مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و دوم شماره 1 (پیاپی 157، فروردین 1393)

The intestinal absorption of fatty acids may take place through simple diffusion as well as through protein carrier mediated transport, although the relative importance of each pathway is dependent on the ambient condition of entrocytes. Cad-mium ion influences the absorption of fatty acids in entrocytes. However, the effect of cadmium ion on the absorption of fatty acids in different pH values has not been evalu-ated yet. Especially, the luminal pH of small intestine has an essential role in the ab-sorption of fatty acids. In the present study we aimed to evaluate reciprocal effects of cadmium ion and pH of intestine lumen on the absorption of fatty acids in rat model. In this experimental research, 3 months old Wistar rats (45 rats) were used for experiments. After killing the rats, their intestine was removed and the duodenum and jejunum segments were dissected. Everted Gut Sacs (EGS) were prepared from these duodenum and jejunum segments. The sacs were filled with buffer solution and incubated in a medium containing an appropriate concentration of oleic acid. Then the amounts of oleic acid that had been absorbed into the EGSs in the presence and absence of cadmium ions under different conditions of pH, was measured. Findings of the study demonstrated that the luminal pH of small intestine was effective on the oleic acid uptake and the inhibitory effect of cadmium ions on the up-take of the acid was influenced by pH condition, so that this inhibitory effect was 32% and 36% at the alkaline pHs 7.5 and 9.2, respectively (P< 0.05). At the acidic pHs, 2.5 and 4.5, the inhibitory effect reduced to 11% and 5%, respectively (P< 0.05). Cadmium ion decreased fatty acid uptake by small intestine in rats, and the acidic pH of intestine lumen could attenuate the inhibitory effect of cadmium ion.

The application of CAM visual stimulation returns to the date of more than fifty years ago. However, the reports of previous studies in this field vary from no effect to significant effects of this method in amblyopia treatment. The purpose of this study was to determine the effect of CAM visual stimulation along with conventional occlusion therapy in anisometropic amblyopic children. Forty amblyopic children aged 4 to 6 years old with no previous treatment were enrolled in this randomized clinical trial study. The subjects were randomly as-signed in two different groups. The group 1 included conventional occlusion therapy and group 2 includes occlusion therapy with complementary CAM visual stimulation. In terms of visual acuity and stereopsis improvement and reduction of amblyopia sever-ity, two groups were compared using the repeated measure ANOVA and LSD Post Hoc tests. In group 1 including conventional occlusion therapy, visual acuity improved from 0.444±0.077 logMAR to 0.138±0.023 logMAR, i.e., improvement of 0.306 log-MAR (P< 0.001) whereas in group 2 including complementary CAM usage, visual acu-ity improved from 0.398±0.075 logMAR to 0.047±0.022 logMAR, i.e., improvement of 0.351 logMAR (P< 0.001). Regarding Stereopsis, the improvements were 157 (from 258±34 to 101±13 seconds of arc, P< 0.001) and 171 (from 237±33 to 66±12 seconds of arc, P< 0.001) for groups 1 and 2 respectively. All subjects of group 2 gained the normal vision at the end of the treatment period, whereas only 47% of subjects of group 1 could achieve this level of vision in that time. Improvement of visual acuity in group 2 was significantly better than group 1 (P< 0.05). Using of CAM visual stimulation along with conventional occlusion will further improve visual acuity and stereopsis in amblyopic children. These findings recommended the CAM visual stimulation as an accompanying and complementary method in amblyopia treatment.

Nonalcoholic Fatty Liver Disease (NAFLD) is one of the most wide-spread human diseases that can impair liver function and sometimes progresses to cir-rhosis. Recently NAFLD has been identified as an independent risk factor for cardio-vascular disease. The aim of this study was to investigate the correlation of fatty liver disease and its sonographic severity on the resistance of the intracranial arteries. This study was a cross-sectional study of 55 patients referred from Gastroen-trology clinic with diagnosis of NAFLD to Sonodoppler department of Iranian Center of Neurological Research. Pulsaltile index as a Hemodynamic parameter of Middle Cerebral (MCA) and basilar Arteries of NAFLD Patients was measured by Trans Cra-nial Doppler (TCD) sonography and the measurements were compared with normal values. Also the association of these indices with serum liver enzymes and sonographic grading of liver involvement was assessed. The analysis was done by SPSS 16. Fre-quency distribution, mean and standard deviation were used in descriptive analysis and statistical test 2 to compare qualitative variables. Pulsatile Index (PI) were normal (MCA, P= 0.166, Basilar, P= 0.053) and there was no significant difference with relation to severity of fatty liver based on so-nography findings (P= 0.789), but serum liver enzyme levels were inversely correlated with basilar artery PI (P= 0.014). Considering the increase of cerebral arteries PI in advanced liver disease, absence of increase in vascular PI of patients in the present study could be attributed to the short duration of disease from diagnosis to perform TCD, lack of advanced liver involvement (absence of liver dysfunction) and the response effect to treatment before the TCD. Therefore, to assess vascular changes over time, repeating the TCD with assess other parameters such as Fibroscan and K18 factor that has more compatibility of liver function, could help to understand the pathophysiology of liver diseases and its effect on vascular resistance.

