مجله دانشگاه علوم پزشکی مازندران
پیاپی 140 (شهریور 1395)

Background and Cerebrospinal fluid (CSF) has a broad set of molecules which is essential for neurogenesis. Human dental pulp stem cells (hDPSCs) are putatively neural crest cell-derived that can differentiate into neurons and glial cells under appropriate neurotrophic factors. The aim of this study was to induce differentiation of hDPSCs into neuroglial phenotypes using Retinoic acid (RA) and CSF.
The hDPSCs were isolated by mechanical enzymatic digestion from an impacted third molar and cultured. 2 × 105 cells were treated by 10-7 µM Retinoic acid (RA group) for 8 days, CSF (CSF group) for 8 days and pre-induced with RA for 4 days followed by inducing with CSF for 4 days (RC group). Nestin, βIII-tubulin and GFAP immunostaining were used for evaluating the differentiated cells. Axonal outgrowth was detected using Bielschowsky's silver impregnation method and Nissl bodies were stained in differentiated cells by Cresyl violet. Data analysis was performed in SPSS V.16 applying One-way ANOVA and Chi-square test.
The morphology of differentiated cells in treated groups significantly changed after 3-5 days. The immunocytochemistry results showed that nestin, the neuroprogenitor marker, was observed in all groups. Whereas, a high percentage of nestin positive cells and ΒIII-tubulin, as mature neural markers, were seen at the pre-induction and induction stage, respectively. Nissl bodies were detected as dark-blue particles in the cytoplasm of treated cells.
The findings suggest that the RA as pre-inducer and CSF as inducer could be used for in vitro differentiation of neuroglial cells from hDPSCs.

Background and Bombesin is a 14-amino acid peptide with high biological functions which has a high affinity to GRP )Gastrin releasing peptide( receptor. GRP receptors are overexpressed in many malignant tumors such as prostate and breast cancers. The purpose of this study was to prepare [HYNIC-(Gly)3-D-Phe13]Bombesin(7-14) to label it easily by 99mTc and to evaluate it as a potential agent for imaging the tumors that have GRP receptors.
In this experimental study, the prepared derivative Bombesin was radiolabelled by 99mTc at 100°C in 10 minutes using the exchange method and radiolabelling analysis was applied by TLC and HPLC. Specific absorption test and specific internalization using prostate cancer cells PC-3 was done by blocking and unblocking the receptors. Biodistribution were determined in normal mice.
More than 95% radiolabelling was obtained. Specific absorption and internalization after 4 hours were 17.9% and 9.5%, respectively in PC-3 cancer cells. Biodistribution data showed rapid clearance from blood with major renal excretion and specific binding to tissues that have GRP receptors such as pancreas.
Conjugated peptide radiolabelled with 99mTc has promising characteristics as potential agent for imaging the tumors that overexpress the GRP receptors.

Background and Atherosclerosis is a form of arteriosclerosis that is one of the main causes of death in the world. In coronary artery disease, the vessels are stenosed due to lipid aggregation and inflammation. Epidemiologic studies have shown that in addition to demographic factors such as age and sex, blood pressure, smoking, obesity diabetes and genetics are also associated with development of atherosclerosis process. The aim of this study was to examine the relationship between these factors and atherosclerosis.
One hundred twenty six Iranian subjects (68 males, 58 females) were recruited based on the study’s inclusion criteria. Total RNA was extracted from WBC and, the gene expression level was determined by RT-qPCR method.
Significant relationship was found between sex (P0.05).
We found that among factors affecting atherosclerosis, sex and LDL-C could change the Sterol Regulatory Element-Binding Protein-2 gene expression.

