Background: Initial fixation strength is critical for the early post-operative rehabilitation of patients with anterior cruciate ligament (ACL) reconstructions. However, even the best femoral fixation devices remain controversial. We compared the results of 2 of the femoral fixation techniques,Rigidfix and Transfix. Materials and Methods: A total of 30 patients with unilateral ACL deficiency were randomly assigned to 1 of 2 groups. In Group A an anatomic single-bundle ACL reconstruction was performed using Rigidfix technique(Mitek, Norwood,MA), Group B were treated by a single bundle using Transfix technique(Arthrex, Naples, FL, USA). For tibial fixation, a bioabsorbable Intrafix interference screw was used for all the groups and the graft was fashioned from the semitendinosus and gracilis tendons in all patients. The patients were subjected to a clinical evaluation, with assessment of the anterior drawer, Lachman's and the pivot-shift tests. They also completed the International Knee Documentation Committee (IKDC) score. Results: At a mean of 14 months (12-17) followup there were no significant differences concerning time between injury and range of movement between the 2 groups. However, the Rigidfix group showed significantly better results for the subjective assessment of knee function ( P = 0.002). The Lachman, anterior drawer, and pivot-shift tests also showed no significant difference between the 2 groups. The IKDC scale showed no significant difference among the groups ( P < 0.001).There was no difference regarding duration of operation and cost of the operation between the 2 groups.On clinical evaluation there was no significant difference between the 2 groups. However, regardless of the technique, all knees were improved by ACL reconstruction compared with their preoperative status. Conclusion: Both techniques can be used for reconstruction of ACL. Other factors, such as psychic profile of the patients should be considered for surgery planning.

Fibro-osseous pseudotumor of the digit is an unusual ossifying soft tissue lesion, which is usually an ill-defined soft tissue mass in radiography, with focal calcification, especially in the proximal phalanx. It predominantly affects young adults and, unlike myositis ossificans, is more common in women. The current case is a 30-year-old man who presented with pain and swelling on the dorsum of middle phalanx of the left index finger without history of trauma. Diagnosis of this lesion requires a high index of suspicion and should be differentiated from myositis ossificans, turret exostosis, and extra-skeletal osteosarcoma, which are discussed. This lesion is considered benign and has an excellent prognosis following complete removal and local recurrence is unusual. No cases of malignant change are on record.

Background: Rheumatoid arthritis (RA) is one of the most frequent autoimmune diseases in the world which affect about 1% of people. Measurement of the anti-CCP1 antibody titer in these patients is one of the new tests that is available in our country and in the multiple studies has been shown to be more specific than rheumatoid factor in the diagnosis of RA (97%). This test becomes positive in early stage of disease and it has a high predictive value. The aim of our study was to determine the relationship between anti-CCP1 antibody and disease activity score 28 (DAS-28) in patients with rheumatoid arthritis. Materials and Methods: A cross-sectional study was performed in 90 patients with RA for evaluating the relation between anti-CCP1 antibody titer and DAS-28, patients were selected by consecutive method; serum samples were collected from patients. Anti-CCP1 antibody was measured by the corresponding enzyme-linked immunosorbent assay. Additionally, erythrocyte sedimentation rates (ESR), rheumatoid factor (RF), DAS-28, visual analog scale (VAS) were determined in patients with RA. Statistical analysis performed with t-test and Pearson's correlations coefficient. Results: Anti-CCP1 level was associated with DAS-28 (P<0.001, r=0.35). The largest linear correlation was between anti-CCP1 antibody levels and VAS; it means that higher titers of anti-CCP1 antibody are associated with more painful joints in our patients. The average of DAS-28 in our positive and negative anti-CCP1 antibody patients was 5.07±1.1 and 3.5±1.5, respectively (P<0.05). Conclusion: There was moderate correlation between anti-CCP1 titer and DAS-28.

