Background: Standardized patient (SP) can serve as a valuable tool to measure the physician performance in actual clinical settings, but it has not been validated for obesity/overweight disorders. This study has been conducted to describe the process of creating reliable and valid SPs for evaluation of general-practitioners' management of obesity/overweight in Iran. Materials and Methods: A total of 6 obese/overweight volunteers (potential SPs) took part in training. Three scenarios, along with corresponding checklists including 102 items representing different aspects of diagnosis and treatment of obesity/overweight, were developed by an expert group. The SPs were trained using role playing method. During this part, one of the SPs failed. The SPs' portrayal of their respective scenario was online watched in another room and the checklist filled independently by the physician, research assistant and other SPs. The reliability of the checklist to be used by the SPs was assessed by Cronbach's alpha. The overall inter-rater agreement was calculated by the intraclass correlation coefficient statistic for total scores. Results: The 5 eligible SPs were all women between 20 years and 39 years of age. Inter-rater agreement between the SPs' total scores was 0.899, value (95% confidence intervals) were 11.8 (0.68-0.98) and P value was <0.001. The Cronbach's alpha for reliability of completed checklists was 0.91. Conclusion: SP could be a powerful instrument for evaluating medical performance of general practitioners in the field of obesity/overweight management. Further research is needed to find the more aspects of training and validation of unannounced SPs in this field.

Background: The effect of electromagnetic field (EMF) as an environmental factor on different organs including female reproductive system is of critical concern. The aim of the present study is to evaluate the effect of low-frequency (LF)-EMF on oocyte differentiation and follicular development. Materials and Methods: The experiment was carried out in animal lab of Faculty of Medicine Tabriz University of Medical Sciences. For this purpose, the BALB/c mice were divided into control and experimental group in animal lab. The pregnant mice in the experimental group were exposed to 3 mT EMF field, 4 h/day during the pregnancy period. The LF-EMF was produced by a system using 50 Hz alternative current, in the control group the pregnant mice were kept in a similar condition without exposure to EMF. The neonatal mice from both groups were sacrificed immediately after birth and their ovary was dissected apart and prepared for light and electron microscopy. Result : Microscopy revealed that in the experimental group, in comparison to control group, oocyte nests were mostly broken and irregularly arranged. The primordial follicles were less developed and nuclei of oocytes with an electron microscope appeared heterochromatic, shrunken and had vacuolated cytoplasm. Conclusion: It is concluded that exposure to EMF during the developmental period could affect both oocyte differentiation and folliculogenesis and may result in reduced fertility, by decreasing ovarian reservoir.

Background : Human papilloma virus (HPV) DNA has been detected in breast carcinoma by different laboratorial techniques, suggesting that the virus could play a role in the pathogenesis of this tumor. Materials and Methods: It was a descriptive study. Systematic random sampling was used for selecting 55 cases of breast cancer and 51 controls of benign breast lesions from the file of Seyedshohada hospital of Isfahan since 2005-2009. A total of 106 paraffin-embedded specimens were selected and HPV DNA was analyzed by polymerase chain reaction and sequenced for different types of HPV in case of positivity for HPV DNA. Data analysis was performed by SPSS 16 software using descriptive statistic, Chi-square, and Fisher's exact tests. Results: Out of 55 malignant and 51 benign breast specimens, 18.2% (10) and 13.7% (7) were positive to HPV DNA, respectively ( P = 0.53); 70% (7) malignant and 43% (3) benign breast specimens were positive to high-risk HPV genotypes. In malignant specimens, the most common high- and low-risk genotypes were HPV-16 (3.6%) and HPV-11 (3.6%), respectively. In benign specimens, the most common high- and low-risk genotypes were HPV-31 (3.9%) and HPV-43 (3.9%), respectively. Among malignant and benign specimens, ductal carcinoma and fibro adenoma were the most common lesions positive to different types of HPV, respectively. Conclusion: This study demonstrated the presence of HPV genome in both malignant and benign tumor tissues in women with breast lesions in Isfahan; therefore, further larger epidemiologic studies need to be analyzed to establish the exact role of this virus in the pathogenesis of breast cancer.

Background: Proximal spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disease characterized by symmetrical proximal muscle weakness and atrophy. According to the severity of the disease and the age of onset, SMA can be divided into three groups. The survival motor neuron (SMN) gene that is located on 5q13 is identified as the disease determining gene. Another gene in this region is neuronal apoptosis inhibitory protein (NAIP), and its functional role in the pathogenesis of SMA has not been fully elucidated. Here, we investigated the correlation between deletions in SMN and NAIP genes with clinical features of SMA patients. Materials and Methods: In the current study, 71 unrelated Iranian patients were investigated for the detection of deletions in SMN1 and NAIP genes. Polymerase chain reaction (PCR) was used to detect the deletions of exon 4 and 5 of the NAIP gene. Deletions in exon 7 and 8 of SMN1 gene were detected by RFLP-PCR with DraI and DdeI, respectively. Results: Our results showed that 51 patients have homozygous deletions in SMN1 and/or NAIP genes. Among these 51 patients, deletion in NAIP gene were found in 35 patients (65.7% of type I, 22.5% type II and 11.42% type III). Conclusion: Defect in SMN1 gene plays a major role in manifesting of the disease and NAIP (4 and 5) gene acts as a modifying factor in severity of symptoms. Correlation between NAIP gene defect and severity of the disease is confirmed. However, the exact role of NAIP gene in SMA has yet to be fully clarified.

Background: The aim of this study was to assess the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) and their associated risk factors among hemodialysis patients in Isfahan, Iran in 2011. Materials and Methods : In this cross-sectional study, a total of 499 chronic hemodialysis patients from eight governmental hemodialysis centers were tested. Demographic information, time duration on hemodialysis, history of blood transfusion, and the number of transfused blood units as risk factors to HBV and HCV infections were calculated. The status of HBsAg and anti-HCV was assessed by serological testing. Results: The overall prevalence of HBV-positive and HCV-positive among study population was 1.2% and 5.2%, respectively. Age, sex, and time duration on hemodialysis were not statistically significant in HBV- and HCV-patients compared with other hemodialysis patients (P0 > 0.05). History of blood transfusion and the number of transfused blood units in HBV infected patients were similar to other patients (P > 0.05). The main risk factors in hemodialysis patients infected by HCV were history of blood transfusion and the number of transfused blood units (P < 0.0001). Conclusion: In conclusion, the prevalence of HBV and HCV infections in hemodialysis centers in Isfahan is lower than in some other cities of Iran. History of blood transfusion and the number of blood units transfused might be a risk factor for HCV gaining. However, further studies are needed to assess the role of other demographic and clinical risk factors in these patients.

Background: The Duchenne muscular dystrophy (DMD) gene is located in the short arm of the X chromosome (Xp21). It spans 2.4 Mb of the human genomic DNA and is composed of 79 exons. Mutations in the Dystrophin gene result in DMD and Becker muscular dystrophy. In this study, the efficiency of multiplex ligation-dependent probe amplification (MLPA) over multiplex polymerase chain reaction (PCR) assays in an Iranian population was investigated. Materials and Methods: Multiplex PCR assays and MLPA analysis were carried out in 74 patients affected with DMD. Results: Multiplex PCR detected deletions in 51% of the patients with DMD. MLPA analysis could determine all the deletions detected by the multiplex PCR. Additionally, MLPA was able to identify one more deletion and duplication in patients without detectable mutations by multiplex PCR. Moreover, MLPA precisely determined the exact size of the deletions. Conclusion: Although MLPA analysis is more sensitive for detection of deletions and duplications in the dystrophin gene, multiplex PCR might be used for the initial analysis of the boys affected with DMD in the Iranian population as it was able to detect 95% of the rearrangements in patients with DMD.

Background: Gene expression of Gama-Aminobutyric acid (GABA _A ) receptor subunits may change during development. Procedures in molecular biology are required to understand the gene expression profile GABA _A R in chicken. The outcome of the results depends on good-quality high-molecular-weight RNA. Several procedures can be used to isolate RNA from the brain of chicken; however, most of them are time-consuming and require disruption of cells or freeze and thaw in the presence of RNase inhibitors. The aim of this experiment was isolation of RNA from chicken embryonic brain tissues using appropriate RNA extraction kit. Materials and Methods: Fertilized eggs from Ross breed (Gallus gallus) were incubated at 38°C and 60% relative humidity in a forced-draft incubator and were turned every 3 h. After 3, 7, 14 and 20 days of incubation, eggs were cooled on ice to induce deep anesthesia. Then whole brains were dissected out. As brains could not be excised in a reproducible way from earlier embryos (embryonic days 4 and 6), whole heads were collected. Chicken embryos between day 7 to 20 and 1 day after birth were decapitated, and their brains removed. Samples were immediately inserted into lysis buffer and stored at −70°C. Total RNA was isolated and a contaminating genomic deoxyribonucleic acid (DNA) was digested. RNA quality was checked using gel electrophoresis. Results: We obtained 52 mg/ml to 745 mg/ml with A260/280 1.7-2.2. Only high-quality RNA, with no signs of degradation, was used for further experiments. Conclusion: In conclusion, protocol was found to be suitable for the isolation of total RNA from embryonic chicken cells.