Thyroid carcinoma is the most frequent malignant tumor of the endocrine system in human body and accounts for nearly 1% of all cancers. Medullary thyroid carcinoma is the third frequent of thyroid cancer and accounts about 5-8% of thyroid cancer. Osteocalcin, known as a Bone Gamma-carboxyglutamic Acid-containing Protein (BGLAP), is the most non collagenous protein. Retinol binding proteins are the family of proteins that have diverse actions but mainly transport retinol in human body. In this study to evaluate effect of existence medullary thyroid carcinoma on metabolism of bone and adipose tissue, plasma level of two mentioned proteins had analyzed. Population in this study consists of 46 individuals with medullary thyroid carcinoma and 44 healthy subjects referred individuals to Research Institute for Endo-crine Sciences, Shahid Beheshti University of Medical Sciences. People with the disease after diagnosis of medullary thyroid carcinoma and pathologically confirmed by biopsy in the initial stages of the study were called. After informed consent, 10 ml of blood from the antecubital vein of left hand in sitting position obtained and after cen-trifugation, plasma was isolated from all samples until analyzed kept in the freezer. Plasma levels of hormones were measured by sandwich type ELISA method. Obtained results were analyzed by SPSS version 16 with independent t-test method. Mean plasma level of osteocalcin in patients was 33.1±3.5 and in healthy sub-jects was 12.5±1.2 ng/ml (Mean±SD) and Odds Ratio (OR) value was 1.04. In patients, mean plasma level of retinol binding protein was 82.5±2.7 and in healthy subjects was 22.8±1.6 μg/ml and OR value was 2.1. The confidence level considered at 95%. These differences of plasma levels were statistically significant (P= 0.001). According to difference between plasma levels of osteocalcin and retinol binding protein-4 in patients suffered of medullary thyroid carcinoma comparison with normal subjects, it can be said that, probably medullary thyroid carcinoma has effect on bone and adipose tissue metabolism, so osteocalcin and retinol binding protein-4 hormones have potential to be used for confirmation of diagnosis or following treatment of medullary thyroid carcinoma.

Currently, autologous and allogeneic adipose tissues represent a ubiqui-tous source of material for fat reconstructive therapies. However, these approaches are limited, and often accompanied by a 40-60% reduction in graft volume following transplantation, limited proliferative capacity of mature adipocytes for ex vivo expansion, and extensive adipocyte damage encountered when harvested with conventional liposuction techniques. Recently, cell-based approaches utilizing adipogenic progenitor cells for fat tissue engineering have been developed and were reported to promote both short-term in vivo adipogenesis and to repair defect sites. The aim of this study was to isolate stem cells from fat tissue than examine the growth of stem cells by invitro tests. For human adipose stem cell isolation (hASC), subcutaneous adipose tissue sites were obtained from female subjects undergoing elective procedures. Tissues were washed 3-4 times in phosphate buffered saline (PBS) and suspended in an equal volume of PBS supplemented with 1% FCS and 0.1% collagenase type I. The tissue was placed in an agitated water bath at 37 1C. The supernatant containing mature adipocytes, was aspirated. Portions of the SVF were suspended in DMEM medium. hASCs were selected based on their ability to adhere to tissue culture plastic and subsequently expanded to 75-90% confluence. Adipose stem cells were isolated and cultured on DMEM. To assess mesenchymal origin of stem cells we used flow-cytomery technique as well as differentiation to osteocyte and chondrocyte lines. The nature of the mesenchymal cells was confirmed by flow -cytometry tech-niques, based on the expression of CD90, CD105, CD166, and lack of expression of hematopoietic markers of CD34, CD31, and CD45. The successful differentiation of our stem cells to osteocyte, chondrocyte had been showed by specific Alizarin-Red and Toluidine-blue staining of cells. Although we have not the results of in vivo tests to support in vivo adipo-genesis either alone or in combination with natural or synthetic matrix, the results showed that stem cells isolation from adipose tissue was successful, and we provided an environment for differentiation of stem cells.