Background: The cytological diagnoses of serous effusions are usually made by routine cytomorphology with certainty. However, overlapping cases sometimes exist between reactive mesothelial and adenocarcinoma cells. We tried to evaluate the diagnostic utility of proliferative index using a Ki-67 monoclonal antibody in distinguishing between reactive mesothelial cells and adenocarcinoma in serous effusions. Materials and Methods: Paraffin blocks and H and E stained slides of peritoneal and pleural fluid cell blocks were retrieved from cytology archive of Alzahra Hospital, Medical University of Isfahan, between 2006 and 2010, from among 1025 slides which were screened to ascertain their appropriate diagnoses. Among of these 80 paraffin-embedded cell blocks, 40 cases for each reactive and adenocarcinoma groups were selected. The proliferative index was calculated by using the Ki 67 monoclonal antibody against nuclear proteins. Results: The mean ages of the patients in the reactive mesothelial and adenocarcinoma groups were 60.58 and 58.45 years, respectively. The gender distribution for the malignant group included 23 cases (%57.5) of females and 17 cases (42.5%) of males. This ratio for reactive group included 14 cases (35%) and 26 cases (65%). The mean of Ki-67 index in adenocarcinomatous cells was 17.15 (SD=15.11) and in reactive mesothelial cells was 3.58 (SD= 3.59) (P=0.001). We consider to using the proliferative marker of Ki-67 on benign and malignant lesions revealed 12% as cut off level. The means of Ki-67 index according to serousal spaces were included: Pleura: 10.56 (SD= 13.06) and peritoneum: 10.03 (SD= 12.78), (P=0.9). Conclusion: Ki-67 index is useful immunostaining panel for differentiation of mesothelial and adenocarcinoma cells in malignancy like ovarian carcinoma that sometimes mimics mesothelial morphology.

Background: Contrast nephropathy is a common and often reversible cause of acute renal failure (ARF). About 10% of ARF in admitted patients might be due to it and may also lead to dialysis. Some methods could prevent it such as fluid therapy with half or normal saline, Na bicarbonate, N-acetyl cysteine (NAC), and so on. The aim of this study was to evaluate the efficacy of NAC to prevent contrast nephropathy. Materials and Methods: In a cross-sectional study, 110 patients who were candidate for intravenous pyelography (IVP) or CT scan enrolled in two groups: Case and control. In patients of case group, meglumine compound and in control group, placebo was prescribed before procedure. Before study and after 48 h, blood urea nitrogen (BUN) and creatinine (Cr) was checked, and glomerular filtration rate (GFR) was measured with Cockcroft-Gault formula. Results: There were no difference between age and gender of two groups. There was also no significant difference between mean Cr before and after study; however, GFR of patients in case group was significantly higher than the control group after 48 h of procedure. Conclusion: Because GFR was higher in case group and there were no drug side-effects in patients, we recommend the use of NAC before administration of intravenous contrast especially in high-risk population such as diabetic patients.

Gene therapy is the process of introducing foreign genomic materials into host cells to elicit a therapeutic benefit. Although initially the main focus of gene therapy was on special genetic disorders, now diverse diseases with different patterns of inheritance and acquired diseases are targets of gene therapy. There are 2 major categories of gene therapy, including germline gene therapy and somatic gene therapy. Although germline gene therapy may have great potential, because it is currently ethically forbidden, it cannot be used; however, to date human gene therapy has been limited to somatic cells. Although numerous viral and nonviral gene delivery systems have been developed in the last 3 decades, no delivery system has been designed that can be applied in gene therapy of all kinds of cell types in vitro and in vivo with no limitation and side effects. In this review we explain about the history of gene therapy, all types of gene delivery systems for germline (nuclei, egg cells, embryonic stem cells, pronuclear, microinjection, sperm cells) and somatic cells by viral [retroviral, adenoviral, adeno association, helper-dependent adenoviral systems, hybrid adenoviral systems, herpes simplex, pox virus, lentivirus, Epstein-Barr virus)] and nonviral systems (physical: Naked DNA, DNA bombardant, electroporation, hydrodynamic, ultrasound, magnetofection) and (chemical: Cationic lipids, different cationic polymers, lipid polymers). In addition to the above-mentioned, advantages, disadvantages, and practical use of each system are discussed.

Background: It has been recently demonstrated that Royal jelly (RJ) has a beneficial role on neural functions. Alzheimer's disease (AD) is associated with impairments of learning and memory. Therefore, the present study was designed to examine the effect of RJ on spatial learning and memory in rats after intracerebroventricular injection of streptozotocin (icv-STZ). Materials and Methods: Rats were infused bilaterally with an icv injection of STZ, while sham rats received vehicle only. The rats were feed with RJ-contained food (3% w/w) (lyophilized RJ mixed with powdered regular food) or regular food for 10 days. Then spatial learning and memory was tested in the rats by Morris water maze test. Results: Results showed that in icv-STZ group latency and path length were increased as compared to sham group, also icv-STZ rats less remembered the target quadrant that previously the platform was located; however, these were protected significantly in STZ group that received RJ-containing food. Conclusions: Our findings support the potential neuroprotective role of RJ and its helpful effects in AD.

