مجله علوم پزشکی رازی
سال بیست و هشتم شماره 10 (پیاپی 212، دی 1400)

Physical activity is associated with a range of positive health outcomes, including fewer depressive symptoms. One plausible mechanism underlying these findings involves Brain-Derived Neurotrophic Factor (BDNF) (1), a protein hypothesized to limit or repair the damage caused by stress. Physical activity increases expression of BDNF, which may enhance brain health (1). In addition, insulin-like growth factor (IGF1) is involved in neurogenesis and regulation of the BDNF gene, and is involved in the growth and differentiation of nerve cells (4). Therefore, one of the factors that may mediate the effects of physical activity and BDNF in the brain is IGF1. Physical activity can stimulate the production of IGF1 by increasing circulating growth hormone. This factor has different biological effects such as neurogenesis, memory effects and cognitive factors and other systemic effects (3). Therefore, it has been suggested that the increase in IGF1 due to physical activity leads to an increase in BDNF, thus increasing the amount of hippocampal synaptic flexibility and expression of molecules related to learning and cognitive functions with physical activity (4).Studies on peripheral blood have been contradictory, with some studies reporting that BDNF increased after physical activity, others decreased, and some showed no significant change (14). On the other hand, afew study was found to measure the effect of intermittent and continuous exercise on serum IGF1 and BDNF levels. Therefore, in this study, we seek to answer the question of whether intense or intermittent intermittent exercise causes serum changes in IGF1 and BDNF in mice, and which exercise method can further influence these two factors.

This was an experimental study with a control group. The samples were 32 eight-week-old male Wistar rats. rats were randomly divided into 4 groups, as follows: moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT), and the baseline control group (C) and the eight weeks control group (C8w). Group C was killed and serum harvested at baseline, and group C8w was retained for eight weeks at the same time as the exercise groups, but did not participate in any exercise program.The MICT group trained for 5 days a week for 8 weeks. The method was according to the training program (13). These exercises were performed for eight weeks and five sessions of running on a treadmill every week (14). BDNF and IGF-1 concentration was measured using an ELISA kit (BASTER kits made in the United States). Normal distribution of data was examined by the Shapiro-Wilk test. To examine the possible difference between groups, 1-way Analysis of Variance (ANOVA) and Tukey post hoc test were performed in SPSS. The significance level was set at P ≤ 0.05.

The results of statistical test showed that the amount of serum IGF-1 levels after MICT training significantly decreased compared to groups C (P = 0.00) and C8w (P = 0.00). Also, a significant decrease in this protein was observed after HIIT training compared to groups C (P = 0.03) and C8w (P = 0.01), but no significant difference was observed between the two groups of HIIT and MICT training. Regarding BDNF variable, protein levels after MICT and HIIT training did not change compared to group C (P = 0.99 and P = 0.91) and C8w group (P = 0.99 and P = 0.98), respectively. There was also no significant difference in serum levels of BDNF protein after MICT and HIIT (P = 0.99).

One of the findings of the present study was the change in BDNF blood circulation levels after exercise intervention, although this change was not statistically significant, but the smallest change in blood circulation levels of this nerve growth factor is clinically important. Because BDNF is one of the main modulators of brain adaptation. These results are similar to the findings of the research of Ives et al. (2016) and Abbaspoor et al. (2020) and with the results of studies by Kallies et al. (2019), Máderová et al.(2019), Church et al. (2016), Kang et al. (2020), Akbari-Fakhrabadi et al. (2021) and Żebrowska et al. (2020) disagree (18-25).one of the reasons for the lack of change in BDNF levels is the intensity and duration of exercise that affects each individual, so that in rodents, an increase in hippocampal BDNF occurs when mice Voluntarily ran about 3,000-10,000 meters a day on a treadmill. In addition to methodological issues, serum BDNF levels may vary due to circadian rhythms of cortisol or sex-dependent hormonal fluctuations and energy balance and nutritional variables (27). Therefore, future studies should consider the period of assessment of exercise-induced flexibility by evaluating short-term and long-term measures of growth factors, perfusion, volume, and memory. Another finding of the present study was a significant change in serum IGF-1 levels after two exercise interventions.This means that a significant decrease in the levels of this growth factor was observed after MICT and HIIT training compared to the controlgroups. Changes in growth factors and adaptations in response to exercise can affect the type, intensity, duration, and frequency of exercise sessions. The present results are in agreement with the findings of Yalanda et al. (2019), Valipour et al. (2019), Ives et al. (2016), Żebrowska et al. (2020) and with the findings of Maass et al. (2016) and Johnson et al. (2020) is the opposite (18, 25, 27, 34-36)A number of researchers have suggested that aerobic exercise stimulates the uptake of IGF-1 nerve growth factor into the bloodstream by cells in specific areas of the brain, such as the hippocampus (35, 37, 38). On the other hand, the type of exercise is veryimportant in response to systemic growth factors such as IGF1 blood levels (39). Whether the increase in IGF1 blood levels is due to a decrease in IGF1 uptake from the bloodstream by the brain or a double increase in the production of this hormone from major sources of its production, such as the liver, is still unclear and needs further study.However, since the present study did not investigate the expression of genes and tissue levels as well as changes in IGF1 receptors at the cellular level, These cases cannot be strongly cited in explaining the results and further studies are needed to elucidate the exact mechanisms of changes in this growth factor by simultaneously measuring gene expression, protein levels, and IGF1 receptors with exercise.In general, it can be concluded that intermittent and continuous exercise significantly decreased IGF1 and also caused a non-significant increase in serum BDNF in male Wistar mice. Exercise as a physiological stress can play a vital role in the normal functioning of the brain by changing the growth factors of the environment and blood circulation. According to the available evidence on the ability of systemic IGF1 to cross the blood-brain barrier, small changes in the levels of this growth factor with exercise can be considered in the physiological adaptations of the brain to exercise. One of the limitations of the present study is the lack of study on the expression of BDNF gene in brain tissue. Also, recent studies show that brain health can be affected by physical activity and exercise. Therefore, it seems necessary to study sports interventions with different type, volume and duration of the present study on brain function and structure, as well as simultaneous examination of tissue and systemic levels of growth factors.

