Tehran University Medical Journal

Background: Acute myeloid leukemia (AML) is blood and bone marrow malignancy. Low-density oxidative lipoprotein (oxLDL) is a pro-inflammatory factor that has free radicals in its structure. OxLDL levels are also rising in diseases such as diabetes, cardiovascular disease, and some cancers. Studies have shown that oxLDL and dyslipidemia are more common in patients with various cancers. This study aimed to evaluate the level of blood lipids and oxLDL in these patients with acute myeloid leukemia.
Methods: In a descriptive study, 36 patients who were diagnosed with acute myeloid leukemia from April 2016 to March 2017 were enrolled. This study was done in Shahid Ghazi Blood Department of Imam Reza Hospital, Tabriz University of Medical Sciences, Iran. Basic information including age, sex, type of disease, cause for referrals of the patients were collected. After obtaining informed consent from patients and 12 hours of fasting, 5 cc blood samples were sent to the Central Laboratory of Shahid Ghazi Hospital to measure the level of blood lipids including cholesterol, triglyceride, low density lipoprotein, high density lipoprotein (HDL), and oxLDL levels. Blood lipid and oxLDL levels were measured by automatic analyzer (Abbott Laboratories, Abbott Park, IL, USA) (ELISA method).
Results: 23 patients (54.8%) were male and 19 (45.2%) were female. The mean age of the patients was 44.06±14.48 years. The lowest age was 25 and the highest was 80 years. In the study, the mean serum cholesterol level was 147.64±42.28 mg/dl, the blood triglyceride was 183.28±79.34 mg/dl, the LDL was 84.89±26.35, and the HDL 29±14.51, the mean oxLDL was 1482.5±6031.85 ng/ml.
Conclusion: The results of this study indicate that dyslipidemia in patients with acute myeloid leukemia has not been evident. Concerning oxLDL, an oxidative stress factor involved in acute myeloid leukemia requires further investigation and studies.

Background: Breast cancer is the most commonly diagnosed and the leading cause of cancer death among females worldwide. The rate of breast cancer incidence among Iranian women is 17% of all cancers, it has been ranked first in Iran. This study aimed to investigate the factors affecting axillary lymph node involvement in female patients with breast cancer.
Methods: A cross-sectional study was conducted on 167 patients with breast cancer diagnosed between March 2012 and March 2015 at Shahid Beheshti of Babol, Shahid Rajaei of Tonekabon and Imam Sajad of Ramsar hospitals. A researcher-made questionnaire was used to collect information on the patients and pathology report of tumor and lymph nodes was completed.
Results: The rate of axillary lymph node involvement was observed in 117 patients (70.1%). Mean age was 49.64±11.62 years in the patients with breast cancer. The highest frequency of lymph node involvement was observed in the 40-49 age group (24%). The average size of tumor was 3.39 cm and the majority of patients had a tumor 2-5 cm (T2) but the most involvement was related to T3 (>5cm). The most common type of cancer and grading were invasive ductal carcinoma (93.4%) and tumor grade 2 (52.1%), respectively. Most lymph node involvement was observed in invasive ductal carcinoma and 85.1% of patients had tumor degree 3. 22.2% of patients with vessels involvement had axillary lymph node involvement. 63% of patients’ tumors had receptors of estrogen and progesterone. A statistically significant association was observed between axillary lymph node involvement and tumor size (P=0.031), tumor type (P=0.007), tumor grade (P=0.011), estrogen receptor (P=0.008) and progesterone receptor (P=0.038).
Conclusion: There was a statistically significant association between axillary lymph node involvement and tumor size, type and grade, estrogen and progesterone receptor status, but there was no statistically significant association between axillary lymph node involvement and age and estrogen as well as progesterone receptor status.

