مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و چهارم شماره 8 (پیاپی 188، آبان 1395)

Stable molecular changes during cell division without any change in the sequence of DNA molecules is known as epigenetic. Molecular mechanisms involved in this process, including histone modifications, methylation of DNA, protein complex and RNA antisense. Cancer genome changes happen through a combination of DNA hypermethylation, long-term epigenetic silencing with heterozygosis loss and genomic regions loss. Different combinations of N-terminal’s changes cooperate with histone variants with a specific role in gene regulation. It have led to load a setting histone that determine transcription potential of a particular gene or genomic regions. DNA methylation analysis in genome region using methylation-specific digital karyotyping of normal breast tissue detect gene expression patterns and DNA specific methylation can be found in breast carcinoma too more than 100 genes in breast tumors or cell lines of breast cancer are reported hypermethylated. Important of DNA methylation on cancer has been concentrated CpG islands hypermethylation. Most of the techniques are able to identify hypermethylated areas. Often, methylated genes play important role in cell cycle regulation, apoptosis, metastasis and tissue invasion, angiogenesis and hormonal signaling. Cyclin D2 (CCND2) gene is an important regulator of cell cycle and increased of expression inhibits the transition from G1 to S cell cycle. This gene is frequently methylated in breast cancer and has been proposed as the first event. Other cell cycle regulator is p16ink4A / CDKN2A that methylated in a large number of human cancers, including breast cancer. Another regulator of the proliferation of breast cancer that methylated is tumor suppressor RAR-β cancer that has been found in lobular and ductal carcinoma. Recent studies have showed the role of epigenetic silencing in the pathogenesis of breast cancer in which tumor suppressor genes have been changed by acetylation and DNA deacetylation. Histone deacetylase inhibitors have different roles in cancer cells and could show the ways of new treatment for breast cancer. In this review, various aspects of breast cancer epigenetics and its applications in diagnosis, prediction and treatment are described.

Problems of live and inactivated influenza vaccines such as, increasing emerge and re-emerge viruses with high human mortality, current epidemics of influenza and direct transmission of avian viruses to human, affect the vaccination program. DNA vaccines as third generation of vaccines is specially considered for control of influenza in human and poultry. The main advantage of these vaccines is humoral and cellular immune responses and broad spectrum of using these vaccines for control of circulating strains of influenza. In this study the conserved fragment of HA2 to form of DNA vaccine was designed to induce immunity against influenza viruses and its heterologous protective immunity against these viruses was evaluated.
The experimental study was performed in Razi Vaccine and Serum Research Institute from December 2014 to July 2015 in Iran. The HA2 was cloned into pcDNA3.1 to assess the HA2 DNA vaccine and mice were immunized with the generated constructs in a DNA prime-DNA boost regimen in 4 groups. The humoral immune responses were analyzed at defined intervals by VN tests. The safety of the vaccine was evaluated by daily inspection and histopathological examination. For evaluation of cellular immunity, proliferation assay was used.
The antibody titre and cellular immunity of immunized mice was significantly higher than control group for two serotypes and the highest responses was in the group with two-time boosting (P The HA2 DNA vaccine significantly enhanced circulatory antibody responses and cellular immunity against influenza current serotypes. This study showed the highest immune responses were in the group that immunized with HA2 in prime and two boosts. Besides that, this construct did not have any local and general reaction and any side effects in treated mice. So, this construct was introduced as candidate for control of influenza virus serotypes.

