مجله دانشکده پزشکی اصفهان
پیاپی 448 (هفته چهارم آبان 1396)

Multiple sclerosis (MS) is known as a neuroimmunological disease in human being. The evidences show that brain-derived neurotrophic factor (BDNF) and its specific receptor, tyrosine receptor kinase B (TrkB) play a role in the development of multiple sclerosis. Previous studies demonstrated that various interventions affect the expression of these factors. This study aimed to investigate the effect of four weeks of aerobic swimming on the level of BDNF and TrkB in the brain of mice with experimental autoimmune encephalomyelitis (EAE) or animal model of multiple sclerosis.
A total number of 80 C57BL/6 mice, aging 10 to 12 weeks and weighing 20 ± 2 gram were divided into eight groups of 10, control, swimming (SW), EAE, EAE SW, EAE solvent (SOL), EAE interferon-beta (IFN), EAE environment (En) SOL, and EAE SW IFN. On post-immunization day 9, animals received IFN (150 IU/g) or were subjected to swimming daily for 4 weeks (5 days/week). Brains were extracted and the levels of BDNF and TrkB were measured via enzyme-linked immunosorbent assay (ELISA). The data were analyzed using one-way ANOVA.
Findings: EAE decreased BDNF and increased TrkB level in the brain of EAE-induced mice. Level of BDNF and TrkB increased in mice brain following swimming and IFN treatment; however these alterations were not significant.
These findings suggest that probably swimming is more effective than IFN to alter the level of BDNF and TrkB in the brain of EAE-induced mice.

Accurate separation of awakening from sleep increases the accuracy of detecting sleep stages and determining sleep efficiency index that is important for medical diagnosis. In this study, 3 new bispectrum-based features were extracted, and combination of them with Bi-Phase correlation was used to detect awakening from sleep.
A gray scale image was made of electroencephalogram bispectrum amounts and converted to binary image with Otsu’s thresholding. Then, 3 features were extracted from it: total numbers of one bits, ratio of one bit in the above of the secondary diagonal to the down of it, and entropy. By combining these features with the average Bi-Phase correlation, an efficient and new way to distinguish the awakening of sleep was proposed.
Findings: The accuracy, specificity, and sensitivity were calculated. Awakening intervals could be distinguished from sleep using Bi-Phase correlation feature by the accuracy of 77.53%, and using ratio of one bit in the above of the secondary diagonal to the down of it, by the accuracy of 88.12%. Finally, combining 3 mentioned features with Bi-Phase correlation gave the ability to separate awakening from sleeping with the accuracy of 92.42%, sensitivity of 91.82%, and specificity of 93.10%.
New features have this capability to use in sleep staging. The proposed method in awakening and sleep discrimination, by combining bispectrum image-based features with Bi-Phase correlation, is better than other existing ýapproaches because of high accuracy and low calculation complexity.

Multiple myeloma is the second most common hematopoietic cancer. This disease is caused by the cancerous category of cells called plasma cells. Detecting and counting plasma cells provide valuable information for pathologists to diagnose this disease. The manual counting and considering of plasma cells are time consuming and due to the tedious nature of this process, it is subject to error. Thus, a computer-aided tool for pathologists to help in the diagnostic process can be very useful. For this purpose, this research presented a computer tool for segmentation of effective cells in multiple myeloma from microscopic images.
In proposed method, after improving the quality of the images using histogram matching and median filter, the cells were extracted using the Chan-Vese deformable model. In addition, for splitting touching cells, the Modified Watershed algorithm was used. Then, the nuclei were extracted applying the k-means clustering method.
Findings: The proposed method was evaluated on 30 microscopic images containing 370 cells. The calculated results of the proposed method showed that similarity measures, sensitivity, precision, accuracy and Dice Similarity Coefficient (DSC) respectively were 89.01%, 89.95%, 97.71%, 98.63%, and 93.86% for cell segmentation, and 91.43%, 92.48%, 96.13%, 98.53%, and 95.47% for nucleus segmentation.
In this research, a novel method was presented for segmentation and extraction of effective cells in the diagnosis of multiple myeloma cancer from microscopic images using deformable models and clustering method. The evaluation results show that the proposed algorithm have improved segmentation performance compared to the previous methods.

Hepatitis E virus (HEV) belongs to the family of Hepeviridae and is the sole member of the genus Hepevirus. HEV infection by genotypes 3 and 4 may tend to chronic infection, especially in immunocompromised patients such as liver and renal transplant patients. This study aimed to assess the frequency of HEV infection in kidney transplant recipients.
This was a cross-sectional study on kidney transplant recipients in Isfahan City, Iran, in 2016. 100 renal transplant recipients were randomly selected and reviewed in Alzahra hospital. Blood samples were obtained from 100 eligible patients. Serum samples were screened for HEV RNA by using real-time polymerase chain reaction (PCR).
Findings: Mean age of the patients was 48.2 ± 14.2 years and 63% of them were men. Based on molecular evaluation, all off 100 studied patients had negative results for HEV.
HEV infection is not an important problem in renal transplant recipient. It is recommended to check the patients with renal transplant for HEV when liver enzyme is elevated and it is not recommended as a routine lab test.