Background and Repetitive strain injury (RSI) is accompanied by an increase in extracellular matrix (ECM), atrophy, and reduces the muscle power. Resistance training (RT) have potential positive effects on muscle function and morphology in elderly. This research examined the effects of eight week therapeutic resistance training on recovery of pathological changes after 6weeks chronic eccentric contraction.
Eighteen elderly male Wistar rats were divided into three groups (control, RSI-rest, RSI-RT). Two experimental groups underwent 6weeks (5 days/week) of fast velocity submaximal eccentric contractions while the control group was inactive. After two weeks rest, RSI-RT group performed 8 weeks resistance training and RSI-rest group was detrained for 8 weeks. Gastrocnemius muscle response was assessed by isometric force and muscle wet mass. Quantitative histopathological analysis was also done in all groups.
Gastrocnemius tissue of injured limbs showed increase in ECM and decrease in myofiber area and isometric force after 6 weeks RSI model in RSI-rest group, but muscle wet mass did not change. RT significantly improved isometric force, myofiber area percent but decreased non-contractile area percentage. However, pathological changes after RSI were not fully recovered by RT.
Therapeutic Resistance training with an emphasis on concentric phase, low velocity and adequate rest can attenuate functional and histopathological changes in muscle after chronic strain injury in elderly rats.

Background and Gastroesophageal reflux disease (GERD) is one of the most common chronic disorders of the digestive system. This survey was performed to determine the effect of Temperament–based dietary intervention on the symptoms of GERD.
In a randomized clinical trial, 60 patients with GERD attending the Qaem Hospital in Mashhad, Iran were randomly divided into nutrition education group (n= 30) and control group (n= 30). In case group, patients were referred to the Traditional Medicine Clinic and their temperament and dystemperament were verified by a traditional medicine physician. Temperament–based dietary education was held in intervention group for 1.5 hours according to the determined dystemperament. The participants were asked to follow the diet for two weeks. In control group, the same process was carried out along with the accustomed dietary education without taking notice to their temperament. The GERD questionnaire, food frequency questionnaire (FFQ), and 24-hour diet recalls (24-HDR) were administered to collect the data. SPSS V.11.5 was used to analyze the data applying Chi-square, Mann-Whitney, Independent T test, and Paired T test.
After the intervention, significant decrease were seen in the symptoms among the intervention group including heartburn (25.5%), frequency of acid regurgitation (14%), heartburn severity (11.3%), acid regurgitation severity (23.6%) and duration of heartburn (5.2%), duration of acid regurgitation (34%), and heartburn dissemination (8.8%) (P Considering temperament in diet can play an important role in improving the symptoms in patients with Gastroesophageal Reflux Disease.

Background and Multiple Sclerosis (MS) is a disease of the central nervous system that is an auto-immune disease, where the immune system gets confused and attacks the nerve cells, damaging this protective layer of myelin sheath. The prevalence of MS is 52 per 100000 worldwide. The relation between Epstein-Barr virus (EBV) and MS is well understood but studies reported different results. This study aimed at determining any association between IgG and IgG and EBV in patients with MS and healthy controls.
A case-control study was performed in which serum samples were collected from 45 MS patients (attending Sari Boali-Sina Hospital, Iran, 2014-2015) and 45 control samples. The blood samples were centrifuged and plasma was separated. All samples were tested for anti EBV antibodies using Enzyme Linked Immunosorbant Assay (ELISA).
In this study, 100% of samples from patients with MS were IgG positive and 85% of control samples were IgG positive. We found that 13.3% of MS positive samples were IgM positive but all control samples were IgM negative.
According to our results the rate of positive IgM against EBV-CA in patients with MS was higher than that in normal individuals.