Background : Invasive pulmonary aspergillosis (IPA) is an important infection in critically ill patients including patients of intensive care units (ICU). Different diagnostic tools are available and since its mortality is high, it is vital to start the antifungal therapy as soon as possible. Knowing the epidemiology of this disease in each ICU and area will help to better and more rapid management of such patients. The aim of this study is to determine the frequency of IPA based on the level of galactomannan in bronchoalveolar lavage fluid in ICU of Al-Zahra hospital, Isfahan, Iran. Materials and Methods : This was a cross sectional study, which was conducted in Al-Zahra hospital, Isfahan, Iran, between 2010 to 2011. The study population was all the patients admitted to ICU and were suspected to have invasive Aspergillus spp pneumonia. The level of galactomannan in bronchoalveolar lavage was measured and demographic data were gathered by the questionnaire. Results : The frequency of IPA in this study was calculated as 2.43% while galactomannan level in bronchoalveolar lavage fluid of this patient (2.50) was significantly higher than others (0.03 ± 0.02). Conclusion : Larger studies are required to determine the exact frequency of IPA and the best antifungal therapy for it.

Background: The aim of the present study was to determine the optimum cut-off point of urine and serum neutrophil gelatinase-associated lipocalin (NGAL) for the predictive diagnosis of acute kidney injury (AKI). Materials and Methods: This study was a prospective observational study which was performed at Alzahra hospital and Emam Hussein Hospital, Isfahan, Iran. During a period of 4 months, from February 2012 to May 2012, consecutive patients admitted to pediatric intensive care unit (PICU) aged between 1 month and 15 years with glomerular filtration rate (GFR) more than 90 ml/min were enrolled in the study. In all the patients who were enrolled in the study, blood and urine samples were attained on the first, third, and fifth day of admission. Serum and urine NGAL were assessed and compared between patients who developed AKI and who didn't. Results: Of 25 patients who enrolled in the study, 13 developed AKI. For the serum NGAL, the most accurate cut-off point was the fifth day cut-off point which was 163 375 pg/ml (sensitivity: 61.5%, specificity: 94.6%, AUC: 0.76) and urine NGAL cut-off point was 86 040 pg/ml (sensitivity: 50%, specificity: 92.5%, AUC: 0.73). Conclusions: In conclusion, we deduced that serum NGAL level significantly elevates in critically ill patients admitted in PICU who develop AKI. Serum and urine NGAL on the fifth day are the best predictors for the AKI with cut-off points 163 375 and 86 040.

Background : Apolipoprotein E (ApoE) is one of the most important carriers of lipids in mammalians. The gene for this lipoprotein (ApoE) is located on chromosome 19 which is related with the pathogenesis of some nervous system disease. ApoE gene is identified as a high guanine-cytosine (GC) content fragment. Detection and amplification of these templates are extensively laborious and baffling. The aim of this study was to find a practical and feasible method for the amplification of the number of GC rich genes such as ApoE. Materials and Methods: We experimented with simple polymerase chain reaction (PCR), nested PCR and PCR with 1-2 propanediol, dimethylsulfoxide (DMSO), and ethyleneglicol as additive substances to enhance the amplification ApoE gene and used the 40 samples of the human whole blood were collected in test tubes with a pre-treatment of ethylene diaminetetraacetic acid. Results: According to our observations, presence of 1-2 propanediol, DMSO, and ethyleneglicol as additive substances resulted to enhanced amplification of ApoE gene. Addition of 1-2 propanediol showed the best results, caused optimization and revealed more specific and sharp bands. Conclusion: According to our findings 1-2 propanediol are the best organic reagent for improving the amplification of ApoE gene. Optimization procedure for each GC rich sequence is recommended to be performed separately in order to identify which of the additive agent is more efficient and applicable for a particular target.

Background: Postanesthetic shivering (PAS) is an accompanying part of general anesthesia with different unpleasant and stressful complications. Considering the importance of proper prevention of PAS in order to reduce its related adverse complications in patients undergoing surgery, in this study, we investigated the effect of orally administrated tramadol in the prevention of this common complication of general anesthesia. Materials and Methods: In this prospective randomized double-blind clinical trial, 80 ASA I and II patients aged 15-70 years, scheduled for elective surgery under general anesthesia, were randomized to intervention (oral tramadol 50 mg) and placebo groups. PAS was evaluated during surgery and in the recovery room, and compared in the two study groups. Results: PAS was seen in 5 patients (12.5%) in the intervention group and 10 patients (25%) in the placebo group (P = 0.12). The prevalence of grade III and IV shivering was 7.5% (3/40) and 25% (10/40) in tramadol and placebo groups, respectively (P = 0.03). Conclusion: The overall prevalence of PAS was not significantly different in the two study groups, but the higher grades of shivering which needed treatment were significantly lower in the tramadol group than in the placebo, and those patients who received tramadol experienced milder form of shivering. It is suggested that higher doses of tramadol would have better anti-shivering as well as analgesic effects. Studying different doses of tramadol would be helpful in this regard.

Background: MicroRNAs (miRNAs) are endogenous non-coding RNAs, 19-25 nucleotides in length, involved in post-transcriptional regulation of gene expression in a considerable majority of mRNAs. Different aspects of cellular activities like cell growth, proliferation, and differentiation are regulated by miRNAs through their regulatory effects on particular RNA species. In many tumors, up- or down-regulation of different miRNAs has been reported. In acute myeloid leukemia, up-regulation of miR-92a has been reported in human in-vitro studies. Materials and Methods: We performed inhibition of miR-92a in an acute promyelocytic leukemia cell line (HL-60), using locked nucleic acid (LNA) Antagomir. At different time points after LNA-anti-miR92a transfection, qRT-Real-Time-polymerase chain reaction (PCR) and Annexin-V/Propidium Iodide staining were performed and the data was analyzed using the Kruskal-Wallis and Mann-Whitney tests. Results: The assessment of the apoptosis and necrosis indicates that miR-92a inhibition can decrease the viable HL-60 cells and this is at least partially due to induction of apoptosis. Conclusion: These findings suggest the inhibition of miR-92a as a novel approach for treatment of Acute Promyelocytic Leukemia (APL).

Background: Cardiovascular diseases are the highest ranking cause of mortality. The prevalence of cardiovascular diseases is increasing among people in developed and developing countries. Since left ventricular hypertrophy is one of the risk factors leading to extremely dangerous heart diseases and even sudden death at early ages, investigating its contributing factors can be beneficial. The purpose of this study was to determine factors contributing to left ventricular hypertrophy in students aged 7-18 years in Isfahan. Statistical population of this case-control study was the 7-18 year old students in Isfahan, who were studied in two groups of children with premature myocardial infarction in their parents and the control group. Materials and Methods : After determining the sample size of 138 people, a two-part questionnaire was designed and demographic characteristics and anthropometric measures were recorded in students' profiles. The obtained information was analyzed using SPSS ₁₅ software and logistic regression model and the results were reported at P < 0.05 . Result : The results showed that among the studied variables, gender, age, body mass index, and blood pressure were associated with the left ventricular hypertrophy. Conclusion: Considering the results and previous studies in this field, it was observed that left ventricular hypertrophy exists at early ages, which is very dangerous and can lead to heart diseases at early ages. Factors such as being overweight, having high blood pressure, and being male cause left ventricular hypertrophy and lead to undiagnosable heart diseases.

Background: Alzheimer's disease (AD) is a neurodegenerative disease with atrophic changes in the temporal lobe. Enlargement of cerebrospinal fluid (CSF) spaces, hippocampal sulcus (HS) enlargement, or an increase in the number or size of hippocampal cavities (HCs) could be associated with medial temporal lobe atrophy (MTA). In this study, we assessed the relation of these CSF spaces with AD. Materials and Methods: A total 36 demented patients with diagnosis of Alzheimer (Mini-Mental State Examination (MMSE) ≤25) and 36 non-demented elderly individuals were referred for basic magnetic resonance imaging (MRI) before initiating anti-dementia therapy in the demented group. Two observers assessed the maximal HS width, as well as the occurrence, number, and size of HCs, and the visual rating score of MTA on magnified coronal high-resolution T1-weighted MR images. Results : The findings of our study indicate that the presence of hippocampal cavity (HC) (especially in the left side) and medial temporal lobe atrophy in demented patients was significantly higher in comparison with non-demented elderly subjects ( P ≤ 0.05). There was a significant relationship between MTA and HS width ( P = 0.003, r = 0.00323), and it also had a trend to be significant with size of HCs ( P = 0.08, r = 0.00314). A correlation between MTA and number of HCs was not detected. Conclusion : HS width is associated with MTA in patients with AD. It may serve as a measure to evaluate MTA for identifying individuals at particularly high risk for Alzheimer progression, and could be employed for selecting subjects for clinical trials or for treatment decisions.

