Advanced Biomedical Research
Year:2025 | Volume:14 | Issue:September|Papers Count:36

Background: It has been shown that shear-wave elastography (SWE) can help the radiologist with the early and efficient classification of breast masses. This study aimed to investigate the role of clinical variables and SWE image features in the classification of breast masses using several common Convolutional Neural Networks (CNNs). Materials and Methods: 834 SWE images were collected prospectively, and of these, 534 images were used to train popular CNNs, including ResNet101, VGG16, Exception, InceptionV3, and DenseNet169. Region of interest (ROI) on SWE images was obtained from a 2D mask manually cropped on B-mode images. Classification of images with and without ROI selection was performed once using image features and once using clinical variables along with image features, and the models’ performance was evaluated. Results: The best performance was related to the DensNet169 and ResNet152 in the classification using both clinical variables and SWE image features such that the accuracy, AUCTest, and AUCValidation of DensNet169 were 94. 01%, 0. 86, and 0. 97, respectively, and for ResNet152 were 91. 62%, 0. 83 and 0. 98. No significant difference was observed in the performance of CNNs for classifying images with and without ROI selection. However, the AUCs of DensNet169, VGG16, and InceptionV3 for images with ROI selection were significantly improved using both clinical variables and image features (P ≤ 0. 05). Conclusion: We conclude that using clinical variables significantly improved the performance of most CNNs in classifying masses on images with ROI selection.

Background: Ventilator-associated pneumonia (VAP) is a major cause of infection in patients, and reducing oral cavity contamination can lower mortality rates due to VAP. This study evaluates the effects of the combined administration of three medications, colistin, chlorhexidine, and tobramycin, on the prevention of VAP. Materials and Methods: This double-blind randomized clinical trial was conducted on 96 patients connected to ventilators and admitted to the intensive care unit of Al-Zahra Hospital in Isfahan. The patients were randomly divided into three groups of 32. Over five days, they received “Colistin + Chlorhexidine, ” “Tobramycin + Chlorhexidine, ” and “Chlorhexidine-alone” four times daily. The Clinical Pulmonary Infection Score (CPIS), patients’ oral hygiene using the Beck Oral Assessment Scale (BOAS), and positive or negative results of oral and tracheal cultures were evaluated before and after the intervention. Results: The results of the present study showed that the CPIS score in the chlorhexidine + colistin group, with the mean of 7. 23 ± 1. 87, was significantly lower than the chlorhexidine + tobramycin group and the chlorhexidine-alone group, with the means of 12. 32 ± 2. 67 and 14. 05 ± 1. 10, respectively (P =. 038). Additionally, the BOAS score in the chlorhexidine + colistin group, with the mean of 3. 04 ± 1. 02, was significantly lower than the chlorhexidine + tobramycin group and the chlorhexidine-alone group, with the means of 6. 25 ± 2. 00 and 7. 06 ± 2. 35, respectively (P =. 042). Conclusion: Preventive and hygienic oral care is an effective factor in reducing VAP. There was no significant difference among the three treatment combinations in reducing the incidence of VAP. However, it appears that adding colistin may have a slightly better performance in preventing lung infections and inhibiting bacterial agents.

Background: Low back pain (LBP) is a prevalent health concern with various causes, including lumbar disc herniation (LDH) and vertebral endplate Modic changes (MCs). This study aimed to investigate the frequency and attributes of MCs in individuals diagnosed with LDH through magnetic resonance imaging (MRI). Matеrials and Methods: This cross-sectional study analyzed MRI scans of 254 patients diagnosed with LDH at a referral hospital between 2021 and 2022. We assessed the presence, type, and location of MCs and the types of disc herniation. Statistical analyses examined the associations among MCs, LDH, age, and gender. Results: Among the participants (118 males and 136 females) with a mean age of 44. 71 ± 13. 14 years, MCs were identified in 31 individuals (12. 2%), with Type II MCs being the most common (71. 0%). The highest incidence of MCs was observed at the L5–S1 segment (41. 9%). Age was significantly associated with herniated discs at L1–L2 (P = 0. 041), L2–L3 (P = 0. 002), and L3–L4 (P < 0. 001), while gender was associated with L2–L3 level herniation (P = 0. 012). The findings demonstrated a notable correlation between LDH and MC development, particularly Type II, with a significant prevalence at the L2–L3 level. Conclusions: These findings underscore the importance of considering specific LDH levels and associated MCs in patient care and treatment strategies. Our study paves the way for future research, advocating for longitudinal studies to explore these relationships and their implications further, explore these relationships in more depth, and develop effective interventions for patients with LBP.

Background: Prompt and precise bilirubin assessment is critical for the appropriate intervention in neonatal jaundice management. Various healthcare settings have adopted transcutaneous bilirubin (TcB) devices for this purpose. This study aimed to analyze the relationship between TcB readings obtained from five distinct body regions and total serum bilirubin (TSB) levels. Materials and Methods: The research encompassed 202 neonates exhibiting clinical signs of jaundice, admitted to the neonatal intensive care unit (NICU) and general wards of Beheshti Hospital in Isfahan. The cohort included neonates of both genders with a gestational age of 30 weeks or more. Measurements of TcB were performed using the MBJ20 jaundice detector probe on the forehead, sternum, auricle, wrist, and interscapular region, and these were then compared with the TSB levels. Results: The study included a balanced sample of 202 newborns, with an equal distribution between males and females. The mean gestational age was 34. 19 ± 2. 63 weeks,the average birth weight was 2083 ± 692. 18 grams, and the TSB level was 9. 95 ± 2. 68 mg/dl. The findings revealed a robust, direct, and meaningful correlation between the TcB and TSB levels across all the sites examined. Notably, the correlation was statistically more pronounced at the sternum and forehead. Conclusion: The study confirms that noninvasive TcB assessment at two specific sites—the sternum and forehead—using the MBJ20 bilirubinometer, provides significant congruence with the TSB levels determined by clinical laboratory techniques in both term and preterm neonates. Measurements at the sternum are marginally more precise than those at the forehead.

