regulation of whole-body metabolism, which is increased with chronic diseases. Therefore, the aim of this meta-analysis is to investigate the effect of exercise training on Fetuin-A levels in individuals with metabolic and kidney diseases.
Methods: A systematic search was conducted in PubMed, Web of Science, and Google Scholar databases until November 2022 using the keywords "exercise training" and "Fetuin-A". To determine the effect size, standardized mean difference (SMD) and 95% confidence interval were calculated using CMA2 software. Heterogeneity was evaluated using the I2 test, and publication bias was evaluated by visual interpretation of the funnel plot and Egger's test. The quality of the included studies was evaluated using the PEDRO checklist.
Results: A total of 16 studies including 21 trials arms and 554 subjects with type 2 diabetes, obesity and kidney disease were included in the meta-analysis. Exercise training resulted in a significant decrease in Fetuin-A levels [-0.93 (CI: -1.35 to -0.51) P= 0.001]. There was a high heterogeneity (I2= 89.24, P= 0.001) and also a significant publication bias (P= 0.001). The results of subgroup analysis based on the type of exercise training showed that aerobic training resulted in a significant decrease in Fetuin-A (P= 0.001) while the reduction of this marker with combined training was not significant (P= 0.33).
Conclusion: Exercise training, especially aerobic training, results in a decrease in Fetuin-A levels in metabolic patients, which may be contributed to the beneficial effects of exercise.

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Background: Adiponectin is one of the most well-known adipokines with anti-inflammatory effects that plays an important role in regulating the whole-body metabolism. The aim of this study was to investigate the effect of high-intensity interval training (HIIT) versus moderate intensity continuous training (MICT) on the circulating levels of adiponectin in individuals with and without metabolic disorders.
Methods: A systematic search was conducted in the databases of PubMed, Web of Science, Academic Jihad Center and Magiran using the keywords "HIIT" and "adiponectin" to identify Persian and English languages published articles until October 2022. Effect size (SMD) and 95% confidence interval were calculated using CMA2 software. I² test for calculation of the heterogeneity and visual interpretation of funnel plot test and Egger test for assessment of the publication bias were used.
Results: Data analysis of 28 interventions (24 studies) showed that HIIT resulted in a significant increase in adiponectin [0.40 CI: 0.12 to 0.68), P=0.004]. Also, the data analysis of eight interventions showed that HIIT led to a non-significant increase in adiponectin compared to the MICT [0.41 CI: -0.04 to 0.86), P=0.07].
Conclusions: The findings of the present study showed that HIIT is a suitable and efficient training method to increase adiponectin, especially in people with metabolic disorders.

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Background: Interval exercises with high intensity and consumption of plant extracts probably have beneficial effects on inflammatory indicators. The aim of this study was to investigate the effect of eight weeks of High-Intensity Interval Training (HIIT) and the consumption of Loquat leaf extract on the serum levels of TNF-α and interleukin-18 in obese men with non-alcoholic fatty liver disease.
Methods: In this semi-experimental study, forty men with non-alcoholic fatty liver disease with body mass index (33.92 ± 1.82) with informed written consent were randomly selected and assigned into four groups: control, training, Extract, Extract + training (Each group of 10 people). Exercises were performed for eight weeks and three sessions per week for 60 minutes with intensity between 80-95% of the reserve heart rate. Two capsules of 250 mg of Loquat leaf extract were also prescribed daily. Paired t-test and analysis of covariance were used.
Results: A significant decrease in the levels of TNF-α (15.3%) and interleukin 18 (14.9%) was observed in the training + extract group (P<0.05). A significant difference was observed in the levels of TNF-α (P=0.001) and interlock 18 (P=0.001) between the groups, and these changes were more significant in the Extract + training group than in the training and extract groups.
Conclusions: It is concluded that performing intense intermittent training along with Loquat leaf extract will be able to improve TNF-α and interleukin 18 indices related to fatty liver in people with non-alcoholic fatty liver disease. However, confirmation of this hypothesis requires more research.