Background: Malnutrition is common among patients with inflammatory bowel disease. The present study aimed to investigate the nutritional status of ulcerative colitis (UC) patients in Isfahan, Iran. Materials and Methods: In this descriptive analytical cross-sectional study, between Dec 2011 and Jun 2012, 99 patients with UC were randomly selected and evaluated. Age, sex, duration of disease, body mass index (BMI) and laboratory parameters recorded for all patients. Nutritional risk index (NRI) was calculated and its association with patients' variables was assessed with regard to UC disease severity. Results: Twelve patients out of 99 patients had mild UC and 87 patients had moderate to severe UC. Based on the NRI, 90.9% were not malnourished and 9.1% were at moderate to severe risk for malnutrition. Among laboratory parameters only, serum potassium level in patients with moderate to severe UC was significantly higher than those with mild UC (P = 0.017). Other laboratory parameters were similar between patients stratified by US status. Patients age s significantly correlate with serum vitamin D, immunoglobulin a (IgA) and potassium level (P > 0.05), also duration of disease was significantly correlate with Phosphorus (P = 0.024) among laboratory parameters. Conclusion: In studied UC patients, malnutrition risk was based on degree of disease severity. Patients with moderate to severe UC were more at risk for malnutrition compared to the patients with mild UC. Furthermore, among laboratory parameters only serum potassium level was higher among patients with moderate to severe UC compared to others.

Background: Water purification processes include the use of chemical compounds despite the concern that they may induce diseases. An ecological solution to this dilemma can come from the use of plant seeds for this purpose. Moringa peregrina (Forssk.) Fiori seeds have water clarification ability. Therefore, the aim of this work was to look for certain water clarification genes in M. peregrina. Materials and Methods: After preparation of M. peregrina callus, mRNA was extracted from these cells. After application of reverse transcriptase, the obtained cDNA (s) were used for PCR amplification of the desired genes using primers based on MO _2.1 gene of Moringa oleifera. DNA amplification products were cloned in E. coli Xl ₁ blue cells and DNA sequences were compared with Mo _1,2 gene in M. oleifera. Results: We obtained 3 PCR products (approximately 200, 300, and 400 bps). Conclusion: After comparison of the sequences of 300bp band obtained from M. peregrina with Mo _1,2 gene in M. oleifera, it seems that 300bp band is a good candidate to investigate regarding its potential flocculent activity.

Background: To compare two methods of tympanic membrane (TM) grafting when graft materials medial or lateral to malleus, this study have been done. Materials and Methods: In this clinical trial which was conducted in Alzahra and Kashani hospitals, between June 2010 and February 2012, 56 patients with chronic otitis media and perforated TM entered the study in two groups. The inclusion criteria consisted of patients who were at least 15-years-old without history of smoking, diabetes mellitus or autoimmune disease. Exclusion criteria of the study: No compliance for follow up, post-surgical ear trauma or any infective pathology that directly affects the ear. In Group A patients, the graft material is pierced in near central part of the graft and they lodged so that the malleus handle projects through the graft perforation. Group B had grafting in the lateral side of the malleus. Three month after surgery both groups examined and tested by audiometry. Success of surgery is defined as complete repair of TM, without lateralization, atelectasis, blunting or retraction pocket. Results: This study contained 28 patients in Group A and 28 in Group B. Overall success rate was 94.64% that was 96.42% in Group A, and 92.85% in Group B. Differences of air-bone gap in each group before and after surgery was 16.10 (±4.89) in Group A, and 15.78 (±3.40) in Group B. Improvement of hearing level was not significant between two surgical methods (P = 0.442). Conclusions: Both techniques (medial and lateral to malleus handle) of TM grafting are effective with success rates 96.42% and 92.85% respectively.

Background: Many aspects of epidemiological and clinicopathological features of gestational trophoblastic disease (GTD), one of the important subject in gynecology oncology, needs to be defined so as to recommend the best approach and management toward it. In the present study, we evaluated 10-years incidence of throphoblastic diseases in north east of Iran in prospective epidemiological and clinicopathological study. Materials and Methods:We reviewed the registered histopathology database archive (120 records) related to throphoblastic diseases of the Ghaem Hospital, Mashhad University of Medical Sciences from 2001 to 2010. Results:Evaluation of the pathological reports revealed 5 (4.2%) choriocarcinom and 115 (95.8%) of hydatidiform mole (HM), with complete and partial HM diagnosis in 29 (25.2%) and 86 (74.8%) patients, respectively. The pregnancy rate of HM patients (2.72 ± 1.86) and choriocarcinoma patients (3.56 ± 2.8) was not significantly different ( P = 0.61). There was no statistical significant difference between the number of pregnancies in HM (2.90 ± 3.13) and choriocarcinoma (3.84 ± 3.80) patients ( P = 0.46). The ratio of complete to partial mole increased with age, although this correlation was not significant. Most patients in both the groups had no history of abortion. O positive was the predominant blood group among the studied patients. Conclusion:Throphoblastic diseases occur during the fertility age mostly, and there is an increased risk with more previous pregnancies; ultrasound sonography is a useful method for primary diagnosis of this disease. Further pathological studies are needed to define the mole type.

Background: The Autologous Chondrocytes Transplantation (ACT) method is being studied for repair of cartilage diseases. As the chondrocytes dedifferentiated during monolayer culture, three-dimensional cultures are suggested to redifferentiate them. The aim of this study was investigation of the effect of TGF-β3 growth factor on chondrocytes in pellet culture system. Materials and Methods: The chondrocytes were isolated from three human articular cartilages by enzymatic digestion. The cells of the second passage were transferred to pellet culture system. We determined the chondrogenic medium with TGF-β3 as the experimental group and without it as the control group. After 2 weeks, the aggrecan production was investigated using histological and immunohistochemical (IHC) methods. Results: The presence of glycosaminoglycans was proved through Toluiden blue staining. Comparison of IHC results using MATLAB software showed that aggrecan in the experimental group was significantly higher than in the control group (P ≤ 0.05). Conclusion: The presence of TGF-β3 in the chondrogenic medium could lead to the production of more aggrecan in chondrocytes cultivated in pellet culture system.

Background: Heparin is one of the most important medication that is used in coronary artery bypass graft (CABG) operations, but some patients demonstrate heparin resistance (HR) during CABG. Heparin resistance was defined as at least one activated clothing time <400 seconds after heparinization and/or the need for purified antithrombin III (AT-III) administration. The goal of this study was the investigation of HR prevalence in our country and relation between HR and post-operative CABG complications. Materials and Methods: One hundred patients that candidate for CABG were selected and surveyed for HR and complications. The data entered to computer and analyzed by SPSS soft ware. The Chi-square and student t-tests were used for data analysis. Results: The prevalence of heparin resistance in our study was 3%. There was no relation among bleeding, cardiac arrest and HR. Bleeding happened in 13 patients of which 1 person was in HR group (33.3%) and 12 in non HR group (12.4%) ( P = 0.34). Cardiac arrest happened in 8 patients, 1 person was in HR group (33.3%) and 7 in non HR group (7.2%) ( P = 0.22). According our data there were no relation among HR and gender and ventilator dependency time. Conclusions: HR is a nearly prevalent complication among patients that undergone CABG that may led to some complications such as bleeding and cardiac arrest. In our study, we did not find significant relation among them, but in frequency these complications were higher in HR group.

Background: Ventilator associated pneumonia (VAP) are one of the most common nosocomial infections in intensive care unit (ICU). The ICU patients are at risk of stress ulcer and gastrointestinal bleeding for different reasons. In order to prevent this complication, anti acids are used for patients. This study compared pantoprazole with sucralfate in incidence of ventilator associated pneumonia. Materials and Methods: This randomized clinical trial was carried out on ICU patients with mechanical ventilation in Alzahra university hospital in Isfahan from 2010 to 2011. One hundred forty eight ventilated patients were randomly allocated in two groups. The first group was treated with sucralfate and the second group was treated with pantoprazole for stress ulcer prophylaxis and followed up during hospitalization in ICU for nosocomial pneumonia. Data analyzed by SPSS software. Results: One hundred thirty seven patients were selected for study. During the study period, 34 cases (24.8%) acquired pneumonia, of which 10 were in the sucralfate group and 24 were in the pantoprazole group (14.1% vs. 36.4%). According to Chi-square test, rate of pneumonia was significantly lower in patients receiving sucralfate than the pantoprazole group ( P < 0.001). Conclusion: On the basis of the results, there is a significant relationship between the kind of drug used for stress ulcer and ventilator associated pneumonia. According to this article, rate of pneumonia was significantly lower in patients receiving sucralfate than the pantoprazole group.

Background: Due to the anatomical variations of the paranasal sinuses and its great importance in sinus surgery, as this area is in very close proximity to vital structures including the optic nerve, carotid artery, and skull base, anatomical knowledge of this area is of high importance. The purpose of this study is defining a full and clear impression of paranasal sinus anatomy and its variations as a model for the human population of the country. Materials and Methods: This study was conducted on 45 cadavers in Isfahan forensic Medicine center during 2010 to 2011. Nasal and paranasal sinuses endoscopic dissection was done with (zero and 30 ^o ) lenses (Olympus). The methods of performed dissection were via the Stamberger technique. Results: This study showed that 88.9% (40 cases) of middle turbinates were in a typical form, while 6.7% (3 cases) were in medial and only 4.4% (2 cases) were in the lateral form. We also observed 88.9% (40 cases) with Agger nasi cells, 37.8% (17 cases) with Onodi cells, 28.9% cases with accessory Ostia of maxillary sinus (13 cases), and 15.6% of the cases (7 cases) with concha bullosa. The position of the maxillary sinus ostium was as follows. The inferior 1/3 of hiatus semilunaris in 38 (84.5%), superior 1/3 of hiatus semilunaris in 4 (4.4%), middle 1/3 of hiatus semilunaris in 5 (11.1%). The sphenoid ostia in 53.3% (24 cases) were slit shape, 28.9% (13 cases) oval, and 17.8% (18 cases) were round shape. Conclusion : Our survey showed that the distance between anterior nasal spine and anterior wall of the sphenoid sinus was within 7.6 ± 0.2 cm SD.