Common Variable Immune Deficiency Disease (CVID) is a group of primary immunodeficiency diseases that is defined as a defect in the functioning of the immune system and is characterized by low levels of immunoglobulin in the blood and an increased incidence of infections. It is a chronic disorder that has no definitive cure and can only be controlled with a blood factor (IVIG) injection. Because of these conditions, patients are affected by a variety of symptoms that limit them. These patients are affected by severe stress and anxiety. This reduces the quality of life and psychological resilience in them. Because this chronic disease affects a person for a long time, its consequences are uncertain, it has high levels of ambiguity in prognosis, and there is no definitive cure. Although medical science has made significant advances in the development of therapies that affect the physical consequences of the disease, facing the consequences of the disease, mental health and emotional adjustment of these patients are the main challenges for the patient and the medical team (9). The important point is that; When suffering from chronic diseases, the psychological factors associated with adaptation in individuals are greatly reduced. Therefore; Positive factors such as resilience, acceptance, life expectancy decrease and also negative factors such as; depression, anxiety and stress increase (10, 11). For this purpose, Logo Therapy was selected as a psychological intervention method and was performed in ten group sessions. The aim of this study was to investigate the effect of group Logo Therapy on increasing resilience and quality of life in CVID patients.

In this study, psychotherapy based on Logo Therapy was developed in 10 group sessions. This online psychotherapy was performed on the experimental group to increase resilience and quality of life of CVID patients and the control group did not receive any intervention and were in contact with the researcher to the extent of informing about the CVID. The statistical population included 32 patients referred to the "Immunodeficiency Research Center of Isfahan University of Medical Sciences" who were randomly divided into experimental and control groups. Logo Therapy helps these patients find meaning and purpose in their suffering and is trained through Logo Therapy techniques to maintain their spirits in the face of difficult and unchangeable conditions and lead a better life. Have. The research protocol is based on the concepts introduced by Victor Frankl and the interpretation of previous protocols. Schulenberg and Hutzel intervention plan was also considered as a research premise (32). In the process of this Logo Therapy, group exercises and homework were developed and presented in order to achieve the following goals:* Helping people to clarify values that have a special meaning to them. Set reasonable goals for individuals. Ensuring that people's goals achieve their meaningful personal values.Practical planning to achieve people's goals and teaching the concept of time in goals.Identify the strengths and weaknesses of people that affect the achievement of their goals. Consider the strengths and weaknesses in planning to achieve goals that are in line with people's values. Teaching Logo Therapy techniques to reduce stress and psychological pressure.The Connor & Davison Resilience Questionnaire (CD_RSC) and the Common Variable Immune Deficiency Quality of Life Questionnaire (CVID_QoL) were used in the pre-test, post-test and one-month follow-up stages of intervention.

The data of this study were analyzed by repeated measures analysis of variance using SPSS23 software. The findings showed; Research stages include; Post-test and follow-up in resilience are not generally different from each other, but in the minimum stages of research i.e. post-test and follow-up or the effect of time on resilience in the two groups, the data are different. The difference between the groups in the stages of research on resilience is equal to 27.1%. Logo Therapy in the post-test phase increased the mean resilience scores in the experimental group and the effect of intervention continued in the follow-up phase. According to the results, it can be concluded that the first hypothesis of the research has been confirmed. In other words, Logo Therapy has been effective in increasing resilience in people with CVID. Post-test and follow-up results on quality of life are generally not different from each other, but at least the process of research stages, i.e. post-test and follow-up or the effect of time on quality of life are different in the two groups. The difference between the groups in the stages of research on quality of life is 12.9%, which shows that Logo Therapy in the post-test phase has increased the average scores of quality of life in the experimental group and the effect of intervention in the follow-up phase has continued. According to the mentioned results, the scores of quality of life and resilience in the post-test stage were associated with a significant increase and in the follow-up stage of intervention was relatively stable. (P <0.05).

From the findings of this study, it is concluded that Logo Therapy has been effective in increasing resilience and the quality of life of CVID patients.The concepts of Logo Therapy taught to these patients have improved their psychological state. Logotherapy has helped these patients become more resilient in the face of illness by teaching concepts such as finding meaning in suffering and accepting it as part of life. Also, the meaning of life has helped these people to accept the existing problems and experience less stress. This acceptance has increased their quality of life. According to the findings of this study, it is suggested that in addition to medical interventions, Logo Therapy should be used as a psychological intervention to improve the quality of life and resilience of these patients. The goal and mission of medicine and psychology is to increase the quality of life of patients. Coherence of these interventions will have significant effects on improving the condition of CVID patients.