Background: There is insufficient evidence to conclude that the timing of tracheostomy alters the duration of mechanical ventilation, hence this study was designed to investigate the correlation between timing of tracheostomy and duration of mechanical ventilation for patients admitted to intensive care unit (ICU) with potentially normal lungs. Materials and Methods: In a retrospective study for a period of 2 years, all adult patients admitted to the medical ICU of Al-Zahra Hospital in Isfahan University of Medical Sciences who needed endotracheal intubation and prolonged mechanical ventilation were considered for inclusion in this study. Data of underlying disease, causes of respiratory failure, age and gender, duration of mechanical ventilation, and interval between intubation time and tracheostomy were collected. The correlations between intubation period and ventilation period were analyzed using a Pearson correlation test. Results: Sixty-six percent of patients (100 patients) were men. The mean ± SD of age of patients was 56.2 ± 20.8 years (18-90 years.). The timing of tracheostomy (duration of endotracheal intubation until tracheostomy) did not exhibit any correlation with the length of mechanical ventilation ( P = 0.43, r = 0.08). The timing of tracheostomy had not any correlation with the age of patients ( P = 0.20, r = 0.129). The length of mechanical ventilation had not any correlation with the age of patients ( P = 0.83, r = 0.02). The timing of tracheostomy was similar in men and women ( P = 0.5). Mechanical ventilation period was not significantly different in both genders ( P = 0.89). Conclusion: Our study with mentioned sample size could not show any relationship between timing of tracheostomy and duration of mechanical ventilation in patients under mechanical ventilation with good pulmonary function in ICU.

Introduction: The main obstacle for tissue engineering is to find the most appropriate cell which is able to produce extracellular matrix (ECM) similar or better than natural chondrocytes in vitro. This study compared aggrecan synthesis's potential between differentiated chondrocytes (DCs) from adipose-derived stem cells (ADSCs) and natural articular chondrocytes (NCs) in 3D culture in vitro. Materials and Methods: Human ADSCs were isolated from sub-cutaneous adipose tissue and then the surface markers including CD 14, 45 CD105, CD90, CD44 were analyzed by flow cytometry. Also human articular chondrocytes were yielded of non-weight bearing area of Knee cartilage. Both types of the cells were encapsulated in alginate scaffolds and cultured in chondrogenic medium with and without TGFβ3 for 3 weeks. Then the extent of aggercan (AGC) production was evaluated by ELISA on days 14 and 21. Results: Our findings indicated that differentiated chondrocytes (DCs) with and without TGFβ3 synthesized more AGC than natural chondrocytes (NCs) on day 14. But DCs without TGFβ3 had higher production than other groups on day 21. Application of TGFβ3 resulted in an increase of amount of AGC in DCs on day 14 but a decrease on day 21 than same group. Conclusion: Since, aggrecan is an important chondrogenic marker, it was concluded that ADSCs can be possible reliable alternative cell source for cartilage tissue engineering in future.

Mucormycosis is a fatal invasive infection which mostly involves diabetic or immunosuppressed patients. Early diagnosis, improving immunosuppression, systemic antifungal therapy, and surgical debridement are necessary for successful treatment. In this case study, we represent a known case of Wegener's granulomatosis (WG), with concomitant sinusal mucormycosis mimicking vasculitic disease relapse, which was successfully treated with surgical debridement, amphotericine, and intravenous immunoglobuline.

Background: Our goal was to identify the clinical criteria for requesting the chest X-ray in patients with blunt trauma and whether its findings such as clinical signs with a high sensitivity could be used to codify the final criteria. Materials and Methods: 386 patients with multiple trauma or blunt chest trauma examined by a physician and the injury mechanism, vital signs, O ₂ saturation, auscultation findings, abrasions and ecchymosis, crepitation, tenderness on palpation, and pain on lateral compression were noted. The physician's clinical judgment on the necessity of a chest X-ray was also noted in a questionnaire. After taking the X-ray, a digital photo was taken and showed to a radiologist to report any significant chest injury. Data were collected and the positive and negative predictive values, sensitivity and specificity were estimated. Results: 350 males (90.9%) and 35 females (9.1%) with the mean age of 47.1 ± 15.5 years old were evaluated. Falling down (37.7%) was the major mechanism of injury and chest pain (48%) the first complaint of patients. In 87.3% of the chest X-rays, there was no abnormal finding. Among several pathological findings in the chest X-rays, hemothorax, and rib fracture (each with 3.4% prevalence) had a higher prevalence. Tenderness on palpation with clinical judgment had a higher sensitivity about 95% and higher specificity about 100% in crepitation detected. Conclusion: Results showed the combination of positive chest pain and tachypnea in the patients could identify a significant chest injury with 100% sensitivity. More studies on this issue are warranted.

