Annals of Colorectal Research Annals of Colorectal Research Ann Colorectal Res http://www.colorectalresearch.com 2322-5262 2322-5289 10.5812/acr. en jalali 2017 6 23 gregorian 2017 6 23 3 2
en 10.17795/acr-29003 Extramedullary Hematopoiesis in a Man With β-Thalassemia: An Uncommon Cause of an Adrenal Mass Extramedullary Hematopoiesis in a Man With β-Thalassemia: An Uncommon Cause of an Adrenal Mass case-report case-report Introduction

Extramedullary hematopoiesis (EMH) commonly occurs in the spleen, liver and lymph nodes. Rare cases of EMH in the adrenal gland have been reported.

Conclusions

In patients in which a history of hematologic disorders exists, careful imaging and hormonal assay should be done to certify a diagnosis of EMH. However, the surgical management becomes inevitable in certain cases.

Case Presentation

We report the case of a 33-year-old man from the South of Iran suffering from major β-thalassemia, who underwent open left adrenalectomy and the histopathology revealed EMH.

Introduction

Extramedullary hematopoiesis (EMH) commonly occurs in the spleen, liver and lymph nodes. Rare cases of EMH in the adrenal gland have been reported.

Conclusions

In patients in which a history of hematologic disorders exists, careful imaging and hormonal assay should be done to certify a diagnosis of EMH. However, the surgical management becomes inevitable in certain cases.

Case Presentation

We report the case of a 33-year-old man from the South of Iran suffering from major β-thalassemia, who underwent open left adrenalectomy and the histopathology revealed EMH.

Extramedullary hematopoiesis;Thalassemia;Adrenal Extramedullary hematopoiesis;Thalassemia;Adrenal http://www.colorectalresearch.com/index.php?page=article&article_id=29003 Shahryar Zeighami Shahryar Zeighami Department of Urology, Shiraz University of Medical Sciences, Shiraz, IR Iran Department of Urology, Shiraz University of Medical Sciences, Shiraz, IR Iran Seyed Ali Eslahi Seyed Ali Eslahi Department of Urology, Shiraz University of Medical Sciences, Shiraz, IR Iran; Department of Urology, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-7112306972, Fax: +98-7112330724 Department of Urology, Shiraz University of Medical Sciences, Shiraz, IR Iran; Department of Urology, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-7112306972, Fax: +98-7112330724 Mohammad Mehdi Hosseini Mohammad Mehdi Hosseini Department of Urology, Shiraz University of Medical Sciences, Shiraz, IR Iran Department of Urology, Shiraz University of Medical Sciences, Shiraz, IR Iran Ali Ariafar Ali Ariafar Department of Urology, Shiraz University of Medical Sciences, Shiraz, IR Iran Department of Urology, Shiraz University of Medical Sciences, Shiraz, IR Iran Sara Pakbaz Sara Pakbaz Pathology Department, Shiraz University of Medical Sciences, Shiraz, IR Iran Pathology Department, Shiraz University of Medical Sciences, Shiraz, IR Iran Mohsen Rastegari Mohsen Rastegari Department of Urology, Shiraz University of Medical Sciences, Shiraz, IR Iran Department of Urology, Shiraz University of Medical Sciences, Shiraz, IR Iran Hajar Khazraei Hajar Khazraei Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
en 10.17795/acr-28187 Is Clinical Evaluation Sufficient for Decision Making in Patients With Penetrating Abdominal Trauma? Is Clinical Evaluation Sufficient for Decision Making in Patients With Penetrating Abdominal Trauma? letter letter Wounds, Penetrating;Trauma;Peritonitis;Laparotomy;Peritoneal Lavage Wounds, Penetrating;Trauma;Peritonitis;Laparotomy;Peritoneal Lavage http://www.colorectalresearch.com/index.php?page=article&article_id=28187 Ahmad Izadpanah Ahmad Izadpanah Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-7132306972, Fax: +98-7132330724 Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-7132306972, Fax: +98-7132330724
en 10.17795/acr-21447 Combined Technique in the Management of Complex Pilonidal Disease Combined Technique in the Management of Complex Pilonidal Disease letter letter Pilonidal Disease;Fistula;Abscess;Surgical Flaps Pilonidal Disease;Fistula;Abscess;Surgical Flaps http://www.colorectalresearch.com/index.php?page=article&article_id=21447 Seyed Vahid Hosseini Seyed Vahid Hosseini Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Alimohamamad Bananzadeh Alimohamamad Bananzadeh Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-7132306972, Fax: +98-7132330724 Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-7132306972, Fax: +98-7132330724
en 10.17795/acr-27621 Frequency of Different Psychiatric Disorders in Patients With Functional Bowel Disorders: A Short Report Frequency of Different Psychiatric Disorders in Patients With Functional Bowel Disorders: A Short Report brief-report brief-report Conclusions