Beginning in 2020, a deadly disease called COVID-19 spread throughout the world, plunging all countries into a viral infection. Viral infections are naturally associated with upper respiratory tract infections, which are commonly reported with fever, headache, and cough. COVID-19 virus can infect a person's respiratory system and lungs, eventually leading to death. The virus can first activate and infect macrophages. Macrophages then transfer COVID 19 to T cells and make them weak. In addition, by weakening T cells, T cell subsets are activated to increase cytokines to enhance the immune response. T cells, CD4 + T cells and CD8 + T cells play an important antiviral role in the body. It is noteworthy that CD4 + T cells in the body produce T cell-dependent (B) cells to increase virus-specific antibodies. On the other hand, CD8 + T cells are a toxic cell and can kill virus-infected cells. Most published studies have focused on the effect of aerobic exercise on immune system function. Recent studies have shown that tai chi and yoga exercises can also be beneficial for immune system function. Exercise has long been known as an important modulator of inflammatory processes. Exercise can apparently have both tonic and suppressive effects on the immune system. The effect of exercise on innate and acquired safety parameters depends on the intensity, load and duration of exercise. As the severity increases, immune function and ultimately the risk of infection increase. These risks depend on immune system regulators (genetics, nutritional status, psychological stress, circadian rhythms), environmental stressors (extreme temperatures, airway irritants) that increase inflammation. In response to exercise, immune cells grow, proliferate, and produce molecules such as cytokines and cytotoxic granules. Prolonged exercise, at least in healthy individuals, appears to reduce basal inflammatory status by reducing the circulation of inflammatory cytokines. Regular periods of short-term training (i.e., up to 45 minutes) with moderate intensity boost the immune system (increase T cells) while frequent periods of long-term high-intensity training (> 2 hours) can suppress the immune system. Acute exercise, even in healthy individuals, leads to a strong inflammatory response that is mediated by leukocyte mobilization (even for short periods of 6 minutes) and increases potent inflammatory mediators such as TNF-α, IL-1. The effect of increasing aerobic capacity on improving lung function and preventing lung injury can be summarized in four mechanisms. The first mechanism of aerobic exercise can prevent the suppression of the immune system by affecting the immune system and increase anti-inflammatory factors. The second mechanism contains the role of aerobic capacity in restoring the elasticity of lung tissue to normal and increasing the strength and endurance of the respiratory muscles, which helps increase ventilation, and reduce lung damage. The third mechanism includes the role of aerobic capacity as an antioxidant to limit the production of free radicals and oxidative damage. The fourth mechanism involves the role of aerobic capacity in reducing cough and clearing the airways by improving pulmonary safety and autonomic modulation.

Google Scholar, ScienceDirect, PubMed, Scopus, SID, Noor, and Magiran databases were reviewed to find studies with exercise training on cognitive impairment in patients with coronavirus and exercise recommendations for their recovery.

New research has shown that neurological complications are emerging as an important cause of disease and mortality in the COVID-19 epidemic. In addition to the respiratory failure caused by COVID-19, many hospitalized patients report neurological manifestations ranging from headache and loss of smell to confusion and stroke. It is also predicted that the COVID-19 can damage the nervous system in the long run. The entry of SARS-COV-2 into human tissues is facilitated by ACE2. However, the lack of ACE2 receptors in the central nervous system (CNS) does not mean that it is resistant to this type of virus. It has been suggested that the virus can reach CNS through the neural circuitry in trans synaptic pathways. One of the consequences of COVID-19 pandemic and its quarantine is depression. Researchers believe that exercise can effectively reduce depression, and one of the strongest modulators of neuroprotective and antidepressant effects of physical activity and exercise is Brain-derived neurotrophic factor (BDNF). Many areas of the brain are affected by depression, but the area that is most often affected in people with depression is the hippocampus, which is involved in memory, emotional processing and stress management. The effect of exercise on the brain can have systemic effects on the whole body because exercise-induced euphoria is associated with the release of endogenous opioids (endorphins), which are significantly increased after running. The adaptive effects of exercise depend on the intensity and duration of the training sessions. Available data suggest that to strengthen the immune system, moderate-intensity exercise for up to 45 minutes can help the immune system adapt. On the other hand, strenuous exercise can suppress the function of the immune system, causing infection of the upper respiratory tract and reappearance of the latent virus.

During the COVID-19 pandemic, quarantine is the best way to prevent infection, but its consequences can weaken the physical, mental, and emotional well-being of individuals. Home-based sports activities can be a good way to prevent or control the above-mentioned issues. Providing training models unique to the target community according to its characteristics and conditions can play an effective role in maximizing the benefits of exercise. Given the potential for the brain to be negatively affected by quarantine-induced inactivity and the possibility of coronavirus invading brain tissue, exercise appears to be effective in brain health. During the quarantine period, all groups in the community must maintain their health by following the WHO physical activity recommendations for at least 150 minutes of moderate-intensity exercise. Considering the decline in cognitive function in old age and its aggravation along with implicit diseases It is better for the elderly to exercise in a way that stimulates their nerves and muscles. It is not clear, so that the exercise of these people improves their memory and executive function.

Wound dressing materials allocate a great portion of skin and draught maintenance in the global medical market.  In previous times the conventional dressing materials as natural and synthesized bondage, Cotton and gas were used for caring of skin wounds. Nowadays the production of modern wound dressing of higher restorative capabilities has attracted the attentions. These modern wound dressing can precipitate the re-epithelization, collagen synthesis and angiogenesis. These modern wound dressing materials can reduce the PH and perform as a barrier to bacterial penetration. There are several methods available for production of fibers and nanofibers. Between these methods electrospinning has attracted much interests. By this procedure it is possible to produce composite fibers and porous mats. The cells can penetrate to these pores and grow appropriately. The manufactured fibers usually have proper uniformity and the dimensions can vary from several nanometers to micrometers. These fibers can be used in different applications such as the filters, the fortifiers, the scaffolds and the wound dressing materials. The biocompatible materials are among the best choices for fabrication of the wound dressing, They can provide the necessary condition for growth of derma and epidermal layers. The multi-polymers Mat fibers have been used for tissue engineering applications, as they have the capability of the simulation of the extracellular Matrix. Drug addition to these scaffolds can enhance the function of this system and improve the restoration capabilities.  The electrospun wound dressing materials facilitate the tissue growth. The electrospun nano-fibers have similar structures to that of the skin and have higher compatibility with blood. They make the wound and tissue restoration possible. In this research the production of two layers wound dressing materials has been conducted by the electrospinning Method. The downward layers of these wound dressing materials have been manufactured from polyvinyl alcohol. Polyvinyl alcohol is a synthetic polymer which has proper electrospinning properties, and therefore it can be used for nanofibers production. The fibers have high tensile strength and an appropriate flexibility. This material is one of the oldest and most common materials that have been utilized for drug delivery systems, wound dressing and wound maintenance, contact lens and artificial limbs. This polymer is biocompatible, and due to the hydroxyl groups, it has reasonable water absorption. Also for infection inhibition vancomycin drug has been loaded in this layer.

