مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و ششم شماره 6 (پیاپی 210، شهریور 1397)

Gastric cancer (GC) is the second leading cause of cancer-related deaths worldwide. It has been proposed that the specific genotypes of Helicobacter pylori (H. pylori) are the causative agents in the development of gastroduodenal diseases, such as chronic atrophic gastritis, peptic ulcerations, and GC. However, disease progression to GC occurs in only a small proportion of infected patients. Recently, we identified a novel polymorphic site in the 3ʹ-end region of H. pylori vacA gene. The vacA c1 genotype increased the risk of GC. This association was independent of and larger than the associations of the m-, i-, and d-type of vacA or cagA status with GC. Therefore, treatment of H. pylori infection may be an effective way to prevent GC. Expression of cytokines and their associations with inflammatory responses has been shown. Several cytokine polymorphisms, such as IL-1B, IL-8, IL-10, and TNF-α have been considered as risk factors for GC. It has been shown that the interaction of bacterial genotypes and host factors plays an essential role in developing GC. Several altered molecular pathways are involved in the pathogenesis of GC. Micro-RNAs are small, non-coding RNAs of 18-25 nucleotides in length that regulate the expression of target mRNAs. Expression pattern of cancer cells is different compared with the normal cells. Micro-RNAs plays a critical role in apoptosis and classified in two groups: pro- and anti-apoptotic agents. Recent studies have confirmed the oncogenic or tumor suppression role of micro-RNAs in cancer cells. They play a significant role in the GC cell physiology and tumor progression, by translational suppression of target genes. These small RNAs have therefore emerged as a new type of GC biomarker with immeasurable clinical potential. Generally, a variety of micro-RNAs involved in different stages of cancer, including tumorigenesis, angiogenesis, and metastasis. Considering to this issue more than 50% of cancers can be cured, if they were diagnosed in the early stages. Hence, identifying the biomarkers of GC could play an important role in prevention, early diagnosis and rapid treatment of patients. In this review article, we have reviewed the latest findings about bacterial and tissue biomarkers of GC

Using natural compounds with low toxicity on normal cells and high efficacy on malignant cells is highly appreciated for treatment of colorectal cancer (CRC). In the present study, the effect of fish-oil derived eicosapentaenoic acid (EPA) on the cell number, cell proliferation rate and caspase-3 enzyme activity in LS174T human colorectal cancer cell line was investigated.
This experimental study was performed in cell culture lab, Institute of Biotechnology, affiliated to the Urmia University, Urmia, Iran from April to September 2017. LS174T colorectal cancer cells at a density of 5×105 cells per well were cultured in RPMI-1640 medium supplemented with 10% fetal bovine serum (FBS) and kept at 37 °C in a humidified incubator with 5% CO2 for 24 hours. Thereafter, the cells were treated with 50, 100, 150 and 200 μmol EPA for 48 hours and cell numbers were counted using neobauer chamber and caspase-3 activities were measured by performing the caspase-3 colorimetric assay (Abcam, Cambridge, MA, USA). Furthermore, 5×103 LS174T colorectal cancer cells were cultured and treated with the above-mentioned EPA concentrations for 24, 48 and 72 hours, after which cell proliferation rate was evaluated by WST-1 proliferation assay (Roche Diagnostics, Mannheim, Germany).
Treatment of LS174T colorectal cancer cells with 50, 100, 150 and 200 μmol EPA decreased the number of cells in a dose-dependent manner. We also found that treatment of malignant cells with increasing EPA concentrations (50 to 200 μmol) significantly decreased cell proliferation in a dose and time dependent manner. After a 72 hours treatment of LS174T cells with 200 μmol EPA, cell proliferation was calculated to be 30.3% compared to untreated control cells. Following 48 hours treatment, caspase-3 activity increased with increasing EPA concentrations in which at 200 μmol EPA, caspase-3 activity increased by 3.4 fold compared to untreated control cells.
Fish-oil derived eicosapentaenoic acid as a safe compound decreases the number of colorectal cancer cells and their proliferation rate and activates caspase-3 enzyme, as an executor protein in apoptosis

