مجله دانشکده پزشکی اصفهان
پیاپی 366 (هفته دوم اسفند 1394)

Breast cancer is the most common cancer among women. HER2 gene is a proto-oncogene that encodes the receptor of tyrosine kinase from epidermal growth factor receptor (EFGR) family. It is an important prognostic factor with a determinant role in treatment of breast cancer. There is no globally accepted method for determining the status of this gene and the method of choice is still a matter of debate. We aimed to evaluate the validity of immunohistochemistry (IHC) method in predicting HER2 status using fluorescence in-situ hybridization (FISH) method and also, to investigate some clinicopathological variables associated with HER2 amplification. In this cross-sectional study, 190 formalin-fixed and paraffin-embedded tissue specimens of invasive breast carcinoma with HER2 of ++ and +++ in IHC evaluation were enrolled. FISH method was performed on all these samples and the relationship of HER2 status and clinicopathological variables was evaluated. The studied population included 160 specimens of ++ and 30 specimens of +++ HER2 in IHC evaluation. The estrogen and progesterone receptors (ER and PR) were expressed in 64.2% and 74.2% of the specimens, respectively. HER2 amplification on FISH method was found in 27.5% and 83.3% of specimens of ++ and +++ HER2 in IHC evaluation, respectively. Tumors with HER2 amplification were more likely to be negative for estrogen (52.2% vs. 26.4%, P < 0.001) and progesterone (39.1% vs. 18.2 %, P = 0.013) receptors. This study showed that immunohistochemistry is not a good method for evaluating HER2 status and decision making about trastuzumab therapy even in patients with +++ HER2.

Carpal tunnel syndrome (CTS) is the most common upper extremity impingement neuropathy caused by median nerve compression within the carpal tunnel due to various conditions such as bone abnormalities, inflammation, trauma, neoplastic lesions and endocrinopathies. Increase in carpal tunnel pressure of more than 20 to 30 mmHg blocks the epineural blood flow; so, the nerve function is damaged. Carpal tunnel syndrome is primarily a clinical diagnosis supported by electrodiagnostic studies; in recent years, different imaging modalities, including magnetic resonance imaging (MRI) and ultrasound, are suggested for diagnosis of carpal tunnel syndrome. During November 2011 and May 2013, 84 patients clinically suspicious for carpal tunnel syndrome were enrolled in our study; the age of patients ranged from 19 to 66 with the average of 43 years and the sex ratio of women to men was 2.7:1. All the patients underwent electerodiagnostic tests (EDT) as the gold standard diagnostic modality and the results of color Doppler sonography (CDS) were compared with electerodiagnostic findings. According to the ecterodiagnostic tests, patients with positive results of carpal tunnel syndrome were divided into three groups of severity including mild with 9 patients (11%), moderate with 14 cases (17%) and severe with 18 patients (21%). Sensitivity of color Doppler sonography for diagnosis of carpal tunnel syndrome was almost 83%, 71% and 55% in severe, moderate and mild groups of carpal tunnel syndrome, respectively. Specificity of this imaging modality was determined near to 81% in all three groups of the patients. In addition to electerodiagnostic tests, which are considered as the modality of choice for diagnosis of carpal tunnel syndrome, Doppler ultrasound can be a non-invasive imaging procedure for evaluation of patients that are clinically suspicious to this syndrome. Considering three groups of carpal tunnel syndrome based on severity of electerodiagnostic signs, results of color Doppler sonography is more reliable in patients with severe signs.

Multiple sclerosis (MS) is a kind of the chronic neurodegenerative diseases of central nervous system (CNS) which usually is associated with neurological disability. In this study, human adipose-derived stromal/stem cells (hADSCs) were transplanted into a rat model of multiple sclerosis (MS) and the efficiency of these cells in remyelination process was determined. Forty adult rats were randomly divided into control, lysolecithin, lysolecithin with medium (vehicle), and lysolecithin with human adipose-derived stromal/stem cells transplantation groups; then, focal demyelination was induced via lysolecithin injection into lateral column of spinal cord. One week after the lysolecithin injection, laminectomy site was re-exposed and for vehicle group, 10 µl of medium and for the transplantation group 10 µl of medium containing 1 × 106 stem cells was transplanted. For the control and lysolecithin groups, just laminectomy site was re-exposed and closed again without intervention. Four weeks after the cell transplantation, immunohistochemistry technique was used for assessment of the presence of stem cells in damaged spinal cord and to assess the extent of demyelination and remyelination, transmission electron microscope was used. Immunohistochemistry study four weeks after cell transplantation showed that the stem cell transplant existed in the lesion site. In addition, the electron microscope micrographs showed that myelin synthesis increased more in the cell transplantation group compared to the other groups. Human adipose tissue-derived stem cell transplantation may be an appropriate method for cell therapy in neurodegenerative diseases such as multiple sclerosis.