Many different wound dressing fabrication methods have been used for many years. Among these techniques, electrospinning has attracted a lot of attention. This simple and cost-effective method produces nano and micro fibers substrates which simulate extracellular matrixes and provide a suitable porous structure for cell adhesion and proliferation. In this study, electrospinning was used for the fabrication of two-layer wound dressing, consisted from chitosan and poly (lactide-co-glycolide) acid (PLGA) as the first layer and polyvinyl alcohol (PVA) and vancomycin as the second layer. For the first layer electrospinning, the solution of chitosan, poly-lactic co-glycolic acid has been provided and transmitted to 5 ml syringe and located in the place.  the syringe tip attached to the electrical current source and the electrospun fibers were collected it on a aluminum foil covered collector. The ejection action was performed by the flow rate of 2 ml per hour and the electrospun fibers were manufactured on a 50 mm diameter collector.  In this research, the distance between the nozzle and the collector was 120mm and the rotating speed of the collector was 16 RPM. The device voltage was set at 15 kilovolts. For electrospinning of the second layer the solution of polyvinyl alcohol and vancomycin was provided and transmitted into 5ml syringe, just like previous steps.  The injection process was performed by the volume rate of 1 ml per hour and electrospun fibers were gathered on the 15 mm diameter collector.  In this level, the distance between the nozzle and the Collector was 200mm, the rotating speed was 10 RPM and the device voltage was set at 15 kilovolts. For cross-linking, the samples were located on the vapor of glutaraldehyde and HCL by the molar ratio of 1:10 for 12 hours.

Electrospun two layer wound dressing microstructure was evaluated by scanning electron microscopy (SEM). It was observed that both layers have homogenous bead free interconnected porous structures. Image measurement software revealed that fiber diameters ranged from 0.2 to 1.2 micrometer, which can provide a proper substrate for cell proliferation. Functional groups of raw materials and chemical bonding between layers were assessed by FTIR analysis. In order to evaluate layers absorption capacity, they were soaked in PBS solution for 24 hours. They showed about 112.4±10.2 % PBS absorption after 24 hours. So they can absorb wound secretions and keep the wound environment dry. Biodegradation tests showed that 32.7 % of these two layer wound dressing was degraded after 3-weeks immersion in PBS solution. Drug release tests demonstrated a burst release of vancomycin in the first hours which followed by decreasing releasing rates. These releasing manner lowered infection appearance in the wound site. Antibacterial activity is an important factor in wound dressing and the co-existence of chitosan and vancomycin provided approximately 98.72 % bacterial reduction in the antibacterial assay. Although the antibacterial test showed a significant reduction in bacterial growth, the MTT test showed that these scaffolds are biocompatible and provide a favorable environment for cell attachment and proliferation.

The images of the microstructure electrospun substrates depicted that electrospun two-layer polyvinyl alcohol vancomycin and poly lactic co-glycolic acid chitosan substrate has a porous fiber structure, in a way that these pores are interconnected.  The fibers of two layers have no beads and they have relatively homogeneous distribution. The water absorption of these scaffolds showed suitable inflation strength in 24-hours of submerge in phosphate buffer saline.  Also the degradation capability of the samples demonstrated the approximately 32% degradation of the structure in 3-weeks.  It illustrated convenient degradation time of wound dressing and it is in good correspondence with previous researchers. Drug delivery assessment of vancomycin from these samples was relatively explosive in the initial hours.  But it reached an equilibrium state in some hours.  The initial explosive delivery can lead to eradication of the initial bacteria and it is a key factor in wound dressing applications. The antibacterial assessment of their structure demonstrated high antibacterial capabilities due to the existence of chitosan and vancomycin in these scaffolds. About 98% of the batteries at the dose of 10 mg/lit were perished.  Also the cellular viability investigation for these scaffolds proved non-toxicity and biocompatibility. The cultured cells on the scaffolds had normal morphology. According to acquired results in this study, it seems that these two layer electrospinning substrates can be useful for wound healing.

Medical errors and their consequences are one of the most important factors threatening patient safety in the health system of all countries, the incidence of which is increasing alarmingly (3, 4). Today, reducing the incidence of medical errors has become a global challenge (5). Despite all efforts to improve and maintain the safety of patients due to medical errors, various communities suffer a lot of financial and human costs and losses every year (6). In the global classification of causes leading to death, medical errors are one of the top ten causes (7). So that one out of every ten hospitalized patients is injured due to medical errors while receiving health care; about 7% of them lead to death (8). Therefore, considering the importance of the issue, this study was conducted with the aim of systematically reviewing, identifying and collecting information about the occurrence of various medical errors in physicians in Iran as an example of a developing society.

This systematic review study in 2019 using search tools in SID, Magiran, Iran Doc, Scopus, Proquest, Pub Meb, web of science, Springer, Cochrane, Elsevier, Science Direct and Google scholar databases has systematically reviewed the studies conducted on the types of medical errors in Iranian physicians from the beginning of the establishment of each of the above scientific bases until August 1, 2019. The search strategy was retrieved and prepared for related studies using PICO-related search terms (patient or population, intervention, control, or comparison and results). In the article search process, MeSH-compliant keywords including Prevalence, error(s) or mistake(s), prescription, physician(s), Surgery or Surgeons, physician(s) error(s) or mistake(s), surgical error(s) or surgeon(s), administration(s) error(s) or mistake(s), medication or drug error(s) or mistake(s), prescribing error(s) or mistake(s), wrong dose(s), wrong medication(s) and Iran or Iranian and Persian equivalent keywords were used. The Cochrane Handbook for Systematic Reviews for Intervention Studies and the PRISMA statement were used to design this study and refine the articles (51). To collect information from the considered articles, Cochran data extraction form for systematic review was used which included the first author, year of publication, nationality of researchers, study design, type of research, sampling method, sample size, research tool and summary of important study findings. An Excel-designed form was used to collect data. Data according to their nature were analyzed and written in a narrative and thematic manner. The following selection criteria were used to find related articles from databases: 1) articles that had full text and were written in Persian or English, 2) articles were published in the field of medical errors only in physicians and the factors affecting it. Of course, it is worth mentioning that in articles in which medical error was simultaneously examined in physicians and nurses, information about physicians was extracted. Gray resources related to unpublished results in dissertations and articles published in low-credit sources were not reviewed due to access problems and insufficient credit. Also, articles on meta-analysis, systematic review, quality, posters, speeches and letters to the editor that were found in the field of various medical errors were excluded from the study.