Sodium valproate, an anticonvulsant drug, has teratogenic effects on humans’ and animals’ skeletal system via causing free radicals and oxidative stress. Carvedilol has beta-blocker, antioxidant and anti-inflammatory effects and was the benefit in diseases such as diabetes and renal failure and has protective effect in experimental oxidative stress models. The aim of this study was to compare the roles of carvedilol and vitamin E (a well-known antioxidant) in reducing or preventing skeletal abnormalities from sodium valproate in rat fetuses.
This study was performed on 30 pregnant rats in four groups. On 8th and 9th days of pregnancy, for first (control) to fourth groups, intraperitoneal normal saline, sodium valproate (300 mg/kg), sodium valproate (300 mg/kg) plus carvedilol (5 mg/kg), and valproate sodium (300 mg/kg) plus vitamins E (100 mg/kg) were administrated, respectively. On the 20th day of pregnancy, all rats were euthanized and fetuses were extracted. Weight and height were determined, skeletal system samples were stained by Alizarin red-alcian blue method, and skeletal system was examined by stereomicroscope.
Findings: In fetuses of sodium valproate group, the incidence rates of exencephaly, cleft palate, spina bifida, and omphalocele were 14.58%, 14.58%, 16.66%, and 10.41%, respectively. However, it decreased to 6.55%, 8.19%, 6.55%, and 8.19% by carvedilol and so to 3.5%, 8.75%, 3.5%, and 3.5% by vitamin E, respectively. The mean length of fetuses in sodium valproate group plus carvedilol and sodium valproate plus vitamin E was significantly less than the mean length in the control group but did not have significant differences with each other. The mean fetal weight in sodium valproate plus vitamin E group was significantly more than sodium valproate and sodium valproate plus carvedilol, although it was lower than the control group.
Carvedilol and vitamin E had similar effects on fetal skeletal abnormality and changes of fetal length caused by sodium valproate; but vitamin E was more protective against fetal weight changes.

Chronic kidney disease (CKD) is a progressive disease. The prevalence of CKD continues to increase significantly due to increasing prevalence of diabetes and obesity and has been estimated 6.5 to 23.7 percent in Iran. The CKD progression may be largely due to secondary factors that are sometimes unrelated to the activity of the initial disease. These include demographic and clinical characteristics and the pattern of antihypertensive drug consumption.
This cross-sectional study was performed in autumn 2014 on 504 patients with chronic kidney disease in Isfahan City, Iran, during 1996-2011. Data on sex, weight, height, body mass index, antihypertensive drug, basic and mean annually blood pressure, underlying disease, proteinuria, serum creatinine, and Estimated Glomerular Filtration Rate (eGFR) were collected using a questionnaire.
Findings: 504 subjects (48.6% men and 51.4% women) with a mean age of 46.64 ± 17.06 years were enrolled in this study. Basic eGFR was 73.33 ± 32.05 ml/min/1.73 m2. Proteinuria was seen in 55.4% of patients. The prevalence of diabetes was 32.1%. Angiotensin converting enzyme (ACE) inhibitor was the most common drug class used by participants and accounted for 76.9% of the utilization; vasodilators were the least used antihypertensive drugs and represented as 0.6% of the total utilization.
The demographic and basic clinical characteristics of our study population nearly were similar to other studies in Iranian population, with these major differences that our participants were significantly younger, and the prevalence of diabetes and glomerulonephritis were higher in comparison to other studies. The utilization pattern of antihypertensive drugs had more accordance with clinical guidelines. The rate of eGFR reduction was significantly slow.

CD8-positive T lymphocytes are important part of cell-mediated immunity and play a central role in induction of immune response against tumor progression. So, these cells might have potential to be used in clinic along with other prognostic biomarkers; however no definite comparison on validation of this maker has been conducted. The purpose of this study was to assess the role of CD8-positive cells in breast cancer outcome and to compare the correlation of tumor-infiltrating CD8-positive cytotoxic lymphocyte density and clinicopathologic parameters with mortality and survival rates in breast cancer.
CD8-positive T cells were detected via immunohistochemistry using the paraffin-embedded tumor samples of 52 patients with breast cancer. Clinicopathologic data including tumor type and grade, lymph node involvement, stage, lymphovascular invasion, metastasis, relapse, patient's family history, and estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki67 markers were reviewed. Mortality and survival rates were obtained.
Findings: There were no statically significant correlations between presence of CD8 and mortality (P = 0.05) or survival (P = 0.09). Increased mortality rate was significantly associated with increased Ki67 (P = 0.045), lymph node metastasis (P = 0.020), higher stage (P = 0.020), metastasis (P > 0.001), and relapse (P = 0.008). In addition, overall survival was significantly associated with lymph node involvement (P = 0.003), higher stage (P = 0.009), metastasis (P = 0.020), negative PR (P = 0.020), and negative Ki67 (P = 0.010).
Although some previous studies reported CD8 as a prognostic marker to be complementary of tumor, node, and metastasis (TNM) staging, but our data did not show any correlation between the presence of CD8 with mortality or survival. The role of immunologic reaction in tumor microenvironment should be further validated using larger patient population with analysis of multiple immune cell lines together.