Background and Human leptospirosis is prevalent and endemic in north of Iran, especially in Guilan and Mazandaran provinces as temperate regions. The purpose of this study was to survey the epidemiologic and sero-prevalence nature of leptospirosis in healthy people in Mazandaran province.
A cross sectional study was carried out in three rural regions in Ghaemshahr, Iran, 2015. The participants included 272 paddy field workers who were selected via convenience sampling. Demographic information was recorded and serum samples were tested for anti-leptospiral IgG antibodies.
The subjects were 184 (67.5%) males and 88 (32.5%) females. There were 265 (98.1%) farmers and 284 (93.4%) worked in paddy fields. Positive anti-Leptospira IgG (> 0.3) was observed in 49 cases (18%). Significant association was found between working in paddy fields and serology test results (P=0.043). But there was no significant relation between age, gender and exposure to animal and positive serology (P=0.699, P=0.32, P=0.092, respectively).
High sero-positivity, high number of people working in paddy fields and ecologic conditions of the province calls for appropriate training programs for farm workers such as wearing standard shoe covers in the hope that leptospirosis is controlled.

Background and Despite rapid progress in medical treatments and acute care technology during the past 30 years alongside increasing costs of medical care, the analysis of outcomes such as mortality risk have been a challenge in intensive care units. The purpose of this study was to predict the mortality rate of premature infants in neonatal intensive care unit (NICU) using artificial neural network model.
This study was performed using the medical records of 100 preterm infants (less than 37 weeks gestation) in Mashhad Qaem Hospital, Iran, during 2007-2010 applying MATLAB. Twenty one variables were used of which 80% were for artificial neural network training and 20 percent were for testing the designed model. To prevent the dispersion of information we used information classification code system and the codes were used to design and test the artificial neural network model.
Per 60 neurons and 20 replication optimum validity was obtained (95.2% in training and 94.56% in experimental stage). The replications were not continued more, since in this case the algorithm would have gone towards overtraining.
This study introduced a method for establishing ANN models in estimating the probability of mortality in premature infants using 21 variables. This model may be used for prediction of many other consequences in NICU such as mechanical ventilation duration and complications such as abnormalities in neuroimaging, necrotizing enterocolitis and bronchopulmonary dysplasia.

Background and Discharge against medical advice (AMA) has negative impacts on treatment outcomes and health care resources. Also, physicians and hospital administrators get involved in litigation. The aim of this study was to investigate the causes of AMA discharges in different wards and emergency departments in teaching and nonteaching hospitals affiliated with Mazandaran University of Medical Sciences.
This cross-sectional study was performed investigating the AMA leaves within 6 months in 2014. Data was obtained from the Department of Medical Records and the Office of Quality Improvement. Data was recorded in a questionnaire consisting of two parts. Part I included demographic information and Part II was about the reasons of discharge against medical advice. Data was aggregated by expert staff in Office of Quality Improvement. SPSS V.18 was applied for data analysis.
The prevalence of AMA leaves in emergency department and other wards in teaching hospitals affiliated with Mazandaran University of Medical Sciences was 3.81% and 4.38%, respectively. These figures in nonteaching hospitals were 8.38 % and 1.59%, respectively. The most common causes of discharge against medical advice were partial recovery, lack of trust in service quality, feeling uncomfortable, and emotional reasons.
To reduce the rate of AMA leaves and its consequences, health care staff should be supportive towards the patients and communicate effectively in order to build their confidence.

Background and Many conventional disinfection methods of effluents raise some health, efficiency and economic concerns. In order to increase the efficiency of disinfection of real effluent, in this study, the catalytic ozonation process was performed and economically compared with chlorination.
Magnetic activated carbon was used as acatalyst in a semi-continuous reactor for disinfection of effluent of municipal wastewater treatment plant in Bandargaz, Iran in 2015. The efficiency of disinfection was determined by thermo-tolerant coliform as indication, and the effect of parameters such as catalyst concentration (0, 0.5, 1, 2, and 5 g/L), initial number of coliforms, contact time (1, 2, 5, 10, 20 and 40 min) and catalyst reuse on disinfection process was evaluated. Finally economic comparison was done with the chlorination.
The results showed that the efficiency of disinfection was increased by increase in the concentration of carbon nano-composite and contact time; at 1 g/L concentration of Catalyst about 1.99 log reduction was observed after 2 min exposure time in which the effluent standards were obtained; while 1.91 log reduction of micro-organisms was measured for single ozonation. The first-order kinetics constant of single ozonation (0.42 min-1) showed an approximately 9-fold increase when the catalyst (2 g/L) was added to the solution. After 7 times reuse of nano-composite, the diminution of efficiency was negligible (1.5%); and more than 57% fall of the cost was observed in a 5-year operational period compared with chlorination.
The catalytic ozonation with the new catalyst of effluent could effectively disinfect the effluent in a short-contact-time, and due to economic considerations it can be used as an effective and economical method in wastewater treatment plants.