Thrombolytic therapy, an appropriate treatment option, if primary angioplasty is not available for the treatment of these patients in the early hours after the onset of the symptoms. The aim of this study was to evaluate the safety and effectiveness of new tenecteplase (TNKase) drug vs. streptokinase in the treatment of ST elevation myocardial infarction (STEMI) patients in Iran.
A systematic review and meta-analysis that was conducted in Iran University of Medical Sciences in September 2017. We searched the MEDLINE, Cochrane Library (DARE-EED-HTA, Web of Science and EMBASE (1980 to March 2017) with number of strategies by the words “myocardial infarction, heart infarction, streptokinase, tenecteplase” in combination with other names of drugs and brands for clinical effectiveness. We hand searched US, European, and Iranian cardiovascular journals. Clinical trials and related observational studies in one of the Persian, English and Korean languages were included in this study. Two review authors independently assessed randomized controlled trials (RCTs) and non-RCT studies eligibility and quality, and extracted the data using data extraction form for interventions reviews. We cross-checked and resolved discrepancies by discussion to reach consensus. Finally, the data were entered to the Review Manager, Version 5.3 (The Nordic Cochrane Centre, Cochrane Collaboration, 2014, Copenhagen, Denmark), and then the Cochran-Mantel-Haenszel test (CMH) were used to analyzed the data. The I2 test has been used to calculate the Heterogeneity.
We included 4 observational studies. Observational study assessment by strengthening the reporting of observational studies in epidemiology (STROBE) checklist and quality was high described. All studies entered the final analysis after the quality assessment. All studies reported mortality. In the meta-analysis of mortality, three studies with a sample of 812 people entered. No difference was observed between tenecteplase and streptokinase in the risk of mortality (RR=0.45, CI 95%: 0.20-1.03, P=0.40), hypotension (RR=1.86, CI 95%: 0.53-6.49, P=0.33), bleeding (RR=1.40, CI 95%: 0.49-3.99, P=0.53), and no difference was observed in the ST Segment resolution >50% (P=0.81).
The results of this study showed that the effectiveness and safety of streptokinase are similar to the tenecteplase drug

Thrombopoietin (TPO) is an important cytokine that has a critical role in regulating hematopoietic stem cells (HSCs) proliferation and megakaryocyte differentiation. Because of scares amount of this protein in human plasma, in many biotechnological centers around the world, recombinant production of this protein has been carried out. This study was aiming to gene cloning and expression of recombinant thrombopoietin.
This research is an experimental laboratory study carried out in Blood Transfusion Research Center, Tehran, Iran, from July 2016 to August 2017. At the beginning HepG2 cell line was cultured and RNA extraction was performed. Extracted RNA was used as template for cDNA synthesis and subsequently the synthesized cDNA was adopted to isolate TPO gene through polymerase chain reaction (PCR) reaction using designed primers. After isolating the TPO sequence from HepG2 cell line, the designated sequence was inserted into pET32 vectors. Recombinant plasmid was amplified by meriting from DH5α replicating system. The amplified plasmids were sequenced via chain termination method. Next step was transforming the recombinant plasmid into Rosetta-gami bacteria to express the recombinant protein. In order to induce protein expression, an appropriate amount of isopropyl β-D-1-thiogalactopyranoside (IPTG) was added to growth media, then bacterial lysate of expression host was prepared and assayed via polyacrylamide gel electrophoresis and western blotting test.
After sequencing of recombinant plasmid, it was confirmed that TPO sequence has been successfully colonized in adopted vector. Subsequent to induction of recombinant protein, total cell protein analysis affirmed that recombinant protein has been expressed in its soluble form at cytoplasmic condition. Location of expected recombinant protein band on polyacrylamide gel and reaction of recombinant protein with His-tag monoclonal antibody at western blotting was asserting that expressed protein is the one of interest.
Rosetta-gami bacteria has capability of expressing recombinant thrombopoietin in its soluble form. By harnessing this method of recombinant protein expression, it would be possible to take advantage of high throughout bacterial expression system which would not produce inclusion body and its product doesn’t need further processing and refolding

The post-dural puncture headache (PDPH) is a common complication in spinal anesthesia. Headache may occure seven days after dural puncture. The headache may be worsened in sitting position and be better in supine position. PDPH is common in younger and tall people. The incidence rate of PDPH related to the size of spinal needle and the number of try and decrease with small, cutting needle and less puncture try. PDPH is a well-known iatrogenic complication of spinal anesthesia, which continues to be a major problem. In this study, we assessed the effect of intravenous aminophylline on prevention of post-spinal anesthesia headache in who were elective for cesarean sections.