Background: A severe pro-inflammatory feedback is the main reason for novel coronavirus (COVID-19)-related complications. Here we intended to investigate the potential involvement of toll-like receptors (TLRs)3, TLR7, TLR8, and TLR9 in the etiopathogenesis of COVID-19. Materials and Methods: mRNA expression of TLR3, TLR7, TLR8, and TLR9 were evaluated in blood samples from 30 COVID-19-infected patients and 30 healthy controls by means of real-time polymerase chain reaction (PCR) approach. Results: The mRNA expressions of TLR3 (P = 0. 038) and TLR9 (P = 0. 009) significantly increased in patients with COVID-19 compared with healthy controls. Additionally, the mRNA expression of TLR3 was significantly higher in the male than in female COVID-19 patients (P = 0. 020). Experiments indicated that the mRNA expression of TLRs was not significantly different between symptomatic and non-symptomatic COVID-19 subjects. Furthermore, no correlation was detected between mRNA expression of TLRs and patient’s clinicopathological data. Conclusion: It seems that TLR3 and TLR9 are involved during COVID-19 infection and might take part in the inflammatory outcome of the patients.

Background: Cataracts are a leading cause of visual impairment worldwide, necessitating effective non-surgical preventative strategies. This study is the first to evaluate the morphological and histopathological effects of Zataria multiflora Boiss essential oil (ZE) on selenite-induced cataracts in rats. Materials and Methods: Seventy-two male Sprague–Dawley rat pups were randomly assigned to six groups: control (C), vehicle control (VC), ZE control (ZC), selenite (S), selenite plus vehicle (SV), and selenite plus ZE (SE). Cataracts were induced by a single subcutaneous injection of sodium selenite (30 μmol/kg) on postnatal day 8. ZE (500 μL/kg, diluted 1: 1 with olive oil) was administered orally twice weekly for 5 weeks. Cataract severity was graded weekly by using Hiraoka’s scale (0–6) by a blinded ophthalmologist. Histopathological changes were qualitatively assessed via hematoxylin and eosin staining. Statistical analysis employed the Kruskal–Wallis test with Dunn’s post-hoc test. Results: No cataracts developed in the control groups (mean grade: 0). The S and SV groups developed severe cataracts (mean grade: 5. 14 ± 0. 64). ZE treatment significantly reduced cataract severity in the SE group (mean grade: 2. 07 ± 0. 59,P < 0. 05 vs. S and SV). Histopathology showed that ZE preserved lens architecture and markedly reduced degenerative changes compared with S and SV. Conclusion: This study provides the first morphological and histological evidence that ZE can prevent or delay cataract formation by preserving lens structure and function in a selenite-induced rat model. ZE demonstrates promising potential as a natural therapeutic agent for cataract prevention.

Background: Earlier studies have been conducted on the associations of individual antioxidants with risk of obesity in different groups of patients,however, no study has been conducted on the association of dietary total antioxidants capacity (TAC) with risk of obesity in military staffs. Materials and Methods: This cross-sectional study was conducted on a population of military staffs in Isfahan, Iran. Complete data were available for 170 men military staffs. A self-administered questionnaire collecting data on demographic traits was given to participants. A validated Willett-format dish-based 168-item semi-quantitative food frequency questionnaire was used to measure dietary intake. Results: Overall, 40. 4% of participants had overweight and 10. 2% had obesity. Participants with the highest dietary total antioxidant capacity (TAC) had 25% higher risk of overweight than those in the lowest category, but the association was nonsignificant (odds ratio, OR: 1. 25, 95% confidence interval, CI: 0. 58, 2. 66, Ptrend = 0. 56). After adjustment for the possible confounders, the association remained nonsignificant (OR: 0. 59, 95% CI: 0. 16, 2. 07, Ptrend = 0. 41). In addition, no significant relationship was seen between dietary TAC and risk of obesity in the crude model (OR: 0. 68, 95% CI: 0. 20, 2. 30, Ptrend = 0. 53) and after adjustments (OR: 0. 89, 95% CI: 0. 08, 8. 91, Ptrend = 0. 82). Conclusion: We found no significant association between dietary TAC and risk of overweight, obesity, and abdominal obesity in Iranian army staffs. The risk of overweight, obesity, and abdominal obesity in Iranian army staffs was not significantly associated with dietary TAC. Further studies using different anthropometric measures are required to shed light on this issue.

Background: The irrational use of antibiotics has become a significant factor in the escalating global crisis of antimicrobial resistance (AMR). AMR is linked to an increasing burden of healthcare-associated infections caused by multidrug-resistant pathogens, which present substantial challenges for infection control and patient management. During the COVID-19 pandemic, the widespread use of antibiotics for treating and preventing secondary bacterial infections further exacerbated the threat of AMR worldwide. This study aimed to determine the antibiotic resistance profile of Gram-negative bacteria (GNB) causing pneumonia after COVID-19 in Northern Iran. Materials and Methods: In this cross-sectional study, respiratory specimens were collected from hospitalized patients with bacterial pneumonia at four hospitals in Northern Iran. The antimicrobial susceptibility profiles were assessed using the standard microdilution method in accordance with CLSI guidelines (2020). Additionally, resistance-associated genetic determinants were evaluated using multiplex PCR. Results: A total of 120 MDR GNB isolates were identified, primarily from sputum specimens (75. 8%). Pseudomonas aeruginosa was the most common pathogen in the ICU, representing 35% of isolates. Resistance rates to antibiotics were high: Ciprofloxacin (85%), Ceftazidime (85%), Gentamicin (80%), and Colistin (77. 5%), while Piperacillin-Tazobactam had a lower resistance rate of 33. 3%. Conclusions: The present study highlights the increasing AMR among GNB causing pneumonia in ICU settings post COVID-19 pandemic in hospitals in Northern Iran. The prevalence of Pseudomonas aeruginosa and high resistance rates to new antibiotics such as Colistin pose significant challenges to treatment, while Piperacillin-Tazobactam shows relatively lower resistance and may be a potential option.

Background: The aim of the present systematic review and meta-analysis was to investigate the effect of Carica papaya on periodontal disease in the adult population. Materials and Methods: A systematic search was performed using the PubMed, Web of Science, Embase, and Cochrane library databases up to June 2021 using related keywords for randomized clinical trials that evaluated the effect of Carica papaya on gingival index (GI), plaque index (PI), and papilla bleeding index (PBI) in the intervention group compared to control group. Results: A total of five eligible studies involving 206 participants were included in the systematic review and meta-analysis. GI score significantly decreased in the intervention group at the end of the treatment compared to the baseline (ES = −0. 64,95% CI = −0. 85–−0. 42,I2 = 90. 4%,P < 0. 001). Furthermore, patients in the intervention group had significantly lower GI (weighted mean difference = −0. 28,95% CI = −0. 45–−0. 10,I2 = 98. 2%,P < 0. 001) and PI (weighted mean difference = −0. 36,95% CI = −0. 59–−0. 14,I2 = 99. 3,P < 0. 001) scores compared with control individuals. However, no significant difference observed between the two groups regarding PBI score. Conclusion: Despite study limitations, this systematic review and meta-analysis highlighted the effective role of oral care products containing Carica papaya for the treatment of periodontal diseases by improving indices like GI and PI.