Background: Micro-Ribonocellic Acids (miRNA) are non-coding nucleic acids that are evolutionally protected and have a length of 24-20 nucleotides. MiRNAs control the expression of genes after transcription by mRNA degradation or translation inhibition. By blocking the oncogenic miRNAs and creating the necessary and functional miRNAs (tumor suppressor), these small regulatory RNAs can have therapeutic applications in cancer. The high mortality from lung cancer highlights the fact that the majority of patients are diagnosed at an advanced stage of the disease. The use of serum biomarkers can help early detection. MiRNA is more stable than mRNA. MiRNA expression in tissue, plasma, sputum, and urine samples can be detected by fixed formulation. In addition, miRNAs are important modulators of gene expression, diagnostic markers, and prognosis. Therefore, in the present study, the expression of miR-137 in the serum of patients with lung cancer was investigated.
Methods: In this descriptive and analytical study, 100 serum samples were collected from patients referring to Masih Daneshvari Hospital in Tehran from August 2017 to May 2018. Also, individual and clinical information were collected by a questionnaire and real-time polymerase chain reaction (RT-PCR) was used for the qualitative evaluation of changes in expression of miR-137.
Results: Data showed that there was no significant difference between the expression of miR-137 in serum samples of the first and second stages of the disease. While in the serum of patients with lung cancer who metastasized in the third and fourth stages, miR-137 expression decreased by 3.2 (P=0.42) and 6.8 times (P=0.003), respectively. Based on the results, it can be inferred that the measurement of miR-137 expression in lung cancer patients with concomitant reduction can be a sign of the progression of the disease.
Conclusion: Based on the results of this study, there was a significant relationship between miR-137 expression and lung cancer.

Background: Prostate cancer has been reported as a worldwide important kind of cancer and the second most common cause of cancer-related mortality among men. Prostate-specific antigen (PSA) serum level is one of the most important markers of prostate cancer diagnosis. While PSA level helps predict the risk of prostate cancer development, researchers still looking for ways to increase the accuracy of prognostic models. To increase the specificity of PSA and decrease of unnecessary biopsies and morbidity, PSA-related parameters such as PSA doubling time (PSADT) have been used. In this study, the relationship between this factor and the severity of prostate cancer was evaluated.
Methods: In this retrospective study, the data of patients who were subjected to transrectal ultrasound-guided (TRUS) biopsy of the prostate and referred to Imam Khomeini Hospital, Tehran, between 2009 and 2017 were reviewed. We enrolled the men with at least two consecutive elevated PSA level within three months to calculate PSADT. Based on the pathology report, primary and secondary Gleason score (GS) were determined. Correspondingly, considering GS, the patients were divided into two groups with high-grade and low-grade tumor (GS<7 considered as low-grade and GS>7 considered as high-grade tumor).
Results: Totally, 1712 cases of TRUS biopsy of the prostate were studied. Among them, 547 (32.3%) had prostate cancer, of whom 73 cases were eligible based on inclusion criteria and were consented to enroll in the study. According to the data obtained, we found a significant difference in PSADT between the two groups of patients with high-grade and low-grade malignancy (mean±SD PSADT, 9.8±14.2 vs. 16.1±14.9 respectively, P=0.004). Considering the seven months as the cut-off point for PSADT in determining malignancy, there was a significant difference between the two groups according to Fisher's exact test (P=0.01).
Conclusion: In our study, PSADT cut-off of 7 months provided the greatest accuracy for differentiation between low-grade and high-grade malignancy, and PSADT has acceptable accuracy for the diagnosis of high-grade tumors.