Background: Medical students spend most of their time in hospital wards and it is necessary to study clinical educational opportunities. This study was aimed to explore faculty members' experience on Ward Round Teaching content. Methods and Materials: This qualitative study was conducted by purposive sampling with the maximum variation of major clinical departments faculty members in Isfahan University of Medical Sciences (n = 9). Data gathering was based on deep and semi-structured interviews. Data gathering continued till data saturation.Data was analyzed through the Collaizzi method and validated. Strategies to ensure trustworthiness of data (credibility, dependability, conformability, transferability) were employed (Guba and Lincoln). Results: Basic codes extracted from the analyzed data were categorized into two main themes and related subthemes, including (1) tangible teachings (analytic intelligence, technical intelligence, legal duties) and (2) implied teachings (professionalism, professional discipline, professional difficulties). Conclusion: Ward round teaching is a valuable opportunity for learners to learn not only patient care aspects but also ethical values. By appropriate planning, opportunities can be used to teach capabilities that are expected of general practitioners.

Background: Numerous associated injuries (bony and/or soft tissue lesions) occur commonly in conjunction with fractures of the femoral shaft in young patients after high-energy injuries. Knee ligamentous injuries, historically called as the internal derangements of the knee or IDK, are mostly not visible in plain radiographs taken in the emergency and these injuries are likely to be overlooked by clinicians because first attention always goes to open wounds and radiologically visible injuries of the limb whenever a patient is received in a trauma unit. Materials and Methods: A total of 93 cases of lower limb long bone fractures were retrospectively analyzed from materials of a prospective study conducted on consecutive patients having high-velocity injuries to lower limb long bones with a view to confirm or rule out concomitant ipsilateral IDK in cases of femoral and tibial shaft fractures, that already employed a policy of focused clinical examination followed by arthroscopy of the ipsilateral knee, immediately after operative fracture fixation under the same anesthesia. The goal was to determine the incidence of concomitant internal derangement of the ipsilateral knee and to understand any value of adding arthroscopy to detect concomitant IDK in lower limb long bone fractures besides careful intraoperative examination to propose a recommendation thereof. Results: Concomitant knee injury was found in 14 femoral fractures and 1 tibial fracture. Fifteen out of 93 (16%) such cases had concomitant knee ligamentous or meniscal injures. A total of 13 anterior cruciate and 4 posterior cruciate tears, 11 collateral ligament tears, and 10 meniscal injuries were confirmed in these 15 knees. Femoral shaft fractures were associated with a high incidence of serious ligamentous, meniscal, and chondral injury. Twelve out of 41 femoral fractures had chondral injuries (contusion), especially of the patello-femoral articulation, identifiable during arthroscopy. Conclusion: One should have high index of suspicion about internal knee injuries and capsule-ligamentous injuries while dealing with femoral shaft fractures in particular. Arthroscopy of knee may safely enhance the diagnosis of simultaneous IDK. We propose that when MR imaging is not possible and when contraindication for arthroscopy does not exist, a careful clinical examination followed by arthroscopy of the knee may be considered a useful adjunct in femoral shaft fractures as it can readily confirm IDK by its ability to objectively look, probe, and distinguish fragile tissue from a normal one. Further study in larger number of subjects is needed to validate our findings.

Background: It is believed that the Helicobacter pylori (H. pylori) vacA gene, as a major virulence determinant (One of the major virulence determinant, not major), may be a risk factor for the development of gastroduodenal diseases. The frequency of vacA genotypes varies in different human populations. This study evaluated the prevalence of vacA alleles/genotypes among dyspeptic patients in Isfahan. Materials and Methods: One-hundred H. pylori-positive adult patients were examined in this study. After culture of gastric biopsies and DNA extraction from individual H. pylori isolates, the (all H. pylori strains harbor vacA alleles, please replace "presence" with "genotypes") of the vacA s and m alleles were determined using polymerase chain reaction (PCR). Results: There were four vacA mosaicisms, including 28 for s1a/m1 (28%), 23 for s1b/m1 (23%), 26 for s1a/m2 (26%) and 23 for s1b/m2 (23%). The s2 allele was not found. The predominant vacA genotype in patients with non-ulcer dyspepsia and duodenal ulcer was s1a/m2, whereas in patients with adenocarcinoma was s1a/m1. Conclusion: The results showed there was no significant correlation between different genotypes of the vacA and the clinical outcomes and appears to vacA genotypes were not useful determinants for gastrointestinal diseases in our area.

Background: Metoclopromide have local anesthetic properties. The main object of performing the present study was to evaluate the analgesic effect of metoclopromide 10 mg when added to lidocaine for intravenous regional anesthesia (IVRA) of upper extremities in trauma patients. Materials and Methods: Ninety patients undergoing upper limb producer were randomly allocated to the three groups to receive 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 ml (Group L, n = 30) or 10 mg metoclopromide plus 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 ml (group LM, n = 30 ) or 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 ml plus 10 mg metoclopromide intravenously (Group IM, n = 30). Results: Our study showed that the onset times for sensory and motor block were significantly shorter in Group LM compared with Group L and Group IM (4.5 ± 0.7 vs. 5.0 ± 0.7 and 5.0 ± 0.6, respectively, P = 0.006 for sensory block; 6.3 ± 0.7 vs. 5.1 ± 0.9 and 5.9 ± 0.6 respectively, P = 0.000 for motor block). The postoperative VAS scores were significantly less at 1, 5, 10, 15, and 30 minutes after tourniquet release in Group LM compared with Group L and Group IM ( P < 0.05). Conclusion: The results of our study showed that adding 10 mg metoclopromide to lidocaine for IVRG in trauma patients reduced intraoperative and postoperative analgesic use till 24 hours and improve quality of anesthesia.

Background: This study was conducted to determine the effect of nurses' workplace on burnout syndrome among nurses working in Isfahan's Alzahra Hospital as a reference and typical university affiliated hospital, in 2010. Materials and Methods: In this cross-sectional study, 100 nurses were randomly selected among those working in emergency, orthopedic, dialysis wards and intensive care unit (ICU). Required data on determination of occupational burnout rate among the nurses of these wards were collected using Maslach Burnout Inventory (MBI) standard and validated questionnaire. Nurses were selected using simple random sampling. Results: The multivariate ANOVA analysis showed that occupational burnout mean values of nurses working in orthopedic and dialysis wards were significantly less than those of nurses working in emergency ward and ICU (P0 = 0.01). There was also no significant difference between occupational burnout mean values of nurses working in emergency ward and ICU ( P > 0.05). t-test showed that there was a difference between occupational burnout values of men and women, as these values for women were higher than those of men (P = 0.001). Conclusion: Results showed that occupational burnout mean values of nurses working in emergency ward and ICU were significantly more than those of nurses working in orthopedic and dialysis wards.

Background: Previous studies suggest a possible association between ABO blood group and the risk of breast cancer. The aim of this study is to investigate the presence of a possible association between breast cancer and blood groups ABO and Rh. Materials and Methods: 549 women including 173 cases and 376 controls were selected. The case group included patients with breast cancer and the cancer diagnosis was confirmed for all of them. The control group included women with no reports of breast cancer. Blood group sampling of all cases was performed. The obtained information regarding presence or absence of cancer, blood type, age group and type of cancer were analyzed. Results: There is no significant association between blood types ABO (Rh) and the breast cancer. ( P > 0.05) It has been found that the prevalence of invasive intraductal carcinoma was 85% among the cases. About 5% of the total diagnosed cancers in the case group were allocated to modularly carcinoma, invasive lobular carcinoma and Paget's disease. There was no relative frequency in specific blood group for these three types of cancer. The blood types ABO (Rh) and breast cancer type showed no significant relation (P = 0.2). Conclusion: According to the obtained results from this study, there was no relative frequency in specific blood group for these three types of cancer and the blood type could not be influenced as a risk factor in breast cancer.