Immune Thrombocytopenic Purpura (ITP) is an acquired autoimmune disorder characterized by a low platelet count; because of anti platelet auto-antibodies. ITP patients have auto antibodies against platelet antigens. T CD4+ lymphocytes are effective cells in immune system that has an important role in auto reactive antibody production and class switching. The pathophisiology and mechanism of ITP is complex and unknown. Numerous studies have difference results about role of T cells in ITP patients. T lymphocytes have been characterized to different subsets. To further investigate about the pathogenesis of ITP, we studied the role of T CD4+ cells and cytokines attributed with platelet count. Therefore, in this research, we evaluated T CD4+ lymphocytes count and interleukin 17 (IL-17), interleukin 11 (IL-11) levels in ITP in comparison with control. In a case-control study, we have studied 60 patients with ITP and 50 normal individuals as the control group. Peripheral blood mononuclear cells were isolated by ficoll histopaque 1.077. T CD4+ cells count in ITP patients and control subjects were studied by flow cytometry method and serum interleukin 17 (IL-17), interleukin 11 (IL-11) concentration were measured by enzyme-linked immunosorbent assay (ELISA) test. All data were expressed as mean±SD. Differences between means were considered significant at the P< 0.05. Tests were performed using SPSS software version 16. This study showed, T CD4+ cells and plasma IL-17 concentration were not significantly different between patients with ITP and the control group. But plasma IL-11 levels were significantly increased in immune thrombocytopenic purpura patients in comparison with controls (P= 0.031). In summary, our study indicated a role of IL-11 in ITP patients, also showed that ITP may not be associated with changes of plasma IL-17 levels and T CD4+ cells count relative to control population. Therefore, measurement of plasma IL-11 levels may be important criteria in development of ITP. In addition, it is concluded that determination of IL-11 can be a diagnostic marker to recognize thrombocytopenic purpura patients.

Influenza viruses are one of the most important etiological agents of res-piratory disease in humans and cause epidemics and pandemics with substantial mor-bidity and mortality worldwide. Vaccination and antiviral treatments are the sole and essential way for the prevention and control of influenza infection. During an influenza epidemic before the production of effective vaccine, antiviral treatments are the first step for the prevention and treatment of influenza infection. Adamantanes and neuraminidase inhibitors are influenza antiviral drugs. Because of the increase of drug resistant viruses, the aim of this study was the evaluation of the antiviral drug resistance in influenza A/H3N2 viruses from 2005-2013 in Iran. In this study 50 influenza A/H3N2 viruses isolated in cell culture were tested. All samples were subjected to M and NA gene sequencing at the National Influenza Center, School of Public Health, Tehran University of Medical Sciences. RNA was ex-tracted from 200 µl of cell culture supernatants using the Roche high pure viral nucleic acid kit. RT-PCR with the Qiagen one step RT-PCR kit was done. The expected size of the PCR products were analyzed by electrophoresis using 1% agarose gels. The PCR products were sequenced for finding the drug resistant mutants. All influenza A/H3N2 viruses except four viruses circulating during 2005-2006 had Ser31Asn mutation at M2 channel protein. In the analysis of neuraminidase gene none of the A/H3N2 viruses had K292R, E119V and N294S mutations responsible for drug resistant strains. This study showed circulating A/H3N2 viruses was resistant to adaman-tanes but susceptible to neuraminidase inhibitors. The national data analyzed in this re-search may help increase knowledge about influenza virus antiviral drug resistance, which is a global public health concern. The authors suggested continuing this study and also the investigation of antiviral drug resistance of influenza A/H1N1 and B viruses.