Background: Inflammatory bowel disease (IBD) is a serious public health problem worldwide. The existing therapy options for IBD are limited and can cause severe difficulties, and thus require more research on alternative therapeutic techniques. Pramipexole is a dopamine receptor agonist with anti-inflammatory effects that was recently discovered. Given the importance of dopaminergic pathways in ulcerative colitis inflammation, we tested pramipexole’s efficacy in a rat colitis model in this study. Materials and Methods: Colitis was induced by administering 3% acetic acid intrarectally. Rats were randomly assigned to one of six groups: normal, colitis control, dexamethasone (1 mg/kg,i. p. ), and pramipexole (0. 25, 0. 5, and 1 mg/kg,i. p. ). In intestinal samples, macroscopic and microscopic lesion ratings, pro-inflammatory cytokine levels (tumor necrosis factor alpha, interleukin-6, and interleukin-1 beta), and myeloperoxidase (MPO) activity were evaluated. Results: Compared to the colitis control group, pramipexole (0. 5 and 1 mg/kg) substantially reduced macroscopic and microscopic intestinal damage, pro-inflammatory cytokine levels, and MPO activity. Furthermore, the indices mentioned above were considerably lower in the dexamethasone treatment group compared to the colitis control group. Conclusions: Our findings indicate that pramipexole has favorable benefits in treating experimental colitis,however, further research is required to determine its clinical value as an IBD therapeutic agent.

Background: Various risk factors thought to impact cervical cancer progression. One way these factors influence cancer development is through changes in the microRNA’s expression, which are small, non-coding, single-stranded RNA molecules around 20–23 nucleotides long. In cervical cancer, specific miRNAs, notably miRNA-9 and miRNA-192, are gaining attention as potential clinical biomarkers. Materials and Methods: RNA was extracted from cervical intraepithelial neoplasia grade I, II, and III (CIN I, CIN II, and CIN III) tissues, as well as their adjacent normal tissues, to compare the expression levels of miRNA-9 and miRNA-192 as potential biomarkers. The extracted RNAs were then converted to cDNA for evaluation using quantitative PCR (qPCR). Results: Pathological analysis revealed that 80% of patients with cervical cancer and CIN III tissues were diagnosed with squamous cell carcinoma, while the proportions for adenocarcinoma and adenosquamous cell carcinoma were 13. 4% and 6. 6%, respectively. Our data indicated a significant increase in the expression of miRNA-192-5p (P < 0. 05) in 15 cervical cancer and CIN III tissues compared to CIN I and CIN II. Similarly, miRNA-9 expression was also elevated in cervical cancer and CIN III tissues relative to CIN I and CIN II. Conclusions: miRNA-9 and miRNA-192 may serve as promising biomarkers for cervical cancer, given their elevated expression levels in the both cervical cancer and CIN III tissues. This expression pattern implies that they could aid in detecting early stages of cervical cancer progression, potentially improving early diagnosis and monitoring. However, further studies are essential to confirm these preliminary findings and validate their clinical relevance.

Zoonotic cutaneous leishmaniasis (ZCL) remains a significant public health challenge in Iran, which reported an incidence rate of 15.8 cases per 100,000 individuals in 2019. Among the countries of the Eastern Mediterranean region, Iran bears a disproportionate burden of this neglected tropical disease, with 18 out of its 31 provinces affected. ZCL is especially prevalent in rural and semiurban areas, where ecological and environmental factors create suitable conditions for disease transmission. Rodent reservoirs, particularly Meriones species, and specific vectors, such as Phlebotomus sandflies, play critical roles in the epidemiology of ZCL in Iran. Recent studies have highlighted dynamic changes in the distribution of ZCL in Iran, with newly identified hotspots in regions such as Beyza district (Fars province), Isfahan, and Razavi Khorasan. These shifts are attributed to climate change, urbanization, and altered land use patterns, which influence vector habitats and reservoir dynamics. Notably, the COVID-19 pandemic has exacerbated the spread of ZCL, redirecting health priorities and increasing the vulnerability of already high-risk areas. The interplay between these ecological factors underscores the importance of understanding localized transmission patterns. Despite the growing prevalence of ZCL, research remains limited in its focus on epidemiological aspects specific to Iran. This review aims to address this gap by examining the geographic distribution, reservoirs, vectors, and ecological drivers of ZCL within Iran. By identifying high-risk provinces and emerging trends, such as those in Fars, Isfahan, and Razavi Khorasan, this study provides a foundation for designing targeted control strategies. Effective interventions, informed by these findings, are crucial in mitigating the future burden of ZCL, particularly as vector habitats are expected to expand due to climatic changes.

Background: Leishmaniasis is a major public health concern, with a high annual incidence and extensive geographical distribution. This parasitic disease is transmitted through the bite of specific species of sand flies and is caused by flagellated protozoa. Leishmania major is one of the main causes of cutaneous leishmaniasis (CL) in Iran, with diverse clinical manifestations. This research seeks to explore the impact of genetic diversity on clinical differences by investigating variations in chromosomal count and analyzing single nucleotide polymorphisms (SNPs) and insertions/deletions (Indels). Materials and Methods: The whole genome of the Iranian Leishmania major strain MRHO/IR/75/ER has been sequenced using next-generation sequencing. Data alignment to the reference genome, variant calling, and SNP, Indel, and chromosomal variation identification were carried out using bioinformatics tools. Results: The findings indicated notable karyotypic variations in the Iranian Leishmania major strain, specifically demonstrating monosomy on chromosome 2 and trisomy on chromosomes 5, 13, 28, and 31. The analysis of SNPs and INDELs revealed 144, 509 genetic variants, with 99% situated within coding regions. Significant changes were observed in MRPA, HSP70. 4, GP63, and CPA, which may affect drug resistance and pathogenicity. Conclusion: This research clarifies the genetic diversity of L. major and its consequences for disease development and resistance to treatment. Further functional studies are essential to validate these genetic discoveries and their implications for clinical practice.