Family physician program, through the expansion of insurance coverage for all, had been performed in Iran since 2005. This study aimed to survey the pattern of costs by the Health Insurance Organization, for the people covered by family physician program in Isfahan Province during 2009-2013. In a cross-sectional study in 2014, documents of the current final costs of the Health Insurance Organization and the Deputy of Health, Isfahan University of Medical Sciences, in the family physician program in the rural areas, urban areas with population under twenty thousands and nomads in Isfahan province during 5 years, from 2009 until 2013, were studied. The collected and analyzed data on the current costs of health care in the outpatient departments consisted of two parts: the cost of outpatient visits (including general practitioners and specialists) and all the costs of medical, laboratory and radiology applied, as well as all hospital costs of people covered by family physician. The referral load to specialists and subspecialists decreased from 0.46 times per person in 2009 to 0.39 in 2013 in the covered population. The trend of inpatient admissions decreased from 63.09 times per thousand in 2009 to 53.99 in 2013 in the covered population, too. Referring to specialists and subspecialists and inpatient care decreased after applying of family physician program.

Vanadium (V) is a candidate to decrease the serum level of glucose in diabetic animal model. However, it affects the lipid peroxidation and antioxidant activity so could make nephrotoxicity and hepatotoxicity. In this study, the protective role of vitamin C as an antioxidant on nephrotoxicity and hepatotoxicity induced by vanadyl sulfate was investigated. This study was designed in 2 protocols. There were 3 groups in protocol 1 that received saline (group 1), saline daily for 7 days plus single dose of vanadyl sulfate (50 mg/kg intraperitoneally) in day 2 (group 2), or vitamin C (250 mg/kg intraperitoneally) daily for 7 days and single dose of vanadyl sulfate (group 3). There were 2 groups in protocol 2 that received saline plus single dose of vanadyl sulfate (50 mg/kg intraperitoneally) in day 2 (group 4) or vitamin C (250 mg/kg intraperitoneally) daily for 2 days plus single dose of vanadyl sulfate (group 5). At the end of experiment, blood samples were collected to measure serum level of blood urea nitrogen (BUN), creatinine (Cr), aspartate transaminase (AST), alanine transaminase (ALT) and alkaline phosphatase (ALP), and all animals were sacrificed for histopathology investigation and determination of kidney tissue damage score (KTDS). In protocol 1, BUN/Cr ratio, kidney weight (KW), and KTDS decreased significantly in vanadyl sulfate plus vitamin C group in comparison with vanadyl sulfate plus saline group (P < 0.05). In addition, serum level of AST and ALP significantly decreased in vanadyl sulfate plus vitamin C group. In protocol 2, not only similar results were not observed, but also vitamin C increased the side effects of vanadyl sulfate. Administration of vitamin C as a potent antioxidant could decrease the vanadium-induced toxicity. So, as vanadyl sulfate can be used for diabetic model in laboratory, vitamin C can be useful to decrease the vanadium-induced nephrotoxicity and hepatotoxicity, too.

Toxicity is ability of chemicals to cause harm. One of the principles of dealing to poisoned patients is bowel decontamination via using laxatives or purgatives to wash out poison‐activated charcoal complex quickly. This study aimed to determine gastrointestinal transit time fallowing administration of magnesium hydroxide, lactulose and polyethylene glycol in poisoned patients referred to emergency ward of Noor hospital, Isfahan, Iran, in 2015. 140 patients were randomly divided into four equal groups of magnesium hydroxide (30 ml with 2‐4 glass of water every 1 hour), lactulose (30 ml with 2‐4 glass of water every 1 hour), polyethylene glycol (70 g with 1 liter water every 20 minutes) and activated charcoal with water. In all patients, the time of taking the first dose of laxatives until to defecation were obtained. The results were compared to each other using SPSS software. There were no significant differences in term of age, sex and toxicant types. The mean time between the first dose of laxative until to defecation was significantly different between the 4 groups (P < 0.001). Between the 3 studied laxatives, polyethylene glycol and then, magnesium hydroxide were more efficient in decreasing mean transit time. The difference in mean transit time between the 3 laxatives was not significant; but, in comparison to activated charcoal with water, the laxatives showed significant difference which was remarkable.

Increasing in cardiovascular risk factors in old age is known as the most common cause of the dangerous heart problems. This study aimed to assess the changes in C-reactive protein, fibrinogen and lipid profile in elderly men after eight weeks of aerobic training. 52 men with more than 60 years of age in the park in the city of Shiraz, Iran, were enrolled as volunteers, and based on body mass index were divided in two equal groups of experimental and control. Then, the experimental group participated in a training program for 8 weeks, 6 days per week. To measure the desired parameters, blood samples were taken from participants before and after the study. The data analysis was done using dependent and independent t tests. Eight weeks of aerobic training significantly decreased fibrinogen (P = 0.001), C-reactive protein (P = 0.001), total cholesterol (P = 0.010) and triglyceride (P = 0.010) and significantly increased high-density lipoprotein (P = 0.006). Eight weeks of aerobic exercise caused a significant decrease in fibrinogen, C-reactive protein, and lipid profile in elderly men and we can use this training program to effectively improve health promotion.