This double-blind randomized clinical trial was conducted on 140 women with 18 to 35 years old and American Society of Anesthesiologists Classification (ASA Class) I and II undergoing spinal anesthesia in elective cesarean section. Patients were randomly divided into two groups called case and control. After umbilical cord clamping 1 mg/kg aminophylline dissolved in 100 cc normal saline was infused to the case group but only 100 cc normal saline was infused for the control group. Patient's blood pressure and heart rate were recorded before spinal anesthesia, immediately after spinal anesthesia, after uterine incision and umbilical cord clamping, after drug injection and then every five minutes. The incidence of headache was assessed at 4, 8, 24, 48 and 72 hours after the surgery.

Although severity and duration of headache in case group was more than in control group, no meaningful difference was found between two groups. The mean changes in systolic blood pressure were greater in control group (P

This study showed that intravenous aminophylline although, caused hemodynamic changes in some case, but it doesnt have any effect on prevention of incidence and severity of post-spinal anesthesia headache in elective cesarean section

Trying to find a drug with more clinical efficacy in treating obesity is one of the priorities. The aim of this study was to evaluate the efficacy of orlistat, sibutramine, lorcaserin and metformin on weight loss in obese people.
The databases of PubMed, Scopus, Google Scholar and Cochran Library were searched up to November 2016. In present study search strategy was performed by using selected keywords. Two independent investigators scanned and extracted the relevant data. The pairwise method was used to compare the difference between the mean difference weight loss for orlistat, sibutramine, lorcaserin and metformin in two direct methods (comparison of orlistat, sibutramine, lorcaserin and metformin with the control group) and non-direct (Compare orlistat, sibutramine, lorcaserin and metformin together). We assessed the quality of included trials using the quantitative 5-point Jadad scale. The heterogeneity across studies was assessed by using Cochrane’s Q and I2 tests. Publication bias was reported by means of funnel plots and Egger’s tests.
The present study performed on 36 clinical studies with a population of 3672. Our study results did show that sibutramine (mean difference -4.97 kg, 95% confidence interval -6.70 to -3.23), metformin (mean difference -4.45 kg, 95% confidence interval -9.27 to 0.38), orlistat (mean difference -2.37 kg, 95% confidence interval -3.45 to -1.30), lorcaserin (mean difference -2.36 kg, 95% confidence interval -4.58 to -0.15), respectively, had the most effect on weight loss compared with the placebo group. In addition, orlistat compared to lorcaserin (mean difference -0.01 kg, 95% confidence interval -2.47 to 2.45) resulted in more weight loss, but compared to metformin (mean difference 2.07 kg, 95% confidence interval -2.78 to 7.02) and sibutramine (mean difference 0.52 kg, 95% confidence interval -4.46 to 5.50) lead to less weight loss.
The present study indicated that orlistat had a greater effect on weight loss compared with lorcaserin, and had lower effect on weight loss compared with sibutramine and metformin in apparently healthy obese individuals

Alzheimer's disease (AD) is the most common disorder of dementia, which has not been cured after its occurrence. AD progresses indiscernible, first destroy the structure of the brain and subsequently becomes clinically evident. Therefore, the timely and correct diagnosis of these structural changes in the brain is very important and it can prevent the disease or stop its progress. Nowadays, remark to this fact that magnetic resonance imaging (MRI) provides very useful and detailed information, and due to non-invasiveness, this method has been great interest to the researchers. The aim of this study was diagnosis of AD with MRI by support vector machine model (SVM).
This is an analytical and modeling research which done in School of Public Health, Kermanshah University of Medical Science, Iran, from February 2017 to November 2017. The data used in this study was a database named Miriad containing brain MRI of 69 individuals (46 Alzheimer's disease and 23 healthy subjects) that was collected at the central hospital in London. Individuals were categorized into two groups of healthy and Alzheimer's disease with two criteria: NINCDS-ADRAD and MMSE (as the golden standard). In this paper SVM model with three linear, binomial and Gaussian kernels was used to distinguish Alzheimer`s disease from healthy individuals.
Finally, SVM model with Gaussian kernel, separated AD and healthy subjects with 88.34% accuracy. The most important Areas for Alzheimer were three Area: Right para hippocampal gyrus, Left para hippocampal gyrus and Right hippocampus. The clinical result of this study is to identify the most important ROI for the diagnosis of Alzheimer's by a clinical specialist. Experts should focus on atrophy in the three Areas.
This study showed that the SVM model with Gaussian RBF kernel can separated AD from healthy subjects by high accuracy. Based on results of this study, can make a software to use in MRI centers for screening AD test by people over the age of 50 years