A total of 15 articles were found, including: 3 Persian articles and 12 English articles. According to the findings of the present study, the prevalence of medical errors in Iranian physicians ranged from 38.1 to 65% (3, 9, 16-18). The most common types of medical errors were prescription error with 17.3% and medication error with 1.98 errors per patient, respectively (4, 28). The most important factors affecting the occurrence of medical errors include:  the education level and type of specialization of physicians (2), low number of physicians and high number of patients (10), lack of proper training of medical staff (9), staff performance, management levels and executive shortcomings (4), long night shift (17), physicians 'handwriting and how to record patients' information in medical records (8), lack of cooperation between physicians in different wards (10), employment in overcrowded hospital wards (4) and the lack of comprehensive treatment guidelines and violations of existing laws (23,10). The results of this systematic review showed that various interventions have been performed to reduce the incidence of medical errors, which can be divided into three areas: the study of the intervention role of clinical pharmacists (18, 28), the use of software for recording clinical prescriptions systematically by a physician or nurse (25,29,30) and other types of interventions (23). Use of clinical prescription registration software by the nurse can increase the acceptability of physicians' performance by warning and recommending and significantly reduce the medication dose error in the neonatal ward compared to the computer recording of information by a physician. In care systems where the physician opposes the implementation of computerized clinical information recording software by himself but nurses tend to computerized clinical information registration and have the necessary ability to implement it, computer software for recording patient information by the nurse can Should be considered as an appropriate alternative method for entering patient information in hospitals (29).

This systematic review showed that in general, the incidence of medical errors in Iranian physicians during the clinical care process is high. Also, the most common type of medical errors in our country's hospitals is the error of a doctor's prescription and then medication errors (9, 17). Unfortunately, despite all the efforts of the Iranian health system to reduce the occurrence of medical errors, the incidence rate is still significant, although it seems lower than the global rate. Of course, the lower rate of medical errors in Iran than the global rate can also be due to under-reporting of errors (9). Therefore, in order to reduce the incidence of medical errors, preventive approaches such as paying more attention to the importance of the interventional role of clinical pharmacists and providing conditions for their wider productivity (18, 28), using more efficient techniques to predict, diagnose and reduce the incidence of medical errors such as Sherpa technique (3,10) as well as the use of intelligent electronic technologies to reduce clinical errors such as systematic registration of clinical information by physicians and nurses (25,29,30) and design, implementation and evaluation of more appropriate intervention approaches to improve the reporting status of medical errors in physicians (9).

Thiamine (vitamine B1) serves as a cofactor for several enzymes involved in carbohydrate catabolism such as pyrovate dehydrogenase and transketolase and alfa-ketoglutarate.thiamine and related vitamine may improve the outcome in children with type 1 diabetes mellitus.Thiamine is absorbed efficiently in the gastrointestinal tract.adequate thiamine intake can be achived with a a varied diet that includes meat and enriched or whole _grain cereals.thiamine is water soluble and heat labile.The requirement of thiamine is increased when carbohydrates are taken in large amounts and during periods of increased metabolism,suc as diseases.thiamine deficiency is common in children with diabetic ketoacidosis (DKA) and treatment of diabetic ketoacidosis may exacerbate this deficiency. To prevent the complications of thiamine deficiency, ketoacidosis caused by diabetes must first be eliminated and then, if metabolic acidosis persists, other factors affecting this process must be addressed. Due to the importance of the subject and the limited studies that have been done to measure the serum level of thiamine, especially in children and adolescents with diabetes, we found the serum level of this vitamin in two groups of children and adolescents with diabetic ketoacidosis and diabetic patients without diabetic ketoacidosis.

This quasi-experimental study was performed by case-control method. The case group consisted of 30 patients with diabetic ketoacidosis who referred to aAliasghar children hospital which is subset of Iran university of medical science in Tehran city for one year. The control group consisted of 30 patients from diabetic patients without ketoacidosis referred to this hospital.The most important inclusion criteria for case group in this study was:age under eighteen years,diabetic ketoacidosis with polyuria and polydipsia,ph under 7.3,fasting blood sugar above 250 milligram in deciliters, keton in urine and not taking treatment for example intravein therapy and insulin infussion before admission in Ali asghar hospital and inclusion criteria for control group was diabetic patients without symptom and sign of ketoacidosis. At the time of admission, blood samples were taken from patients with diabetic ketoacidosis and evaluated for blood gas indices including HCo3, PCo2, pH, determination of serum levels of thiamine, sodium, potassium, hemoglobin, blood sugar, lactate and HbA1C. Serum thiamine levels were also measured in patients without diabetic ketoacidosis.For determine of serum levels of thiamine in two groups the samples of whole blood were froze in under 70 degrees centigrade and sent to the lab then measured serum levels of thiamine by HPLC method. After admission of patients, initial measures for the treatment of diabetic ketoacidosis including hydration with isotonic fluids, insulin injection at a rate of 0.1 Unit / Kg / hr were performed according to the same protocol for all patients in the case group. All demographic information of patients in both groups along with the results of laboratory tests and patients' consciousness status scores were recorded in information forms for each patient and analyzed and evaluated using SPSS software version 23.