Hypertension is one of the major risk factors for cardiovascular disease. The studies show that factors such as vitamin D, parathyroid hormone, calcium and phosphorus are involved in the regulation of blood pressure. The purpose of this study was to investigate the relationship between blood pressure with vitamin D, parathyroid hormone, calcium, and phosphorus in sedentary postmenopausal women.
This investigation is in the form of a descriptive correlational study that was performed in September 2015. The statistical population was all healthy and sedentary postmenopausal women 50-70 years old in Urmia city, Iran. Fifty-four sedentary postmenopausal women were selected as subjects and voluntarily and bona fide participated in this study. General and anthropometric characteristics of height, weight, and body mass index (BMI) in subjects were measured by wall-meter with an accuracy of one millimeter, digital scale with precision of 100 g (Beurer, Germany), and dual emission X-ray absorptiometry (DXA) (Hologic, USA) machines, respectively. Diastolic and systolic blood pressure was measured by indicator machine. Serum levels of vitamin D, parathyroid hormone, calcium, and phosphorus were measured by ELISA and Auto-analyzer (BT 1500, Biotecnica, Italy machines, respectively.
The mean general, anthropometric, and physiological/laboratory variables of subjects were: age 54 yr, height 156 cm; weight 72 kg; BMI 29 kg/m2; systolic and diastolic blood pressure 76.20 and 110.70, respectively; vitamin D 25.22 ng/ml, parathyroid hormone 33.29 ng/ml, calcium 9.44 ng/ml, and phosphorus 3.26 ng/ml. Moreover, results showed that there was no significant relationship between systolic and diastolic blood pressure and vitamin D (P>0.581 and P>0.619, respectively). There was no significant relationship between systolic and diastolic blood pressure and parathyroid hormone (P>0.623 and P>0.341, respectively). There was no significant relationship between systolic and diastolic blood pressure and calcium (P>0.704 and P>0.141, respectively). There was no significant relationship between systolic and diastolic blood pressure and phosphorous (P>0.058 and P>0.357, respectively).
The results suggest that there is no relationship between systolic and diastolic blood pressure with serum levels of vitamin D, parathyroid hormone, calcium, and phosphorous in sedentary postmenopausal women 50-70 years old.

Different treatment used for resolving menopausal problems. Some studies assayed effectiveness of citalopram but it had some side effects and other studies about medicinal plants in Iran, including Melissa (combination of officinalis and foeniculum vulgare) showed improvement insomnia and anxiety. This study decided to assay effectiveness of this drug and comparison with placebo and citalopram in treatment of sleep disturbance of menopausal women.
Sixty postmenopausal women suffering from sleep disturbances that referred to Yas hospital between 2011-2013 were recruited to this double blind controlled study with 8 weeks’ follow-up period. They were randomized in three groups of twenty patients each, group A: received Melissa 600 mg that made by traditional medical school, group B: received citalopram 20 mg from Arya company that increased to 30 mg after one week and group C: received placebo. The patients were evaluated by Pittsburgh Sleep Quality Index (PSQI) questionnaire before and after treatment, also we checked the side effects of every drugs. Study was dissertation of one of the author with code 22263. This research has been supported by Tehran University of Medical Sciences and Health Services Grant. This study was registered at Iranian Registry of Clinical Trials with code of IRCT2013072714174N1.
Pittsburgh sleep quality index improved significantly in all groups, there was significant differences between Melissa group and two other group, but there wasn’t significance difference between citalopram and placebo group, there was a trend in favor of Melissa versus citalopram and placebo. All of seven field of PSQI improved significantly in all groups that showed improvement of sleep quality in all field of sleep disturbance.
Melissa (compound of officinalis and foeniculum vulgare) may be recommended for the treatment of sleep disturbances in postmenopausal women. Although further investigation with more cases is needed to find long-term results and compare with hormone therapy.

Psoriasis is a T-cell mediated chronic inflammatory disorder with multiple skin, nails and joints involvement. The reported prevalence of psoriatic arthritis varies from 5 to 42 cases per 100 psoriasis patients. Insulin resistance is believed to be central to the pathogenesis of metabolic syndrome, a constellation of major risk factors for cardiovascular diseases, including atherogenic dyslipidemia, truncal adiposity, hypertension and hyperglycemia. The association of psoriasis and psoriatic arthritis with metabolic syndrome is increasingly being reported. Although the literature relating psoriatic arthritis to metabolic syndrome is accumulating, there is still a paucity of evidence, especially from Asia. Here, we examined the prevalence of metabolic syndrome and its components in patients with psoriatic arthritis.
The study was performed among outpatients attending the specialty clinic and rheumatology ward of Rasoul-e-Akram general hospital between January 2014 and April 2015. A consecutive sample of 80 patients diagnosed as having psoriatic arthritis was studied. Age, gender, body mass index, blood pressure and waist circumference, and history of smoking of patients were measured and asked at the enrolment visit. Venous samples were taken after 8 h of overnight fasting for the estimation of serum lipid profile, glucose and uric acid levels. Also an ultrasonographic examination was done for detection of non-alcoholic fatty liver disease.
46 patients (57.5%) were male and 34 patients (42.5%) were female. Mean age of the participants was 43 years (SD: 11.3). The prevalence of abnormal components of metabolic syndrome was 53.8% for BMI, 48.8% for TG level, 50% for HDL, 46.3 for LDL, 45% for Cholesterol, 23.8% for FBS, 46% for waist circumflex in men and 47.7% in women and 42.5 for uric acid. 40% of the patients had abnormal SBP and 41.2% had abnormal DBP. Thirty percent of the participants were current smokers and 43.8 had NAFLD on ultrasonographic examination.
51.3% of patients had metabolic syndrome according to the adult treatment panel III criteria for adult Asian patients.

