nasim khosravi

This scoping review aimed to investigate the status of breast cancer (BC) preventive behaviors and screening indicators among Iranian women in the past 15years. BC, as the most common cancer in women, represents nearly a quarter(23%) of all cancers. Presenting the comprehensive view of preventive modalities of BC in the past 15 years in Iran may provide a useful perspective for future research to establish efficient services for timely diagnosis and control of the disease.

The English and Persian articles about BC screening modalities and their indicators in Iran were included from 2005 to 2020. English electronic databases of Web of Science, PubMed, and Scopus, and Persian databases of Scientific Information Database (SID) and IranMedex were used. The critical information of articles was extracted and classified into different categories according to the studied outcomes.

A total of 246 articles were assessed which 136 of them were excluded, and 110 studies were processed for further evaluation. Performing breast self‑examination, clinical breast examination, and mammography in Iranian women reported 0%–79.4%, 4.1%–41.1%, and 1.3%‑45%, respectively. All of the educational interventions had increased participants’ knowledge, attitude, and practice in performing the screening behaviors. The most essential screening indicators included participation rate (3.8% to 16.8%), detection rate (0.23–8.5/1000), abnormal call rate (28.77% to 33%), and recall rate (24.7%).

This study demonstrated heterogeneity in population and design of research about BC early detection in Iran. The necessity of a cost‑effective screening program, presenting a proper educational method for increasing women’s awareness and estimating screening indices can be the priorities of future researches. Establishing extensive studies at the national level in a standard framework are advised

Heart rate variability (HRV) is negatively associated with mortality. Decrease in HRV is common in cancer patients. The association between HRV and general survival in cancer patients has made HRV a valuable biomarker for evaluation of the disease prognosis. Exercise is considered an interventional strategy to improve various outcomes in cancer patients. The present paper provides a descriptive review of the literature regarding the effect of exercise interventions on HRV in cancer patients.

A systematic search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines in PubMed and Google Scholar, from inception since 1950 till October 15, 2018. The terms exercise, training, cancer, neoplasms, heart rate variability, and HRV were used in the search. Eligible studies were those trials using structured exercise intervention and having untrained adult cancer patients. Only English-language papers were included in the review.

Eight studies were included in the review. Of the various HRV parameters, 2 in the time domain (SDNN and RMSSD) and 3 in the frequency domain (LF, HF, and LF/HF) were commonly reported in the studies. Exercise intervention increased SDNN, RMSSD, and HF in all the studies, although the difference did not reach statistical significance in some cases. The results regarding LF and LF/HF were not consistent.

In general, exercise intervention can improve HRV in cancer patients. It is suggested that SDNN, RMSSD, and HF parameters be used in the evaluation of exercise effects on HRV because these parameters a) have prognostic value and b) more suitably reflect the effects of exercise training in these patients.

As breast cancer treatment going forward, need for supportive strategies grows. That creates an important call to summarize what has been done regionally. In this study, we systematically reviewed articles that proceeded rehabilitation and supportive care in breast cancer patients in Iran to present a research map of rehabilitation research in the past 10 years in Iran. All articles published from January 2006 to October 2015 were included. All of the breast cancer studies in Iran were searched in 3 English (Web of Science, PubMed, and Scopus) and 2 Persian databases (SID and IranMedex).
Study Selection: All papers related to rehabilitation in breast cancer were included and categorized into 5 subgroups including qualitative, instrument, lymphedema, interventional, and observational studies. Three reviewers (two surgeons and an epidemiologist) screened the primary search and divided it into subgroups. Two reviewers used a checklist to critically appraise the full text of the selected articles. The necessary information of retrieved articles was extracted and recorded in the designed data extraction spreadsheet in Excel software. A total of 194 articles (102 in English and 92 in Persian) were assessed for eligibility of inclusion in the review, of which, 121 were excluded, and 73 studies were kept. The included studies consisted of 14 on qualitative design, 5 studies in the translation and validation of research instruments, 7 articles in the field of lymphedema, 20 articles about different intervention modalities on breast cancer patients (including education, social status, psychological, exercise, etc.), and 27 observational studies about anxiety, depression, quality of life, sexual function, emotional distress, complementary medicine, lifestyle, etc. Most of the reviewed studies insisted on a prevalence of physical, psychological, functional, and spiritual problems of breast cancer survivors and their caregivers. Designing a mega project to offer a palliative and rehabilitation service package according to the needs of Iranian patients may become a priority in their health care system.

Exercise is now strongly recommended for breast cancer patients to improve their overall health and quality of life. Monocytes play an important role in the cancer immune system and a better understanding of how acute exercise alters the monocyte subsets would aid in exercise prescription.