Background: There have been numerous reports of impairment in neurocognitive functions, including visual processing speed (VPS), among patients who have developed brain metastasis. Therefore, this study aims to develop a model that calculates the probability of normal tissue complication arising from VPS impairment after whole-brain radiotherapy. Materials and Methods: In this study, 18 patients were examined for VPS impairment at the 4-month follow-up. After the hippocampus delineation, dose-volume histograms (DVHs) were generated. Normal tissue complication probability (NTCP) models were calculated for VPS using the Lyman model and multivariable logistic regression analysis. Results: VPS was observed in 33. 3% of patients. TD50 was obtained at 38. 43 Gy. The most predictive variable in univariate analysis was VTot, but none of the dosimetric and clinical variables were selected as predictive variables in the multivariate regression analysis (P > 0. 05). The overall predictive performance of both models was satisfactory,however, multivariate logistic regression was superior. Conclusion: This study modeled the probability of VPS following irradiation of the hippocampus. The NTCP curve showed that by keeping a maximum dose of hippocampi less than 20 Gy, NTCP becomes <25%.

Background: Cryptosporidium spp. is a parasite that causes diarrheal disease in humans and animals, known as cryptosporidiosis. It is commonly transmitted through contaminated water, food, and surfaces contaminated with feces from infected humans or animals. Cryptosporidiosis is a severe public health and environmental challenge, so most studies focus on vulnerable groups, including immunocompromised individuals, children, livestock, and water. Materials and Methods: In this study, 217 patients admitted to the hospital who experienced symptoms such as acute or chronic diarrhea within 48-72 hours of admission were examined by the modified Ziehl Neelsen (MZN) stain for microscopically, and the amplification of 18S rRNA gene for the nested polymerase chain reaction (PCR) survey. Results: Cryptosporidium spp. prevalence was estimated to be 0. 00% (0/217) by microscopy,however, PCR results indicate that 0. 92% (2/217) were positive fecal samples. Conclusions: The distribution of nosocomial diarrhea specifically caused by Cryptosporidium is uncommon. It is imperative to note that healthcare settings, including hospitals, can be potential sources of transmission of various infectious diseases, including cryptosporidiosis. Understanding the impact of nosocomial diarrhea caused by various pathogens in developing countries is necessary for hygiene management.

Background: This study aimed to evaluate the effects of different doses of dexmedetomidine and propofol on sedation, hemodynamic changes, and postoperative complications in patients undergoing ovarian puncture surgery. Materials and Methods: This randomized controlled trial was conducted on 96 women candidates for ovarian puncture surgery. In the first group (DEX-0. 5), a bolus dose of dexmedetomidine 0. 5 µg/kg was administered for the induction of anesthesia, followed by a maintenance dose of dexmedetomidine 0. 5 µg/kg/min. In the second group (DEX-1), a bolus dose of dexmedetomidine 1 µg/kg was administered for induction, followed by a maintenance dose of dexmedetomidine 1 µg/kg/min. In the third group (control group), propofol 50 µg/kg/min was administered for induction of anesthesia. Results: SBP, DBP, and MAP were significantly lower in the control group compared to the other groups (P value < 0. 05). The mean scores of patient and surgical satisfaction levels in the DEX-0. 5 group were significantly higher than the control group (4. 00 ± 1. 02 and 4. 41 ± 0. 57, respectively) and in the DEX-1 group (6. 00 ± 1. 35 and 4. 61 ± 0. 56, respectively) compared to the control group (2. 90 ± 2. 10 and 3. 10 ± 0. 32, respectively) (P value < 0. 05). Need for additional analgesics was significantly higher in the control group compared to the intervention groups (P value < 0. 05). Conclusion: It seems that the administration of dexmedetomidine 1 µg/kg, due to better pain relief, higher satisfaction, less need for additional analgesics, and minimal occurrence of complications, can be recommended as a safe and effective dose in ovarian puncture surgery.

Background: Candidiasis is one of the most common fungal infections caused by Candida species. Due to increasing reports of various side effects of current antifungals and the emergence of resistant isolates, other therapeutic tools seem necessary. Recently, researchers focused on herbal medicines with fewer side effects and lower costs. This study aimed to evaluate the antifungal susceptibility and toxicity profiles of dry extract of Crocus sativus petals in C. albicans isolates from patients with proven candidiasis. Materials and Methods: Fifty clinical isolates of C. albicans were gathered, cultured, and stored. After preparing and purifying the dry extract of C. sativus petals, the cytotoxicity test was performed by MTT assay in the L929 cell line. Antifungal susceptibility testing of dry extract of C. sativus petals and fluconazole was performed using the broth microdilution according to the CLSI-M27-S3 document. Data were analyzed using SPSS version 27 software. P < 0. 05 was considered as a significant statistical value. Results: The minimum inhibitory concentrations 50 and geometric mean of fluconazole and dry extract of C. sativus petals for all isolates were (0. 25 µg/mL and 0. 19 µg/mL) and (4 µg/mL and 5. 32 µg/mL), respectively. These values were statistically different (P < 0. 05). The dry extract of C. sativus petals had lower antifungal activity against C. albicans than fluconazole. Conclusions: We found that the antifungal activity of the dry extract of C. sativus petals is lower than that of fluconazole,however, its safety can be considered a potential therapeutic option for treating different forms of candidiasis.

Background: High-throughput data generation is developing in the cancer area and offers a better opportunity of understanding molecular pathways involved in the progression of tumors. Meta-analysis of gene expression based on data integration makes it possible to determine changes in gene expression with more accuracy. This approach and downstream analysis were utilized for colorectal cancer to identify promising biomarkers and drug targets. Materials and Methods: First, a systematic search was performed in the Gene Expression Omnibus (GEO) database. Meta-analysis was used to obtain differentially expressed (DE) genes from the NetworkAnalyst database. Moreover, microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and transcription factors (TFs) enriched with DE genes were determined by the Enrichr database. The integrated DE genes-miRNAs-lncRNAs-TFs network was constructed and analyzed using Cytoscape software. Then, the downstream analyses of hub genes were performed. Results: The primary candidate genes, HNF4A, FLI1, MITF, E2F4, SPI1, FOXA2, VDR, and SMAD3, which are overlapped nodes with the highest degree, betweenness, and closeness centrality parameters in the top 30 nodes were selected. Also, the hsa-miR-26b-5p, hsa-miR-16-5p, hsa-miR-124-3p, and hsa-miR-92a-3p were introduced as key non-coding RNAs with the highest degree and betweenness centralities. For the determination of the clinical significance of hub genes, the mutation, differential expression, and survival analysis were assayed. Also, the drugs related to candidate hub genes were determined. The functional analysis revealed pathways significantly related to cancer progression. Conclusion: Employing systems biology approaches with holistic insight can identify essential genes and their regulation as possibilities for further experimental testing.

