Journal of Research in Medical Sciences1735-19953063202601281172211722EN20260111<p><strong>Background:</strong> The current study was conducted to assess the effect of grape seed extract (GSE) supplementation on inflammatory biomarkers, oxidative stress, clinical symptoms, and quality of life in migraine patients.</p><p><strong> Materials and Methods:</strong> In this randomized double?blinded controlled clinical trial, 50 patients with migraine were randomly allocated to receive either 200 mg/day GSE<br />supplement (n = 25) or placebo (n = 25) for 8 weeks. Severity, frequency and duration of migraine attacks, headache daily result (HDR), quality of life, migraine disability, mental health, anthropometric indices, blood pressure, and serum levels of calcitonin ene?related<br />peptide (CGRP), vascular cell adhesion molecules?1, total antioxidant capacity, and malondialdehyde were measured at baseline and end of the trial. Results: Based on the within?group comparison, patients in the GSE group had a significant reduction in severity,<br />frequency and duration of migraine attacks, HDR, migraine disability, systolic blood pressure, and serum levels of CGRP. GSE group also had better scores in the  igraine?specific quality of life questionnaire and mental health questionnaire. When we performed the analysis using the univariate analysis of variance, the effect of GSE on serum CGRP levels (?0.07 ± 0.03 in the GSE group vs. 0.07 ± 0.03 in the placebo group, P = 0.003) remained significant.</p><p><strong> Conclusion:</strong> This study provides evidence supporting the beneficial effects of GSE supplement on the serum levels of CGRP. Trial registration: IRCT20121216011763N56.<br /><br /></p>http://jrms.mui.ac.ir/index.php/jrms/article/view/11722http://jrms.mui.ac.ir/index.php/jrms/article/download/11722/6497

Journal of Research in Medical Sciences1735-19953063202601281172311723EN20260111<p><strong>Background:</strong> To investigate the risk factors of preoperative bone metastasis (BM) of prostate cancer (PCa) by using semi?quantitative single?photon emission computed tomography/computed tomography (SPECT/CT) whole?body bone imaging and peripheral blood biomarkers, and to establish a morphological map model to evaluate its prediction accuracy.</p><p><strong>Materials and Methods:</strong> Clinical data of 220 patients diagnosed with PCa were retrospectively analyzed. BM was identified using SPECT/CT. Based on the presence<br />or absence of BM, patients were divided into two groups. Univariate and multiple logistic regression analyses were performed on various factors, including age, laboratory parameters, prostate volume determined, clinical tumor stage (cTx), and Gleason score (GS). Draw the receiver operating characteristic curve and calculate the area under the curve (AUC), and analyze the predictive efficacy. In addition, we construct a nomogram representing the BM prediction model using clinical data and generate a calibration plot to<br />assess the accuracy of our predictions.</p><p><strong> Results:</strong> The analysis of univariate and multiple logistic regression demonstrated that (target area?nontarget area)/nontarget area (T?NT)/NT, alkaline phosphatase (ALP), total prostate?specific antigen (tPSA), cTx, and GS were independent predictors of BM in PCa. The tPSA displayed the highest AUC of 0.68 (95% confidence interval [CI]: 0.62–0.75) among the five independent predictors. The best predictive efficacy was shown when the predictive model was established using these five factors, as evidenced by the AUC of 0.80 (95% CI: 0.75–0.86) being higher than any single indicator. The predictive model’s external validation data sensitivity and specificity metrics were 66.67% (8/12) and 95.65% (22/23), respectively, which were consistent with the model’s initial sensitivity of 58.02% and specificity of 87.77%, indicating high accuracy and stability.</p><p><strong> Conclusion:</strong> The established predictive model, incorporating (T?NT)/NT from semi?quantitative SPECT/CT, ALP, tPSA, cTx, and GS, exhibits strong predictive<br />efficacy with high accuracy and stability, providing a reliable tool for preoperative assessment of BM risk in PCa patients.<br /><br /></p>http://jrms.mui.ac.ir/index.php/jrms/article/view/11723http://jrms.mui.ac.ir/index.php/jrms/article/download/11723/6498

Journal of Research in Medical Sciences1735-19953063202601281172411724EN20260111<p><strong>Background:</strong> Postoperative pain is a significant concern following percutaneous nephrolithotomy (PCNL). While tubeless PCNL has reduced discomfort, effective and simple analgesic techniques are still needed.</p><p><strong> Materials and Methods:</strong> A double?blind, randomized controlled trial was conducted at two tertiary hospitals with 120 adult patients having solitary renal pelvic stones &lt;3 cm. Patients were randomized into two groups: the intervention group received 20 mL of 0.25% bupivacaine infiltrated into the tract at surgery end, and the control group received no infiltration. Postoperative pain was assessed using the visual analog scale (VAS) at 6, 12, and 24 h. Both patients and outcome assessors were blinded. Data from 57 intervention and 56 control patients were analyzed.</p><p><strong> Results:</strong> Baseline demographic, anatomical, and perioperative characteristics were well?matched between the two groups (all P &gt; 0.05). Repeated?measures analysis of variance revealed a significant main effect for both time (P &lt; 0.001) and treatment group (P = 0.006). The bupivacaine group consistently reported significantly lower mean VAS pain scores at 6 h (4.33 ± 0.97 vs. 4.85 ± 1.05, P = 0.008), 12 h (2.68 ± 0.81 vs. 3.16 ± 0.95, P = 0.005), and 24 h (1.53 ± 0.68 vs. 1.84 ± 0.71, P = 0.018) than the control group postoperatively.</p><p><strong>Conclusion:</strong> Infiltration of the nephrostomy tract with 0.25% bupivacaine is a simple and effective method for significantly reducing postoperative pain at 6, 12, and 24 h after tubeless PCNL. This technique provides a sustained analgesic benefit and should be considered for routine implementation to enhance patient recovery.<br /><br /></p>http://jrms.mui.ac.ir/index.php/jrms/article/view/11724http://jrms.mui.ac.ir/index.php/jrms/article/download/11724/6499