According to the research finding in fifty percent of all patients of our study including diabetic ketoacidosis patients and nondiabetic ketoacidosis patients the serum level of thiamine was low. In this study 56.7 percent. of patients with diabetic ketoacidosis had thiamine deficiency at the time of admission and in patients without diabetic ketoacidosis 43.3 percent had thiamine deficiency In the present study, the serum level of thiamine at the time of admission in patients with diabetic ketoacidosis was significantly lower than patients in the control group. HbA1c levels were also significantly higher in diabetic ketoacidosis patients than in controls. Also, serum thiamine level in patients with diabetic ketoacidosis had a statistically significant relationship with HbA1c level. It means that poor control blood sugar is accompany with lower serum level thiamine.The present study is the first study that investigate serum level of thiamine in type one diabetic children and relation of it with HbA1C. Also results of this research show that diabetic ketoacidosis treatment worse the thiamine deficiency. There was no statistically significant relationship between serum thiamine level in diabetic ketoacidosis patients with lactate level, ketoacidosis severity, Hemoglobin, Blood sugar, sodium, potassium, and Blood urea nitrogen. The results showed that there was no statistically significant relationship between serum thiamine level in patients with diabetic ketoacidosis and age, sex, severity of diabetic ketoacidosis, history of diabetic ketoacidosis and duration of symptoms.

The results of the present study showed that the treatment of diabetic ketoacidosis exacerbates thiamine deficiency in these patients. Although the relationship was not statistically significant, a decrease in thiamine levels was observed. Therefore, it is recommended to consider thiamine supplements in children with diabetic ketoacidosis. On the other hand, the weaker the blood sugar controls, the lower the thiamine level. Therefore, it is recommended that due to the side effects of thiamine deficiency in diabetic patients, all of these patients be encouraged to eat a healthy diet include foods containing thiamine in the diet for example fish, poultry, rice, oat

Sedentary lifestyle causes overweight in women, obesity in women is associated with the development of physical problems and metabolic diseases, such as diabetes, hypertension, cardiovascular disease, some cancers, anxiety and personality disorders and Osteoarthritis is one of the effects of inactivity in women (2).Cross-fit training, which is a combination of resistance and explosive training, has shown a greater increase in speed and physical strength compared to traditional training methods (6). High-intensity exercise training and short rest periods in cross-fit exercise have resulted in fitness and improve muscle strength, muscle endurance, aerobic fitness, and body composition (7). These exercises affect the four components of health-related physical fitness (aerobic fitness, physical fitness, body composition and flexibility) athletes (8). Some studies have examined the effect of cross-fit exercises on some physical and anthropometric parameters, but have stated conflicting results. Women athletes who have combined cross-fit training with their training have experienced many improvements in professional sports (9). Smith et al (2013) reported that cross-fit improved aerobic and muscular endurance, and that fitness factors altered the vo2max of young women after a 10-week period of cross-fit training compared to traditional exercise (11). However, in Patel et al (2008) study on overweight and obese adults, no significant changes in body composition were observed after 8 weeks of cross-fit training (12). Also, in Blocker et al (2015) study, conventional training methods were compared with new training methods, including cross-fit training in healthy men after 6 weeks. In this study, it was concluded that although significant difference in strength improvement was observed, but there was no significant difference in terms of improving cardiovascular endurance (24). Knowing effective training methods can play an important role in preventing disease progression and reducing treatment costs in sedentary people. Therefore, the study of safe and effective methods to maintain and develop physical fitness for a wide range of people has always been the focus of researchers. Cross-fit exercises are useful for everyone and compared to other traditional training programs, this type of exercise requires less time (14). As mentioned, studies on the effect of cross-fit exercises on physical and anthropometric parameters in some cases have different results and the reports are ambiguous. Therefore, the aim of this study was to investigate the changes in physical fitness factors and some anthropometric indices of inactive young women following eight weeks of cross-fit training.

In this semi-experimental study, 20 inactive young women (age 24.9±2.40 years, Body mass index 22.2.2±7.7 kg/m2) from the Shiraz city were purposefully and accessibly selected and randomly assigned to exercise and control groups. The experimental group performed cross-fit exercise program 3 sessions per week, each session 60 minutes with intensity of 50 to 60% of the maximum repetition for 8 weeks. Changes in physical fitness factors and anthropometric indices of subjects were measured using Rockport test, sit-ups, 4×9 meters agility shuttle run, 45-m sprint and Sargent jump test. Data were analyzed by independent and dependent t-test at the p<0.05.

The results showed that cardiorespiratory endurance (40.4 vs. 33.9), trunk muscle strength (34.1 vs. 24.5), speed (6.81 vs. 8.07), lower muscle power (36.6 vs. 29.8) and agility (13.4 vs. 16.6) increased significantly in the exercise group compared to the control group. Also, after 8 weeks, body mass index, waist circumference and pelvic circumference in the experimental group decreased significantly compared to the control group (p=0.001).

The findings of the present study show that eight weeks of cross-fit training improved cardiorespiratory endurance, torso muscle strength, speed, lower torso muscle strength and body agility. The findings of this study were consistent with the results of Previous research (11, 15-18). Although the physiological mechanisms of changes in post-fit fitness have not yet been identified, it is possible that exercise specificity may play a role in the metabolic adaptations observed in these changes (22, 23). Improving cardiorespiratory endurance can be specific to the type of activity. In the present study, cardiorespiratory endurance is similar to the improvement in VO2max observed following resistance training or moderate to high intensity running (24). In fact, the variety of cross-fit exercise programs can explain these results. The increase in torso muscle strength after cross-fit training in the present study is similar to the Goins study, which showed 12%, 13% and 8% improvement in weight lifted during Deadlift 1-RM, squats and shoulder presses after six weeks of cross-fit training, respectively. Reported in recreational exercise (15). In the present study, weights of about 50 to 60% of the maximum repetition of individuals were used and an improvement in trunk muscle strength was observed compared to the control group, while some studies have shown that cross-fit training can be compared to resistance training, according to ACSM guidelines can further increase muscle strength measured by the Margaria-Kalamen test (28). Some studies have also reported that people who exercised according to ACSM guidelines developed greater improvements in cross-fit guidelines. Experience muscle strength (measured by standing length jumps) (29). The number and duration of cross-fit training sessions per week has the greatest effect on changing body composition. In one study, during two sessions of cross-fit training with participants, training showed that experience level was a determining factor in achieving progress (9). on the other hand, even when exercise was a useful tool for maintaining body mass. Diet plays a key role in improving these parameters. Finally, comparing the present results with the results of previous studies, the initial level of physical fitness factors can play an important role in post-program changes. In trained subjects, the capacity to improve these parameters may be less than the capacity of sedentary participants. Cross-fit exercises were one of the strengths of the present study; This is because this type of exercise can have different answers and adaptations than other exercise programs. However, understanding the effects of cross-fit training on fitness requires more research. There were some limitations in the present study, such as not measuring other indicators of physical fitness, measuring body composition (adipose tissue and lean body mass) and muscle damage following this type of exercise. It can help to better explain and interpret the results in sedentary women, and ultimately diet is a limiting factor in achieving changes in body composition, so controlling the diet during the exercise protocol can provide an understanding of the results obtained. This is a research weakness suggested by future studies to measure these factors in sedentary women. According to the results, Cross-fit training could possibly improve the fitness and anthropometric indices of inactive women.

