مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و هفتم شماره 2 (پیاپی 218، اردیبهشت 1398)

Prostate cancer is currently the third malignant disease in Iran and fifth common cancer worldwide. The aim of this study was to determine the expression of GPRC6A, E.cadherin, and ZEB1 genes in prostate cancer in comparison with benign tumor. Since early detection of cancer plays an important role in treatment, this study aims to identify the role of GPRC6A, E.cadherin and ZEB1 genes in screening of prostate cancer.
In this case-control study, 30 samples including 15 samples of malignant prostate cancer and 15 samples of benign tumor were collected from the patients. RNA was extracted from the tissues, followed by cDNA preparation. In the last step, expression of GPRC6A, E.cadherin and ZEB1 genes was measured using the Real-time polymerase chain reaction (PCR) technique and the Relative expression software tool (REST), Version 2009 (http://rest.gene-quantification.info/).
In this study, the expression of GPRC6A genes compared to its benign tumor increased 3-fold, ZEB1 expression in prostate cancer, compared to its benign tumor, increased 2-fold, and expression of E.cadherin gene in cancerous samples compared to benign tumor declines 10 was equal. In this study, there was no significant relationship between the expression of genes in benign and malignant samples with common diagnostic factors in this type of disease such as age, Prostate-specific antigen (PSA), pathologic stage and Gleason score.
According to this study and similar studies, increased expression of GPRC6A in prostate cancer cells can stimulate the progression of cancer cells by regulating cell proliferation and invasive response to various ligands. Increasing the expression of ZEB1 and decreasing the expression of E.cadherin is also due to the lack of binding of cells and spread of metastasis. As a result, tumors express ZEB1 with absence of E.cadherin is associated with advanced disease or metastases, which indicates that ZEB1 induces EMT and tumor progression in clinical cancers. Therefore examined genes have potential for screening prostate cancer and they can be used as a diagnostic marker for prostate cancer with further investigation.

Metronidazole resistant clostridium difficile is one of significant pathogens in Iran. It is one of the WHO-declared microbial resistance emergencies. Prevalence of metronidazole resistant clostridium difficile is rising. The aim of this study was to detect prevalence of metronidazole-resistant clostridium difficile using meta-analysis in Iran.
This study was conducted as a meta-analysis. Articles and derivatives were reviewed by two researchers. Initially, each of the researchers searched the databases separately and used all available Persian and English articles in Kurdistan University of Medical Sciences, Iran, from October 2017 to February 2018. Persian databases (including Magiran, Irandoc, Barakat and SID) and international databases (including PubMed, Sciencedirect, and Scopus) were searched during this period (2007-2016) with a combination of phrases and keywords. The list of references to these studies has also been evaluated and relevant articles have been included in the study. First, all the articles were extracted and then duplicated articles were deleted using the EndNote software, version X6 (Thomson Reuters™, New York, NY, USA) through the search for electronic banks. Such that the high heterogeneity (50% From the search of medical databases at first, 68 articles were selected. In total, 19 remaining studies entered the meta-analysis phase. In this study, the overall prevalence of clostridium difficile is 32.57% (CI95%: 21.86-44.30); in 2016 it was 55.25% (CI95%: 50.22-60.19) and in 2009 was14.26% (CI95%: 12.32-16.37). The heterogeneity was estimated to be 98.7% (CI95%: 98.5-98.8).
Based on the results of this study, the prevalence of metronidazole resistant clostridium difficile in Iran is high and increasing.