Psychiatric disorders are very prevalent among patients with functional bowel disorders. Prompt diagnosis and appropriate management of associated psychiatric disorders along with GI targeted treatments may lead to a better outcome in these patients.

Results

Of 60 patients with functional bowel disorders (including 39 IBS), 51 (85%) were diagnosed with at least one psychiatry disorder. The most common disorders were dysthymia (25%) and obsessive-compulsive disorder (20%). There was no significant difference between IBS patients and other functional bowel disorders regarding the prevalence of psychiatric disorders.

Objectives

In this study, psychology evaluation was performed for a population of patients with functional bowel disorders.

Patients and Methods

One hundred patients with functional bowel disorders including 50 patients with irritable bowel syndrome (IBS) referred to GI clinics were candidates for psychiatry evaluation; of those 60 patients completed the study. Psychiatric disorders were diagnosed using a structured clinical interview based on diagnostic and statistical manual of mental disorders IV (DSM IV).

Background

Functional gastrointestinal (GI) disorders are very common and many patients with such disorders are not satisfied with treatment outcomes. Psychological aspects of functional disorders need special attention that may play an important role in patient management.

Conclusions

Psychiatric disorders are very prevalent among patients with functional bowel disorders. Prompt diagnosis and appropriate management of associated psychiatric disorders along with GI targeted treatments may lead to a better outcome in these patients.

Results

Of 60 patients with functional bowel disorders (including 39 IBS), 51 (85%) were diagnosed with at least one psychiatry disorder. The most common disorders were dysthymia (25%) and obsessive-compulsive disorder (20%). There was no significant difference between IBS patients and other functional bowel disorders regarding the prevalence of psychiatric disorders.

Objectives

In this study, psychology evaluation was performed for a population of patients with functional bowel disorders.

Patients and Methods

One hundred patients with functional bowel disorders including 50 patients with irritable bowel syndrome (IBS) referred to GI clinics were candidates for psychiatry evaluation; of those 60 patients completed the study. Psychiatric disorders were diagnosed using a structured clinical interview based on diagnostic and statistical manual of mental disorders IV (DSM IV).

Background

Functional gastrointestinal (GI) disorders are very common and many patients with such disorders are not satisfied with treatment outcomes. Psychological aspects of functional disorders need special attention that may play an important role in patient management.

Functional Gastrointestinal Disorders;Mental Disorders;Irritable Bowel Syndrome Functional Gastrointestinal Disorders;Mental Disorders;Irritable Bowel Syndrome http://www.colorectalresearch.com/index.php?page=article&article_id=27621 Bahareh Fakhraei Bahareh Fakhraei Non-Communicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, IR Iran Non-Communicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, IR Iran Ali Firouzabadi Ali Firouzabadi Department of Psychiatry, Research Center for Psychiatry and Behavioral Sciences, Hafez Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran Department of Psychiatry, Research Center for Psychiatry and Behavioral Sciences, Hafez Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran Mojtaba Farjam Mojtaba Farjam Department of Medical Pharmacology, School of Medicine, Fasa University of Medical Sciences, Fasa, IR Iran Department of Medical Pharmacology, School of Medicine, Fasa University of Medical Sciences, Fasa, IR Iran Mohammad Reza Fattahi Mohammad Reza Fattahi Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Mohamad Hasan Kazemi Mohamad Hasan Kazemi Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Mahvash Alizade Naini Mahvash Alizade Naini Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Maryam Moini Maryam Moini Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, P. O. Box: 71935-1311, Shiraz, IR Iran. Tel/Fax: +98-7136281442 Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, P. O. Box: 71935-1311, Shiraz, IR Iran. Tel/Fax: +98-7136281442
en 10.17795/acr-28983 Laparoscopy and Intra-Abdominal Sepsis Laparoscopy and Intra-Abdominal Sepsis review-article review-article Results

Laparoscopic surgery has been shown to have a role in the acute setting. Studies show it has become the gold standard in the appendicitis. High quality Randomized controlled trials are in short supply but observational and cohort studies have shown equivalence and with increasing experience complication rates are reduced. Evidence is also increasing in the management of diverticular disease, crohn’s and ulcerative colitis as well as post-operative complication management and acute presentations of colorectal cancer.