Background: Gastric cancer (GC) is considered as one of the most common types of cancer worldwide with poor prognosis and generally limited treatment options. Recent studies have indicated that HER2, MDM2, MYC, MET, and TP53 play an important role in the development of gastric cancer. Therefore, the aim of this study was to evaluate the incidence of amplification/deletion of these genes in patients with gastric cancer.
Methods: In this descriptive study, a total of 37 gastric cancer tissue samples from GC patients including 23 males (62.2%) and 14 females (37.8%) referred to the Hematology-Oncology and Stem Cell Research Center of Shariati Hospital, Tehran, from March 2015 to February 2016 were evaluated. The patient's age at diagnosis ranged from 33 to 85 years (median: 65 years). The amplification pattern of HER2, MDM2, MYC and MET genes and TP53 deletion were investigated by fluorescence in situ hybridization (FISH) technique performed on 3 to 5 micron section obtained from formalin-fixed and paraffin-embedded cancer tissues.
Results: The tumors were preferably identified at the distal stomach (54.05%) in comparison to tumors arising from the gastric cardia. The tumor size varied between 2 and 5 cm (average, 3.5 cm). Seven of the cases (19%) had advanced tumors at the time of diagnosis. HER2, MDM2, MYC, MET and TP53 copy number alteration were successfully determined in all samples obtained from the GC patients. HER2, MDM2, and c-MYC genes were amplified in 2 (5.41%), 1 (2.7%) and 3 (8.11%) of 37 patient samples, however, MET gene amplification and TP53 deletion were not observed in the obtained GC tissue samples. Co-amplification of HER2, MDM2, and MYC genes, and co-amplification of HER2 and MYC genes were detected in one patient.
Conclusion: The results of this study indicate the low frequency of MDM2, HER2 and MYC genes in gastric cancer patient and their copy number alterations may provide diagnostic and prognostic marker for GC patients.

Background: The rate of recurrence and mortality in high-risk prostate cancer remains high. On the other hand, the use of chemotherapy in metastatic prostate cancer has improved overall survival of patients. The aim of this study was to evaluate the effect of neoadjuvant chemotherapy alone on increasing survival of patients with high risk localized prostate cancer
Methods: This is a systematic review study. Databases including Scopus, Medline, PubMed, Google Scholar, Cochrane, Embase were searched. The terms used include prostate cancer, adenocarcinoma, neoadjuvant, chemotherapy, chemotherapy alone, systemic therapy. Of the various types of articles, only oiginal research studies that specifically focused on neoadjuvant chemotherapy (not chemotherapy with target therapy, immunotherapy, or hormone therapy) were identified. Inclusion criteria included study type (original research studies) and sample type (high-risk localized prostate cancer patients) and outcome type (patient survival).
Results: A total of 17 original research studies were identified. All of these studies were phase one or phase two. Docetaxel was the most commonly used chemotherapy drug. Also, the most common regimen used was the use of docetaxel alone. The rate of decrease in prostate-specific antigen (PSA) (>50%) after neoadjuvant chemotherapy was reported in 24 to 58% of patients. PSA declines of less than 50% after neoadjuvant chemotherapy occurred in 40 to 100% of patients. No studies reported a complete pathologic response following neoadjuvant chemotherapy. However, the relative pathologic response and reduced tumor volume were seen in the majority of patients. All of these studies showed that neoadjuvant chemotherapy alone, in high-risk prostate cancer patients, was almost well tolerated and that the complications were mostly mild (grade 1 and 2). Grade 3 and 4 complications were negligible. A 2-year recurrence-free survival of up to 68.5% and a 5-year recurrence-free survival of up to 49% were reported. The overall 5-year survival also ranged from 35 to 48%.
Conclusion: The use of neoadjuvant chemotherapy alone has not clearly increased the survival of patients with high-risk localized prostate cancer, and there is controversy in studies.

Background: Melatonin is one of the drugs which are used in the treatment of sleep problems, including insomnia and sleep deprivation. The aim of the present study was to evaluate the melatonin effect on sleep quality in patients with cancer.
Methods: This quasi-experimental study was performed on cancer patients with trouble sleeping who were treated with melatonin (3 mg per day) for a month. Sleep quality according to the Pittsburgh sleep quality index (PSQI) questionnaire was evaluated before and after taking melatonin. This study was conducted in the Oncology Clinic of Imam Reza Hospital, Kermanshah City in Iran from August 2016 to February 2018.
Results: There was a significant difference between the sleep quality of patients with cancer before and after taking melatonin (P<0.05). In other words, before taking melatonin, sleep quality of none of the patients was not optimal but after taking melatonin, the sleep quality of 52% of patients was satisfactory. Also, there was a significant difference between the components of subjective sleep quality (P<0.001), sleep latency (P<0.001), sleep duration (P<0.001), sleep efficiency rate (P<0.001), sleep disturbances (P=0.001), and daytime dysfunction (P<0.001) of patients with cancer before and after taking melatonin. There was no significant difference between the components of subjective sleep quality, sleep latency, sleep duration, sleep efficiency rate, sleep disturbances, and daytime dysfunction of cancer patients with age, sex, kind of cancer, and kind of metastasis before and after taking melatonin (P˃0.05).
Conclusion: According to the mentioned findings, it seems that the administration of melatonin to enhance sleep quality in patients with cancer is effective.