Background and Molasses is colored, toxic and non-biodegradable compound which is found in the wastewater of fermentation industries. This study investigated the kinetic and efficiency of molass dye removal and mineralization in the yeast wastewater using nanocomposite catalysts in ozonation process.
The catalytic ozonation process (COP) of colored effluent of biological treatment of yeast production factory was carried out using semi-continuous flow cylindrical reactor and the effects of operational parameters such as initial pH value (4-10) and reaction time (5-60 min) on removal efficiency of dye and mineralization were investigated. After determining the kinetic parameters of reaction, the effects of some other parameters such as adsorption and reuse of the catalyst were calculated and the efficiency was compared with single ozonation process (SOP) and granular carbon as catalyst.
The removal efficiency of dye of molass factories effluent and its kinetic, at the condition of initial dye concentration 4521 ADMI, catalyst concentration 2 g/L and 60 min reaction time were 95% and 0.045 min-1, respectively; while these parameters in SOP and granular activated carbon as catalyst were 71% with 0.018 min-1 and 86% with 0.028 min-1, respectively. But, the mineralization and its kinetic in COP were 74% and 0.023 min-1, respectively, in which initial TOC was decreased from 510 mg/L to 132 mg/L.
The nanocomposite was found to have the best efficiency in dye degradation and TOC removal and it is easy to recover and reuse over and over by magnet. The main mechanism of dye degradation in COP was chemical oxidation and less occurred by adsorption.

Background and Soil pollution to hydrocarbons in oil field zones in southern Iran and areas close to oil and gas transportation pipe lines is a major environmental problem. The current study aimed at determining the efficiency of bioremediation of n-Hexadecane contaminated soil as a model contaminant.
Aged hydrocarbon contaminated soils were used as the origin of bacteria isolation. Isolation of n-Hexadecane degrading bacteria was carried out through enrichment in mineral salt medium and incubation in 31 oC in shaker incubator at 150 rpm by repetitive cultures during 6 consecutive refreshing. Finally, two pure strains were isolated and identified by PCR. Bioremediation of initial n-Hexadecane concentrations of 500, 1000 and 5000 mg/kg was investigated in eight weeks.
Two Pseudomonas aeruginosa strains capable of n-Hexadecane biodegradation were isolated. The removal efficiencies at the end of day 56 for n-Hexadecane initial concentrations of 500, 1000 and 5000 mg/kg were 93.6%, 87.5%, and 69.62%, respectively.
Isolated Pseudomonas aeruginosa bacteria demonstrated high n-Hexadecane biodegradation potential in soil and also biosurfactant production, therefore, they could be used for bioremediation of hydrocarbon contaminated soils.

Background and Nowadays High-intensity focused ultrasound (HIFU) as non-ionizing radiation is used for cancer treatment. Ultrasound beams when crossing the border of two environments are refracted causing decrease in the beam focusing within a tumor. Also, it may induce damage to normal tissues. In this study, we evaluated the focal depth shift induced by ultrasonic beam refraction.
At first, the level of shift caused by the difference in two specific tissues were calculated for one element of transducer. Then it extended to all of the transducer elements and total shift was calculated. Designed algorithms were implemented in MATLAB. Also, HIFU simulator was used according to the US Food and Drug Administration (FDA) regulations to simulate HIFU therapy.
The results showed that beam refraction caused by different velocity shifted the focal point. Therefore, an algorithm was proposed for controlling the focal depth and was tested on four models with two layers of tissue. Results showed that using the proposed algorithm corrected much of the focal point shift. Also, it was noted that a part of this shift was caused by absorption of the beam in tissues.
Not controlling the focal point shift can induce damage to normal tissues. Therefore, using computational algorithms significantly corrected the focal point shift and lead to increasing safety and having adequate control in HIFU therapy.