Background: There is a novel hypothesis in that antibodies may have specificity for two distinct antigens that have been named "dual specificity." This hypothesis was evaluated for some defined therapeutic monoclonal antibodies (mAbs) such as Trastuzumab, Pertuzumab, Bevacizumab, and Cetuximab. In silico design and construction of expression vectors for trastuzumab monoclonal antibody also in this work were performed. Materials and Methods: First, in bioinformatics studies the 3D structures of concerned mAbs were obtained from the Protein Data Bank (PDB). Three-dimensional structural alignments were performed with SIM and MUSTANG softwares. AutoDock4.2 software also was used for the docking analysis. Second, the suitable genes for trastuzumab heavy and light chains were designed, synthesized, and cloned in the prokaryotic vector. These fragments individually were PCR amplified and cloned into pcDNA™ 3.3-TOPO^® and pOptiVEC™ TOPO^® shuttle vectors, using standard methods. Results: First, many bioinformatics tools and softwares were applied but we did not meet any new dual specificity in the selected antibodies. In the following step, the suitable expression cascade for the heavy and light chains of Trastuzumab therapeutic mAb were designed and constructed. Gene cloning was successfully performed and created constructs were confirmed using gene mapping and sequencing. Conclusions: This study was based on a recently developed technology for mAb expression in mammalian cells. The obtained constructs could be successfully used for biosimilar recombinant mAb production in CHO DG44 dihydrofolate reductase (DHFR) gene deficient cell line in the suspension culture medium.

Ureteropelvic junction obstruction (UPJO) and vesicoureteral reflux (VUR) are two of the most common urologic problems in children that sometimes coexist simultaneously in a patient. However, presentation of UPJO after VUR treatment is rare. We will present two cases and discuss diagnostic and therapeutic aspects of the condition.

Introduction: It has been previously reported that ulcerative colitis (UC) could be associated with cytomegalovirus (CMV) infection. There is controversy among different studies; however, this study is conducted in Isfahan. We evaluated the frequency distribution of CMV infection in Iranian patients with active UC comparison to normal individuals. Materials and Methods: This case-control study was conducted on 22 patients with active UC and 22 age- and sex-matched controls (F: M = 1). Samples were taken from colonoscopic specimens and tested with sensitive primers of the CMV using the polymerase chain reaction method, the most sensitive method for detecting CMV infection. Results: Patients and controls were similar in age (35.9 ± 11.03 years in the case and 40.8 ± 11.3 years in the control group) P=0.153. CMV DNA was found in 13.6% of the subjects in each group; therefore, total percentage of CMV infection was 13.6%. Six cases with CMV infection were three males and three females with age of 38.5 ± 11.02 years (compared to 38.3 ± 11.5 years in noninfected subjects P=0.968). Conclusion: In our study, Iranian patients with active UC did not have a higher rate of CMV infection than controls.

Background: In recent decades, because of increasing prevalence of immunocompromised disease, non-tuberculous mycobacteria that have been known already as environmental bacteria presented as an important pathogens. In this study, the prevalence of NTM in Isfahan city water samples was determined bydifferent methods including culture methods with biochemical tests. Materials and Methods: Eighty-five water samples were collected from different sources in Isfahan, Iran. The mycobacterial isolates were identified by the growth characteristics, pigment production, semi-quantitative catalase test, Tween 80 hydrolysis, arylsulfatase test (3 and 14 days), heat-stable catalase (pH 7, 68°C), pyrazin amidase (4 and 7 days), urease, nitrate reduction test, and colony morphology. Results: Chlorine concentrations of the samples ranged from 0 to 1.8 mg/l. Twenty-one culturable species including M. fortuitum, 23.8% (5 cases); M.smegmatis, 14.3% (3 cases); M. chelonae like organisms, M. terrae complex, M. gordonae and M. mucogenicum, 9.5% (2 cases for each species); M. avium complex, M.phlei, M. xenopi, M. fallax, and M. flavescenc 4.8% (1 case for each species) were identified. Conclusion: The results of this study showed the incidence of different species of NTM in this geographical region in Iran. Studies show that the prevalence of immunocompromised disease is increasing in the community and it needs different treatment management strategy; therefore, the results of this study can be useful in this strategy.