Iranian Red Crescent Medical Journal
Volume:20 Issue: 1, Jan 2018

Conversation over the cell phone while driving is a known risk factor for road traffic crash. Using hands-free to talk on the cell phone may remove visual and manual distraction yet not the cognitive distraction.
The purpose of this study was to better understand the mechanisms of cognitive distraction due to hands-free cell phone conversation (HFPC) while driving.
Twelve male and 12 female University students in Tehran, Iran, were selected via the consecutive convenient sampling method, and randomly assigned to one of the following administrations of cross-over quasi-experimental study design, during year 2016: Administration 1, participants performed the tests while involved in HFPC, took rest for 60 minute, and then performed the tests another time without HFPC; Administration 2, participants performed the tests without HFPC, took rest, and then performed the tests another time with HFPC. Each participant moved to the other administration after 7 to 10 days. The Vienna test system (VTS) was used to measure simple and choice reaction time, selective attention, visual orientation, and visual memory. Linear regression analysis was used to study the change in test scores due to HFPC.
The mean age of participants was 27.1 ± 5.3 years. A history of road traffic crash (regardless of severity) was reported among 9 (37.5%) participants in the previous year. Hands-free cell phone conversation while driving was directly associated with mean time correct rejection score (P Using hands-free devices to converse during driving, impaired reaction time, selective attention, visual orientation and visual memory, which are essential for safe driving. Thus, the use of these devices does not preclude cognitive distraction and should be restricted.

Resilience is defined as skills, abilities, knowledge, and insight that people gain over time to overcome problems and hardships and cope with challenges.
Due to the lack of a gold standard to measure resilience, the current study aimed at designing and validating a resilience scale in Patients with cardiovascular and respiratory diseases.
The current methodological study was conducted in 2016 in 3 consequential phases. In the first phase, the concept of resilience was defined and analyzed in patients with chronic physical diseases using hybrid concept analysis. In the second phase, based on the findings obtained in the phase 1, the item pool was generated. In the third phase, in order to evaluate the psychometric properties of the tools, 375 patients in public places of Tehran, Iran, were selected using the multistage cluster sampling method to complete the scales.
Based on the results of the content analysis, the primary item pool included 142 items, which was reduced to 57 items by excluding the repetitive and combining the overlapping ones. After administering face validity, content validity, and item analysis, a total of 30 items remained. The exploratory factor analysis, by eliminating 1 item, indicated five 5, explaining 65% of the total variance, and the Kaiser - Meyer - Olkin (KMO) index was 0.949, showing a significant difference (P = 0.0001). Discriminant validity showed that patients with higher education were more resilient. Cronbach’s alpha coefficient of the final version of the 29 - item scale was 0.943.
The 29 - item resilience scale was a simple, valid, and reliable tool to measure resilience in patients with cardiovascular and respiratory diseases.

Resilience is defined as skills, abilities, knowledge, and insight that people gain over time to overcome problems and hardships and cope with challenges.
Due to the lack of a gold standard to measure resilience, the current study aimed at designing and validating a resilience scale in Patients with cardiovascular and respiratory diseases.
The current methodological study was conducted in 2016 in 3 consequential phases. In the first phase, the concept of resilience was defined and analyzed in patients with chronic physical diseases using hybrid concept analysis. In the second phase, based on the findings obtained in the phase 1, the item pool was generated. In the third phase, in order to evaluate the psychometric properties of the tools, 375 patients in public places of Tehran, Iran, were selected using the multistage cluster sampling method to complete the scales.
Based on the results of the content analysis, the primary item pool included 142 items, which was reduced to 57 items by excluding the repetitive and combining the overlapping ones. After administering face validity, content validity, and item analysis, a total of 30 items remained. The exploratory factor analysis, by eliminating 1 item, indicated five 5, explaining 65% of the total variance, and the Kaiser - Meyer - Olkin (KMO) index was 0.949, showing a significant difference (P = 0.0001). Discriminant validity showed that patients with higher education were more resilient. Cronbach’s alpha coefficient of the final version of the 29 - item scale was 0.943.
The 29 - item resilience scale was a simple, valid, and reliable tool to measure resilience in patients with cardiovascular and respiratory diseases.