Conclusions

Laparoscopic surgery is feasible in the management of intra-abdominal sepsis. It has become the new accepted standard in the management of appendicitis, and is safe, feasible and increasing in the management of complex diverticular disease, acute IBD and colorectal cancer in the emergency and post-operative setting.

Context

Intra-abdominal sepsis has significant morbidity and mortality. In the developed world, there are many common causes originating from the lower gastrointestinal tract including diverticular disease, appendicitis, perforated cancers, and inflammatory bowel disease. It has a high cost and is associated with high levels of significant morbidity and mortality. Management options include radiologic drainage and surgical options include resection for more widespread sepsis. Laparoscopic surgery has increased and has been useful in elective setting. Its use in the emergency setting is less evaluated.

Evidence Acquisition

Evidence was acquired by searching online medical databases including Pubmed, Medline and Embase.

Results

Laparoscopic surgery has been shown to have a role in the acute setting. Studies show it has become the gold standard in the appendicitis. High quality Randomized controlled trials are in short supply but observational and cohort studies have shown equivalence and with increasing experience complication rates are reduced. Evidence is also increasing in the management of diverticular disease, crohn’s and ulcerative colitis as well as post-operative complication management and acute presentations of colorectal cancer.

Conclusions

Laparoscopic surgery is feasible in the management of intra-abdominal sepsis. It has become the new accepted standard in the management of appendicitis, and is safe, feasible and increasing in the management of complex diverticular disease, acute IBD and colorectal cancer in the emergency and post-operative setting.

Context

Intra-abdominal sepsis has significant morbidity and mortality. In the developed world, there are many common causes originating from the lower gastrointestinal tract including diverticular disease, appendicitis, perforated cancers, and inflammatory bowel disease. It has a high cost and is associated with high levels of significant morbidity and mortality. Management options include radiologic drainage and surgical options include resection for more widespread sepsis. Laparoscopic surgery has increased and has been useful in elective setting. Its use in the emergency setting is less evaluated.

Evidence Acquisition

Evidence was acquired by searching online medical databases including Pubmed, Medline and Embase.

Diverticulitis;Appendicitis;Laparoscopy;Crohn’s Disease;Colorectal Cancer;Ulcerative Colitis Diverticulitis;Appendicitis;Laparoscopy;Crohn’s Disease;Colorectal Cancer;Ulcerative Colitis http://www.colorectalresearch.com/index.php?page=article&article_id=28983 Peter Edward Coyne Peter Edward Coyne Colorectal Unit, Department of Surgery, Northumbria Healthcare NHS Trust, Northumberland, UK; Colorectal Unit, Department of Surgery, Northumbria Healthcare NHS Trust, Northumberland, UK. Tel/Fax: +344-8118111 Colorectal Unit, Department of Surgery, Northumbria Healthcare NHS Trust, Northumberland, UK; Colorectal Unit, Department of Surgery, Northumbria Healthcare NHS Trust, Northumberland, UK. Tel/Fax: +344-8118111 Reza Kalbassi Reza Kalbassi Colorectal Unit, Department of Surgery, Northumbria Healthcare NHS Trust, Northumberland, UK Colorectal Unit, Department of Surgery, Northumbria Healthcare NHS Trust, Northumberland, UK
en 10.17795/acr-29511 Antioxidant and Anti-Inflammatory Effects of Gel and Aqueous Extract of Melilotus officinalis L. in Induced Ulcerative Colitis: A Rattus norvegicus Model Antioxidant and Anti-Inflammatory Effects of Gel and Aqueous Extract of <italic>Melilotus officinalis</italic> L. in Induced Ulcerative Colitis: A <italic>Rattus norvegicus</italic> Model research-article research-article Conclusions

It can be concluded that the M. officinalis L. extract can be used as an effective medicine to treat UC in animal model and also in human subjects.