Human breast milk contains high levels of fat and toxins. These substances which exist in our country based on many reports. This study aimed to evaluate the concentration of polychlorinated biphenyls (PCBs) in the mother’s milk during the first postnatal week.
This study was accomplished on 50 mothers who gave birth to a healthy infant at Vali-e-Asr University Hospital, Tehran University of Medical Sciences, Tehran, Iran, from 2014 through 2015. Within the first postnatal week a 20 cc sample of mother’s breast milk was obtained and was sent for laboratory analysis to measure PCB levels via GC-Mass method. Except of PCBs, triglycerides (TG), high-density cholesterol in breast milk was also measured. Also the relation between fat and polychlorinated bi phenyl was assessed. The association between PCBs and body mass index of mothers was investigated.
Mean age of mothers was 29.41±6.14 year. PCB180 was significantly correlated with TG values, while this correlation was not observed for other types of PCBs. There was no correlation between cholesterol and fat high-density with PCBs. Other PCB isomers 138, 153, 180 and 101, had not correlation with triglyceride, cholesterol and high density fat. There was a significant correlation between increasing weight and the concentration of PCB101, and PCB180 concentrations. It was also observed between increasing weight and the concentration of PCB101 (P=0.033, r=0.293) and concentrations of PCB180 (P=0.034, r=0.428), there was a significant correlation. In our study PCB101, (r=0.278, P=0.048) and PCb28 (r=0.328, P=0.021) were significantly correlated with body mass index (BMI).
The present study showed a higher than normal concentration of polychlorinated biphenyls in breast milk. And therefore these compounds will be transferred to the baby. Due to the damaging effects of these toxins, it is recommended additional studies on larger groups and other types of samples (mother blood, cord blood etc.).

Multidrug-resistant bacteria make many problems in clinical therapy, design and manufacture of synthetic drugs. Pseudomonas aeruginosa is one of the most important multidrug-resistance bacteria leads to variety infections in human especially in immunocompromised, patients with severe burns, and nosocomial infections. It Recent years, this organism makes a big challenge in clinical treatment of infections using a wide range of antibiotics. Medicinal herbs for thousands of years to prevent or treat infectious diseases were considered. Today, pharmacists have high interest of using medicinal herbs to prepare a new antimicrobial compounds. The goal of this study was to investigation the effect of aqueous and alcoholic extract of fresh garlic on the expression of genes encoding elastase and exotoxin A virulence factors, in P. aeruginosa PAO1 strain.
Present study was an experimental study and performed from 2015 to 2016 in Hamadan University of Medical Science, Iran. The minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) of aqueous and alcoholic extract of garlic was determined. Then in order to investigation the gene expression of elastase and exotoxin A genes, quantitative real-time polymerase chain reaction (qPCR) method was performed at sub-MBC concentrations.
According to the results aqueous extracts of garlic had better impact in comparison with alcoholic alone. At concentration of 64 and 8 mg/ml of aqueous extract the expression of both elastase and exotoxin A genes were decreased. Although, the expression of elastase gene was most affected by garlic at different concentrations than exotoxin A.
The results suggested that the compositions of garlic extracts can inhibit the production of virulence factors in P. aeruginosa. So in order to treat infectious diseases in the near future, medicinal plants known as new antimicrobial drugs can be used alone or with antibiotic drugs against pathogenic bacteria.