Confirmed evidences on superiority of subcuticular suturing compared to interrupted suturing method, in terms of postoperative complications such as wound infection, size of scar, or abscess formation is few.
The present study aimed to compare absorbable subcuticular suturing supported with Steri-Strips™ to interrupted nonabsorbable suturing method after appendectomy.
In a randomized controlled trial, seventy patients with the diagnosis of acute appendicitis at Besat hospital, Hamadan University of Medical Sciences, Iran in the year 2016 were enrolled in the study and were randomly assigned into two groups. In the case group (n = 35), the wound suturing was done using subcuticular suturing supported by Steri-Strips™ and in the control group (n = 35), suturing was performed using interrupted mattress suture. All patients were visited at postoperative day one, seven, thirty and ninety.
The width of the scar and the mean of severity of pain score at postoperative day seven in the case group were significantly shorter and lower than the control group (1.05 ± 0.66 vs. 3.62 ± 1.77 mm, P Skin closure using absorbable subcuticular suturing supported by Steri-Strips™ method in patients with uncomplicated appendicitis may be safe and feasible and may result in higher levels of patient satisfaction.

Aberrant DNA methylation of cytosine guanine dinucleotide sides (CpGs) is one of the earliest and most frequent alterations in cancer. However, there is no complete understanding of the methylome in hepatocellular carcinoma (HCC), and few studies comprehensively evaluated methylation signatures of HCC based on high-throughput platforms.
Based on the DNA methylation data of HCC, the current study aimed at identifying the specific DNA methylation biomarkers to diagnose HCC.
The current study used bioinformatics method based on the published microarray data of HCC was implemented in Linyi, Shandong Province, China in 2017. Using GSE57956 data downloaded from the Gene Expression Omnibus database, the differentially methylated genes between HCC and normal groups were identified. Next, hierarchical clustering was conducted to measure whether the differentially methylated genes could distinguish the HCC from the normal samples. Furthermore, functional enrichment analyses were respectively implemented for up- and down-methylated genes to further extract the potential biological processes based on DAVID tool.
According to the cutoff threshold of ≥ 0.2 average beta-values difference, 1340 differentially methylated genes (1660 CpGs) were identified including 978 up-methylated and 682 down-methylated genes. Utilization of the up-methylated and down-methylated genes to enrich gene oncology (GO) terms and biological pathways led to the identification of several important function regions, and the most significant ones were innate immune response, transcription from RNA polymerase II promoter and neuroactive ligand-receptor interaction.
Functional terms (innate immune response, transcription from RNA polymerase II promoter, and neuroactive ligand-receptor interaction) might be as potential targets for HCC diagnosis and treatment.

One of the most common disabilities after stroke is impaired balance, so improving balance is essential for performing daily activities through rehabilitation. A task-oriented exercise program is an effective approach to improving balance.
The aim of this study was to investigate the effects of a task-oriented exercise program on balance in patients with hemiplegia following stroke.
This randomized clinical trial was conducted between October 2015 and January 2016, and 20 Iranian patients with hemiplegia following stroke were randomly assigned to experimental (n = 10) and control groups (n = 10). The experimental group received a 4-week task-oriented exercise program, and the control group received 4-week conventional physiotherapy, respectively. The patients were evaluated before and after the exercise intervention. Clinical measures included the Berg Balance Scale (BBS) while laboratory measures included the plantar pressure distribution, the center of pressure path length (COP path length), and the center of pressure confidence ellipse area (COP area).
Significant improvement was observed in the BBS after completion of the exercise program in both the experimental and the control groups (50.5 ± 1.08 and 46.8 ± 3.96, P 0.05). The BBS, COP path length, and COP area improved significantly in the experimental group compared to the control group following intervention (P A task-oriented exercise program is associated with an improvement in balance in patients with hemiplegia following stroke.

Ischemic stroke is a major cause of permanent disability and inflammation has a prominent role in stroke pathology. Stem cell therapy is a new approach for stroke treatment. Mesenchymal stem cells (MSCs) are appropriate for this approach due to neuroprotective and immunomodulatory effects.
In this experimental study, the neuroprotective effects of mesenchymal stem cells (MSCs) on brain injury after transient middle cerebral artery occlusion (tMCAO) in rats was investigated with emphasis on inflammatory factors.
Mesenchymal Stem Cells were isolated from bone marrow of rats and expanded by cell culture. Thirty-six male Wistar rats were randomly selected and divided to 6 groups. The MCAO model was performed in 4 groups with 24 and 72 hours of reperfusion. A single infusion of 2 × 106 MSCs was transplanted in one of the 24-hour and 72-hour groups and others received saline. In the sham groups, surgery was done without MCAO. Behavioral tests were evaluated and infarct volume was measured by staining of brain sections. Serum levels of Interleukin (IL) 1β and Tumor necrosis factor (TNF) α were measured by the enzyme linked immunosorbent assay (ELISA). Relative expression of Interleukin (IL)1β, tumor necrotizing factor (TNF)α, and IL6 genes were assessed in penumbra of the ischemic region using real time polymerase chain reaction (PCR).
The study results indicated that total behavioral scores were increased 72 hours after MSC transplantation (14.5 ± 2.0, P The MSCs had a neuroprotective effect in ischemic stroke via modulation of inflammatory response, and serum levels of IL1β and TNFα could be used as markers for evaluating anti-inflammatory effects of MSCs.