Background

Ulcerative colitis (UC) is a chronic condition of intestine illness accompanied by some unknown etiology with different immune, genetic and environmental factors.

Objectives

The current study aimed to evaluate the antioxidant and anti-inflammatory effects of the Melilotus officinalis L. in the acetic acid induced UC in rats.

Materials and Methods

The plant aqueous extraction and high performance liquid chromatography and Ferric Reducing Antioxidant Power (FRAP) assay were performed on aqueous extract to identify its compounds and antioxidant activities. Also, 70 adult male rats were and UC was induced using 3% acetic acid solution. They received different daily doses of M. officinalis L. in two forms (orally, 500 and 1000 mg/kg) and gel extract (10% and 20%). On the 7th day, the colon tissues were examined regarding the macroscopic and histopathology lesions plus oxidative stress and compared to the positive and negative control groups.

Results

HPLC analysis revealed that five grams of the flower powder contained 9.7 mg gallic acid, 99 mg catechin, 21.9 mg caffeic acid, 0.86 mg chlorogenic acid, 1.13 mg quercetin, 548.9 mg cinnamic acid, 289 mg coumarin and 126 mg p-coumaric acid. The FRAP value of the extract was 2.91 ± 0.14 μM/g. There were significant differences between the group of rats which received the gel or aqueous extract of the flower compared to the negative control group using normal saline and the base gel and they had no significant differences with the positive control group using the Asacol, regarding the pathologic, malondialdehyde, and weight improvements.

Conclusions

It can be concluded that the M. officinalis L. extract can be used as an effective medicine to treat UC in animal model and also in human subjects.

Background

Ulcerative colitis (UC) is a chronic condition of intestine illness accompanied by some unknown etiology with different immune, genetic and environmental factors.

Objectives

The current study aimed to evaluate the antioxidant and anti-inflammatory effects of the Melilotus officinalis L. in the acetic acid induced UC in rats.

Materials and Methods

The plant aqueous extraction and high performance liquid chromatography and Ferric Reducing Antioxidant Power (FRAP) assay were performed on aqueous extract to identify its compounds and antioxidant activities. Also, 70 adult male rats were and UC was induced using 3% acetic acid solution. They received different daily doses of M. officinalis L. in two forms (orally, 500 and 1000 mg/kg) and gel extract (10% and 20%). On the 7th day, the colon tissues were examined regarding the macroscopic and histopathology lesions plus oxidative stress and compared to the positive and negative control groups.

Results

HPLC analysis revealed that five grams of the flower powder contained 9.7 mg gallic acid, 99 mg catechin, 21.9 mg caffeic acid, 0.86 mg chlorogenic acid, 1.13 mg quercetin, 548.9 mg cinnamic acid, 289 mg coumarin and 126 mg p-coumaric acid. The FRAP value of the extract was 2.91 ± 0.14 μM/g. There were significant differences between the group of rats which received the gel or aqueous extract of the flower compared to the negative control group using normal saline and the base gel and they had no significant differences with the positive control group using the Asacol, regarding the pathologic, malondialdehyde, and weight improvements.

Colitis, Ulcerative;Inflammation;Extract;Ulcerative Colitis;Asacol Colitis, Ulcerative;Inflammation;Extract;Ulcerative Colitis;Asacol http://www.colorectalresearch.com/index.php?page=article&article_id=29511 Ali Reza Safarpour Ali Reza Safarpour Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Fatemeh Kaviyani Fatemeh Kaviyani Transgenic Technology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Transgenic Technology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Masood Sepehrimanesh Masood Sepehrimanesh Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Gastroenterohepatology Research Center, Research Tower, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, P. O. Box: 7193-51311, Shiraz, IR Iran. Tel: +98-7136281442 Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Gastroenterohepatology Research Center, Research Tower, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, P. O. Box: 7193-51311, Shiraz, IR Iran. Tel: +98-7136281442 Nasrollah Ahmadi Nasrollah Ahmadi Department of Pathology, School of Veterinary Medicine, Shiraz University, Shiraz, IR Iran Department of Pathology, School of Veterinary Medicine, Shiraz University, Shiraz, IR Iran Omid Koohi Hosseinabadi Omid Koohi Hosseinabadi Laboratory Animals Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Laboratory Animals Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Nader Tanideh Nader Tanideh Transgenic Technology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Transgenic Technology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Najmeh Showraki Najmeh Showraki Department of Oral Medicine, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, IR Iran Department of Oral Medicine, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, IR Iran
en 10.17795/acr-28794 Comparison of Oncologic Short Term Results of Laparoscopic Versus Open Surgery of Rectal Cancer Comparison of Oncologic Short Term Results of Laparoscopic Versus Open Surgery of Rectal Cancer research-article research-article Conclusions