Ten breast cancer survivors (age: 59 ± 7.1) who completed their primary cancer treatment within the previous year were evaluated in this study. Using flow cytometry, monocyte subset percentages were evaluated before, immediately after, and 1 hour after 45 minutes of acute, intermittent exercise. Exercise intensity was 60% of peak wattage obtained from a cardiopulmonary exercise test.

The percentage of CD14 monocytes and CD14࠽ monocyte subsets changed significantly across the trial (p= 0.016 and p = 0.016, respectively), with a small, non-significant increase immediately after exercise (CD14: 9%, p= 0.314; CD14࠽: 5%, p= 0.594) followed by a larger significant decrease 1 hour after exercise relative to baseline (CD14: -26%, p= 0.015; CD14࠽: -28%, p= 0.021). CD14࠽ subpopulation showed a tendency to change across the trial but this did not quite reach significance (p= 0.097).

These findings suggest that acute intermittent exercise mobilizes CD14 monocytes and CD14࠽ monocyte subsets in breast cancer survivors in a manner that is comparable to previous reports in healthy individuals. Further studies are warranted to determine the functionality of the mobilized monocytes and the effects of exercise training.

This study aimed to evaluate the effects of yoga on lymphedema volume, range of motion and quality of life (QOL) in women with Breast Cancer Related Lymphedema (BCRL).
This is a non-randomized semi-experimental clinical trial. Women with BCRL were allocated to receive either Complete Decongestive Therapy (CDT), n = 18) or CDT with an 8-week yoga intervention (n = 18). Outcomes were the volume of arm lymphedema, range of motion (ROM) and QOL. A measurement was conducted at baseline, post-intervention and 4 weeks after the end of intervention.
It was shown that the edema volume decreased and QOL and ROM increased compared to baseline measurements. However the inter-group changes were not significant regarding the scores of QOL (p = 0.536), edema volume (p = 0.846) and ROM (p = 0.209) during the study.
It appears that the yoga intervention with CDT is not superior to CDT alone in lymphedema treatment. Regarding patients’ access to yoga classes and absence of side effects, further studies about its effects and cost-effectiveness are recommended.

Exercise is a major non-pharmacological intervention to improve quality of life in breast cancer patients. Given the enhanced utilization of exercise programs worldwide and lack of proper guidelines for breast cancer exercise programs in Iran, a group of different experts gathered to draw an exercise framework in these populations
This is a qualitative study using a focus group discussion method. Eight participants with different expertise were gathered. We had a moderator and two assistant moderators.
After analyzing, two challenging themes emerged: (1) conducting different types of exercise as home-based, and (2) pre-participation assessments. We had seven subthemes for the first theme, which in turn were divided into three categories: aerobic exercises, resistance training, and exercise intensity monitoring. Also we extracted two subthemes for pre-participation assessments.
Based on opinion of different experts who are involved in breast cancer care process, conducting different types of exercise as home-based, and pre-participation assessment should be considered.

Increased physical activity is associated with a reduction in the risk of breast cancer; however, the exact mechanism of the reduction is not yet completely known..
This study aimed to investigate the effect of six months of aerobic exercise on the plasma interleukin (IL)-6 and tumor necrosis factor-alpha (TNF-α) levels as breast cancer risk factors in postmenopausal women..
Patients and This study was a randomized controlled trial. We randomly assigned 41 postmenopausal, sedentary women aged 50 to 74 to either an exercise or a control group. The intervention involved facility-based aerobic exercise (three days/week, at 70 - 80% of the maximum heart rate, for six months)..
Twenty-seven women completed the study. The plasma IL-6 level decreased by 21.3% in the exercisers and by 6.9% in the controls, and the intervention effect was significant (P = 0.001). The plasma TNF-α level decreased by 17.1% and 10.8% in the exercisers and controls, respectively, although the effect of exercise was not statistically significant (P = 0.28). Overall, long-term aerobic exercise may result in a decreased IL-6 concentration..
We suggest that regular aerobic exercise can favorably alter the inflammatory profile, which is a known risk factor in breast cancer development, in postmenopausal women..

