مجله دانشکده پزشکی اصفهان
پیاپی 473 (هفته اول خرداد 1397)

Successful spermatogenesis requires a series of tightly controlled epigenetic events leads to condensation of sperm chromatin. Through these epigenetic events, expression of transition nuclear proteins (TNPs) and protamines (PRMs) rise to replace with histones. Many epigenetic factors are involved in regulation of these genes. Therefore, evaluation of histone modifications e.g. H3K9ac and H3K9me2, as powerful epigenetic tool in regulation of mentioned genes, can represent better insight into molecular mechanisms of infertility.
The consent was obtained from 60 azoospermic infertile men referred to Royan Institute, Tehran, Iran, according local ethical approval. Then, based on spermogram and pathological features of patients, testes tissue samples were collected from three groups including complete maturation arrest, sertoli cell only syndrome, and hypospermatogenesis (as positive control). Expression of TNPs and PRMs were evaluated using quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Besides, chromatin immunopercipitation (ChIP) coupled with real time- polymerase chain reaction was performed to evaluate the incorporation of H3K9ac and H3K9me2 into regulatory regions of mentioned genes.
Findings: There was a significant decrease in expression of TNP and PRM genes in two groups of spermatogenic failure in comparison to positive control. These findings also confirmed by chromatin immunopercipitation data which revealed decreased incorporation of H3K9ac (activating mark), and increased incorporation of H3K9me2 (repression mark) into regulatory regions of mentioned genes in complete maturation arrest and sertoli cell only syndrome groups vs. positive control.
These finding implies significant association of histone modifications with altered expression of sperm chromatin condensing genes and impairment of spermatogenesis in male infertility.

Obesity in children and adolescents is a complicated health problem that causes serious complications at younger and older ages, including diabetes and heart diseases. Obesity depends on many factors at an early age. Therefore, this study aimed to investigate the predictive factors of anthropometric indices in boys aged 9 to 11 years in Isfahan City, Iran, during the years 2015 and 2016.
This study was carried out on 282 students aged 9 to 11 years. After obtaining student's satisfaction and recording demographic data, their height and weight were measured and their body mass index (BMI) was recorded. Besides, indicators of physical activity, socioeconomic status, and nutritional status were also recorded. Chi-square and ANOVA tests were used to compare the data.
Findings: 41 (14.5%), 171 (60.6%), 42 (14.9%), and 28 students (9.9%) had body mass index of less of than 5, 5 to 85, 85-95 (overweight), and over 95 percentiles (obese), respectively. It was also found that only high socioeconomic and high levels of education for parents, as much as the self-employment of fathers had significant correlation with obesity and overweight in children (P Considering the high prevalence of obesity and overweight in children aged 9 to 11 years, the identification and screening of risk factors in children is very important in order to prevent obesity and overweight among them.

This study aimed to compare the effect of adding dexmedmodine and fentanyl to bupivacaine on the adequacy of anesthesia and postoperative pain in lumbar discectomy under spinal anesthesia.
In a clinical trial study, 105 patients who candidate for lumbar discectomy in Kashani hospital in Isfahan, Iran, during the years 2016-17 were selected and randomly divided into three groups of 35 patients. For the spinal block, in the first group, 15 mg Marcaine plus 25 µg/kg fentanyl, in the second group 15 mg Marcaine plus 50 µg/kg dexmedetomidine, and in the third group, 15 mg Marcaine alone was were injected. The adequacy of anesthesia and postoperative pain was compared between the groups during and after the surgery.
Findings: The mean postoperative pain in the three groups of Marcaine fentanyl, Marcaine dexmedmotidine and Marcaine alone was 5.09 ± 1.5, 4.14 ± 1.1, and 4.89 ± 1.5 (P The use of the combination of dexmedmotidine and Marcaine in patients undergoing lumbar disc surgery with local anesthesia is accompanied by a reduction in the appropriate postoperative pain, and a greater satisfaction of the patient and the physician.

Knee osteoarthritis (KOA) is the most common musculoskeletal disorder which often targets elderly. The aim of this study was to evaluate the effects of the high-intensity Nd:YAG laser therapy (HILT) compared to conventional physiotherapy (CPT) on pain and function in patients with knee osteoarthritis.
In this randomized clinical trial study conducted in 2016-2017, sixty eligible patients with knee osteoarthritis were randomly assigned into two groups of high-intensity Nd:YAG laser therapy and conventional physiotherapy [including ultrasonography and transcutaneous electrical nerve stimulation (TENS)]. They received ten sessions of treatment. All patients were evaluated for pain intensity, range of knee flexion, functional tests, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire at the baseline and after the treatment. Wilcoxon and paired t tests were used to compare intragroup changes pre and post-intervention, and Mann-Whitney and independent sample t tests were used to compare between-group changes.
Findings: There were significant differences in all variables (P The results of the study indicate that high-intensity Nd:YAG laser therapy is more effective in decreasing pain and increasing functional performance in comparison to conventional physiotherapy in patient with knee osteoarthritis.

Totally implantable central venous access (port-a-cath) is being used increasingly in patients with cancer for chemotherapy administration and other therapeutic procedures. We investigated the rate of port-related complications and patients’ satisfaction in these patients.
We prospectively followed up 44 patients with acute leukemia who underwent port placement in Alzahra and Milad hospitals, Isfahan, Iran, between May 2012 and May 2013. Port-related complications were examined in detail and analyzed statistically. In order to evaluate the patients’ satisfaction, some questionnaires were filled in by patients.
Findings: 46 port-a-caths were implanted in 44 patients. Two patients underwent a second placement after removal the first. No case of early complications was reported, in comparison to 16 cases (38.1%) of late complications consisted of rupture and/or migration (9.5%), thrombosis (11.9%), cellulitis (4.8%), bacteremia (14.3%), and erosion (2.4%). The mean patients’ satisfaction was 65.
The most common complication reported in our study was the catheter-related blood stream infection. It is suggested that by multimodal educational programs for health care providers and patients, more than 50% of this complication could be avoided. Patients’ satisfaction relates to their background information, and incidence of complication.