Laparoscopic surgery is an effective technique for safe margin and removing lymph nodes in rectal cancer.

Objectives

This study was performed to evaluate oncologic results of open versus laparoscopic surgery of rectal cancer in terms of resection margins, removal of lymph nodes and recurrence rate.

Patients and Methods

This descriptive-analytic study was performed on 88 patients with middle and lower rectal cancer in the two equivalent groups of laparoscopic and open surgery in Mashhad Ghaem and Omid hospitals during 2011 - 2013. Information including age, sex, number of removed and involved lymph nodes, proximal, distal, and radial margins, tumor stage and location, recurrence and disease-free survival collected in the questionnaire and analyzed using descriptive statistics and frequency distribution tables and t-test.

Results

Both groups of open and laparoscopic surgery had similar characteristics of age, sex, recurrence and disease-free survival, tumor margins and one-year mortality. The number of removed and involved lymph nodes was higher in the laparoscopic group (5.16 vs. 3.55, respectively, with P < 0.050, and 1.74 vs. 0.59 with P = 0.023), but the ratio of involved lymph nodes to the total number of removed lymph nodes was not different between the two groups (LNR) (P = 0.071). Tumor stage was higher in the laparoscopic group and most were in stages II and III (P < 0.001).

Background

Today, with improvements in laparoscopy technique, surgery of rectal cancer is performed by laparoscopy.

Conclusions

Laparoscopic surgery is an effective technique for safe margin and removing lymph nodes in rectal cancer.

Objectives

This study was performed to evaluate oncologic results of open versus laparoscopic surgery of rectal cancer in terms of resection margins, removal of lymph nodes and recurrence rate.

Patients and Methods

This descriptive-analytic study was performed on 88 patients with middle and lower rectal cancer in the two equivalent groups of laparoscopic and open surgery in Mashhad Ghaem and Omid hospitals during 2011 - 2013. Information including age, sex, number of removed and involved lymph nodes, proximal, distal, and radial margins, tumor stage and location, recurrence and disease-free survival collected in the questionnaire and analyzed using descriptive statistics and frequency distribution tables and t-test.

Results

Both groups of open and laparoscopic surgery had similar characteristics of age, sex, recurrence and disease-free survival, tumor margins and one-year mortality. The number of removed and involved lymph nodes was higher in the laparoscopic group (5.16 vs. 3.55, respectively, with P < 0.050, and 1.74 vs. 0.59 with P = 0.023), but the ratio of involved lymph nodes to the total number of removed lymph nodes was not different between the two groups (LNR) (P = 0.071). Tumor stage was higher in the laparoscopic group and most were in stages II and III (P < 0.001).

Background

Today, with improvements in laparoscopy technique, surgery of rectal cancer is performed by laparoscopy.

Rectal Neoplasms;Open Surgery;Laparoscopy Rectal Neoplasms;Open Surgery;Laparoscopy http://www.colorectalresearch.com/index.php?page=article&article_id=28794 Ehsan Solati Ehsan Solati Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran Ghodratollah Maddah Ghodratollah Maddah Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran Abbas Abdollahi Abbas Abdollahi Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran; Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-5138022677 Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran; Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-5138022677 Alireza Tavassoli Alireza Tavassoli Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran Masoumeh Safaei Masoumeh Safaei Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran Mehdi Jabbari Nooghabi Mehdi Jabbari Nooghabi Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran; Department of Statistics, Faculty of Mathematical Sciences, Ferdowsi University of Mashhad, Mashhad, IR Iran Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran; Department of Statistics, Faculty of Mathematical Sciences, Ferdowsi University of Mashhad, Mashhad, IR Iran