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Background: Despite the increased use of complementary medicine by diabetic patients, there is no clear estimation of complementary and herbal medicine use by these patients in Iran. This study was conducted to investigate the uses of herbal medicine among patients with type II diabetes in Yazd, Iran, in 2022.
Methods: A cross-sectional study was carried out on 633 patients with type II diabetes referred to the Diabetes Research Center in Yazd City from June to September 2022. A questionnaire-based theory of planned behavior developed and validated by the researcher was used for data collection. In addition to demographics and disease-related information, the instrument included questions about using herbal medicine used. Descriptive statistics, Chi-square, Fisher's exact, and linear regression tests were used to analyze the data.
Results: The most common herb used was cinnamon (34.7%). The majority of patients used herbs daily (56.9%). Using herbal medicine was significantly associated with Attitude (r= 0.48, p< 0.001) Subjective norm (r= 0.39, p< 0.001), perceived behavior control (r= 0.38, p< 0.001) and intention (r= 0.4, p< 0.001). Constructs of the theory of planned behavior 73% predicted intention to use herbal medicine. Subjective norm structure had the highest predictive power of intention to consume herbal medicine (ß= 0.49, p< 0.001).
Conclusion: Subjective norm is the most predictor of intention to use Herbal medicines in patients with diabetes. Therefore, it is very important to pay attention to the beliefs, customs, and culture of the surrounding community in the correct self-management of disease control and the use of effective drug control.

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Background: Diabetes can cause serious cardiovascular complications by disrupting the autophagy pathway. Therefore, this study aimed to investigate the effect of high-intensity interval training (HIIT) on the intracellular levels of autophagy proteins in the left ventricular tissue of rats with type 1 diabetes.
Methods: In this experimental study, 18 2-month-old male Sprague-Dawley rats with an average weight of 300±20 grams were selected. Twelve rats had type 1 diabetes after intraperitoneal injection of STZ (with a dose of 50 mg/kg of body weight) solution. Rats were randomly divided into two groups: diabetic training and diabetic control (each group, six heads). A healthy control group (six heads) was also considered. The training group underwent HIIT four days a week for six weeks. GraphPad Prism version 9.5 software and one-way ANOVA, and Tukey's post hoc tests were used to analyze the data. The significance level was considered P≤ 0.05.
Results: ULK1 and FIP200 levels showed a significant increase in the left ventricle after 6 weeks of HIIT training compared to the healthy control group and the diabetic control group (P= 0.0001).
Conclusion: Considering the increase in ULK1 and FIP200 proteins, it can be concluded that HIIT training can activate the autophagy pathway; Therefore, in prescribing this type of exercise for diabetic subjects, the intensity and duration of the exercise should be considered.

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Background: Transcription factor 7-like 2 (TCF7L2) is one of the strongest genetic risk factors associated with type 2 diabetes mellitus (T2DM). The purpose of this study was to investigate the effect of 10 weeks of high intensity interval training (HIIT) on hepatic TCF7L2 expression in T2DM rats.   
Methods: In this experimental study, fourteen males Wistar rats with T2DM induced by streptozotocin-nicotinamide injection were randomly divided into exercise (n=7) and control (n=7) groups. The exercise group performed the HIIT protocol on a treadmill for 10 weeks and 5 days per week. Hepatic TCF7L2 expression, blood glucose level, hemoglobin A1c (HbA1c), insulin and insulin resistance were measured 48 hours after the last training session. Data were analyzed by independent T test at P< 0.05.
Results: Hepatic TCF7L2 expression and serum insulin were significantly higher in the exercise group compared to the control group (P˂0.05). Blood glucose level, HbA1c and insulin resistance were significantly lower in the exercise group than in the control group (P˂0.05).      
Conclusion: Based on these findings, it seems that the improved glycemic control in response to HIIT is partially dependent on the inhibition of gluconeogenesis caused by increased hepatic TCF7L2 expression.  

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Background: gestational diabetes is one of the most common diseases during pregnancy, and health literacy of pregnant mothers plays an important role in the prevention and management of the disease. The study aimed to examine and compare the health literacy of pregnant women with gestational and non-diabetic diabetes visiting health centers in the city of Yazd in 1402.
Methods: This descriptive-analytical study was conducted on 206 diabetic and non-diabetic pregnant women; the cluster health center sampling method and pregnant mothers were randomized sampling method. The data was collected using a health literacy questionnaire and analyzed using Chi Square tests, independent t-Tests and variance analysis.
Results: The results of the study showed that the average health literacy score of non-diabetic pregnant mothers (74.26 ± 13.75) was significantly higher than the average health literacy score of diabetic mothers (47.527 ± 21.06) (P< 0.001) and the percentage of diabetic women with insufficient health literacy was reported as 69% and 3.9% of non-diabetic women, which indicates a significant difference in the level of health literacy between diabetic and non-diabetic pregnant mothers (P< 0.001). In addition, diabetic mothers showed an inverse relationship between health literacy and the number of pregnancies and their children, while this trend was not observed in non-diabetic mothers (P< 0.001).
Conclusion: The results of this study indicate that non-diabetic pregnant women have higher health literacy than those with gestational diabetes, highlighting the importance of enhancing health literacy in this group of mothers. Additionally, the strong relationship between health literacy and the mother's diabetes status underscores the need for targeted programs and training to improve health literacy among diabetic pregnant women. Therefore, enhancing health literacy can be crucial in better managing gestational diabetes and improving maternal health outcomes.