To assess patient' reaction towards bedside teaching in the nephrology ward of Imam Khomeini Hospital Complex (Tehran) and to identify the factors that may influence it.
A cross-sectional study was conducted in the nephrology ward of Imam Khomeini Hospital Complex from march to September, 2014. All inpatients present on the day of the study were interviewed using a structured questionnaire.
146 patients were examined in this study that 62 patients (42.5%) were women and 84 cases (57.5%) were men. 112 (76.7%) of patients had a good feeling about the training to physicians. The behavior of students was evaluated respectful by 132 individuals (90.4% of patients). Total number of 106 individuals (72.6% of patients) had trusted to the health care team and 120 people (82.2% of patients) knew that the physicians’ behaviors are associated with the respect to their religious beliefs. Not being same sex of the examiners was important for 47 individuals (32.2% of patients). The number of 123 cases (84.2% of patients) evaluated the physician's behavior with respect to their privacy. The number of 119 individuals (81.5% of patients) received their responses from the examiners. Statistical tests indicate a significant relationship between the respectful behavior of students with patient and good feeling about training to physicians, so that the 95.5% of people who have seen the respectful behavior of students to oneself had a good feeling about training to physicians (P˂0.001). The relationship between the presence of teacher with students and good feeling on training to physicians was significant (P=0.013). Positive feeling about practicing physicians was associated with patient age. So the age average of people who feel good about practicing physicians was significantly lower than the other people (47.2±17 versus 55.6±18 and P=0.028).
The relationship between respectful behavior and presence of teacher with students and age and good feeling on training to physicians was significant.

Cooling is one of the main processes in bone temperature decrement, while drilling. this experiment was conducted for examination of alcohol effect as cooler in prevention of thermal necrosis.
Bovine femur bone was considered as specimen and inclusions criteria for this study were: femur bone, cortical area and without bone periosteum. Drilling process was conducted by two types of k-wire- Trocar and Diamond, three speeds and three feed rates and in the time of march, 2016 in the place of university of Isfahan, Iran. Two type of thermometer- K-thermocouple and infrared thermometer- were used for temperature measurement, and all data were logged by data logger. Drilling processes were conducted by milling machine with ability of table movement for feed rate parameter. Method of alcohol usage in cooling was in form of conducting alcoholic gauze with k-wire while rotating.
Totally in the cases of trocar and diamond wires, while were cooled by alcohol, the risk of bone necrosis decreased about 44.44% and 66.66%. All temperature data were logged by changing parameters. maximum temperature, 94.5 °C, belonged to trocar wire in a non-cooling condition and after usage of cooler it decreased to 75 °C. In the usage of diamond wires, the maximum temperature was recorded 71 °C and the temperature while using alcohol was 51 °C. Diamond wire had better result in both conditions of cooling and no cooling, and this is related to geometric differences between two types of wires.
Due to obtained data from examination, utilization alcohol can have an important influence on final bone temperature decreasing. The way of using alcohol was in the style of attrition soaked gauze onto wire while insertion.

Attention deficit hyperactivity disorder (ADHD) is common in adults, and associated with comorbidities and negative consequences in many parents of children with ADHD. The aim of this study was to determine ADHD and personality disorder in parents of children with ADHD compared to the healthy group.
This cross-sectional descriptive and the analytic study were conducted in 2015 in Roozbeh Psychiatric Hospital Tehran and the sample group consisted of 45 adult subjects with ADHD children and 45 healthy adults who were chosen control method. questionnaires Conner’s adult attention deficit hyperactivity disorder questionnaires, Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II), Conner’s parent’s scales between the two groups were completed, and Strengths and Difficulties Questionnaire (SDQ) and Symptom Checklist -90- Revised (SCL-90-R) were completed in the group controlling. And for parents who had a score above the cutting point for the diagnostic assessment of personality disorder Structured Clinical Interview for DSM-IV Axis II Disorders, to assess personality disorders, as well as for the diagnostic assessment of ADHD in adults Diagnostic Interview for ADHD in Adults (DIVA) was conducted.
The incidence of ADHD in parents of children with ADHD than parents with healthy children was 6/5 equivalent and the prevalence of B cluster disorders, C cluster disorders, passive-aggressive personality disorder and depressive personality disorder in parents of children with ADHD was higher than the cut-off point parents with healthy children (P˂0.01). The most common subtypes in parents of children with ADHD were respectively mixed (attention- hyperactivity) (38.5%) and attention deficit (30.8%).
The prevalence of ADHD and personality disorders in parents of children with ADHD are more than parents with healthy.