Background and The last way of noise control is using hearing protective devices that maybe the first way of noise control in some industries. Obviously if the hearing protection device is not used continuously and properly, its actual performance is reduced. The aim of this research was to investigate the relationship between demographic variables and BASNEF training constructs in promoting hearing protection device use for longer durations.
A case-control study was carried out in which 50 individuals participated in each group. A questionnaire was developed based on BASNEF training contracts and participants completed the questionnaire before and three months after the intervention. The intervention was performed according to BASNEF training model in experimental group using both theoretical and practical methods, while the control group received no trainings.
Before the intervention, significant correlations were observed between the awareness construct and age, attitude, influencing people and educational level, and also between enabling factors and marital status (P0.05).
Based on our findings, there was a strong correlation between influencing people construct and educational level, therefore, they require further attention when planning for training programs in promoting the use of hearing protection devices for longer durations.

Background and Occupational fatigue is one of the main problems in work environments. Investigation of different aspects of occupational fatigue in drivers is of great benefit in reducing the level of road accidents.
We conducted a cross-sectional study in 420 drivers of heavy vehicles. Data was collected using a demographic and job information questionnaire and Swedish Occupational Fatigue Inventory (SOFI). T-Test and multivariate linear regression were applied for data analysis.
The average daily driving hours was found to be significantly associated with all dimensions of fatigue except for lack of energy (P Occupational fatigue in drivers has close relations with their habits and occupational activities. Modifying some negative behaviors such as smoking, inactivity, lack of attention to rest and continues driving can play major roles in incidence of occupational fatigue.

Background and Many studies investigated patient rights in Iran in the past decade, but there is few information on the awareness of cancer patients about their rights. This study was conducted to evaluate the awareness of hospitalized cancer patients about patient bill of rights.
In a cross-sectional study 200 patients with cancer in oncology ward in Sari Imam Khomeini Hospital were recruited and face to face interviews were conducted (in 2014). Information was collected in a four-part survey questionnaire based on patient bill of rights. Data analysis was performed in SPSS10.
The patients were 56.5% males and the mean age was 55.5±16.62 years. Among the patients 34% were illiterate and 17% were found to be with low literacy. The majority of the participants (79%) had not seen the patient bill of rights and 16% had low information about that. Also, most of the participants (98%) reported poor performance of the hospital staff in providing the patients with the contents of patient bill of rights at the time of registration and conditions and treatment costs at the time of admission. There were significant relationships between the scores for knowledge on patient bill of rights, educational level, occupation, and income.
In this study, the patients did not have enough information about their rights, therefore, appropriate planning is needed to increase awareness among patients about their rights.

Background and Middle age is a developmental stage. Women in this stage are capable of preserving and promoting their health. Nonetheless, there seems to be several issues affecting their health-oriented behaviors. Identifying such behaviors from the perspective of middle-aged women are of great importance in protecting and promoting their health. This study aimed at defining health seeking behaviors in middle-aged women.
The study was conducted by qualitative approach and conventional content analysis was adopted. The participants included 20 middle-aged women who were recruited by purposive sampling. Semi-structured face to face interviews were conducted to collect the data. Then verbatim transcription of interview data was done and categories were extracted. First, semantic similarities were identified and sub-categories were specified, then in reconsideration related sub-categories were placed in a same category.
Four categories were identified including the status of health knowledge, understanding of health and diseases, controlling the health-oriented behaviors and "using self-soothing behaviors". Eight sub-categories were also determined: awareness of health risks, preventive/permissive behaviors, understanding of health, understanding of disease, health promoting behaviors, interactive behaviors, soothing and spiritual calming behaviors as health-seeking behaviors.
The findings expressed behaviors that women showed in their quest for health. In fact, this quest for health is manifested in strategies that women adapted to maintain and promote their physical and mental health. In such a quest women constantly rely on their own knowledge of health, perception of health and diseases and tranquilizing and relaxing methods.

