مجله تعالی بالینی
سال دهم شماره 3 (پیاپی 28، زمستان 1399)

Colorectal cancer is the fifth common cancer in men and the third in women in Iran. There is no therapeutic approach for metastatic colorectal cancer, so it is imperative to identify new chemotherapeutic and molecular targets to improve patient’s survival and the probability of being cured. Resistance to apoptosis plays an important role in the development and progression of different cancers such as CRC. Understanding the basis of the mechanism of apoptosis pathways and the tools used by cancer for escaping from apoptosis results in the design of effecient therapies that inhibit cell growth. One of the apoptosis pathways is the extrinsic–Fas/FasL pathway. In this article, the extrinsic pathway of apoptosis with focus on death pathway of Fas and FasL in colorectal cancer has been reviewed aimed at finding new therapeutic targets for CRC. Fas-mediated apoptosis of lymphocytes normally serves immunoregulatory roles. Anti-tumor cytotoxic T cells and NK cells eliminate tumor cells by inducing Fas-mediated apoptosis using FasL. Cancer cells such as colon tumor cells enable a “Fas counterattack” against Fas sensitive antitumor lymphocytes and lead to immune suppression against tumor cells. This systematic review article was conducted by searching keywords; Cancer, Apoptosis, Fas, FasL, Immune system in valid sources. 86 studies analyzing apoptotic changes in cancer from 1995 to 2020 were selected and used. Fas counterattack is a mechanism, used by tumor cells to evade immune surveillance. It might be important to study the basis of this mechanism to design tumor-specific and effective treatment. Triggering Fas-mediated  apoptosis is an effective approach to cancer therapy. Altering the expression of Fas and FasL genes can inhibit the tumor strikes back by tumors and our immune system and work officially against tumor cells.

In autism spectrum disorders, diagnosing it is a matter of importance for two reasons: screening for reducing of expenses and diagnosing for well-timed and important intervening. Therefore; this study is a systematic review on autism spectrum disorders diagnostic tools emphasizing Iranchr('39')s diagnostic system.
Using systematic review study method, key words like screening tool autism and diagnostic tool on information sources like science direct, Springer, Scopus and Googlescholar and also using screening and diagnostic tools of Autism on information sources like magiran and SID, this study was carried out and during 1980 until 2020, 144 essays were done and by using systematic sampling 58 of them were finally resulted. Results showed that among tools created for autism spectrum disorders, 6 screening tools, 8 diagnostic tools, 2 native Iranian tools and 34 tools connected with normalization results belonged to other countries and 10 papers on considered tools normalization were done in Iran. It seems that for applying useful and valid tools to diagnosing the Iranian autistic kid, normalizing more tests is required so that diagnosing process by valid tools can be made.

Nowadays, the explosion of the volume of educational information, easy access to educational resources has led to development of the Learning quality approach, because providing any training without looking at quality is a learning mistake and the effectiveness, effectiveness and permanence of learning experiences is an undeniable principle of educational survival. n some sciences, such as health and medicine, the importance of educational survival is directly related to human survival Therefore, the present study aims to review the quality of studentschr('39') effective learning experiences in medical sciences. The present study is a systematic review in which the keywords were determined based on MESH and then searched in databases: SID, Iran Medex, Pubmed, Google scholar, Cochrane, Scopus, Web of Science Uptodate, Magiran. The search results led to the finding of 98 articles that were studied and thematically analyzed in collaboration with the authors, at the end of the search, 14 articles were obtained and finally 11 articles that were close to the thematic and content criteria and the purpose of the study entered the systematic review study. Findings showed that learning characteristics are influenced by past learning experiences. Direct and indirect factors such as the content of teaching, the way of educational interaction, the efficiency of educators, the readiness of learners, the teaching method in the teaching and learning process affect learning that need to review the educational system in the health system. The results of the study showed that the criteria and indicators of effective learning in the health system is an important principle that needs to be reviewed and revised educational curricula with a qualitative approach to learning experiences. because the smallest educational mistake in teaching-learning of health system students can lead to operational errors in the future of health system graduates.

Non-graft-versus-host disease(non-GVHD) Ocular complications after hematopoietic cell transplantation(HCT) are uncommon. Although these side effects may consider it to be a minor side effect, however, for the patients, blurred vision, vision loss or other eye symptoms can be troublesome. This study was designed to review the non-GVHD ocular complications after bone marrow transplantation.
A search of the PubMed database in English language from 2004 to 2018 was used to search for published articles on ocular complications of hematopoietic stem cell transplantation with the following terms: hematopoietic stem cell transplantation, bone marrow transplantation, eye or ocular, side effects, eye and vision.
In this review, cataract was the most common ocular complication seen in more than 11% of adults and more than 4% of children. Glaucoma was observed in 0.4% to 1.7% of cases. Bacterial, fungal, protozoan, and viral infections have been seen in more than 2% of patients after hematopoietic stem cell transplantation. However, noninfectious eye involvement such as hemorrhage, ischemia, and retinal detachment has been observed in more than 3% of patients. Most studies have emphasized that awareness of non-GVHD ocular complications is essential for both transplant physicians and ophthalmologists provide comprehensive collaborative team care. 
Available evidences suggest that initial ocular evaluation before HCT should be considered in all patients undergoing hematopoietic stem cell transplantation. Follow-up assessments should be considered based on clinical presentations and risk factors. Preventive strategies and treatments for post-HCT ocular complications remain to be considered on individual case basis.

The use of metal alloys is an integral part of orthodontic treatment. In order to complete the treatment period, these metal alloys are used for a long time in orthodontic patients and Direct contact with saliva and food causes corrosion of metals and release of ions. Since the increase in the amount of ions released causes a cytotoxic state for the body, the present review study briefly examined the release of cytotoxic ions from fixed orthodontic wires in vitro. In this review study, articles related to Persian keywords (Orthodontic appliances, Chromium Ions, Nickel Ions, Metal Ions Release, Saliva, Orthodontic Treatment) in the Persian Data bases of Magiran, noormags, Irandoc, Scientific Information Database (SID) and English Keywords (Orthodontic appliances, Chromium Ions, Nickel Ions, Metal Ions Release, Saliva, Orthodontic Treatment) External databases were searched by Pubmed, Google Scholar, Scopus, ISI during the years 2001 to 2019 and 21 related articles in this field were reviewed. Findings from studies showed that during orthodontic treatment, metal ions such as nickel, chromium and cobalt are released from components such as brackets, wires and orthodontic bands and They are important because they can cause hypersensitivity and cytotoxic conditions. Therefore, more studies are needed to investigate the effects of various laboratory dimensions, including the effects of temperature, variable times, and types of mouthwash brands, to help more accurately identify and detect the release of toxic ions.