Postoperative peritoneal adhesion: an update on physiopathology and novel traditional herbal and modern medical therapeutics.

Postoperative peritoneal adhesion (PPA) is a serious clinical condition that affects the high percentage of patients after abdominal surgery. In this review, we have tried to focus on pathophysiology and different underlying signal pathways of adhesion formation based on recent progress in the molecular and cellular mechanisms. Also, the strategies, developed based on traditional herbal and modern medicines, to prevent and treat the PPA via regulation of the molecular mechanisms were investigated. The search engines such as Google Scholar, PubMed, Scopus, and Science Direct have been used to evaluate the current literature related to the pathogenesis of adhesion formation and novel products. Recently, different mechanisms have been defined for adhesion formation, mainly categorized in fibrin formation and adhesion fibroblast function, inflammation, and angiogenesis. Therefore, the suppression of these mechanisms via traditional and modern medicine has been suggested in several studies. While different strategies with encouraging findings have been developed, most of the studies showed contradictory results and were performed on animals. The herbal products have been introduced as safe and effective agent which can be considered in future preclinical and clinical studies. Although a wide range of therapeutics based on traditional and modern medicines have been suggested, there is no agreement in the efficacy of these methods to prevent or treat adhesion formation after surgeries. Further basic and clinical researches are still needed to propose the efficiency of recommended strategies for prevention and treatment of PPA.

The study of the factors affecting the time of ring fall off in circumcision using Plastibell.

INTRODUCTION: Circumcision is one of the oldest surgeries and is commonly done in various communities. One of the most common methods of this operation is using a ring or plastible. Given that one of the complications of circumcision by the ring is a delay in the ring fall off, this study is done with the purpose of determining the factors that affect the time of the ring fall off. MATERIALS AND METHODS: This study was done in case series-prospective way. At first, local anesthesia was performed in the form of ring block and using 0.2 cc lidocaine 2% per kg body weight with an insulin syringe and then, by making a linear incision on the foreskin, a ring of the right size was placed on the glans. The foreskin was stretched on the ring and the 0-2 or 0-3 suture was tied to the ring groove and finally, the foreskin was removed from the distal part to the ring. Parents were asked about age, size of suture used, time of ring fall off, and status of sitz bath usage and were recorded even they done completely, incompletely, or not. RESULTS: Finally 465 patients started the study with the average age of 7.55 4 ± 4.72 months. The average time of the ring fall off was 66.7 ± 60.2 days. People who had used the sitz bath completely (92.6 ± 36.2 days), compared to those who had used incompletely (63.8 ± 06.2 days) or no use at all (93.9 ± 58.2 days), they had shorter ring retention time (P < 0.001). Also, people who were used 0-3 suture had shorter ring retention time compared to those who were used 0-2 suture (82.6 ± 42.2 days versus 56.2 ± 27.8 days and P < 0.001). There was a significant relationship between age of ring retention and age, and the time of the ring fall off is shorter in those who are younger and the "less than or equal to 3 months" age group had the least time of the ring fall off. CONCLUSION: The results of this study showed that there is a significant relationship between the duration of the ring fall off and the age of individuals and the use of a sitz bath and the use of thinner suture (0-3).

Therapeutic properties of botulinum toxin on chronic anal fissure treatment and the patient factors role.