Many studies on the management of spouses' emotions emphasize the quality of their future interactions. One of the most inefficient ways to manage emotions in the family is triangulation, which reduces self-differentiation and increases excitability and fusion. Since the relationship between these variables has not been studied in a structural model, the aim of this study was to develop a structural pattern of triangulation in the family and the tendency to extramarital relationships through differentiation mediation.Extramarital relationships are one of the most important factors threatening the performance, stability and continuity of marital relationships (2). A review of research background in the field of extramarital affairs shows that most previous studies in this field have focused on two general areas: The first area of research have been focused on the definitions and types of relationships, identifying related variables such as gender differences, Age and education (8), religious beliefs, cultural differences, duration of the main relationship, level of sexual satisfaction (9) and etc. The second area of research has studied the application and effectiveness of various therapies in the treatment of harm caused by extramarital affairs in the relationship between spouses (10). Recent research often addresses the question of whether a person's management of anxiety and emotions as a factor in the development of extramarital affairs (11). One of the inefficient ways to manage negative emotions in the relationship between spouses is triangulation. Triangulation is the entry of a third person into a conflicting binary relationship to help stabilize the system. The emergence of triangulation in the family increases the level of integration of the individual with the system and decreases individuality, which in fact refers to the same concept of Bowen differentiation as the ability to regulate one's emotions and balance between individuality and integrity (14). A review of the research literature shows that although differentiation grows from the very first years of life based on the performance of the main family, but its level is not constant throughout life and is variable based on life events (17). A review of the research literature shows that for the first time Multrap (1990) has proposed a connection between concepts from Bowen's intergenerational theory and extramarital affairs. He stated that individual differentiation has an important connection with breach of contract. Considering the expansion of mass media and developments in the family system in recent decades, changing premarital relationships, increasing the relationship between the sexes, changing the style of marital relationships and values, the importance of stability and durability of marriage and prevention of important factors involved in The collapse of the family system is very important and necessary. Therefore, the study of effective predictors of extramarital affairs, which according to studies, is one of the most important factors in divorce and damage to the family system, requires special attention. Since the relationship between variables has not been studied in the form of a structural model, so this study intends to examine the direct and indirect effects of variables in the tendency to extramarital relationships in the form of a model. In this regard, the researcher is looking for the question whether self-differentiation has a mediating role in the relationship of triangulation in the family and extramarital relationships?

The present study was a basic research and in terms of research method was correlational and using structural equation modeling design. The target population was married people in Tehran in 1999 and 349 of them were selected by available sampling to participate in the study. The research method was that the assessment packages entitled (research on family injuries) were distributed among about 400 married people in two areas of Tehran and all those who wished to participate in the research were asked to complete the packages. Inclusion criteria were, being married and at least 20 years old. The criterion for leaving the study was not completing all the tests package. Thus, 349 packages that were complete were used in the research. Also, in this study, all ethical issues, including informed consent, voluntary and harmless participation, answering questions via the researcher's email and providing the results if desired, were considered. Since in this study we were looking to examine the complex relationships between variables, structural equation modeling (using LISREL 8.80 software), correlation test between variables and bootstrap test were used. The structural equation model method examines the pattern in two stages, which include the measurement pattern and the structural test. The measurement model evaluates the validity and reliability of measurement tools and research structures, and the structural model measures the relationships of latent variables.

Given that structural equation modeling is a statistical method based on matrix-covariance, so before evaluating the measurement model and structural model, important assumptions for structural equation modeling include the normality of univariate and multivariate and the absence of multiple alignments was examined. The default absence of multiple alignment was investigated by checking the correlation matrix between the obvious variables. Examination of this matrix indicates that there is no multiple alignment between them. Structural equation modeling was used to evaluate the measurement model and the structural model using the maximum likelihood estimation method. The measurement model identifies the relationship between visible variables and latent variables. Evaluation of this model is done using confirmatory factor analysis. The fit indices of the measurement model show the optimal fit of this model. Thus, visible variables have the ability to operate latent variables. Evaluation of the hypothetical model of the research showed that the hypothetical model fits with the measurement model (CFI = 0.96, IFI = 0.96, RMSEA = 0.077). The results showed that triangulation indirectly affects extramarital relationships through self-differentiation. The results also showed that triangulation is not directly related to extramarital relationships (0.07) and self-differentiation has a mediating role in the relationship between triangulation and extramarital relationships.

Triangulation in the family leads to low levels of differentiation in individuals, is likely to lead to extramarital affairs. The way a person manages his emotions during conflicts and stress in a relationship is an important factor in maintaining balance in the relationship and the continuity of his marriage. Triangulation in the family, followed by low levels of differentiation in individuals, is likely to lead to extramarital affairs. Further research is needed to improve the quality of marital relationships and emotion management with the necessary training and to prevent extramarital affairs.

Arthritis defines a large group of diseases primarily affecting the joint. It is the leading cause of pain and disability in adults. Osteoarthritis affecting the knee or hip is the most common form among over 100 types of arthritis and chronic degenerative disease of articular cartilage and the most common type of arthritis. The purpose of the study was to explain the effect of eight weeks of moderate intensity aerobic exercise and mesenchymal stem cell injection (MSCs) on the expression of Beclin-1, Mir-155 and mTOR genes in damaged cartilage tissue in rats with knee osteoarthritis.