Background: This study was designed to investigate the various extracts of Allium giganteum in term of their cytotoxic effects on gastric and colon cancer cell lines and then fractionation of extract with the most desired effects on cancer cells in comparison to the normal cell line. Materials and Methods: The A. giganteum air-dried bulbs were extracted in four solvents including aqueous, butanol, chloroform: methanol (9: 1), and dichloromethan extracts. Evaluating the cytotoxicity of extracts were done by MTT assay against HT-29, KATO-III, and HUVEC cell lines. The extract with The most cytotoxicity on cancer cells and lower toxicity on normal cell line was subjected to the fractionation by MPLC using a RP-18 silica gel column and in the next stage and the cytotoxicity of resulted fractions were determined by MTT assay. Results: Chloroform: methanol extract was the safest extract on HUVEC cells with great cytotoxic effects against cancer cell lines (IC50 17. 3 and 23 µg/mL, for KATO-III and HT-29, respectively). The results of MTT assay for 7 fractions of the chloroform: methanol extract showed that 5th fraction (E) was the most cytotoxic fraction (IC50 9 and 11. 2 µg/mL for HT-29 and KATO-III, respectively). TLC and NMR analysis of the fractions suggested the presence of steroidal saponins as the main constituents. Conclusion: Significant cytotoxic effects of Allium giganteum was established against GI cancer cell lines especially fractions rich in steroidal saponins. So, these fractions are attractive candidate for the isolation and identification of effective ingredients.

Background: Increased miR-93 and decreased miR-34a expressions have been shown in prostate cancer (PC). Prostate-specific antigen (PSA) and androgen receptor (AR) exert a significant role in the onset and progression of PC. This research tried to investigate the effect of EGCG on the expression of miR-34 and 93 and the expression of PSA and AR in PC cell lines. Materials and Methods: The effect of 5, 20, and 40 µg/ml concentrations of EGCG on the expression of miR-34a and miR-93 on the LNCaP cell line was evaluated through RT-PCR. LNCaP cells were treated with a miR-34a mimic and a miR-93 inhibitor combined with 40 µg/ml of epigallocatechin-3-gallate (EGCG) and then assessed gene expressions using real-time analysis. Cell migration was investigated by scratch assay. Results: At concentrations of 5 and 20 µg/ml EGCG, the miR-34a and miR-93 expression levels exhibited a reduction compared to the control cohort. Conversely, at a concentration of 40 µg/ml EGCG, there was a notable elevation in the expression levels of miR-93 and miR-34a compared to the control group. Furthermore, a combination of high concentration of EGCG with a miR-34a mimic and miR-93 inhibitor led to a significant change in the expression of PSA and AR in contrast to the EGCG group. Conclusion: Given the potential cytotoxicity of high concentrations of EGCG toward cancer cells and the conceivable impact on nonmalignant cells, it is imperative to approach its consumption with greater care.

Background: This study aims to assess tetracycline chemical pleurodesis through tube thoracostomy in prevention of spontaneous pneumothorax in patients with normal computed tomography (CT) scans following their first episode of primary spontaneous pneumothorax (PSP). Materials and Methods: We conducted a prospective, double-blinded, census clinical trial involving 66 patients with spontaneous pneumothorax, referred to Isfahan University of Medical Sciences affiliated Hospitals. The patients were randomly divided into two groups. Tube thoracostomy was embedded for all patients. The first group was treated with tetracycline 2 g, 5 mL of lidocaine 2%, and 50 mL of normal saline injected through an embedded thoracostomy tube. The second group was performed with the same procedure without tetracycline injection. Thereafter, patients were followed up for 12 months. Results: This study was conducted on 32 (48. 5%) cases and 34 (51. 5%) controls. SPS recurrence occurred in 16 patients, with the following distributions: 14 males (P value = 0. 627), 14 controls (P value = 0. 001), and 12 smokers (P value = 0. 207). Tetracycline pleurodesis correlated with a significantly lower recurrence rate (odds ratio [OR] =12. 16,P value = 0. 014). Conclusion: Tetracycline chemical pleurodesis via thoracostomy tube in patients with first episode of PSP may significantly decrease the rate of recurrence. However, further large-scale clinical trials are needed to establish this effect.

Background: Low back pain (LBP) is a socioeconomic burden worldwide and a major contributor to healthcare costs. Mobilization and dry needling (DN) are well-known treatments for LBP, and both of them, as a part of treatment, can relieve LBP. Due to the importance of choosing interventions with greater effects on patients’ recovery, in this study we intend to compare DN and lumbar spine mobilization, as complementary therapies in combination with routine physiotherapy in the treatment of patients with chronic nonspecific LBP (CNLBP). Materials and Methods: The study is a two-arm randomized, double-blind, double-dummy, controlled trial comparing DN to lumbar spine mobilization in individuals (n = 56,18–45 years of age) with CNLBP. The experimental group will receive DN plus sham mobilization, and the control group will receive Maitland mobilization plus sham DN (eight treatment sessions in 4 weeks). The primary outcome is functional disability, and the secondary outcomes are pain, lumbar multifidus (LM) and quadratus lumborum (QL) function, lumbar range of motion (ROM), pain pressure threshold (PPT). Results: The results of this protocol study provide information on the comparison between the effects of two complementary therapies, DN and mobilization, in people with chronic nonspecific LBP. Conclusion: In this study, we intend to solve the methodological problems of the previous study in this field. The results of this study allow the therapist to choose an intervention that may have more therapeutic effects in combination with routine physiotherapy in the treatment of CNLBP. Trial Registration: 1) ClinicalTrials. gov (NCT05214456) and 2) IRCT. ir (IRCT20210706051802N1).