This study was done to determine presenting features and treatment out-come of Rhino-Orbital-Cerebral Mucormycosis (ROCM). This cross sectional study was conducted during 14 years (from 1998-2012) in two educational hospitals of Mashhad University of Medical Sciences in patients with rhino-orbital-cerebral mucormycosis. Clinical symptoms, predisposing factors, demografic parameter and treatment outcome were collected by SPSS and analyzed by cox regression model. A total of 123 cases were (92 proven, 1 probable, 30 possible). From 92 cases of proven rhino-orbital-cerebral mucormycosis, 52% men and 48% women were rec-orded. The most risk factor were diabet 42.4% and immune deficiency 38%. From which 32 patients have hematologic malignancy (50% ALL, 37.5% AML, 6.3% aplas-tic anemia, 6.3% other). Mean time of admission in hospital were 30.1±29.3 days (1-230 days). The sign and symptoms were fever 41.3%, nasal ulceration or necrosis of palate 54.3%, orbital sign 59.7%, Headache 55.4%, central nervous system sign 28.2% and facial sign 53.2%. Median time between first symptoms and start of amphotricin B was 8.2±8.6 days. Treatment consist of both surgery and amphotricin B was done in 70.5% of patients. Mean number of surgery were 1.8±1.5. The mean time of mortality was 60.3±83 day. Thirty seven percent of patients survived with a 6 months follow up. Initial symptoms of sinus invasion by mucormycosis are indistinguishable from other more common causes of sinusitis. We must consider these diseases if there is nasal ulceration or necrosis of palate with fever and orbital sign. Diabet and immune deficiency are the most risk factor for rhino-orbito-cerebral mucormycosis. There is no relationship between age, predisposing factors and adverse effect of drugs with surviv-al. Progression to central nervous system in imaging pattern are related with hospital mortality. Treatment modality and number of surgery affect to mortality P= 0.001, P= 0.033. Survival was affected with the total dose of amphotericin B (P= 0.026).

Abacavir is an anti-retroviral medication used to treat HIV infected/AIDS patients and its efficacy has been proven in randomized clinical trials. The most significant adverse reaction associated with abacavir is the acute hypersensitivity phenomenon which manifests in many forms and in severe cases could result in death. Hypersensitivity reaction to abacavir has been closely linked to the presence of HLA-B*57:01 allele. Avoidance of abacavir initiation in allele-positive patients is the most effective strategy in preventing possible severe hypersensitivity reactions. Previous epidemiologic studies have made great strides toward delineating HLA-B*57:01 allele frequency in different regions of the World and the available results indicate significant discrepancy between geographical regions. Despite these efforts, no study to date has determined the allele frequency among Iranian HIV-positive patients. The aim of the present study was to determine the proportion of allele-positive patients among a group of Iranian HIV-infected patients. Between September 2012 and February 2013, 122 HIV-positive patients were selected among patients referred to Imam Khomeini Hospital’s Consultation cen-ter for high risk behaviors using the convenience sampling method. Sampling scheme was designed in a manner to include equal number of infected patients with and without clinical Acquired Immunodeficiency Syndrome (AIDS). Patient data was collected using available records and a blood sample for DNA analysis was also obtained. Presence of HLA-B*57:01 allele was determined using the Polymerase Chain Reaction- Sequence Specific Method (PCR-SSP). Seventy three patients (59.8%) were male. Co-infection with hepatitis B and C was observed in 1.7% and 40.7% of the patients, respectively. History of addiction and anti-retroviral therapy was positive in 50.0% and 60.7% of the patients, respectively. Overall, three patients were allele-positive which corresponds to a frequency of 2.46% (95% CI: 0.005-7.30). No association between presence of allele and investigated vari-ables were identified. Frequency of HLA-B*57:01 allele among a group of Iranian HIV-infected patients is estimated to be 2.5%. This rate is comparable to those reported in other Middle-Eastern countries, yet is relatively lower than reports generated from South-Eastern Asia, Europe, and the United States. Future studies with larger sample sizes are needed to corroborate these findings.

In most children with Acute Lymphoblastic Leukemia (ALL) and Non Hodgkin’s Lymphoma (NHL) who have received chemotherapy with and without radi-otherapy, some late effects due to treatment may occur such as endocrinopathies. We evaluated growth criteria (including short stature, obesity) and thyroid test function in 50 children with ALL (n= 25) and NHL (n= 25) 3-17 year-old in remis-sion period who randomly received chemotherapy with (n= 25) or without (n= 25) radi-ation such as our treatment groups. The values for height, weight and BMI in less than 5th or more than 95 th percentile considers abnormal. Six (12%) patients were in less than 5th percentile height (short stature). Two patients (4.0%) had over-weight and 48 (96%) were in normal range of BMI. Six (12%) patients were in less than 5th and 3 (6%) were in more than 95 th weight percentile. There was no significant difference between two different treatment groups for TSH (P= 0.662 (but there was a significant difference between these groups in case of T4 (P= 0.049(. Mean and SD for T4 in patients with chemotherapy alone was less than in whom received chemotherapy plus radiotherapy. There was no significant difference between ALL and NHL groups for TSH, T4 (P= 0.567, 0.528 respectively). Two boys with ALL without history of radiation had hypothyroidism that had based on their la-boratory data. Regarding to effects of thyroid dysfunction on short stature and obesity in adolescent with ALL and NHL, we suggest to have more attention about growth, thy-roid test to avoid late side effect of malignancy treatment.