Background and Trauma is the fourth leading cause of death in some developing countries and the second cause of death among young people in Iran. Focused assessment with sonography for trauma (FAST) as part of the preliminary examination is invaluable in emergency care. The aim of this study was to evaluate the accuracy of FAST in determining free abdominal fluid in traumatic patients admitted in an emergency department.
A cross-sectional study was carried out in 150 trauma patients in emergency department (Imam Teaching Hospital, Sari, Iran). FAST reports for presence of free fluid in the abdomen by emergency residents were compared with those of abdominal and pelvic CT scan (oral and intravenous contrast). Sensitivity, specificity, positive predictive value and negative predictive value were evaluated.
The mean age of patients was 37.02 ± 14.46. There were 26 (84%) males and 24 (16%) females. In FAST and CT scan of the abdomen with oral and IV contrast 13 (8.7%) and 10 patients (6.7%) were reported with free fluid in the abdomen.
Ultrasound is a reliable tool for assessing trauma patients that can be performed with reasonable accuracy. Emergency physicians are constantly available upon admission, therefore, ultrasound plays an important role in decisions made for trauma patients in emergency departments.

Background and Bisphenol A is a synthetic xenoestrogen that is used in large amount to produce polymers (polycarbonates, epoxy resins). It easily cross the blood-brain barrier and is reported to influence the central nervous system especially neurogenesis and synaptic transmission. In this research the effects of chronic administration of bisphenol A on spatial learning and memory in adult male rats was studied.
Forty male Wistar rats were randomly divided into four groups (n= 10); a control and three BPA (10 and 50 and 100 µg/kg) groups. Bisphenol A was administered intraperitoneally for 15 days. The morris water maze was used to study the spatial learning and memory for 5 consecutive days. Data analysis was performed using one-way ANOVA.
Compared with the control group, treatment with BPA in 10 and 50 µg/kg doses reduced spatial memory (P Results showed that bisphenol A increased the distance and latency time in finding the hidden platform. It seems that bisphenol A has negative effects on spatial memory by affecting synaptic transmission in central nervous system.

Background and Severe early childhood caries (S-ECC) are amongst the major problems of oral health in children. The purpose of this study was to determine any relationship between S-ECC and body mass index (BMI) in children (2-4 years of age).
In this case-control study, 300 S-EEC infected and 300 S-ECC free children were randomly selected from Tehran kindergartens. Data was collected by examinations and demographic data, different variables including height, weight, BMI, nutrition type, milk consumption were recorded in a checklist. Data were subjected to Chi-square and Logistic regression tests.
Gender and nutrition type in the first two years of life, milk consumption and having special eating habits were significantly associated with developing S-ECC (p-value No significant relationship was noted between body mass index and severe early child hood caries.

Background and Sexual satisfaction is a pleased experience or satisfaction of an individual or a couple during any stage of sexual intercourse including libido, arousal and orgasm that could change during pregnancy due to multiple physical or psychiatric changes. This study aimed at investigating the level of sexual satisfaction in pregnant women with gestational diabetes.
We conducted a cross-sectional study in which 150 pregnant women attending Sayyad-e-Shirazi Hospital in Gorgan, Iran, were recruited. Using non-randomized convenience sampling they were classified into two groups: getational diabetes group and non-diabetic control group. Two questionnaires were administered including ENRICH Marital Satisfaction Scale consisting of 35-items (previously validated in Iran) and Female Sexual Function Index-FSFI.
The mean scores for sexual satisfaction according to ENRICH Marital Satisfaction Scale and FSFI were 61 ±10 (moderate to high) and 24±4, respectively, which the latter represented a poor sexual function. Sexual satisfaction level was found to be higher in those aged 25-30 years old but this difference was not statistically significant.
Our results showed no significant difference between diabetic pregnant women and non-diabetics in sexual satisfaction. But sexual function was affected in pregnant diabetic women that could be due to the coincidence of pregnancy and diabetes.

