نشریه پژوهش در پزشکی
سال چهل و هفتم شماره 1 (پیاپی 185، بهار 1402)

Non- alcoholic fatty liver is a disease that will lead to liver cirrhosis if not treated. Curcumin is the active substance of the rhizome of the turmeric plant, which has antioxidant, anti- inflammatory, antimicrobial, etc. properties. In the present study, the effects of curcumin analog on the expression of SIRT1 and FAS genes and the accumulation of triglycerides in fatty HepG2 cells (fatty liver model) have been investigated.

In this experimental study, after cultivating HepG2 cells in the right medium and conditions, the MTT test is used to choose the right dose for curcumin and it’s analog. After oiling the cells and treating them with the desired compounds, RNA was extracted and cDNA was made. Then, in order to investigate the effect of curcumin and its analog on the expression of SIRT1 and FAS genes, Real- Time PCR was used. SIRT1 activity was measured using a fluorometric kit and intracellular triglyceride levels were also measured using a triglyceride detection kit. And finally, the results were analyzed with t- test and one-way Anova statistical methods with p-value < 0.05.

As a result of the treatment of HepG2 fatty cells (fatty liver model) with Cur, the relative expression of SIRT1 gene (1.52 ± 0.8) and its enzyme activity (2.1 ± 0.7) increased significantly compared to the control group (for gene expression: 0.9 ± 1.79 and for enzyme activity: 0.8 ± 1.66). On the other hand, the relative expression of the FAS gene (0.6 ± 1.69) compared to the control group (0.8 ± 2.03), as well as the accumulated triglycerides in these cells, and has decreased significantly. Also, in the group treated with FCur compared to the control group, the level of SIRT1 gene expression (2.76 ± 1.16) and enzyme activity (3.2 ± 1.21) increased significantly, and the level of FAS gene expression (0.2 ± 1.1) decreased significantly compared to the control group. The increase in SIRT1 enzyme activity in the FCur group has increased more compared to Cur, and the decrease in FAS gene expression in the treatment of cells with FCur has been significantly higher compared to Cur. The reduction of intracellular lipid was somewhat higher in the treatment with FCur compared to the treatment with Cur. (In all evaluations, p-value < 0.01 for curcumin and p-value < 0.001 for its derivative).

It seems that curcumin analog (FCur) can be used as a medicinal supplement in the treatment of fatty liver, along with other common treatment methods, due to its wide range of pharmacological activities, including its effects on lipid metabolism in the liver.

At least one main suture of the skull is closed prematurely in craniosynostosis, which may lead to different skull and face deformities and various types of child developmental delay. Increased posterior-anterior diameter of the skull is the main characteristic of sagittal craniosynostosis. The cranial index is the most important parameter for diagnosing and monitoring children with this deformity. This index is generally determined by direct measuring of infant’s head dimensions or using skull CT scan. Artificial intelligence-based techniques could identify the shape of the head from routine digital photos of a child and therefore, that may play a useful role in assisting physicians and parents with early diagnosis of skull anomaly, better intervention follow- up, and reducing medical system financial costs.

In this diagnostic study, by developing an executive scientific method, automatic measurement of the cranial index in sagittal craniosynostotic infants based on a simulated annealing algorithm was done (by using routine digital photos of their heads). Pre-operative photos of 59 patients operated in Mofid children hospital (Tehran, Iran); were processed, and the cranial index (normal value between 75% to 85%) was calculated with the proposed algorithm and compared with pediatric neurosurgeon measured values using Matlab software.

The proposed algorithm calculated the cranial index with acceptable accuracy. The simulated annealing algorithm determined the cranial index with the mean of 72.04 and the standard deviation of 5.21, which have minimal differences with surgeon-measured values with the mean of 72.21 and the standard deviation of 5.08. In the statistical investigation, using paired t-test, there was no statistically significant differences between these two methods (p-value = 0.52). The values measured by this method in 55 patients out of 59 studied patients (93.2%) are in the range of optimal values determined by the specialist (P ≤ 0.8).

It seems that the proposed method could determine the cranial index from routine digital patient’s head photos with acceptable accuracy. More development of this method may assist physicians and parents in early diagnosis of this anomaly, better monitoring of treatment results, and reducing medical financial costs.

In developing countries, the prevalence of breast cancer has increased and is becoming a major global problem. Extensive research has been devoted to understanding the causes of breast cancer and creating new treatment methods for this disease. The canola plant is rich in sulfur-containing compounds responsible for its rich content of glucosinolates, pungent aroma, and flavor. This plant contains antioxidants such as vitamin C and E, carotenoids, and antioxidant enzymes such as catalase, superoxide dismutase (SOD), and peroxidase. This research aims to investigate the effect of canola oil nanoemulsion on the hematological factors of mice suffering from breast cancer with the TUBO cell line.