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Background: The purpose of this study was to investigate the effect of two types of interval and continuous training on apolipoprotein M, TNF-α and IL-6 of visceral fat in rats fed a high-fat diet.
Methods: Twenty-four male Wistar rats were randomly divided into four groups including standard diet (ND), high-fat diet (HFD), high-fat diet with moderate intensity continuous exercise (HFD+MICT), high-fat diet with high intensity interval training (HFD+HIIT). The HIIT and MICT groups performed their group specific training for 8 weeks, 5 sessions per week. The HIIT protocol consisted of 6 bouts of 4-minute exercise at 85-90% of the maximum speed, which had a 2-minute active rest, and the MICT protocol performed at 65-70% of the maximum speed. Protein levels of apolipoprotein M, TNF-α and IL-6 in visceral fat were measured using western blot method.
Results: Eight weeks of HFD increased the protein levels of apolipoprotein M, TNF-α, and IL-6 in visceral fat compared to the ND group (P< 0.05). In contrast, both HIIT and MICT protocols led to a significant reduction of visceral fat IL-6 compared to the HFD group (P= 0.001). Also, MICT caused a significant decrease protein levels apolipoprotein M compared to the HFD group (P= 0.04). However, both exercise protocols had no significant effect on TNF-α (P< 0.05). Also, there was no significant difference between training groups (P< 0.05).
Conclusion: Exercise training improves adipose tissue inflammatory markers in high-fat diet-fed rats, and moderate-intensity continuous training may be a more appropriate approach.



 

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Background: Obesity is a multifactorial disease whose incidence and burden on societies around the world is increasing. Sexual performance in these patients is an important aspect that is often ignored. Therefore, the aim of the present study was to investigate the effect of a period of endurance training along with electrical stimulation on the gene expression of some sex markers in testicular tissue of fasted obese rats.
Methods: In this experimental study, with a control group of 40 male Wistar rats (8 weeks old, weighing 200±19 grams), after induction of obesity and weight gain, randomly divided into 5 groups of 8: control, fasting-obese, fasting-endurance exercise, fasting-electrical stimulation and Fasting-endurance training-electrical stimulation were divided. Intervention groups for a period of 4 weeks under endurance sports activity (with a speed of 10 to 20 m/min and duration of 20 to 40 minutes), electrical stimulation (foot shock device for 0.5 mA and 20 minutes) and fasting (8 to 16 hours) were placed. After exercise and anesthesia, tissue sampling was done and after molecular processes, gene expression was measured using Real time-PCR machine. For data analysis, two-way analysis of variance test was used at a significance level of P< 0.05 and GraphPad software.
Results: The results showed that endurance training led to a significant increase in the expression of 5αR and aromatase genes in fasting obese rats compared to the obese group (P= 0.0001). Also, electrical stimulation and its combination with endurance training led to a significant increase in the expression of 5αR gene (P= 0.0001), but this increase was not significant in Aromatase gene (P= 0.377).
Conclusion: It seems that endurance training and electrical stimulation during fasting by increasing the expression of 5-alpha reductase and aromatase genes in obese samples is effective in their sexual health and leads to its improvement. Also, a combination of electrical stimulation and exercise can have positive effects on this process, but more studies are needed.

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Background: This study aimed to investigate the relationship between stigma associated with type 2 diabetes and subjective well-being measures (life satisfaction and positive/negative affect) mediated by emotional stress and illness perception in people with type 2 diabetes.
Methods: The present research was descriptive based on correlation models. The statistical population included patients with type 2 diabetes who referred to the diabetes clinic of Ayatollah Taleghani hospital in Kermanshah, 207 adults were selected using the convenient sampling method and data were collected using questionnaires Type 2 Diabetes Stigma Assessment Scale (DSAS-2) (Browne et al., 2016), life satisfaction (Diener, 1985), Positive/Negative Affect Schedule (Watson et al., 1988), Illness Perception (Broadbent et al., 2006) then analyzed with SPSS and Amos software.
Results: The results showed that there was a significant relationship between stigma, life satisfaction, and positive/negative affect (P < 0.01). Stigma was also able to predict life satisfaction indirectly and negatively through emotional distress, and negative affect indirectly and positively through emotional distress and illness perception.
Conclusion: The results indicate the need for interventions to reduce the stigma associated with type 2 diabetes and improve the mental well-being of people with this disease.