Background: Low Back Pain (LBP) is one of the most prevalent musculoskeletal disorders in the world. About 10–15% of LBP patients develop chronic symptoms. Proprioceptive deficiency is one of the possible mechanisms for LBP chronicity, and females are more susceptible than males. We can use an unstable sitting balance or Wobble Board Training (WBT) for proprioceptive training of low back. Lumbar postural control is separated from lower limb postural control in this position. So, we aimed to study the effect of proprioceptive exercises in a sitting position on LBP patients, as it wasn’t specified in this position until now. Materials and Methods: In this randomized clinical trial, 40 women with Chronic Non-Specific Low Back Pain (CNSLBP) and a mean age of 40. 37 ± 4. 79 were randomly allocated into the control or intervention group subsequently after checking the inclusion criteria. Participants in the control group were treated with Conventional Physical Therapy (CPT), and participants in the intervention group were treated with CPT + WBT in the sitting position. Pain and disability index were evaluated in both groups before treatment, immediately, and 4 weeks after treatment. Results: The results show that the pain and disability index improved after treatment in both groups, but the intervention is not significantly effective on either the pain (P = 0. 81) or the disability index (P = 0. 15). Conclusion: WBT in a sitting position is not significantly effective in treating women with CNSLBP.

Background: Candida species are opportunistic pathogens that can cause local or systemic invasive infections in patients hospitalized in intensive care units (ICUs). The present study aimed to rapidly and precisely identify Candida species, especially Candida auris, from patients hospitalized in high-risk units using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. Materials and Methods: In this study, 136 clinical samples were prospectively collected from different organs of patients hospitalized in high-risk units recruited from three tertiary care training hospitals in Isfahan. Direct microscopic analysis using potassium hydroxide 10% followed by culturing on Sabouraud dextrose agar and CHROMagar culture media was primarily used to screen Candida species. Molecular detection of clinical isolates was mainly done using the PCR-RFLP method. Then, all the isolates were subjected to confirmatory diagnosis again through amplification of the C. auris-specific PCR. Results: Candida albicans was the most prevalent isolate (48. 8%), followed by Candida glabrata (17. 6%), Candida tropicalis (16. 1%), Candida parapsilosis (6. 6%), Candida krusei (5. 8%), Candida famata (4. 4%), Candida kefyr (2. 9%), and Candida guilliermondii (1. 4%). Therefore, the prevalence of non-albicans Candida species was higher than C. albicans isolates. No C. auris isolates were identified among 136 patients. However, according to the positive control, C. auris had no restriction enzyme cleavage site for MspI, and its PCR and digestion products were the same size (401 bp). Conclusions: The simple and reliable PCR-RFLP assay used in the study has the potential to identify rare yeasts such as C. auris. It can reduce turnaround times and costs if applied in developing countries.

Tracheal stenosis may follow a period of tracheal intubation. Postintubation tracheal stenosis is caused by either cuff-induced ischemic damage, injury after formation of a tracheostomy, or a combination of the two. Management may require tracheal dilation via rigid bronchoscopy. This can either be performed under general anesthesia using neuromuscular blocking drugs or under deep sedation using regional blocks. We describe a case of tracheal stenosis in a patient who had sustained extensive burns 4 months previously. Because of resource limitations in our healthcare setting, we successfully dilated her tracheal stenosis under deep sedation and translaryngeal anesthesia, avoiding general anesthesia and neuromuscular blocking agents.

Background: This study aimed to investigate the prevalence of hepatitis B and C viruses in patients at the Shahid Motahari Clinic in Shiraz, Iran, from 2018 to 2022 using molecular diagnostic tests. Materials and Methods: This cross-sectional study was conducted on patients who underwent polymerase chain reaction (PCR) molecular tests for the diagnosis of hepatitis B and C at the Shahid Motahari Clinic in Shiraz. A total of 538 PCR tests for hepatitis B and 457 tests for hepatitis C were administered. Among them, 69 patients diagnosed with hepatitis B virus (HBV) and 60 patients with HCV were selected for examination, and their clinical data were collected. Results: The prevalence of HBV and hepatitis C virus (HCV) in the study population was 17. 28% and 20. 56%, respectively. Most infected patients were male, married, and of Fars ethnic background. The main risk factors for HBV were extramarital sex and a family history of hepatitis B or C, whereas the main risk factors for HCV included drug injection, blood transfusion, imprisonment, tattooing, and extramarital sex. The findings revealed that the two most common HCV subtypes were subtype 3b (72%) and subtype 1a (28%). Conclusion: The results showed that 17. 28% of participants had HBV and 20. 56% had HCV. The majority of those with HBV or HCV were male, Fars, and married. Patients with HBV had a high incidence of family members with hepatitis B/C, whereas those with HCV had a high incidence of transfusion, drug injection, tattooing, and imprisonment. The most common HCV subtypes were 3b and 1a.

Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition characterized by airflow limitation and systemic effects. Computed tomography (CT) imaging offers valuable insights into structural changes beyond spirometry, particularly for assessing emphysema severity. This study examines the relationship between CT-derived measures of pectoralis muscle area (PMA), subcutaneous fat volume (SFV), and vascular dimensions with emphysema progression in COPD patients. Materials and Methods: This cross-sectional study included 220 male COPD patients aged 40–75 who underwent CT scans. The associations between SFV, PMA, pulmonary artery diameter (PAD), ascending aortic diameter (AaD), and their ratio (PAD/AaD) with emphysema severity were analyzed. Emphysema was graded using the Fleischner Society classification system, and statistical analyses were performed to assess these associations. Results: Significant differences were observed in all imaging variables across emphysema severity groups (P < 0. 05). Patients with advanced emphysema exhibited higher PAD (29. 9 ± 3. 1 mm), AaD (36. 1 ± 2. 3 mm), and PAD/AaD ratio (0. 84 ± 0. 10). PMA showed a weak negative correlation with disease severity (ρ = −0. 16, P = 0. 028), while both PAD and AaD exhibited moderate positive correlations (ρ =0. 37, P < 0. 001). No significant correlation was found for SFV (ρ = −0. 05, P = 0. 46). Conclusions: Quantitative CT-derived metrics, particularly PAD, AaD, and PMA, are significantly associated with emphysema severity, providing valuable insights into COPD progression. These metrics can serve as potential biomarkers for assessing disease severity, supporting a more personalized approach to patient management.