Background: Hypercholesterolemia that can increase stress oxidative has destructive effects on brain functions. Vitamin E is a powerful antioxidant and its effects on decrement of oxidative stress in the diseases such as Alzheimer's and hypercholesterolemia are demonstrated. The aim of this study was evaluation of the effects of vitamin E on the level of neuronal apoptosis in granular layer of dentate gyrus in the rabbits that fed with high-cholesterol diet. Materials and Methods: Male New Zealand white rabbits were divided into the control, the Vitamin E (50 mg/kg; gavage), the high-cholesterol diet (containing 2% cholesterol), and the high-cholesterol diet-vitamin E groups. Serum levels of cholesterol, LDL, and HDL, before and after the regimen for 6 weeks, were measured. Then, the rabbits for immunohistochemical staining (TUNEL Test) and evaluation of neuronal apoptosis in dentate gyrus of hippocampal formation were anesthetized and brains were dissected. Results: Results showed that after the regimens, serum levels of cholesterol, LDL, and HDL in the cholesterol receiving groups were increased significantly (P < 0.05). Histological results demonstrated that neuronal apoptosis in the dentate gyrus of the high-cholesterol diet group was increased significantly (P < 0.05) comparing to the control group; however, vitamin E decreased apoptosis as there wasn't any significant differences between the high-cholesterol diet-vitamin E and control groups. Conclusions: Present results showed that consumption of high-cholesterol diets through hypercholesterolemia and its complication can induce neuronal death in hippocampus and probable resulting cognition disorders; however, vitamin E has neuroprotective effects and prevents neuronal apoptosis significantly.

Background: Toll-like receptor-5 (TLR-5) is a member of TLRs family and responsible for bacterial flagellin recognition. The activation of TLR-5 with flagellin leads to initiation of signaling cascades, which in turn results in transcription of pro-inflammatory cytokines. Regarding the critical role of TLR-5 agonists and antagonists in activation of innate immune responses, an increasing number of studies have focused on their therapeutic applications in drug and vaccine design. In this study, to identify the most critical region and residues of TLR-5 for interaction with flagellin, different truncated forms of TLR-5 were designed and subjected to protein-protein interaction studies. Materials and Methods: The interactions of the full native TLR-5 and its truncated forms with bacterial flagellin (FliC) were evaluated using Hex docking server and molecular interaction analysis was performed using Dimplot analysis. Results: According to our in silico results, truncated form C (an amino acid sequence containing residues 174-401 of TLR-5) has the most suitable interaction with FliC and seven amino acids within this region were found to be crucial for the interaction with flagellin. Conclusions: These results provide new insights in to potential drug target sites of TLR-5, which may guide future TLR-5 targeting studies.

Background: Carbon nanotubes (CNTs) have a large variety of applications in tissue engineering and biomedical devices. The biocompatibility and cytotoxicity of CNTs have been studied widely, however, up until now; there was uncertainty on how nanosized materials behave in the human body and stem cells. The current study describes the functionalized carbon nanotubes on adipose-derived stem cells (ADSCs) for viability and proliferation purposes in vitro. Materials and Methods: After chemical modification of the CNTs, the ADSCs were cultured in Dulbecco's Modified Eagle's. Medium (DMEM) having doses of 0.1, 1, 10, 20, 50, and 100 μg/ml of CNTs. On the third and seventh days of the experiment, the cellular viability, proliferation, and stemness were determined, using the MTT, trypan Blue, and flow cytometry assays in variable CNTs dosage. Results : In doses of 0.1 and 1 μg/ml, the expression of the surface markers were similar to the control groups on day three, but decreased in higher dosages on day seven. The viability of both groups was the same on day three, but in comparison to the control groups, was found to decrease in the higher dosages on day seven. Conclusion: The effect of CNTs on the viability and proliferation of ADSCs is a function of time and the doses used. Through further investigation by using these particles, we expect that we should be able to increase the viability and proliferation of ADSCs.

Background: It has been shown that plants from the family Rhamnaceae possess anticancer activity. In this study, we sought to determine if Ziziphus spina-christi, a species from this family, has cytotoxic effect on cancer cell lines. Materials and Methods: Using maceration method, different extracts of leaves of Z. spina-christi were prepared. Hexane, chloroform, chloroform-methanol (9:1), methanol-water (7:1) methanol, butanol and water were used for extraction, after preliminary phytochemical analyses were done. The cytotoxic activity of the extracts against Hela and MDA-MB-468 tumor cells was evaluated by MTT assay. Briefly, cells were seeded in microplates and different concentrations of extracts were added. After incubation of cells for 72 h, their viability was evaluated by addition of tetrazolium salt solution. After 3 h medium was aspirated, dimethyl sulfoxide was added and absorbance was determined at 540 nm with an ELISA plate reader. Extracts were considered cytotoxic when more than 50% reduction on cell survival was observed. Results: Hexane, chloroform, chloroform-methanol, butanol, methanol-water and aqueous extracts of Z. spina-christi significantly and concentration-dependently reduced viability of Hela and MAD-MB-468 cells. In the both cell lines, chloroform-methanol extract of Z. spina-christi was more potent than the other extracts. Results: From the finding of this study it can be concluded that Z. spina-christi is a good candidate for further study for new cytotoxic agents.

Background : Appropriate determination of tidal volume (VT) is important for preventing ventilation induced lung injury. We compared hemodynamic and respiratory parameters in two conditions of receiving VTs calculated by using body weight (BW), which was estimated by measured height (HBW) or demi-span based body weight (DBW). Materials and Methods : This controlled-trial was conducted in St. Alzahra Hospital in 2009 on American Society of Anesthesiologists (ASA) I and II, 18-65-years-old patients. Standing height and weight were measured and then height was calculated using demi-span method. BW and VT were calculated with acute respiratory distress syndrome-net formula. Patients were randomized and then crossed to receive ventilation with both calculated VTs for 20 min. Hemodynamic and respiratory parameters were analyzed with SPSS version 20.0 using univariate and multivariate analyses. Results : Forty nine patients were studied. Demi-span based body weight and thus VT (DTV) were lower than Height based body weight and VT (HTV) (P = 0.028), in male patients (P = 0.005). Difference was observed in peak airway pressure (PAP) and airway resistance (AR) changes with higher PAP and AR at 20 min after receiving HTV compared with DTV. Conclusions : Estimated VT based on measured height is higher than that based on demi-span and this difference exists only in females, and this higher VT results higher airway pressures during mechanical ventilation.

Background: Ambiguous genitalia is a hereditary disorder that usually requires early attention and detection. The discovery of ambiguous genitalia in a neonate is situation that could be difficult to manage, not only because of complications such as salt-losing, but also due to the importance of sex determination before psychological gender could be established. Awareness of the prevalence of ambiguous genitalia can affect the attitude and consideration of physicians and related medical personnel about disease in different communities. So in this study, the prevalence of ambiguous genitalia and undescended testes (UDT) in Iran was reported. Materials and Methods: This national study was conducted in 2009-2010 as part of the routine screening examinations at school entry in Iran. The physical examinations were performed for students at entry to three school levels by physicians and medical personnel. Execution and conduction of this program was the duty of the University of Medical Sciences in each province. Results: On average, the prevalence of ambiguous genitalia was 0.04% at national level (0.03%, 0.05%, and 0.03% at 6, 12, and 15 year olds, respectively). The prevalence of ambiguous genitalia was not significantly different according to age group and living area. The average of UDT) prevalence in the whole country was 0.13%. The prevalence of UDT was higher at elementary school level than in the other two levels. Conclusion: Although the prevalence of genitalia abnormalities was not high in the school students in Iran, given the importance of the issue and in order to find the ambiguous genitalia or UDT, medical examinations and parental notification should be taken seriously at an earlier age.

Background: To evaluate the efficacy and side-effects of cyclosporine-A (CsA) in improvement of consciousness and cognitive dysfunction of patients with diffuse axonal injury (DAI) after traumatic brain injury (TBI). Materials and Methods: This study is designed as a randomized double-blind placebo-controlled with 100 patients suffered from DAI. CsA was administered to the intervention group (n = 50) as 5 mg/kg/24 h via 250 ml dextrose water (DW) 5% solution (DW 5%) during the first 8 h after trauma. The control group (n = 50) received only DW 5% in the same course. The presenting Glasgow coma scale in addition to the Glasgow outcome scale-extended (GOS-E) and mini-mental state examination (MMSE) in the 3 ^rd and 6 ^th months after trauma were documented. The serum values for complete blood count (CBC), blood urea nitrogen (BUN), creatinine (Cr), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) were checked to assess for complications. Results: Most patients in both groups had type II DAI (46%). There was no significant difference between groups in the GOS-E scores after 3 and 6 months. All participants were in moderate or severe classes of MMSE with no statistically significant difference. Except for the higher BUN level in the cyclosporine treated group, 48 h after admission (P = 0.012), the difference in the level of Cr, AST, ALT, and ALP was not significant and all were in the normal range. The CBC results showed only significant difference for White Blood Cell (WBC) count at 12 h (P = 0.000). Conclusion: The administration of CsA is not effective in the improvement of consciousness and cognitive function. However, it brings about no adverse effects.