Multiple sclerosis (MS) is a chronic disease of the central nervous system (CNS), which affects the adaptability and interaction skills of the patient with family, relatives, and the society. Maintaining proper social relationships is very important for patients with MS.
This study aimed to evaluate the effect of self-care education on the social adaptability of patients with MS.
This randomized clinical trial was conducted on 50 patients with MS, referred to the MS society of Markazi province, Iran. They were selected based on inclusion criteria and were randomly divided into 2 groups, intervention and control. The patients were educated face-to-face, through a 5-session program on self-care behaviors. Social adaptability scores of the groups prior to the intervention and 1 and 4 weeks after the intervention were compared. Demographic data and the personal resource questionnaire (PRQ) were used for data collection. PRO was translated into Persian and assessed psychometrically by the researchers.
In the intervention group, the mean social adaptability score 1 and 4 weeks after the intervention showed a significant increase as compared with the mean score prior to the intervention (57.36 ± 6.6 and 87.8 ± 9.7, respectively, vs. 29.04 ± 5.6; P = 0.0001). Such a significant increase was also observed between the social adaptability scores at Week 1 and 4 (P = 0.0001). No increase was observed in the scores of the control group. The mean social adaptability score 1 and 4 weeks after the intervention was significantly higher in the intervention group (57.36 ± 6.6 and 87.8 ± 9.7, respectively) than it was in the control group (30 ± 6.6 and 30 ± 6.6, respectively) (P = 0.0001).
Results of the current study indicate that face-to-face education about self-care behaviors improved social interactions in patients with MS. Hence, this intervention can be utilized to enhance social skills in this patient population.

There is a great deal of interest in using adipose tissue-derived mesenchymal stem cells (AT-MSCs) for clinical applications. However, the important limitations of clinical application of stem cells are the small number of cells and their differentiation into undesirable lineage in vitro. To overcome this problem, various growth factors are studied extensively.
The current study aimed at using 3 different doses of epidermal growth factor (EGF), glial cell line-derived neurotrophic (GDNF), and leukemia inhibitory factor (LIF) to culture AT-MSCs and evaluating their effects on proliferation, viability, differentiation potential, and maintenance of the stemness state of cells.
The current experimental study was conducted on 8 - 10 male NMRI (Naval medical research institute) mice provided from research center and experimental animal house of Jundishapur University of Ahvaz, Iran, from September 2016 to April 2017. AT-MSCs were isolated from mice adipose tissue. The cells were cultured with three different doses of EGF, LIF, and GDNF. The morphology and cell proliferation of the AT-MSCs were studied on the days 3, 7, and 11 by an inverted microscope and MTT assay, respectively. To evaluate the stemness state of the cells, Oct4 expression was measured using quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Also, differentiation potential of AT-MSCs toward adipogenic and osteogenic lineages was assessed. All tests were done in triplicate.
Proliferation and viability of the AT-MSCs cultured in 10 µg/mL EGF, 5 µg/mL LIF, 5 µg/mL GDNF (b2 group) and 20 µg/mL EGF, 5 µg/mL LIF, 5 µg/mL GDNF (b3 group) increased significantly in the days 7 and 11 (170.27 (13.94), 174.39 (18.85) versus 100 (12.08) P EGF, LIF, and GDNF enhanced proliferation and viability of the AT-MSCs, but for clinical purposes, the growth factors should be applied cautiously.