In the experimental study, 35 adult male Wistar rats (mean weight 210±10g) were randomly divided into five healthy groups: osteoarthritis, osteoarthritis+ aerobic exercise, osteoarthritis+ mesenchymal stem cells and osteoarthritis+ exercise group. Aerobic+ mesenchymal stem cells were divided. Osteoarthritis was surgically treated. Exercise consisted of running on a treadmill for eight weeks, five sessions per week, each session lasting 35-45 minutes at a speed of 18 meters per minute. The mesenchymal stem cell group received 1 6 106 mesenchymal stem cells per kg by intra-articular injection of the knee. 48 hours after the last training session and at 12 hours of fasting, knee cartilage samples were isolated and the expression of Mir-155, Beclin-1 and mTOR genes measured by R-T PCR.

The results of the study showed that there is a significant difference between the effect of training and injection of mesenchymal stem cells on Beclin-1mRNA levels (P ˂ 0.001). The results also showed that there was a significant difference between OA group and healthy control groups (P=0.008), MSCs+ OA (P=0.009), exercise+ OA (P=0.001) and MSCs+ exercise+ OA (P=0.001). Also, there was a significant difference between exercise+ OA group (P=0.008) and MSCs+ exercise+ OA (P=0.002) and MSCs+ OA group. However, there was no significant difference between exercise+ OA and MSCs+ exercise+ OA groups (P>0.05). In the present study, it was found that there was a significant difference between groups in the expression of miR-155 groups (P<0.001). Also, the difference between OA group and three groups of exercise+ OA (P=0.002), MSCs+ OA (P=0.001), exercise+ MSCs+ OA (P=0.003) was significant. On the other hand, there was a significant difference between exercise+ MSCs+ OA and MSCs+ OA group (P=0.008). However, there was no significant difference between the two groups of exercise+ OA and MSCs+ OA (P>0.05). The results showed that there was a significant difference between the mean mTOR and mRNA expression of the groups (P<0.001). Also, there was a significant difference between OA group and healthy control groups (P=0.001), MSCs+ OA (P=0.014), exercise+ OA (P=0.021) and MSCs+ exercise+ OA (P=0.003). Also, there was a significant difference between MSCs+ OA group (P=0.022) and MSCs+ OA (P=0.002). However, there was no significant difference between OA+ training groups and MSCs+ OA (P>0.05).

The results of the present study showed that beclin-1 expression is one of the signs of differences between healthy chondrocytes and osteoarthritis. Decreased expression of Beclin-1 may be associated with decreased autophagy, mitochondrial damage and chondrocyte apoptosis. However, a mild intensity exercise training period was associated with increased expression of Beclin-1. In line with the findings of the present study, Zhang et al. (2019) showed that four weeks of running on treadmill at a gentle speed of 18 m/min increased the expression of beclin-1 factor mRNA in chondrocytes of osteoarthritis model mice. Another finding of this study was to increase the expression of beclin-1 factor mRNA by mesenchymal stem cell injection. It should be noted that due to the essential role of Beclin-1 in autophagy and being on the axis of accumulation of proteins involved in autophagy in the membranes of autophagy system, increasing changes in Beclin-1 levels with mesenchymal stem cells indicate an increase in autophagy activity in cartilage tissues and chondrocytes. Cell culture media studies showed that optimal level of autophagy maintains stem cell function and strengthens autophagy activation, differentiation and triggering of stem cell signals. In addition, strengthening the autophagy system also prevents stem cell apoptosis. It was also reported that stem cell migration is affected by autophagy and low hand regulation of Beclin-1 is associated with increased levels of caspase-3 and stem cell apoptosis. In the present study, the progression of knee osteoarthritis was associated with an increase in the expression of MIR-155. However, aerobic training and stem cell injection were associated with decreased expression of MIR-155. The present study is the district research to investigate the effect of aerobic training and stem cells on mir-155 expression. However, in recent years, some studies with different methodology have investigated mesenchymal stem cell interactions, inflammation and MIR-155 and pointed to the role of oxygen free radicals (ROS). Therefore, in the present study, the status of apoptosis and its markers were not measured; reducing the expression of this factor with mesenchymal stem cell and aerobic training may stop the expression of pre-apoptotic proteins. Another finding of the present study showed that osteoarthritis increased mTORmRNA levels of articular cartilage. This can be indirectly related to lack of optimal autophagy control and progression of apoptosis in chondrocytes. In line with this finding, Ying et al. (2015) showed an increase in the expression of mTORmRNA chondrocytes despite osteoarthritis in human, mouse and dog cartilage, and exercise training used in the present study along with mesenchymal stem cell injection was effective in reducing mTORmRNA levels. Although complex-1 rapamycin (C1-mTOR) is the primary regulator of autophagy in mammals, overexpression of mTORmRNA along with beclin-1 reduction are signs of decreased autophagy capacity and aging. However, protein levels were not measured, the intensity of exercise was mild and moderate and its effects were observed in changing the expression of mTOR along with the increase of Beclin-1. This result may reflect the availability of the necessary ground for autophagy and its inhibition in chondrocytes. Application of moderate intensity training in osteoarthritis that promotes the growth and proliferation of chondrocytes. The progression of osteoarthritis is associated with profound changes in epigenetic control of gene expression and transcription factors, leading to certain changes in target gene expression in the joint tissue by changing the methylation status of the genome. Overall, the results of this study showed that a moderate-intensity training period, while increasing Beclin-1 levels, reduced the levels of MIR-155 and mTOR. However, in the present study, protein expression of molecules as well as levels of other autophagy factors such as ULK-1 and LC3 were not measured, which is one of the limitations of the present study. Therefore, it is suggested that people with osteoarthritis use moderate-intensity exercise training and stem cell to improve the expression of articular cartilage autophagy genes.