Background and Scorpion envenomation is a serious health problem in tropical and subtropical regions. There are several reports on scorpion stings in Kazerun, Iran, therefore, the present study was conducted to establish a strategy to reduce the rate of scorpion sting.
The study was conducted in 2009 to 2014. Relevant information was collected from Kazerun health center.
A total of 2377 cases of scorpion sting were reported during 5 years including 51.4% males and 48.6% females. The highest and the lowest rate of scorpion sting were found in individuals aged 25-34 years old (23.2%). The highest rate occurred in 2012 (25.7%). The scorpion stings were more frequent in summer (52.4%) and in August (22.6%). Majority of scorpion sting cases lived in rural areas (59.4%). The maximum numbers of scorpion sting were observed in hands (52.5%) followed by feet (35.2%), trunk (10.1%) and head and neck (2.2%).
Due to the weather condition in Kazerun scorpion sting is one of the major health issues in this city. It seems that personal protection trainings through public media, especially in rural areas can be effective in reducing scorpion sting.

Background and Beam shaper is a type of applicator used in conjunction with the intraoperative electron radiotherapy. This study aimed at quantitative evaluation of the photon contamination of this applicator using Monte Carlo simulation.
In this experimental study, at first the head of LIAC accelerator was simulated along with the beam shaper applicator using MCNPX Monte Carlo code. Validity of the simulated model was evaluated by comparing the percentage depth dose curves obtained by Monte Carlo simulation and practical dosimetry. Finally, the photon contamination at different clinical field sizes and electron energies was quantitatively determined.
The results showed that by increase in field size, the photon contamination of the beam shaper applicator was considerably decreased. Furthermore, increment of electron energy could increase the photon contamination.
Increasing the photon contamination at the phantom surface by increment of electron energy and decrement of field size can be attributed to increasing the probability of electron interaction with the steel blades of the beam shaper and production of bremsstrahlung radiation at higher energies. Due to the photon contamination, employing the beam shaper applicator can increase the surface dose.

Multiple myeloma is a monoclonal malignant proliferation of plasma cells that causes osteolytic lesions in the vertebrae, ribs, pelvic bone, skull and jaw. We report a case of a 66 year-old-woman with pain and right facial swelling. Radiographic examination showed a well-defined radiolucent lesion in left posterior mandible. An incisional biopsy was performed and histopathological examination revealed proliferation of malignant plasma cell with off-center and hyper chrome nucleus. The results of biopsy, imaging, and laboratory investigations led to the diagnosis of multiple myeloma. This maxillofacial manifestation of multiple myeloma is not that rare, but dentist knowledge about maxillofacial manifestation can help in early diagnosis and consequently better prognosis of the disease.

Fetus papyraceus is a rare condition that describes a mummified fetus during multiple pregnancies. In this condition one fetus dies in early pregnancy, while the other fetus/es continue to live. The cause is unknown, but it does not seem to be a coincidental event. It is believed to be the result of abnormal growth and development in early pregnancy. This study describes a case of fetus papyraceus that was diagnosed during labor.
In ultrasound examination of a pregnant woman (19 weeks and 4 days gestational age) she was found to be pregnant with twins. It reported one live fetus and one dead fetus. Delivery was performed in natural course at 38 weeks and 4 days gestational age in which a boy was born alive and apparently healthy (Apgar scores 9 and weighing 3000 grams), while the other was a dead fetus that seemed mummy weighing 800 grams.
Fetus papyraceus is rare and its early diagnosis is of great benefit in preventing severe complications. Full investigation of the fetus and placenta will help to determine effective factors in formation of fetus papyraceus.