مجله دانشکده پزشکی اصفهان
پیاپی 388 (هفته چهار امرداد 1395)

Invasive ductal carcinoma (IDC) is the most frequent type of breast carcinoma. Epstein-Barr virus is the most suspicious virus for the viral etiology of breast cancer. The aim of this study was to determine the expression of EBV nuclear antigen-1 (EBNA-1) in IDC.
40 Iranian women with invasive ductal carcinoma of breast were enrolled in this study. Tumors were assessed for the expression of EBNA1 antigen by PCR technique. Demographics of patients as well as characteristics of tumors including size, grade, and axillary lymph node status were collected and compared between EBNA1 positive and EBNA1 negative tumors.
Findings: The mean age of patients was 48.7 year. EBNA-1 PCR assay was positive in 11 patients (27.5%). The mean diameter of tumors was 4.43 cm. Axillary lymph nodes were involved in 22 patients. Tumors were grade I, II, and III in 5, 19, and 16 patients, respectively. EBNA-1 positive tumors were significantly larger than EBNA-1 negative tumors (5.5 ± 2.6 vs. 4.0 ± 2.4; P = 0.049).
According to the results of this study, EBV might have a role in the pathogenesis of breast cancer.

Pseudomonas lipopeptides such as white line-inducing principle (WLIP) have important antimicrobial activities. When a WLIP producer bacterium is grown close to P. tolaasii, a white line precipitate will be formed between them Identification of white line reaction (WLR) defense strategy and its distribution among different pseudomonads might help to use such an approach for the treatment of infectious diseases In current study, through a degenerate polymerase chain reaction (PCR) method, the partial characterization of genetic system of NRPS-based WLR was attempted in Pseudomonas aeruginosa for the first time in the world.
Domain analysis of non-ribosomal peptide synthetase (NRPS) enzymes was performed by the nonribosomal peptide synthetase-Polyketide synthases (NRPS-PKS) tool. Multiple DNA sequence alignments, phylogenetic analyses and local Blast searches were performed by Geneious Pro. The gDNA was extracted from P. aeruginosa LMG 1272 and degenerate PCR was carried out.
Findings: First, PCR amplification based on the C1 and TE domains was performed. Despite trying several modifications, a number of bands were obtained in addition to our expected band. For this purpose, the gene wlp/wip blast against Pseudomonas aeruginosa genomes was performed. Two homologes with about 50% identity to wlpB in RW10S2 were obtained. New primers were designed by which the target fragment could be amplified whose Blastp identified only one protein in bacterium Ralstonia solanacearum SD54 with the identity of about 43%.
This study shows that the defensive white line formation by P. aeruginosa is governed most likely by a genetic system different from what has been reported before.

Nowadays, the biodegradable polymer nano-composites have particular importance in tissue engineering because of mechanical properties and good biocompatibility. The aim of this study was to design and evaluate nano-composite fibrin/polyvinyl alcohol (PVA) scaffold using electrospinning method and cell viability on it.
Nano-composite scaffold fibrin/PVA were prepared by electrospinning method while 28.5% of the polymer was formed of fibrin. The porosity of the scaffolds was calculated via scanning electron microscopy by using “Matlab” software and porosity morphology, their distribution and size of the nanofibers. Water absorption test and contact angle measurement were performed. Also, human adipose-derived stem cells were used for cell viability evaluation on scaffolds.
Findings: The mean diameter of electrospun fibrin/PVA scaffold was measured 500 nm. The average pore size and porosity of the prepared sample was 1.7 micrometers and 83.81%, respectively. The average contact angle was 31.71 degrees and 24-hour average water absorption was measured 68.5%. Evaluation test of the cell viability has a significant difference compared to control groups.
The results of this study show that electrospun scaffolds fibrin/PVA can be used in cartilage and nerve tissue engineering.

Tardiness or delay in diagnosis of appendicitis, as the most common cause of acute abdomen around the world, is the most important factor in increasing mortality rate in patients. Therefore, early diagnosis is still a challenge for surgeons to be based on signs and symptoms and laboratory tests to make them sure to decide about the surgery.
In a cross-sectional antegrade study, 200 patient who had come with acute abdominal pain to Modarres hospital emergency room, Tehran, Iran, in 12 months were enrolled; the data of 181 patient were complete that was relevant to our study. Alvarado and modified Alvarado scales were used for data collection by the chief resident of surgery. Pathology report was the standard criterion in this survey.
Findings: The accuracy of modified Alvarado score in diagnosis of appendicitis was 81.4% in comparison with 74.0% of Alvarado score. Our modified score with the sensitivity of 88.0% (vs. 67.7%) and the same specificity of 64.4% in detecting normal cases and positive predicting value (PPV) of 66.0% (vs. 41.9%) in diagnosis of acute appendicitis and positive predicting value of 87.3% (vs. 84.1%) in cases of score of more than of 6 was a better score compare to Alvarado score.
Adding abdominal pain, male gender, and qualitative C-reactive protein (CRP) to Alvarado score was resulted in obtaining a higher accuracy in the diagnosis of acute appendicitis.

Thrombotic thrombocytopenic purpura (TTP) is severe form of thrombotic microangiopathies. Mechanism of this disease has been linked to a disintegrin and metalloprotease with thrombospondin type 1 motif member 13 (ADAMTS13) activity. This protease cleaves von Willebrand factor (VWF). This disease manifest with severe deficiency in ADAMTS13 and increase concentration of ultralarge multimers of VWF that leads to extensive microvascular platelet deposition thereupon thrombocytopenia and small-vessel occlusion, followed by hemolytic anemia. Incidence of disease during pregnancy is 1 in 25,000. VWF levels increase in third trimester and ADAMTS13 levels reduce. Before start of specific treatments such as plasmapheresis, maternal mortality was about 85% and fetal mortality approached 80%. Our purpose is review of the newest method of investigation and management the disease of TTP in the third trimester of pregnancy.
Case Report: Patient is 30 years old woman with term pregnancy with complaint of nausea, vomiting, weight gain and high blood pressure. In primary lab data has hemolysis, elevated liver enzyme and low platelet. She admitted with suspicion of hemolysis elevated liver enzyme low platelet count (HELLP) syndrome. Because of ongoing decrease of platelet count and hemolysis she underwent emergency caesarian section. After caesarian section as regards hemolytic microangiopathic anemia and diagnosis of TTP plasmapheresis started. The patient finally improved and was discharged.
TTP is correlated with pregnancy. Regarding the definite and effective therapeutic impress of plasmapheresis in TTP, it is advised to start plasmapheresis in patients whose laboratory and clinical data are suspicious to TTP.