Background: Chromomycin A3 (CMA3) staining is one of the staining methods for detecting protamine deficiency in sperm nucleus. CMA3 is a fluorochrome that competes with protamines for binding to DNA double helix. It has been shown in our previous studies that percentage of CMA3 positive spermatozoa in semen has a close significant relationship with the fertilization rate in in vitro fertilization (IVF). The aim of this study was to examine the ultrastructural differences between sperms in patients who had high fluorescent percentages of yellow or red in CMA3 staining (protamine deficient) with patients with low fluorescent percentages. Materials and Methods: Semen samples are taken from five patients with high fluorescent percentages and five patients with low fluorescent percentages. Then the samples are passed for the different steps of preparing for electron microscopy. After the sectioning and mounting on grids, they are investigated under the transmission electron microscope. Results: Sperms in patients with low percentages of positive spermatozoa often have a normal appearance. Sperms in high fluorescent samples frequently have unpacked chromatin. Furthermore acrosomes of these sperms are thinner or disturbed. Also sometimes there are irregularities in sperm head membrane. Conclusion: Protamine deficiency in sperm nucleus can cause ultrastructural anomalies in sperm chromatin such as unpacking of it. It also is concomitant with acrosome and sperm membrane disturbances.

Background: the aim of this study was to determine the relation between serum and filter paper thyroid-stimulating hormone (TSH) levels in neonates with congenital hypothyroidism (CH). We also tried to determine an appropriate cutoff point of filter TSH for recalling screened neonates. Materials and Methods: in this descriptive-analytic study, records of 2283 neonates who had been recalled during CH screening program in Isfahan (Iran) were studied. The relation between serum and filter paper TSH levels in the studied neonates was assessed and the best cutoff point of filter TSH and its sensitivity and specificity for proper diagnosis of CH were determined. Results: among the studied neonates, 103 (4.5%) were diagnosed with CH. Using receiver operating characteristic (ROC) curve, the best cutoff point for diagnosing CH was 7.5 with a sensitivity of 74.8% and specificity of 71.3%. The rates of false positive and false negative diagnoses at this cutoff point were28.7% and 25.2%, respectively. There was a significant relationship between serum and filter paper TSH levels. Conclusion: the cutoff point for recall should be changed to 7.5 for appropriate screening outcome. On the other hand, considering the low cost of filter paper and importance of missing any case of CH, changing the cutoff point is not necessary. However, further studies in different parts of Iran are required to obtain more accurate results and consider all related factors.

Background: Increased apolipoprotein B100 (apo B) and decreased apolipoprotein A-I (apo A-I) production are important risk factors in atherosclerosis. Urotensin II (UII), as the most potent vasoconstrictor in human, is related with hypertension and probably atherosclerosis. Because of the relationship between the hypertension and lipoprotein metabolism in atherosclerosis, the aim of this study was to test the effect of urotensin II on apo B and apo A-I expression in hepatic (HepG2) cell line. Materials and Methods: HepG2 cells were treated with 10, 50, 100, and 200 nmol/L of urotensin II (n = 6). Relative apo B and apo A-I messenger RNA (mRNA) levels in conditioned media, normalized to glyceraldehyde-3-phosphate dehydrogenase, were measured with quantitative real-time polymerase chain reaction method. In addition, apo B and apo A-I levels were also estimated and compared with the controls using the western blotting method. Data were analyzed statistically by ANOVA and non-parametric tests. Results: The apo B mRNA levels were not increased significantly following the treatment with UII. However, apo B protein levels were increased significantly after the treatment with urotensin II, especially at 100 and 200 nmol/L. The apo A-I mRNA and protein levels in conditioned media also were not significantly changed. However, there was a significant decrease in apo A-I mRNA and protein levels at 200 nM UII. Conclusions: UII might increase apo B at protein level probably through participating factors in its synthesis and/ or stability/degradation. In addition, UII may have decreasing effect at more than 200 nM concentrations on apo A-I.

Background: Considering the higher prevalence of congenital hypothyroidism (CH) in Iran and the importance of determination of the etiology of CH for assessing appropriate treatment strategies, understanding the pathogenesis of CH and the implications of its inheritance and prognosis, the aim of this study was to determine the etiology of CH 7 years after initiation of the program in Isfahan province. Materials and Methods: In this cross-sectional study, children with a primary diagnosis of CH studied. They clinically examined and their medical files were reviewed by a Pediatric Endocrinologist. Considering screening and follow-up lab data and radiologic findings the etiology of CH was determined. Screening properties of different etiologies of CH was compared. Results: In this study, 437 patients with permanent CH (PCH) were studied. Etiology of PCH in 316 (72.3%) and 121 (27.7%) of cases was thyroid dyshormonogenesis and thyroid dysgenesis, respectively. Prevalence of agenesis, ectopia, hypoplasia and hemiagenesis in thyroid dysgenetic patients was 13.3%, 6.4%, 4.3% and 3.7% respectively. Mean of thyroid stimulating hormone in screening, recall and after discontinuing treatment at 3 years of age was significantly lower in dyshormonogenetic CH patients than dysgenetic ones(P < 0.01). Conclusion: Seven years of our experiences in CH screening program indicated that the etiology of CH in Isfahan, with a higher rate of CH, with a predominance of thyroid dyshormonogenesis is different from most of the studies world-wide and similar to other reports from Iran. The findings of the current study provide us baseline information for determination of CH pathogenesis in this region.

Background: In this prospective case series we have assessed the clinical effects of 8 weeks military training on the lower extremity of the recruits. Materials and Methods: Military recruits who met the eligibility criteria and gave informed consent were entered into the study. They were asked to fill out a self-reporting pain and functionality questionnaire before and after their training. They were also examined by a physician before and after their military training. The questionnaire and examination were concentrated on three blocs: lower back, knee, and foot. Results: Three-hundred and seventy-three study subjects were evaluated. The study showed that there is a significant difference in reporting lower back pain after the training compared to the rate of complaints prior to the training (P < 0.001), knee pain, and foot pain also increased significantly (P < 0.1 and P < 0.0001, respectively) The difference was most prominent in foot complaints. Physical examination also showed significant increase in lower extremity findings following the training (P < 0.05). Conclusion: Our study shows that there is a need for a new approach to military training of male recruits in Iran in order to minimize the adverse health effects.

Background: Recent studies have demonstrated that during chronic Helicobacter pylori (H. pylori) infection bone marrow-derived-mesenchymal stem cells (BMD-MSCs) migrate to the gastric tissue and could be also the origin of gastric adenocarcinoma. The chemokine receptor CXCR4 through binding to its ligand stromal-derived factor (SDF-1) plays a crucial role in migration of inflammatory and stem cells. However, the possible effect of H. pylori infection on the SDF-1/CXCR4 axis has not yet been elucidated. Materials and Methods: Gastric epithelial cell line, AGS, and BMD-MSCs were cocultured with H. pylori for 24 h. The expression of CXCR4 was examined in BMD-MSCs by quantitative reverse transcription polymerase chain reaction (qRT-PCR) and flow cytometry, and SDF-1 expression in AGS cells was detected by qRT-PCR and enzyme-linked immunosorbent assay. Further, migration of BMD-MSCs toward SDF-1 was evaluated by chemotaxis assay. Results: We found that coculture of H. pylori with BMD-MSCs or AGS: (i) enhanced CXCR4 expression on the cell surface of BMD-MSCs and (ii) increased SDF-1 secretion by AGS cells. Consistently, we observed that H. pylori-treated BMD-MSCs showed a higher capability to migrate toward SDF-1 gradient compared with untreated cells. Conclusion: We found that H. pylori upregulates CXCR4 expression in BMD-MSCs and enhance their migration toward SDF-1. This study provides the first evidence that H. pylori infection may enhance BMD-MSCs migration through acting on the SDF-1/CXCR4 axis.

Background: The scope of this study was to preserve whole detailed structure of dissected and decalcified bones, taken from used cadavers, by a new plastination technique. Materials and Methods: Specimens we used in this study were sheep femurs and human bones including pelvis, femur, tibia, and fibula. Bones, at first, fixed with 5% formalin and were decalcified with 5% nitric acid, and then were fixed again and washed under the tap water. The resulted flexible bones were dehydrated in -25΀C acetone and degreased them in +25΀C acetone. Then, the experimental and control specimen were placed in the vacuum chamber for forced impregnation with our new flexible unsaturated polyester resin (UP ₈₉ method) and silicon resin (S ₁₀ method), respectively. Finally, the strength and flexibility of plastinated decalcified specimens were investigated by tensometer, and the weight diversity was measured by digital balance. Results: Plastinated bones prepared by this technique were found to be dried, non-fragile, durable, odorless, non-greasy, and demonstrating all detailed structures of the bones. Tensile and weight tests results indicated that plastinated decalcified femurs have owned higher flexibility and strength but lesser weight than plastinated undecalcified femurs. The characteristics of both experimental and control groups of plastinated decalcified specimens were found to have no significant difference. Conclusions: Our synthesized resin found to be much more economical than conventional plastination method. In more details, properties of these new products were the same as, S ₁₀ method, from points of strength, flexibility and weight, but, since the money cost for producing them was about one fifth that of S ₁₀ method.