Obesity is a global health threatening issue with increasing prevalence in the developed and developing world. The limited efficacy and side effects of conventional treatments motivated the researchers to look for novel, safe, and effective therapeutic strategies.
The current study aimed at investigating the anti-obesity effects of green tea in a population in North of Iran.
The current single-blind, placebo-controlled, parallel, clinical trial was conducted in Guilan outpatient clinic in Rasht, Iran, from January to December 2015. Eligible subjects were randomly allocated into 2 groups of green tea and control. In the GT Group, a cup of green tea and in the C group an equal amount of mineral water was taken 30 minutes after breakfast and lunch. The outcomes including body weight (BW), body mass index (BMI), hip circumference, waist circumference, and waist-to-hip ratio were measured at baseline, as well as 8 and 12 weeks after the intervention (T0,T_1, T_2).
Finally, data obtained from 84 cases in groups GT (n = 41) and C (n = 43) were analyzed. No significant difference was observed in terms of baseline demographics and measurements between the 2 groups including male/female (P = 0.766), age (P = 0.376), weight (P = 0.846), height (P = 0.413), waist circumference (P = 0.619), hip circumference (P = 0.619), and waist-to-hip ratio (P = 0.301). According to the intragroup analyses, the trend of changes from baseline to 12 weeks after intervention were significant in both groups (P = 0.001); BW (79.88 ± 7.06 to 72.44 ± 6.82 kg) and (80.21 ± 7.16 to77.07 ± 7.22 kg) , BMI (29.95 ± 1.79 to 26.86 ± 2.59 kg/m2) and (29.69 ± 2.1 to 27.07 ± 2.22 kg/m2) , waist circumference (87.77±6.06 to 83.913 ± 6.13 cm) and (86.94 ± 8.05 to 85.23 ± 7.89 cm), and hip circumference (102.41 ± 7.35 to 98.3 ± 7.54 cm) and (101.02 ± 8.47 to 99.31 ± 8.81 cm) in GT and C groups, respectively. However no such difference was observed in waist/hip ratio in the GT and C groups (P = 0.087) and (P = 0.322), respectively. A significant difference was observed at T1 (P = 0.024 and P = 0.025) and T2 (P = 0.025 and P = 0.006), according to weight and BMI, respectively. However, the differences were not statistically significant based on the other variables.
Green tea could be a safe and effective choice for patients with obesity. However, further well-designed trials are required to confirm these findings.

Breast cancer (BC) is the most common cancer among women worldwide. It can be categorized into at least 5 main groups, based on antibody markers, such as estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2), which are dissimilar in terms of risk factors, distribution, prognosis, treatment, and clinical outcomes. In this study, we evaluated the survival and therapeutic outcomes of BC using immunohistochemical biomarkers in order to improve disease prognosis and eliminate concerns among women.
The subjects included 1772 women with a diagnosis of BC from January 1999 to January 2014, admitted to Shohada educational hospital and Azar clinic, Tehran, Iran. In this analytical cross sectional study, we selected a simple classification, based on the expression of ER, PR, and HER2. Then, we classified BC patients into 4 subgroups: luminal A (ER and/or PR, HER2-); luminal B (ER and/or PR, HER2); basal-like (BCL) (ER-, PR-, HER2-); and HER2/neu (ER-, PR-, HER2) subtypes. In addition, we integrated lymphovascular invasion (LVI) and tumor grade for identifying the groups in terms of HER2 (1 or 2 if LVI- was attributed to luminal A or if LVI was attributed to luminal B, respectively). P value ≤ 0.05 was considered statistically significant.
The majority of tumors were luminal A (37.16%), luminal B (15.14%), and BCL (13.12%) subtypes, whereas only 6.82% were related to HER2/neu and others were missing. There was a significant difference between immunohistochemical subgroups with respect to tumor grade (P These findings indicate that risk of mortality in each subgroup can be reduced by adjusting for tumor grade and stage.

Iron is one of the most essential elements of life that plays a major role in structure of the most cells of body and is potentially toxic and dangerous, because it easily participates in oxidation-reduction reactions and produces reactive oxygen species, which leads to oxidative stress; nanomaterials such as iron nanoparticles found in environmental pollution and can also be dangerous.
The current study aimed at evaluating and comparing the effects of accumulation of conventional iron oxide and iron oxide nanoparticles in rat ovary and its relationship with serum oxidative stress.
The current experimental study was conducted on 5 groups of female rats, control, iron oxide (15 mg/kg), and iron oxide nanoparticles (5, 15, and 45 mg/kg). All rats were treated intraperitoneally for 16 days. Then, they were euthanized and their ovarian tissue was removed, and iron accumulation in the ovaries was measured by atomic absorption. Malondialdehyde (MDA), carbonyl protein, thiol protein, and total antioxidant activity were also measured in rats serum samples.
According to the current study findings, iron accumulation increased significantly (P = 0.046) in the group that received conventional iron oxide, as compared with the control group. Also, the mean of total antioxidant activity (4.4 ± 294.31 µM/L) and thiol protein (3.3 ± 381.09 µm/mL) showed a significant (P ≤ 0.05) differences in group that received conventional iron oxide, compared with the other groups, MDA and protein carbonyl had no significant (P ≥ 0.05) difference.
According to the findings, conventional iron oxide particle induced more accumulation and more oxidative stress than nanoparticles.