Blood loss during spinal decompression and fusion is high and at times more than the patient’s total estimated blood. Increased blood loss may increase the risks of morbidity and eventually length of hospital stay (LOS). The aim of this study was to identify predictor factors of blood transfusion requirements and the length of hospital stay in adult patients who underwent lumbosacral surgery. This was a multicenter cross-sectional study to predict factors of hospital length of stay (LOS) and intraoperative red cell transfusion in patients undergoing major posterior lumbar spinal surgeries. In this study, 298 patients who needed spinal surgery were enrolled. Multiple linear regression results revealed the following information. Among variables that had significant association with the volume of intraoperative blood loss, considerable predictors were the number of level fused (R2 = 0.42), mean intraoperative SBP (R2 = 0.22), length of operation (R2 = 0.31) and increasing age (R2 = 0.37). Significant predictors for the length of hospital stay were increasing age (R2 = 0.22), much more comorbid conditions (R2 = 0.30), operation length (R2 = 0.27), the number of level fused (R2 = 0.21) and the volume of intraoperative blood loss (R2 = O.29). The results of logistic regression revealed that length of operation, preoperative Hb value, number of level fused and mean intraoperative SBP considerably predicted the need for intraoperative blood transfusion. Diminishing intraoperative SBP could decrease intraoperative blood loss and eventually less red cell transfusion and shorter LOS. Besides, correcting preoperative anemia in female patients before elective surgeries could decrease a need for red cell transfusions and ultimately decreased red cell transfusion complication rate and shorter hospital LOS.

The aim of this study was to determine predictive factors of blood transfusion and the length of hospital stay in patients who underwent spinal surgery that required discectomy or decompression with laminectomy, without segmental instrumentation. The purpose of this multi-center, prospective cross-sectional survey study was to determine predictive factors of blood transfusion and the length of hospital stay in 252 adults’ patients who underwent spinal surgery that required discectomy or decompression with laminectomy, without segmental instrumentation. Descriptive analysis, univariate and multivariate analysis were used to describe the predictive factors of blood transfusion requirement and the length of hospital stay (LOS). According to our statistical analysis the length of operation (R2: 0.65 and p< 0.001) and the volume of intra-operative blood loss (R2: 0.66 and p=0.033) significantly predict the postoperative LOS in patients who had had the lumbar discectomy. Additionally major predictors for intra-operative blood loss were the length of operation (R2:0.30 and p<0.001) and much more comorbid conditions (R2:0.34 and p=0.002).The considerable predictors for postoperative LOS in patients who had had laminectomy without instrumentation were the length of the operation (R2: 0.34 and p<0.001), perioperative blood loss (R2: 0.44 and p=0.042) and also age >50 (R2: 0.42 and p<0.001). As well, the length of operation (R2: 0.27 and p<0.001), mean of perioperative systolic blood pressure (R2: 0.31 and p<0.001) and the co-morbidities (R2: 0.42 and p<0.001) were the significant predictors for perioperative blood loss. In order to our study, in discectomy and laminectomy without instrumentation, length of operation and the volume of perioperative blood loss seem to be the significant predictors for length of hospital stay.

Blood loss during spinal decompression and fusion is high as much or more than the patient’s total estimated blood. It is possible that increased blood loss increased the risks of morbidity and eventually length of hospital stay (LOS). The aim of this study was Identification the predictors of blood transfusion in major spine surgery. This multi-center study was a cross-sectional survey study of predicting factors of LOS and intraoperative blood transfusion in patients undergoing posterior lumbar spinal surgeries between April 2012 and June 2013. In this study, 298 patients who needed spinal surgery upon for spinal stenosis, for spondylolishtesis and for fracture were enrolled. Revision surgeries were not included. The number of level fused (mainly more than three segments) had significant correlation with intraoperative blood loss (IBL). Intraoperative mean SBP was the second momentous variable subsequent to the number of level fused. It appears diminishing intraoperative mean SBP could directly proportional to decreased IBL, need of red cell transfusion, short operation time and eventually decreased LOS. Length of operation was important as intraoperative SBP in predicting IBL and eventually LOS. In this study, we observed that number of instruments (especially more than six screws) had significant correlation with IBL though in logistic analysis it was not useful predictor for IBL. Factors included: increasing age, length of surgery, increased intraoperative mean SBP, more level of laminectomy and furthermore the number of instruments could positively predict IBL. Operation length, level of fused, intraoperative mean SBP and preoperative Hb value could be useful predictor for blood transfusion. Also, age>50y, the volume of IBL (especially more than 500cc), operation length (particularly more than 180 minute), increased level of fused (mainly more than 3 levels) and the number of comorbid conditions could predict increasing LOS. This multi-center study was a cross-sectional survey study of predicting factors of LOS and intraoperative blood transfusion in patients undergoing posterior lumbar spinal surgeries between April 2012 and June 2013. In this study, 298 patients who needed spinal surgery upon for spinal stenosis, for spondylolishtesis and for fracture were enrolled. Revision surgeries were not included.