Identifying determinants of maternal mortality is essential in developing appropriate health policies for reduction of maternal death. This study aimed to determine the determinants of maternal mortality in Iran during 1990- 2015 and also to identify the trends of these determinants during the same period.
This is a quantitative longitudinal study that has been conducted at the Tehran University of Medical Science, Iran, from March to December 2018. Initially, a long list of determinants (n=32) were identified through a comprehensive systematic reviews. Variables with more than 25% missing data were omitted and the missing values for remaining variables were estimated through statistical methods. The data for the identified variables were gathered through internal sources including Iran’s Ministry of Health and international sources including the websites of World Bank, World Health Organization and United Nations. Finally, 12 indicators as determinants of death were constructed after data processing and data management and their associations with maternal mortality rate in Iran were examined through regression analysis.
Maternal mortality rate has been reduced by 80% during 1990- 2015 in Iran. Improvement of indicators including employment status, total health expenditure share (as a percent of GDP), vaccination coverage, urbanization, access to health and welfare facilities, GDP per capita and political performance played a significant role in reduction of maternal deaths according to the multivariate analyses. A reduction in out of pocket payment and total fertility rate also showed a significant association with lower maternal mortality. However neither education level in the country nor life expectancy at birth showed an important role in the maternal mortality rate.
Maternal mortality rate was reduced significantly in Iran during the last quarter of the century. Maternal death is not only affected by health and biological factors of mothers, but also, by macro-economic, social and welfare factors. A high political performance of the countries also is a grantor of better health of mothers and the community in general.

Intensity-modulated radiotherapy (IMRT) is one of the most usable methods in prostate radiotherapy that is used with different techniques. The aim of this study was to evaluate and compare the dosimetric and radiobiological effects of prostate IMRT techniques regarding to joint volume between the target tissue and organs at risk as a patients anatomical parameter.
This research was a cross-sectional, analytical, and quantitative study that was carried out from April 2016 to June 2018 at the radiotherapy and oncology center of Shoheday-e-Tajrish Hospital and Medical Physics Department of Tarbiat Modarres University Tehran, Iran. Four various prostate IMRT techniques (9, 7 and 5 fields and automatic) were planned on 63 prostate cancer patients CT scans. Radiobiological effects were calculated using Relative Seriality model for the organs at risk (bladder and rectum) and target tissue. Results of mentioned prostate IMRT techniques were compared based on the patient’s anatomical parameter. 
For the patients with joint volumes ranged from 0 to 15%, statistical differences were not observed among various IMRT techniques. The tumor control probability and complication free tumor control probability values decreased as a function of joint volume. The normal tissue complication probability value increased as a function of joint volume. The 9 and 7 fields IMRT techniques had not any significant differences (P=0.06) in all of the joint volume ranges. In patients with the joint volumes higher than 30%, the 9 and 7 fields techniques showed significantly better radiobiological values in comparison with 5 fields and automatic techniques (P=0.009).
In the patients with lower percentage of joint volume, all the mentioned prostate IMRT techniques showed same radiobiological effects; however, in the patients with higher joint volume percentages (> 30%), the 9 and 7 fields techniques have better results. It is proposed to use the 7 fields technique instead of the 9 fields technique, especially in prostate cancer cases with high uncertainty in patients’ setup.

With the increase in the number of premature neonates, there are concerns about the complications of this group. One of the common complications of preterm neonates is fungal sepsis. Therefore, this study was conducted to evaluate the efficacy of intravenous fluconazole on fungal sepsis and other complications related to premature newborns under 1200 g in a neonatal intensive care unit. The study was conducted by field trial. The intervention included intravenous injection of fluconazole (3 mg/kg, twice per week for 6 weeks) in neonates weighing less than 1200 gr in the Izadi Hospital in Qom, Iran. The intervention was conducted on September 2016 in entire population of the study. The control group was retrospective and from neonates admitted to Izadi Hospital, which were hospitalized before intervention. The outcomes (such as the need for amphotericin injection, death, fungal sepsis, time taken to reach enteral feeding and length of stay) were compared between the two groups. There was no significant difference between the two groups regarding their sex ratio (P=0.139), gestational age (P=0.834), type of delivery (P=0.841) and birth weight (P=0.458). After the intervention, fungal sepsis (from 65% to 48.3%) and the need for amphotericin injection (from 27.1% to 5%) were significantly reduced, and the mortality rate decreased from 40% to 28.3%, but this decline was not statistically significant (P=0.178). After the intervention, the length of stay in hospital (P=0.142) and neonatal intensive care unit (P=0.422), time to reach the weight of 1500 gr (P=0.717), and time taken to reach enteral feeding (P=0.289) did not change significantly. Proportion of pneumothorax, apnea, necrotizing enterocolitis, retinopathy of prematurity and need for respiratory support did not change significantly. The present study showed that administration of venous fluconazole could reduce fungal sepsis in neonates weighing less than 1200 grams in the intensive care unit. However, this study failed to demonstrate the effect of fluconazole on death, pneumothorax, apnea and need for respiratory support.