Journal of Research in Medical Sciences1735-19953063202601281172511725EN20260111<p><strong>Background:</strong> Considering the insufficient data regarding the relationship between isocaloric substitution of macronutrients, sleep, and mental health in the Middle East, we sought to examine this association among Iranian adult men.</p><p><strong>Materials and Methods:</strong> This cross?sectional study was performed on 354 middle?aged Iranian men (mean age: 38.6 ± 5.34 years). Dietary data were collected using a validated food frequency  questionnaire, and participants were divided into tertiles based on dietary macronutrient intake. Sleep quality was assessed using the Pittsburgh Sleep Quality  index, and sleep?related outcomes (daytime sleepiness and insomnia) and mental health (depression, anxiety, and stress) were evaluated using standard questionnaires. Multivariable logistic regression was applied to indicate the associations.</p><p><strong>Results:</strong> Participants in the highest tertile of protein intake showed significantly lower odds of poor sleep quality in both crude (odds ratio [OR]: 0.55; 95% confidence interval [CI]: 0.32, 0.95) and adjusted (OR: 0.53; 95% CI: 0.30, 0.93) models. Substituting carbohydrates with an equivalent amount of protein was associated with 26% lower odds of poor sleep quality (OR: 0.74; 95% CI: 0.55, 0.99). In addition, substituting animal protein with the same amount of plant protein was linked to 29% lower odds of poor sleep quality (OR: 0.71; 95% CI: 0.51, 0.99). No other significant associations were found in both pairwise and substitution models.</p><p><strong>Conclusion:</strong> Our findings indicate that isocaloric substitution of carbohydrates with protein, and animal protein with plant protein, is related to lower odds of poor sleep quality. We found no other significant associations between isocaloric substitution of macronutrients and sleep?related and mental health outcomes.<br /><br /></p>http://jrms.mui.ac.ir/index.php/jrms/article/view/11725http://jrms.mui.ac.ir/index.php/jrms/article/download/11725/6500

Journal of Research in Medical Sciences1735-19953063202601281172111721EN20260111<p><strong>Background:</strong> Achieving successful vascular access for hemodialysis is critical for patients with end?stage renal disease. The creation of an autologous arteriovenous fistula (AVF) is the preferred approach; however, patients with small?caliber radial arteries often face challenges, leading to high rates of AVF failure. Balloon dilation?assisted AVF (BDA?AVF) creation has emerged as a promising technique to address these limitations. This meta?analysis evaluates the effectiveness of BDA?AVF creation in improving primary<br />patency rates at 6 and 12 months in patients with small?caliber radial arteries.</p><p><strong> Materials and Methods:</strong> A systematic review and meta?analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta?Analyses guidelines. A total of 25 studies involving 2450 patients were included. The primary outcomes were 6? and 12?month primary patency rates, assessed through a random?effects model. Secondary outcomes included procedural success, maturation rates, and complications. Data extraction and quality assessment were performed independently by two reviewers.</p><p><strong>Results:</strong> BDA?AVF creation demonstrated a pooled 6?month primary patency rate of 87.8% (95% confidence interval [CI]: 85.8%–89.8%) and a 12?month rate of 75.2% (95% CI:<br />73.2%–77.2%). Comparatively, traditional AVF techniques achieved significantly lower patency rates (6 months: 61%, 12 months: 50%). Procedural success was reported in 92% of cases, with a maturation rate of 88%. Complications were minor and included<br />localized hematoma (5%) and mild arterial spasm (3%). BDA?AVF creation is a safe and effective intervention for patients with small?caliber radial arteries, offering superior patency rates compared to traditional methods.</p><p><strong>Conclusion:</strong> These findings support the adoption of balloon dilation as a standard practice in selected cases, enhancing vascular access outcomes and improving the quality of care for hemodialysis patients. BDA?AVF creation shows promising short? and mid?term outcomes, particularly in patients with small?caliber radial arteries, but evidence for long?term durability is lacking. However, limited long?term follow?up across included studies restricts conclusions about AVF durability, and further high?quality trials are warranted. Future studies should focus on long?term outcomes and cost?effectiveness to further refine this technique.<br /><br /></p>http://jrms.mui.ac.ir/index.php/jrms/article/view/11721http://jrms.mui.ac.ir/index.php/jrms/article/download/11721/6496