Menopause is a critical and sensitive period and has a common symptom of vasomotor signs, psychologic changes and sleep disorders. With regarding the citalopram complications and effects of Iranian herbs, the aim of this study was to compared the therapeutic effect of the combination of area part of Melissa officinalis and fennel fruits extract with Nigella sativa powder with citalopram on menopausal symptoms of post-menopausal women.
This randomized clinical trial was conducted in Islamic Azad University of Pharmaceutical Sciences, Tehran, Iran, from April 2015 to October 2017. 56 postmenopausal women referred to the clinics of Gorgan health centers with the age between 45 and 65 years, natural menopause confirmed by amenorrhea for at least 12 months, discomfort a hot flash were randomized to two treatment groups. Group 1 (28 patients) received 1000 mg (Melissa officinalis extract, Nigella saliva powder, and fennel fruits) and Group 2 (19 subjects) received 20 mg citalopram in an eight-week course of treatment (1 per day for each group). The frequency of the variables in the Menopause-Specific Quality of Life Questionnaire (MENQOL) was compared in the two groups before and post intervention. The questionnaire included of twenty-nine questions in four domains of vasomotor, psycho-social, physical and sexual symptoms.
The mean age in the herbal treatment group was 47.78±5.5 years and in the citalopram group was 46.4±4.9 years, and t-test did not show this difference in two groups (P=0.362). There was no significant difference in the improvement of menopausal symptoms compared to the citalopram group in the combined product group, but the feeling of anger and fatigue in the citalopram group was greater after treatment (P=0.03).
The present study showed that the combination of Nigella Sativa, Melissa officinalis extract, and fennel fruits generally do not reduce menopausal symptoms in postmenopausal women, and it's just the feeling of anger and fatigue has been better than the citalopram group

Although electrical energy is one of the best and cleanest energy sources, the proper protection and utilization of it, always and everywhere is problematic. One of the most important problems is electric shock and the dangers that can sometimes be lost in the lives of people. When a body or part of it is completely located in a strong power supply field or a contact with a device that is connected to a high voltage power supply, the person experiences an electrical burn. Electrical burn injuries account for about 5% of beds in large burn centers. The type of complications due to electrical burns varies according to the location of the current flow, its severity and tissue resistance. But usually the most severe physical and emotional complications are in the upper arms and legs of the body. While electrical injuries primarily result in burns, they may also cause fractures or dislocations secondary to blunt force trauma or muscle contractions. In high voltage injuries, most damage occur internally. On the other hand, psychological trauma and subsequent disability and unemployment problems affect the lives of electric burn victims. Understanding and managing the short-term and long-term complications of electrical burns is important in addition to proper and timely treatment of the injured person. Electric current with a high voltage of 1000 Volts causes a wide and deep burn which may not be estimated exactly at the onset of a visit by the doctor and also patient himself. So, it should be mentioned the issues legally, to the patients and their relatives, in terms of the severity of lesions and the complications of probable amputation. On the other hand, because prevention is always better than cure, so appropriate information through the mass media can reduce the number patients and their complications. In this review study, introducing various types of electrical burns and the reported statistics, various complications of electrical burn are discussed. Awareness of the incidence of electrical burns in the population and its various complications can help to plan and manage the problems of electric burn injuries, as well as adopting strategies to prevent these incidents

Tinea versicolor (TV) is common superficial fungal infection of the human skin characterized by scaling macula and mild disturbance of skin observed as pigmented and depigmented regions. Typically, it affects the chest, upper back, neck and shoulders. However, rarely, involvement of other unusual regions of the body such as the scalp and face, arms and legs, palms and soles, groin, vagina and axillary region has been reported.
This case report is a case of axillary TV caused by Malassezia furfur that involved a 32-year-old woman that referred to Ghaem Medical Mycology Laboratory, Department of Health, Rescue and Treatment of Iran Police Force, in Tehran at February of 2018. Clinical appearance of lesions was erythematous or brownish pigmented macula with mild scaling of skin in involved areas. After sampling, to diagnosis, direct smears of 15% Potassium hydroxide (KOH) with scales and stained once with methylene blue were prepared. In direct microscopic examination, budding yeast cells with typical scar and short curved mycelium were observed. To identifying, culture on Sabouraud dextrose agar and modified Dixon agar media and other differential tests were performed. Finally, Malassezia furfur was identified as a causative agent of disease. The patient was taken on treatment of ketoconazole ointment for 4 weeks, approximately and lesions were disappeared.
Malassezia furfur can causes Tinea versicolor in uncommon region such as axillary location. The clinicians must be aware of these variations in location of TV and perform the appropriate diagnostic workup when lesions have the characteristic morphology of TV despite an unusual location in order to differentiation from other disease such as candidiasis and erythrasma