Background: Colorectal cancer is the second most common cancer in the world which is mainly caused by epigenetic and environmental factors. Among these epigenetic factors, gut microbiota is an important one. Although it has not been proved a unique group of bacteria correlated with colorectal cancer, these findings have generally demonstrated differences between healthy and disease gut microbiome in population. Actually, the identification and investigation of intestinal microbiota in early detection of colorectal cancer have been highlighted in new researches and studies. Herein, in the current study, we aimed to evaluate the number of selected gut bacteria including Lactobacillus and Escherichia coli and Prevotella in the fecal specimens of adenomatous polyposis patients, colorectal cancerous cases in compared to normal participants in terms of estimating important role of gut microbiota during colorectal cancer initiation and progression.
Methods: The current research was a case-control study. Fecal samples were provided from 31 healthy individuals, 42 adenomatous polyposis patients and 20 colorectal cancer cases that were referred to Taleghani Hospital, Tehran, Iran, from August 2016 to August 2017 for colorectal cancer screening tests. Fecal samples were collected to analyze intestinal bacteria including, Lactobacillus, Escherichia coli, and Prevotella by absolute quantitative real-time polymerase chain reaction (PCR). The number of these gut bacteria was precisely determined by this method of real-time PCR.
Results: Higher number of Prevotella with 24.6 CT number (P<0.005) and E.coli with 20.4 CT number (P<0.015) were achieved in colorectal cancer cases and adenomatous polyposis patients in contrast to samples from normal individuals. On the contrary, the opposite range was observed for the quantification of Lactobacillus and greater numbers of bacteria (CT=28.6) were detected in normal, compared to the colorectal cancer cases and adenomatous polyposis (P<0.001).
Conclusion: The gut microbiota composition of individuals with colorectal cancer and adenomatous polyposis differs from that of healthy individuals, and the higher numbers of pathogenic microbiota versus beneficial microbiota present in those with colorectal cancer and adenomatous polyposis. In contrast, healthy individuals have higher numbers of beneficial gut microbiota than pathogenic microbes. These findings need more experimental analysis and investigation to better clarify.

Background: The most common types of non-melanoma skin cancer are basal cell carcinoma (BCC), and squamous cell carcinoma (SCC). AKIEC -Actinic keratoses (Solar keratoses) and intraepithelial carcinoma (Bowen’s disease)- are common non-invasive precursors of SCC, which may progress to invasive SCC, if left untreated. Due to the importance of early detection in cancer treatment, this study aimed to propose a computer-based model for identification non-melanoma malignancies.
Methods: In this analytic study, 327 AKIEC, 513 BCC, and 840 benign keratosis images from human against machine with 10000 training dermoscopy images (HAM10000) were extracted. From each of these three types, 90% of the images were designated as the training set and the remaining images were considered as the test set. A deep learning convolutional neural network (CNN) was developed for skin cancer detection by using AlexNet (Krizhevsky, et al., 2012) as a pretrained network. First, the model was trained on the training images to discriminate between benign and malignant lesions. In comparison with conventional methods, the main advantage of the proposed approach is that it does not need cumbersome and time-consuming procedures of lesion segmentation and feature extraction. This is because CNNs have the capability of learning useful features from the raw images. Once the system was trained, it was validated with test data to assess the performance. Study was carried out at Shahid Beheshti University of Medical Sciences, Tehran, Iran, in January and February, 2020.