Background: Bimalleolar ankle fractures, particularly those resulting from supination–external rotation (SER) mechanisms, are common injuries. This study evaluates the short-term clinical outcomes and quality of life following surgical treatment of these fractures. Matеrials and Methods: This prospective cohort study was conducted at two trauma centers in Isfahan, Iran. A total of 34 adults, with SER-type bimalleolar ankle fractures, underwent open reduction and internal fixation. Additionally, a matched control group comprising 34 healthy individuals was included in the study. Functional outcomes were evaluated using the Foot and Ankle Outcome Score (FAOS) and the Short Form-36 (SF-36) in the control group, as well as at three and six months post-surgery for the patient group. Results: The study included 24 males (70. 6%) and 10 females (29. 4%) in the case group, with a mean age of 32. 8 years (SD ± 9. 7) and a mean BMI of 26. 01 kg/m² (SD ± 1. 91). Significant improvements were observed in the patient group from three to six months post-surgery across multiple FAOS and SF-36 domains. FAOS pain scores increased from 67. 8 ± 7. 5 to 83. 9 ± 8. 3 (P < 0. 001), and activities of daily living improved from 75. 3 ± 8. 0 to 88. 7 ± 8. 5 (P < 0. 001), approaching control levels. SF-36 physical functioning scores rose from 63. 5 ± 8. 2 to 81. 3 ± 7. 9 (P < 0. 001). However, domains, like symptoms, sports/recreation, social functioning, and role-emotional, remained lower than controls at six months (P > 0. 05). Conclusions: Surgical treatment of bimalleolar ankle fractures leads to significant short-term functional improvements, with a low complication rate. While promising, continued rehabilitation beyond six months may be necessary for complete functional restoration.

Background: Opioid addiction is a major public health problem that causes impairments in cognitive and oxidative processes. The present study has been designed to investigate the therapeutic potential of aerobic exercise, combined with herbal supplements (Rosa Canina L, Matricaria recutita, and Berberis), on oxidative stress and spatial learning during morphine withdrawal. Materials and Methods: This trial consisted of 45 male C57BL/6 mice, divided into nine groups, with the induction of morphine dependence. Herbal supplements were combined with aerobic exercises for a 4-week intervention. Spatial learning was analyzed using the Morris Water Maze test,oxidative stress biomarkers were measured as superoxide dismutase (SOD), malondialdehyde (MDA), and total oxidative status (TOS),and gene expression levels of proenkephalin (PENK), prodynorphin (PDYN), and nuclear factor erythroid 2-related factor 2 (NRF2) were evaluated using real-time polymerase chain reaction (PCR). Results: Morphine-dependent mice exhibited impaired spatial learning and elevated oxidative stress. Herbal supplements and aerobic exercise, separately, enhanced spatial learning and antioxidant capacity, but the most significant benefits were seen when combined in reducing escape latency and improving SOD and TOS levels. Gene expression analysis revealed that the combination treatment brought PENK, PDYN, and NRF2 levels closer to those of the control group, suggesting synergistic neuroprotective effects. Conclusions: The combination of herbal supplements and aerobic exercise is promising in reducing oxidative stress and improving cognitive recovery during morphine withdrawal. These findings point to a holistic approach in addressing opioid addiction and may inform future clinical applications in improving rehabilitation outcomes and quality of life among affected individuals. Further research is needed to optimize these interventions for broader application.

Background: Knee osteoarthritis (OA) significantly impairs mobility and quality of life in elderly patients. Total knee arthroplasty (TKA) is a well-established surgical intervention to alleviate severe pain and improve knee function. This study aimed to evaluate the effect of TKA on pain severity and knee joint function in patients aged 60–70 years. Materials and Methods: This quasi-experimental study included 40 patients who underwent TKA at a teaching hospital between August 2021 and February 2023. Pain severity and knee function were assessed using the Visual Analog Scale (VAS) and the Knee Society Score (KSS), respectively. Assessments were performed preoperatively and at 3 and 6 months postoperatively. Results: The study included 31 women and 9 men, with a mean age of 65. 20 ± 3. 46 years and an average BMI of 28. 7 ± 3. 4 kg/m². A significant reduction in pain was observed, with mean VAS scores decreasing from 8. 40 preoperatively to 3. 05 at 6 months postoperatively (P <. 001). Knee function improved markedly, with the KSS scores increasing from 36. 13 preoperatively to 75. 75 at 6 months (P <. 001). Both pain intensity and knee function showed significant improvements at each time point, with continued benefits observed over time. Conclusions: TKA significantly reduced pain and improved knee joint function in elderly patients. These findings support the effectiveness of TKA as a treatment for knee osteoarthritis, highlighting its potential to enhance the quality of life in the elderly population. Further research is recommended to explore the long-term outcomes and factors that influence patient satisfaction.

Background: Laparoscopic cholecystectomy is the standard surgical procedure in symptomatic gallstones. Laparoscopy is a minimally invasive surgical method. The aim of the present study was to investigate the effect of dexamethasone (DX) administration on postoperative pain management following laparoscopic cholecystectomy. Materials and Methods: 165 patients with laparoscopic cholecystectomy surgery were studied in this double-blind clinical trial. They were randomly divided into three groups: A) DX1 (Intravenous DX): Injection of 0. 1 mg/kg DX intravenously, B) DX2 (Local DX): Injection of 0. 1 mg/kg of DX, diluted with normal saline, injection volume of 10 mL, injection into the bed of the removed gallbladder through a laparoscopic 10 mm subxiphoid trocar, and C) Control: Injection of placebo, the volume and injection site are similar to group B. The amount of postoperative pain in patients was recorded using the Visual Analogue Scale score in 5 times (15 minutes, 30 minutes, 1 hour, 6 hours, and 12 hours after entering the recovery room). Results: In terms of postoperative pain, there was a statistically significant difference between the studied groups so that the amount of postoperative pain 6 hours and 12 hours after surgery in the intravenous DX group was lower than that in the local DX and placebo groups (P = 0. 001). Conclusions: The results of this study showed that the administration of intravenous DX has a better effect than the administration of local DX in pain management after laparoscopic cholecystectomy.

Background: The present study investigated the neuroprotective effect of simvastatin (SIM) against behavioral changes and histological alterations in the hippocampus induced by methylphenidate (MPH). Materials and Methods: Male Wistar rats were divided into the following groups: control, normal saline (0. 2 mL), MPH (10 mg/kg), and MPH (10 mg/kg) plus SIM (10, 20, or 40 mg/kg). Open Field Test (OFT) and Elevated Plus Maze (EPM) evaluated mood and motor activity. Hippocampus DG and CA1 histomorphological changes were also evaluated. Result: MPH caused anxiety, depression, and motor activity disorder in animals in OFT and EPM (P < 0. 001), while SIM altered MPH-induced mood and motor activity disorders in both tests (P < 0. 001). MPH caused quantitative (P < 0. 001) and qualitative changes in hippocampus DG and CA1 cells. SIM (10, 20, and 40 mg/kg) inhibited these neurodegenerative changes of MPH on DG and CA1 cell counts (P < 0. 001) and morphology. Conclusion: SIM conferred neuroprotective properties against MPH-induced behavioral and inhibited MPH-prompted hippocampal cell changes.