Background: There are no generally accepted criteria for the ultrasonographic diagnosis and grading of varicocele. We aimed to determine the best position and site for color Doppler ultrasonographic (CDUS) evaluation of the testicular vein to define the clinical grades of varicocele ultrasonographically. Materials and Methods: This study consisted of 103 men (44 normal and 59 with clinical varicocele). First, WHO clinical grade of varicocele was determined by physical examination. Then, the diameter of largest testicular vein at four different sites was measured in both upright and supine positions with or without Valsalva maneuver. Finally, the cut-off points of venous diameter for different clinical grades were determined using the values of the position and sites that had the strongest correlation with the clinical grades. Results: The strongest correlation between venous diameter and clinical grade of varicocele was observed when the venous diameter was measured at the level of epididymal head in the upright position with Valsalva maneuver (r: 0.87, P-value < 0.0001). In aforementioned conditions, venous diameter of 2.35 mm (sensitivity 87%, specificity 87%) can distinguish normal subjects from grade 1 varicocele, venous diameter of 3.15 mm (sensitivity 58%, specificity 70%) can discriminate grade 1 from grade 2, and venous diameter of 3.75 mm (sensitivity 83%, specificity 70%) can differentiate grade 2 from grade 3. Furthermore, venous diameter of 2.65 mm (sensitivity 91%, specificity 89%) can distinguish normal subjects from patients with clinical varicocele. Conclusion: The best position for CDUS examination of patients suspected of having varicocele is the upright position with Valsalva maneuver, and the best site for venous diameter measurement is at the level of epididymal head.

Background: CXCR4 is a cognitive receptor for stromal-derived factor-1 (SDF-1) and has been previously shown to be associated with tumor growth and invasion of many cancers. However, its expression and function in gastric cancer has not been well clarified. Materials and Methods: Herein, we studied the expression of CXCR4 on gastric samples from patients with gastric adenocarcinoma in comparison with precancerous lesions by employing qRT-PCR. Results: Our qRT-PCR data show that CXCR4 is highly expressed in tissue samples from patients with gastric cancer than precancerous lesions (2.4 times higher, P value < 0.05). When we correlated the level of CXCR4 with clinicopathological findings, we observed that CXCR4 level is associated with staging of the disease and lymphatic invasion. In conclusion: We present evidence that CXCR4 level is significantly elevated in later stages of gastric cancer. Thus, CXCR4 may play a crucial role in gastric cancer progression.

Background: Cardiovascular diseases (CVD) are the most serious cause of mortality in developed and developing countries. Epidemiological studies indicated that dyslipidemia is the major risk factor of CVD. Dyslipidemia can be modified either by proper lifestyle or medical intervention or by the combination of both. Conjugated linoleic acids (CLA) and ω3 fatty acids have beneficial effects on plasma lipids and lipoproteins. The aim of this study was to evaluate the effect of CLA and omega-3 fatty acids (ω-3 fatty acids) supplementation on lipid profile in atherosclerosis patient. Materials and Methods: This study was a 2-month clinical randomized trial. Ninety atherosclerotic patients with angiographically diagnosed coronary atherosclerosis who were referred to Emam Reza Heart Clinic of Shiraz University of Medical Sciences from February to march 2011 were selected if they fulfilled the inclusion criteria. The participants were randomly classified into 3 groups receiving 3 g/d CLA or 1 920 mg/d ω3 or placebo for 2 months. High-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), triglycerides (TG), and total cholesterol were measured before and after the intervention. This study was a two-month clinical randomized trial. Results: Data were analyzed using SPSS software (SPSS Inc, Chicago, version19). Although CLA did not appear to have a significant effect on TG, ω3 supplementation significantly reduced TG level. Consumption of CLA and ω3 supplementation did not significantly affect HDL cholesterol, LDL cholesterol, and total cholesterol. Conclusions: ω3 supplementation significantly reduced TG level but CLA and ω3 did not show significant changes in other indices of lipid profile in atherosclerotic patients.

Background: Some investigators indicated the effect of electrical or chemical stimulation on different parts of the brain and its effect on animal's behaviors. Furthermore, drug addiction is known to be associated with dysfunction of memory and motivational systems. In this study, we aimed to evaluate the effect of electrical stimulation of nucleus accumbens (NAc) with different currents intensities on conditioned place preference (CPP) induced by morphine. Materials and Methods: Male Wistar rats were randomly divided for experimental groups (n = 8). We investigated the influence of electrical stimulation with different current intensities (low: 15 μA, median: 50 μA and high: 100 μA) on NAc with ineffective and effective dose of morphine (0.5 and 5 mg/kg, respectively) on acquisition and expression of morphine-induced place conditioning in male rats. Results: The doses of subcutaneous administration morphine (2.5 and 5 mg/kg, P < 0.05 and P < 0.001; respectively) induced CPP compared with saline group. Furthermore, our findings are showed that electrical stimulation (100 μA) of NAc suppressed morphine-induced CPP. It revealed impairment of learning and memory formation in conditioning process due to morphine administration. Conclusion: It is possible that high current intensity (100 μA) had an accompanied effect by a reversal of the increased tissue contents of dopamine and its metabolites in the NAc of morphine-induced CPP rats. Furthermore, high current intensity in combination with ineffective dose of morphine (0.5 mg/kg) increased morphine-induced CPP probability via the prove reward system.

Background: Recently, Acinetobacter has emerged as significant hospital pathogen, notoriously known to acquire antibiotic resistance to most of the commonly prescribed antimicrobials. Many risk factors are associated with Acinetobacter infections, especially in patients in intensive care unit (ICU). This study aims to isolate Acinetobacter from various clinical specimens and to determine its antimicrobial sensitivity pattern. Materials and Methods: Identification, speciation and antimicrobial sensitivity testing were performed using the standard microbiological techniques. Slime production was also tested by microtiter plate and tube method. Results: From the processed clinical specimens, 107 Acinetobacter strains (1.02%) were isolated of which 76 (0.74%) isolates were from general wards and 31 (11.96%) were from ICU. Significantly higher percentage of Acinetobacter strains was found in ICU compared with general wards (P < 0.05). Most common Acinetobacter infection was abscess. Infections were more common in males and were associated with major risk factors such as post-surgical, diabetes mellitus, catheterization, extended hospital stay and prolonged antibiotic usage. Acinetobacter baumanii was the most common species isolated to cause abscess, wound infection, etc. 62.61% and 28.97% isolates produced slime by microtiter plate and tube method. Imipenem was most sensitive drug followed by amikacin. Ceftazidime, cefotaxime, piperacillin were most resistant. 43.00% isolates were IPM resistant. A. baumanii was more resistant to commonly used antimicrobials. Conclusion: Acinetobacter nosocomial infections resistant to most antimicrobials have emerged, especially in ICU. Early identification and continued surveillance of prevalent organism will help prevent the spread of Acinetobacter in hospital environment.

Background: The public conviction that 'herbal remedies are safe' has led to an increased consumption of these products. This study was performed in view of the wide distribution of herbal remedies, the risks posed by self-treatment with these products, and the existing reports about the toxic effects of some medicinal herbs. Materials and Methods: In this study the effect of some of the most used herbal drops of A, B, C, and D on the liver function of rats was examined at different doses, namely minimum dose, maximum dose, and 2.5 times the maximum dose indicated in the brochures. The rats were administered the said doses via a feeding tube for 50 days. The liver function parameters including aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), alkaline phosphatase (ALP), total serum protein, albumin, and urea were measured using the spectrophotometric method. Results: The animals' liver tissues were examined pathologically. The A drop did not change the liver function parameters significantly. The B drop increased the LDH by 34% compared to the controls, at the maximum administered dose. The C and D drops increased the ALT, AST, and LDH significantly compared to the controls. The histological findings suggest the possible effect of C and D drops on the function of hepatocytes. Conclusions: We recommend that the herbal formulations available in pharmaceutical markets be more closely controlled in terms of quality, as well as toxicity, especially with regard to the possible effects on the hepatic function.

Background: Psoriasis is a common dermatologic disorder, with fluctuating response to treatment. Considering the proven immunomodulatory effects of oral simvastatin in psoriasis, this trial study was enrolled to determine whether the topical form has also antipsoriatic effects. Vitamin D analogs known to be effective and are considered the first line of therapy in mild to moderate cases. In this study, the efficacy of topical calcipotriol 0.005% ointment (as a standard method of treatment for psoriasis) versus combination of calcipotriol plus topical simvastatin is compared in the treatment of psoriasis. Materials and Methods: A total of 80 subjects with symmetric psoriasis who had body surface involvement up to 20% were divided randomly into 2 groups. Group A were treated with calcipotriol 0.005% ointment twice daily and Group B with calcipotriol 0.005% ointment twice daily and simvastatin 3% ointment twice daily for 12 weeks. The results were evaluated by a Blind Dermatologist using psoriasis area severity index (PASI) score at baseline, 4 ^th , 8 ^th and 12 ^th week of treatment. In a similar way, a subjective assessment performed by patients based on photo-evaluation at the end of the study. Results: Despite a continuous reduction in PASI score in both groups, according to both physician (P = 0.603) and patient (P = 0.243) assessment topical simvastatin was not statistically more effective than conventional treatment of psoriasis at the end of the study. Conclusion: This study indicates that topical simvastatin is not associated with significant impacts in the treatment of psoriasis as compared to oral form. This study indicates that psoriasis is a systemic disorder with variable skin manifestations.