Background: Ovarian cancer is the fifth leading cancer-related cause of death in women worldwide and is often diagnosed at advanced stages. Regarding the low sensitivity and specificity of the currently available diagnostic techniques, in the present study, we aimed to evaluate the accuracy of RMI and ROMA indexes and comparing these two indexes with CA-125 and HE4 parameters for the diagnosis and differentiation between benign and malignant ovarian tumors. Also, we determined the optimal cut-off level of these markers in patients who attended Arash Women’s Hospital.
Methods: In this cross-sectional study, we included 137 women with ovarian mass who were attended the gynecology clinic of Arash Women's Hospital, Tehran, Iran (April 2017-April 2019), and were eligible according to the inclusion criteria. We included patients with an adnexal mass over 3 cm. Our exclusion criteria were as the following: pregnancy, age under 18 and over 90 years, taking hormonal agents, renal failure, suspected ovarian torsion, ovarian cancer and taking antibiotics, nitric oxide compounds, and heavy metals. Based on serum CA125, HE4, and ultrasound findings, ROMA and RMI indexes were determined for each patient, and the sensitivity and specificity of HE4, RMI, ROMA, and CA125 were compared with the result of the operative histopathologic assessment.

Conclusion: Measurement of HE4 before menopause and CA125 during menopause seems to be helpful in the early detection of ovarian cancers in women with ovarian masses.

Background: Neck mass is one of the most common clinical findings in all age groups. Differential diagnosis of masses includes a range of pathologies from congenital to infectious or neoplasm. Understanding the risk factors of neck masses can help us to assess them properly. The purpose of this study is to obtain the epidemiological and clinical features of different neck masses in Kerman, Iran.
Methods: This research was a descriptive, retrospective and cross-sectional study. 120 Patients that have been biopsied from neck masses during March 2014 to March 2018  in the otorhinolaryngology department of Shafa hospital of Kerman (referral center of otorhinolaryngology disease of southeastern Iran), were the participants of the study. Data regarding age, sex, history of addiction, smoking and definite pathologic diagnosis were collected and analyzed with SPSS 20^th version.
Results: Of 120 cases, 57.5 % were male and 42.5% were female. In the malignant masses group, the male to female ratio was 4.1 to 1. The average age of patients was 39.44 years old. From them, 20.83 percent had a history of smoking but 79.17 percent had never experienced smoking. In addition, 77.5% of the patients have not experienced opium consumption and 22.5% were addicted to opium regularly. There was a significant relationship between smoking and opium consumption and the incidence of malignant cervical masses (P<0.05). In the pathological study, inflammatory and infectious masses with 48.33 percent were in the head of pathology; malignant neoplasm with 25 percent, benign neoplasms with a prevalence of 12.5 percent and congenital masses with a prevalence of 9.7 percent were in the next ranks.

Background: Skin cancer is the most prevalent type of cancer and melanoma is the deadliest kind of skin cancer in the world. Due to enhanced induction of apoptosis and ROS levels, low-level lasers can be utilized to destroy skin cancer cells. Lasers are used to treat some skin lesions. Vitamin A is beneficial in the prevention and treatment of skin cancer. Vitamin A inhibits the pathway of cancer signals in the skin and suppresses tumor growth. In this study, the combined effect of low-level laser radiation (LLL) and vitamin A on cellular factors of skin melanoma cancer cells was investigated.
Methods: An in-vitro interventional laboratory study was performed in the cell culture laboratory of Medical Laser Research Center, Yara Institute in 2020-2021 (July 2020 to July 2021). First, A375 skin cancer cells were cultured in DMEM with 10% FBS. After preparation and culture of A375 cell lines, different concentrations of vitamin A (1, 5, 50, 100 μM) and LLL energy doses (1, 2, 5, 10 J/cm²) as treatments were done. Combination research of these treatments was performed to eliminate skin melanoma cancer cells. The rate of viability was determined using the MTT test, and the rate of apoptosis was determined using flow cytometry.