Background: Immune cells that predominantly contribute to the homeostasis and regulation of the immune system are regulatory T (T reg) cells. The specific markers of these cells, which are considered as immune control points, play a role in the function and regulation of the immune activity of these cells, and their expression can be related to clinicopathological features of colorectal cancer (CRC). The aim of the present study was to evaluate the expression changes of immune checkpoint genes of T reg cells (glucocorticoid-induced tumor necrosis factor receptor [GITR] and lymphocyte-activation gene 3 [LAG-3]) in patients with CRC. Materials and Methods: 30 peripheral blood mononuclear cell (PBMC) samples from patients with CRC and 30 samples from healthy individuals were studied. A quantitative polymerase chain reaction (qPCR) was completed for analyzing the relative expression of immune checkpoint genes of T reg cells (GITR and LAG-3). The relationship with clinicopathological features and diagnostic values of the genes was examined. REST and SPSS software were used for statistical analyses. Results: The results showed that the expression of LAG-3 (but not GITR) gene in the population of PBMCs of patients with CRC has a significant decrease in expression compared to healthy individuals. Further analyses showed that these expression changes were not related to the clinicopathological characteristics of the CRC patients. Conclusion: The expression pattern of immune checkpoint genes of T reg cells in CRC patients may have a clinical value. Hence, investigation of a larger population of patients can be useful in order to evaluate their diagnostic power in differentiating between healthy and tumor patients.

Background: Infertility diagnostic investigations and treatment through assisted reproductive technology (ART) predispose infertile women to stress, while stress itself can severely affect the results of infertility treatment. This research aimed to investigate the effect of Jawarish Amla Concoction on controlling stress in female candidate intracytoplasmic sperm injection (ICSI) or in vitro fertilization (IVF). Materials and Methods: This randomized clinical trial was conducted between December 2022 and June 2023 at Shahid Akbarabadi Hospital, affiliated with the Iran University of Medical Sciences (IRCT20230411057883N1). A sample of 100 infertile female candidates for ICSI/IVF was randomly divided into two groups. Patients in the intervention group received one tablespoon of the Jawarish Amla Concoction (Phyllanthus emblica, Rosa damascene, and honey). The control group was only followed up on without any intervention. The stress level of the patients was measured based on Newton’s Fertility Problem Inventory (FPI) at the beginning and end of the study, and its changes were compared in both groups. Results: Ninety women completed the study, and their data were analyzed. The mean FPI score in the intervention group was 160. 76 ± 28. 2 before the intervention and 153. 39 ± 28. 5 after the intervention, while it was respectively 141. 07 ± 25. 58 and 142. 8 ± 31. 05 in the control group. After four weeks, the percentage of changes in the FPI score was 16. 67 ± 3. 32% in the intervention group and 11. 28 ± 1. 18% in the control group (P = 0. 045). No complications were observed. Conclusion: Consuming the Jawarish Amla Concoction for four weeks significantly reduced stress in female candidates for ICSI/IVF.

Background: Lophomonas blattarum is a protozoan, which is controversial regarding pathogenicity in the respiratory disease, and identification methods. This study investigated the presence of this protozoan in patients admitted to the intensive care unit (ICU) to assess these controversies. Materials and Methods: Samples of 83 patients hospitalized in the ICU ward of Afzalipoor, Shafa, and Shahid Bahonar hospitals (Kerman, Iran) were collected. The samples were examined using microscopy and real-time polymerase chain reaction (PCR) to check the presence of Lophomonas blattarum. Then, the efficiency of the method used was investigated using bioinformatics studies and the presence of Trichomonas tenax in the samples was investigated. Results: Of 83, 38 (46%) were female, 45 (54%) were male, and their age was 46. 6 ± 14. 45 years. Microscopic examination did not show any in the samples. The real-time PCR method showed 16 positive samples with primers that had been reported in other studies for Lophomonas blattarum. The bioinformatics study showed the method introduced in the other studies lacks the efficiency and specificity, and there is no information in the databases to design a molecular method based on the PCR for identification of Lophomonas blattarum. The results of examining the presence of Trichomonas tenax using the real-time PCR method showed that 16 samples with a positive result for Lofomonas blattarum contained Trichomonas tenax, which indicated that a misidentification had probably occurred. Conclusion: The current methods that are used to identify Lophomonas blattarum do not have the sensitivity and specificity required to identify this protozoan.

Background: Excessive intake of fructose can lead to insulin resistance (IR). Metformin is commonly used as a first-line treatment for type 2 diabetes, and naringenin, a flavonoid known for its anti-inflammatory properties, can potentially improve insulin resistance. However, the effects of combining these two treatments have not been evaluated. Therefore, the present study aims to investigate the combined effects of naringenin and metformin on fructose-induced insulin resistance in male rats. Materials and Methods: Male Wistar rats were divided into five groups: control (without receiving fructose), fructose-induced insulin resistance,F group (with receiving fructose for 8 weeks), fructose+metformin,FM (receiving metformin for last 4 weeks), fructose+naringenin,FN (receiving naringenin for last 4 weeks) and fructose+metformine+naringenin,FMN (receiving metformin and naringenin for last 4 weeks). At the end of the experiment, after an oral glucose tolerance test (OGTT), following deep anesthesia, blood drawing was performed to measure glucose, insulin, total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), triglyceride (TG), tumor necrosis factor-alpha (TNF-a), interleukin 6 (IL-6), free fatty acid (FFA), homeostatic model assessment for insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), and liver enzymes. Results: Although metformin and naringenin each alone showed anti-hyperglycemic effects, combined treatment of metformin with naringenin could more remarkably improve glucose intolerance, decrease glucose, TNF-alpha, IL-6, FFA, TG, and TG/HDL-C ratio, and alanine aminotransferase in FMN group compared to F group (P <. 05 to P <. 0001). Conclusion: Our findings demonstrated that the combination therapy of metformin and naringenin, as a novel therapeutic approach, reduced insulin resistance by improving glucose and lipid metabolism, as well as inhibiting inflammation.