Background: Compensatory ocular counter-torsion (COCT) is supposed to maintain the eyes aligned with the visual environment following head tilt. Because of some recent controversies the functional capacity of this phenomenon was defined according to the extent of induced astigmatic axis error following head tilt. Materials and Methods: Objective autorefractometry was performed on 70 eyes with a regular astigmatism of ≥2D at vertical, right head tilt and left head tilt positions of 5°, 10°, 15°, 20° and 25°. Astigmatic axis error was calculated according to the difference between the defined axis at each tilted head position and the defined axis at the vertical head position. A tiltometer was used for this purpose to show the angle of head tilt without disturbing the process of refractometry. Results: The mean astigmatic axis error was 3.2° ± 1.5° and 18.4° ± 4.2° at the head tilt angles of 5° and 25° respectively. The mean percentage of tilt angle compensation by COCT was 36% and 26% at the head tilt angles of 5° and 25° respectively. There was a direct relation between the head tilt angle and the induced astigmatic axis error (ANOVA, P < 0.001, 95% of confidence interval [CI]). Astigmatic axis error values at right head tilt were significantly lower than their corresponding values at left head tilt (ANOVA, P = 0.04 95% CI). Conclusion: Any minimal angle of head tilt may cause erroneous measurement of astigmatic axis and should be avoided during refraction. One cannot rely on the compensatory function of ocular counter-torsion during the refraction.

Background: Local reference data are needed in the screening of children for thyroid enlargement. We determined the thyroid gland volume using the ultrasonography (US) in schoolchildren of Isfahan, Iran. Materials and Methods: A total of 360 schoolchildren (59% girls) aged 8-15 years who met the study criteria were entered the study. Clinical grading of goiter was performed by an endocrinologist according to the World Health Organization (WHO) classification. Then, a single expert radiologist performed thyroid volume measurement using a portable ultrasound device. Urinary iodine (UI) concentration was checked in 36 randomly selected cases. Results: On physical examination, 327 (91%), 32 (8.8%) and 1 (0.2%) subjects were classified as normal, borderline and goiter Grade 2. Mean thyroid volume measured by US was 1.46 ± 0.70 ml. Thyroid volume in boys was significantly higher than girls (1.58 ± 0.67 ml vs. 1.38 ± 0.71 ml; P = 0.009). Thyroid volume was positively correlated with the clinical grade of the goiter (r = 0.30, P < 0.001) and with age (r = 0.25, P < 0.001). Both median and 95 ^th percentile of thyroid volume of our subjects was lower than the reference values reported by WHO. Median of UI was 16.90 μg/dl. UI was not correlated with thyroid volume (r = 0.12, P = 0.46). Conclusion: The thyroid size in Isfahanian schoolchildren is lower than the reference values reported by WHO. These data could be used in determining local reference in the screening of children for thyroid enlargement.

Background: Human T-cell lymphotropic virus HTLV-I/II is a retrovirus that has been associated with different diseases. HTLV-I/II routes of transmissions are exposure to contaminated blood, blood transfusion, needle sharing, breast feeding, and sexual contact. The seroprevalence of HTLV-I/II in HIV infected patients has not been well characterized in Iran. We conducted a serological survey to determine the relative frequency of HTLV-I/II in HIV+/AIDS and healthy blood donors in Isfahan. Materials and Methods: In this cross-sectional study, we compare the relative frequency of HTLV-I/II in HIV+/AIDS group (56 persons) with asymptomatic blood donors (57 persons) in Isfahan. Participant completed the questionnaires that include demographic information, age, sex, and sexual partnership during last 6 months, sexual behavior and past history of blood transfusion or other blood products. We confirm the HIV+ status in patients group with western blot test. Evaluation of HTLV-I/II were done using ELISA test with DRAPIO third generation kit. Questionnaire data and laboratory results were analyzed by SPSS18. Results: During the period of 2010-2011, a total of 56 HIV-infected patients and 57 healthy persons participated in this study. Among HIV positive patients, one person had positive test for HTILV-I/II representing the relative frequency of 1.8%, and in healthy individuals none of them were positive. Conclusion: In our survey, relative frequency of HTLV-I/II was 1.8% in HIV+ patients. This study reveals that relative frequency of HTLV-I/II in HIV positive patients is considerable but determining the need for screening of HTLV-I/II requires further investigation.

Background: One of the challenges in lentiviral vector-based suicide gene therapy by toxin or apoptosis-inducing genes is death of packaging cells. Therefore, the process of production of these lentiviral particles would be stopped in this step. We proposed that insertion of a reverse promoter between R and U5 regions of 5' long terminal repeat (LTR) in transfer plasmid could be considered as a solution for this problem. But it is not known, whether the insertion of RΔU3 sequence between the promoter and target gene in proviral genome during the life-cycle of lentivirus may interfere whit gene expression in target cells. Materials and Methods: The following were performed in this study: insertion of RΔU3 sequence in pEGFP-N1 plasmid, evaluation of the expression of eGFP gene after calcium phosphate co-precipitation transfection of pCMV-RΔU3-GFP construction in 293T cells, and quantitative assay of eGFP gene by flow cytometry technique. Results: Our results from flow cytometry technique analysis showed that there was no significant difference between the expression of eGFP gene in transfected cells with pEGFP-N1 and pCMV-RΔU3-GFP plasmids (P > 0.05). Conclusion: In this step of our strategy, we demonstrated that modification of orientation and location of promoter may overcome some issues in lentiviral suicide gene therapy, especially when toxin or apoptosis-inducing genes are used.

Background: To investigate the role of testosterone (T) in the pathogenesis of ejaculatory symptoms, particularly premature ejaculation (PE). Materials and Methods: A total of 41 male patients with PE as well as 41 controls with no sexual dysfunction were recruited in this cross-sectional study. We used the stopwatch measurement to monitor the intravaginal ejaculatory latency time (IELT). Patients with mean IELT values lower than 60 s were considered to have PE. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), total testosterone (TT) and free testosterone (FT) were measured in patients as well as controls. Patients with thyroid dysfunction, hypogonadism, hypertension and dyslipidemia were excluded from the study. Results: The serum levels of FT and FSH were significantly higher in cases (P = 0.036 and 0.003, respectively). There was no significant difference between TT, LH and PRL levels of the two groups. Conclusion: Patients with PE have higher FT and FSH levels compared with normal men. The causative relationship between these entities and also the clinical importance of this finding has to be determined by more comprehensive studies.

Background: Post-dural puncture headache (PDPH) is a known complication of neuroaxial anesthesia and may be associated with significant morbidity. As invasive treatment for PDPH has known complications, pharmacologic management may be preferable. The main objective of the present study was to evaluate the effects of combining administration of intravenous aminophylline and dexamethasone on PDPH in patients who underwent lower extremity surgery in comparison with using either drug alone and also comparing them with placebo. Materials and Methods: One hundred and forty patients, aged 20-65 years, scheduled for lower extremity surgery in Alzahra University Hospital under spinal anesthesia were enrolled in this randomized, double-blind, placebo-controlled study. Patients were divided into four groups of 35 each and received aminophylline 1.5 mg/kg i.v. (group A), dexamethasone 0.1 mg/kg (group D), aminophylline 1.5 mg/kg plus dexamethasone 0.1 mg/kg i.v. (group AD), and placebo (group P). The incidences of PDPH and complete response were evaluated at 6-48 h after arrival to the ward in the four groups. Results: Patients in group AD had significantly lower incidence of PDPH (5.88% vs. 20.58% for group A and 17.14% for group D with P < 0.05), the highest incidence of complete response, and also, less analgesic requirement compared with groups A, D, and P throughout 6-48 h (1.2 ± 0.4 vs. 2.3 ± 0.75 for group A, 1.8 ± 0.6 for group D, and 3.3 ± 1 for placebo group with P < 0.05). Conclusion: Combine administration of aminophylline 1.5 mg/kg plus dexamethasone 0.1 mg/kg significantly reduced PDPH better than using either drug alone in patients who underwent lower extremity surgery under spinal anesthesia.

Background: Retinal pigment epithelium (RPE) is a hexagonal monolayer of pigmented cells located between the neural retina and the choroid with an essential role for visual function. So, isolation, propagation and maintenance of their functional integrity of RPE are crucial for research in vitro which next used for cell transplantation. The evaluation of features of RPE cells as a sheet after 14 days has not been reported yet. This study aimed to examine and compare three protocols for RPE isolation from rabbit eyes and obtain a proper protocol, which illustrated isolated RPE cells as a sheet cause to preserve their characterize even after 2 weeks. Materials and Methods: RPE cells were prepared from eyes of 24 rabbit eyes. After enucleating of eyes, anterior segment discarded and posterior segment cut to small pieces. Two of these procedures are based on the enzymatic digestion, but third protocol based on mechanical dissection. The culture cells harvested and morphological feature of cells assessed by phase-contrast microscope and then analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR) and immunocytochemistry. Results: Evaluation of morphological feature showed that isolation of RPE cells as a sheet lead to preserve their hexagonal morphology. Immunocytochemistry and RT-PCR assessment demonstrated RPE cell cultured in sheet maintained their phenotypic feature, tight junction and the distribution of actin and cytokeratin filament. Comparison of three protocols showed that dissociation of RPE cells as a sheet was superior in the preserve of RPE characteristic. Conclusions: Isolation of RPE cells as a sheet maintains the integrity of these cells, this procedure promising a therapeutic approach, which is important for some retinal diseases.