Although significant advances have been made in scientific and medical technology, but the rate of medical complaints has also risen. The purpose of this study was to investigate the effect of handling of medical malpractice cases in the hospital complaints committee on the reduction of patient complaints to law enforcement authorities. In this descriptive study, patients complained about ophthalmology from April 2005 to December 2005 at Farabi Hospital, Tehran, were evaluated. The complainant's patients, if confirmed by the trusted doctors, were invited to complaints committee, and the subject of the complaint was examined and tried to obtain patient satisfaction. A total of 87 patients complained to ophthalmologists completed a complaint form 71 (81.7%) of the cases were male. Statistically, the number of complaints was significantly lower in those with lower education (P=0.02). The prevalence of primary disease, 52 cases (59.8%) was cataract and 14 cases (16%) due to refractive errors and refractory surgery. In the examination of complaints by trusted doctors in the hospital, 11 cases of ophthalmologic error were identified, with a mantle rate of 12.6%, and the cases were reviewed by the complaints committee. Of the cases of complained that confirmed by the committee, only one person sued the law enforcement, which represented 9% of the defaulted item. These statistics showed a significant decline compared to the past year at the same center, and the percentage of defaults to law enforcement was 37.5% (P<0.05). Establishing committees to handle complaints of ophthalmologic failures in hospitals and providing a clear and honest atmosphere to hear the subject of complaints by patients and their companions, and then trying to get patients' satisfaction and helping them continue their treatment can lead to reduced complaints of patients to the authorities Legal, like forensics medicine department and medical council.

Tissue engineering is a developing multidisciplinary and interdisciplinary field involving the use of bioartificial implants for tissue remodeling with the target for repair and enhancing tissue or organ function. Acellular nerve has been used in experimental models as a peripheral nerve substitute. The purpose of the present study was to evaluate the mechanical and histological characteristics of acellular nerve scaffolds compared to the fresh nerve for application in environmental nerve repair.
This experimental study was conducted in Ferdowsi University of Mashhad Regeneration Research Laboratory, Mashhad, Iran, from May 2017 to October 2018. In this study for preparing the scaffold. The rats were sacrificed by intraperitoneal anesthesia with 10 % Chloral Hydrate solution. Then sciatic nerve fragments of the rats were removed above the nerve branching site and after cleansing of the tissues were decellularized by Sondell method, briefly nerves were treated with a series of detergent baths consisting of distilled water for 8 h, Triton X-100 for 12 h, and sodium deoxycholate for 24 hours according to the Sondell protocol. All acellularization steps were performed at room temperature. Then decellularized scaffolds were evaluated histologically and mechanically.
The results of tissue evaluations showed that decellularization of scaffolds were done completely, this was demonstrated by hematoxylin and eosin staining and DAPI staining. Also the specialized tissue evaluations by picro-fuchsin staining and evaluation the scaffolds by scanning electron microscopy (SEM) micrographs showed that the collagen and elastin strands are relatively preserved in the extracellular matrix in comparison with control groups. As well as mechanical examination of scaffolds in tensile test showed that extracellular matrix of scaffolds was relatively preserved the main components of tissue compared to control group and scaffolds have good mechanical resistance quality for use in tissue engineering.
The results of the present study showed that decellularized scaffolds that prepared with Sondell decellularization method by preserving the main components of the tissue can be a good platform for investigating cellular behaviors.