BACKGROUND: One of the most frequent distressing diseases which causes anal pain and bleeding after defecation is anal fissure. Despite a poorly understood pathogenesis, the internal anal sphincter spasm has been identified to play a central role in pathogenesis. Recently, botulinum toxin is being used increasingly for the treatment of chronic anal fissure to achieve chemical sphincterotomy and reduce internal sphincter tonicity. Based on the heterogeneity among the published studies, we aimed this study to evaluate its healing rate and for recognizing the factors of patients which may affect the outcome. SUBJECTS AND METHODS: In a prospective case series medical research, 106 patients who suffer from chronic anal fissure were treated by botulinum toxin injections. All patients received 30 units of botulinum toxin and were physically examined every week for 2 months. They were evaluated for bleeding, pain, hematoma, thrombosis, infection, incontinence, and healing of the fissure. At the end of the follow-up period, the fissure healing rate and its relation to age, gender, prior topical therapy, duration of symptoms, and the position of the fissure were assessed. RESULTS: At the end of the study (8 weeks), the healing rate was 84.9% (90 patients responded to injections). Healing rate was higher in females and in patients who experienced a shorter duration of symptoms before injection. The mean healing time was 4.68 weeks. In addition, patients with one fissure (anterior or posterior) demonstrated higher healing rate and shorter healing time compared to patients with two fissures (anterior and posterior). CONCLUSION: This study demonstrated that botulinum toxin injection is safe and effective for the treatment of chronic anal fissures, with a low complication rate. In addition, the healing rate was higher in females, patients with shorter duration of symptoms, and those with one fissure.

Oncogenic miRNAs and target therapies in colorectal cancer.

OncomiRNAs involved in human colorectal cancer (CRC) are capable of suppressing the expression of their targets via cleavage or translational arrest. Therefore, an improved understanding the functions of these oncomiRNAs and the molecular pathways in CRC development that they are involved in will assist in the manipulation of miRNAs, providing a novel therapeutic approach against CRC. In this review, we provide a particular perspective of miRNAs implicated in the progression of CRC. We describe an interaction network of CRC-associated miRNAs and their targets involved in tumor growth, proliferation, migration/invasion, epithelial-to-mesenchymal transition (EMT) formation, metastasis, and anticancer resistance. Additionally, the therapeutic potentials of these miRNAs in CRC are fully discussed. Thus, key oncogenic miRNAs involved in progression and metastasis of CRC (e.g., miR-181a/b, miR-135a/b, miR-150 and miR-150-5p, miR-155, miR-181b, miR-200 a/c, miR-22, miR-106a, hsa-miR-103a, hsa-miR-1827, miR-135b, miR-150 and miR-150-5p, miR-181b, and let-7f-5p) are considered in this review. Furthermore, proangiogenic and antiapoptotic miRNAs, their molecular regulatory networks, biological functions, and target genes are also discussed. An in-depth understanding of the molecular mechanisms underlying the regulation of miRNAs will increase the knowledge of miRNA regulatory function in the progression of CRC and promote the development of novel therapeutic measures.

A Rare Coexistence of Retrorectal and Ovarian Cysts: A Case Report.

INTRODUCTION: Retrorectal cysts are rare benign lesions which are frequently diagnosed in middle-aged females. According to their origin and histopathologic features, retrorectal cysts are classified as squamous-lined (dermoid or epidermoid) cysts, postanal gut (tailgut) cysts, and rectal duplications (enteric or enterogenous cysts, enterocystomas). Described in this case report is an extremely unusual patient, a woman who simultaneously had a retrorectal cyst and an ovarian serous cystadenoma in addition to a long history of misdiagnosis and multiple unsuccessful surgeries. CASE PRESENTATION: The patient was a 45-year-old female who presented with back pain, rectal fullness, constipation, and urinary symptoms. Upon her first pregnancy, a cystic pelvic mass had been misdiagnosed as an ovarian cyst. During the following 17 years, she had undergone several ineffective operations. The last CT scan and MRI studies revealed two separate noncalcified, unilocular, cystic lesions with well-defined borders in the retrorectal and retroperitoneal spaces. Two cysts were excised completely by a combined abdominoperineal approach. Pathological assessment revealed a dermoid cyst and an ovarian serous cystadenoma. No complications occurred during the 18 months of follow-up. CONCLUSIONS: Coexistence of a retrorectal cyst and a serous cystadenoma is very unusual. Retrorectal cysts are rare entities that remain a difficult diagnostic and therapeutic challenge. Misdiagnosis and multiple unsuccessful surgeries are common. Complete surgical removal is the treatment of choice and requires a multidisciplinary approach in complicated cases.