To summarize the vascular ultrasonographic features of intravenous leiomyomatosis (IVL) and assess the role of this method for the accurate diagnosis of patients with IVL. The current study was carried out in Shandong provincial hospital affiliated to Shandong university and Shandong medical imaging research institute, Shandong university of Jinan, Shandong province, P.R. China in 2017.
The 9 samples of IVL were collected from patients undergone surgery from July 2007 to December 2016 in the department of gynecology of the hospital. The clinical data, vascular ultrasonographic findings, and histologic results were retrospectively reviewed. Six patients underwent computed tomography (CT) and 3 patients were examined by magnetic resonance imaging (MRI). Clinical symptoms included lower extremity edema, chest congestion, and syncope. Any pelvic masses found were identified. On ultrasonography, the internal iliac vein, common iliac vein, and the inferior vena cava (IVC) were all involved with dilated veins and isoechoic masses noted in all 9 patients. The right ovarian vein was involved in 2 patients, and in 3 patients, masses had emerged in the IVC and spread into the right atrium, at times intruding into the tricuspid orifice during diastole. All 9 patients underwent a 1-stage thoracoabdominal surgical procedure. There was no documented recurrence of the masses in 7 patients and in the remaining 2 patients; solid pelvic masses were detected 3 or 6 months after the surgery. No intravascular masses were detected.
Ultrasonography is performed to evaluate the features and path of extension of IVL. Patients diagnosed with uterine leiomyoma or hysterectomy were at greater risk of developing IVL. Vascular ultrasound could be used as an additional diagnostic tool for IVL screening and diagnosis in patients at an early age.

Arteriovenous malformations (AVMs) are abnormal connections between an artery and a vein whereby the interconnecting capillary network is missed. Vein of Galen is a short midline venous structure formed by the confluence of the two internal cerebral veins and the basal veins of Rosenthal and the aneurismal malformation of this vein is a congenital vascular anomaly that comprises 30% of the pediatric vascular malformations. The pathogenesis of the vein of Galen aneurysmal malformation (VGAM) is unknown. Here, we report a neonate patient with complications related to vein of Galen aneurysmal malformation.
A 9-day-old male neonate referred with icter, poor feeding, tachypnea, and tachycardia and was admitted to the neonatal intensive care unit (NICU) of Vali-e-Asr hospital in Birjand city, Iran, on 5th July 2016. In his chest X-ray (C-X-ray), a cardiomegaly was shown. Suspecting to congenital heart disease, a transthoracic echocardiography was performed. In echocardiography, a patent foramen ovale (PFO) with the right to left shunt, small ventricular septal defect (VSD), and tiny patent ductus arteriosus (PDA) were observed, which are the signs of heart failure. The observed heart defects in echocardiography did not justify heart failure in this patient; therefore, we decided to do brain and liver sonography for rolled/out AVM. In brain sonography, an echo-free zone in midbrain with very high turbulence flow vessel was observed that confirmed A-V malformation.
In the infancy, VGAM is usually presented with high cardiac output failure that can be associated with multiorgan dysfunction. Since the prenatal diagnosis of VGAM and its treatment will be associated with better prognosis, intrauterine detection of this anomaly and its treatment are recommended.

Cytomegalovirus (CMV) is an important pathogen, and its infection develops in 70% to 90% of transplant patients. Upper gastrointestinal (GI) symptoms in the solid organ recipient are common (20%) and clinical signs are more serious in 10% of cases.
This study reports on a 30-year-old male with end-stage renal disease that had undergone kidney transplantation from a CMV negative donor at Imam Khomeini hospital, Urmia, Iran during June 2013. After 1.5 months, he was admitted with fever, generalized body pain, oral aphthous ulcers, and epigastric pain accompanied by malaise. Endoscopic examination and clinicopathological investigations revealed multiple antral erosions with surrounding erythema.
Management and Outcome: The patient was started on Intravenous (IV) ganciclovir 5mg/kg per day, every 12 hours initially for 3 weeks. Afterwards, the general condition of the patient improved.
The colon and stomach were the most common sites of the gastrointestinal infection, yet localization to the gastric antrum is not common.