The Multi state Markov models have extensively application with categorization of laboratory marker of CD4 cells for evaluation of HIV disease progression. These models with different states result in different effects of covariates and prediction of HIV disease trend. The main purpose of this study was comparison of four and five states models with the three- state in order to select the model with better prediction ability of occurrence of HIV and finally death in HIV positive people. A total of 305 HIV positive people were included in this cohort study in the Iran AIDS center in Imam Khomeini Hospital in Tehran that entered during March 1995 to January 2005 and then fallowed up to October 2014. The three continuous- time Markov models of three-, four- and five- state models were fitted to data to describe the evolution of a HIV disease Trend over different states.
For comparison of models, two criteria of modification of Akaike’s criterion (DRAIC) and likelihood cross-validation criterion (DRLCV) along with their 95% tracking interval was used. For fitting of these models and estimation of transition matrix and the hazard ratio of gender and treatment independent variables, the msm package of R project for statistical computing, version R 3.2.4 (www.r-project.org) was used. The results showed that the four- state model has more prediction ability than five-state model for evaluation of HIV disease Trend. In the four-state model, the progression hazard ratio to death for people who received highly active antiretroviral therapy (HAART) was 0.64 lower than who didn’t get this therapy. Moreover, the progression hazard ratio for men was 2.33 fold in comparison to women. The disease progression hazard ratio to death was 4.9 fold for men in comparison to women. The (DRAIC) and (DRLCV) criterions showed that the four-state model has more predictive ability of the progression trend of HIV disease in comparison of five-state model.

Today, with the increasing use of ionizing radiation like X-rays in diagnosis and treatment of diseases, the risk of fetal exposure in pregnant women also increases. Therefore, protecting pregnant women from ionizing radiation is essential and is considered as the standard criterion for Medical Radiation Center. So the aim of this study was to investigate the observance of protective principles and 10-day rule in imaging of susceptible women. This cross-sectional study was carried out at the Radiography Centers of Semnan University of Medical Sciences, Iran, from July 2017 to September 2017. First, patients who were under radiography, were asked about the knowledge of the radiographers about the 10-day rule and radiation protection. Then a questionnaire with 12 questions was given to the radiographers in radiology and CT scan center. Finally, the existence of protection guidelines for pregnant women was determined by asking manager and checking at the moment. The patient's question about pregnancy failed about 19%, which did not have a significant relationship with patients' singleness (P=0.0004). Also the mean scores for the knowledge of radiographers about radiation protection were 14.21±0.96, which did not have a significant relationship with their work record and place of employment and their educational level (P=0.09). On the other hand, in half of the radiography centers, the written radiation protection guidelines were not available. Principles of radiation protection and 10-day rule for radiography of women who were prone to pregnancy were desirable but due to importance of radiation protection, the rules should be more carefully implemented.

Ovarian fibroma is the most common benign solid tumor of the ovary. The most common symptoms are abdominal discomfort and pain. Ovarian fibroids are associated with Meigs syndrome in 1% to 10% of cases. The aim of study is report of a case of Meigs syndrome A 65-year-old menopausal woman who complained of abdominal pain was referred to our academic hospital of Mashhad, Iran, in April 2018. In abdominal examination, a soft mass with size of 200×100 mm, was detected. Also leukocytosis and increase in CRP was observed. Marker CA125 was higher than 200. In CT scan in right adnexa heterogeneous mass 170×100 mm with enhancement was reveled. pleural effusion was reported in the both lungs and collapse of underlying lung tissue in Chest X-ray. Explorative laparotomy was performed. Ascites and inflamed omentum covered the surface of right ovary was detected. The huge solid-cystic hemorrhagic, irregular mass with a specific pedicle that enclosed in the capsule in right adnexa was seen. Right salpingo-oophorectomy was performed. The result of final pathologic was benign proliferative lesions of mitotic fibroblasts were reported according to ovarian fibroma. In case of accompanying ovarian mass with ascites and pleural effusion, after the exclude of ovarian malignancies, Meigs syndrome should be considered in differential diagnosis.