In this experimental research, the synthesis of nanoemulsion from canola oil was carried out, and its size and stability were confirmed. Then the TUBO cancer cells were cultured and injected into mice. The treatment was carried out with canola oil nanoemulsion with 1, 2 and 4% concentrations and homogenous with tamoxifen. Statistical analysis of data related to blood parameters was done by SPSS statistical software .One-way ANOVA and Tukey's test were used to compare the results between groups (p<0.05 was considered significant).

In the present study, the count of white blood cells in the cancer group increased significantly compared to the control group (control: 3167 ± 93, cancer: 8150 ± 676, P < 0.01). Furthermore, by performing the treatment and increasing the amount of Canola oil nanoemulsion, the amount of white blood cells decreased compared to the cancer group (4775 ± 1557 and P < 0.01). On the contrary, the count of red blood cells decreased from 7712000 ± 400000 in the control group to 5908000 ± 190000 in the cancer group (P < 0.001). Treatment with nanoemulsion corrected this change and increased the number of red blood cells to 6444000 ± 120000 (P < 0.05). Regarding hemoglobin and related parameters, no significant difference was observed between the control and the cancer groups and treatmentwith nanoemulsion and tamoxifen groups. The number of platelets in the cancer group showed a significant difference from the control group, and the treated groups showed significant changes = somewhat similar to the control group (control: 787000 ± 131243, cancer: 405250 ± 40034, treated with nanoemulsion: 633400 ± 48264 (P < 0.05).

The synthesized Canola oil nanoemulsion with the size below 50 nm and a zeta potential of about -30 has high stability and uniform dispersion. Cancer induction caused changes in the blood parameters of mice. The treatment with nanoemulsion improved the condition to the desired extent, which is probably related to the antioxidant compounds present in the Canola oil.

Oral candidiasis is the most common opportunistic infection of the oral mucosa with Candida spp. Candida species form a biofilm in patients who need orthodontics with removable plaque, and this structure can lead to Candidemia. It is important to find effective plant compounds, which have fewerside effects and are natural, to prevent biofilm formation. The aim of the present study was to determine the effect of adding Thymus vulgaris and Cinnamomum verum essential oils to self- cure acrylic blocks on Candida albicans colonization.

In this experimental study, the antifungal activity of essential oils of Thymus vulgaris, Cinnamomum verum and nystatin against of Candida albicans ATCC10231 was evaluated in order to determine MIC according to CLSI-M27S4 guidelines. Powder and monomer were poured into tablet molds to make self-cure acrylic plaques. A total of 144 self- cure acrylic plaques were divided into 24 groups of 6 in petri dish. Three groups contained powder and monomer, three groups contained nystatin drug, and 18 groups contained different concentrations of essential oils of Thymus vulgaris and Cinnamomum verum. Then, the samples were incubated in artificial saliva enriched, with Candida albicans at 37°C and the effects of essential oils of Thymus vulgaris and Cinnamomum verum on the binding of Candida albicans were reported by the cfu/ml count method. Statistical analysis of data was done using Stata-15 software. ANOVA and Tukey's test were used to confirm the results.

The evaluating the sensitivity of Candida albicans ATCC10231 to essential oils of Thymus vulgaris, Cinnamomum verum and Nystatin were obtained as MIC= 120µg/ml, MIC= 340µg/ml and MIC= 1µg/ml, respectively. The attachment of yeast cells to self- cure acrylic blocks for Cinnamomum verum essential oil was significant in MIC= 340 µg/ml (p= 0.02), MIC= 680 µg/ml (p= 0.01) and nystatin 1 µg/ml (p= 0.00) compared to the negative control group. However, this amount was not statistically significant for Thymus vulgaris essential oil        (p= 0.14).

Adding essential oil of Cinnamomum verum to acrylic resin prosthesis can be effective in controlling the proliferation of Candida albicans on the surface of the prosthesis. However, its effects on the physical properties of acrylic resin dentures need further studies.

Blastocystis sp., is one of the most common intestinal protozoan parasites found in both human and animal fecal samples. The pathogenicity and cytopathic effects of subtypes ST1-3 and 6 of Blastocystis sp., on gastrointestinal cell line are unclear. This study aimed to investigate the impacts of intra- subtype variations on the apoptosis and cytopathic effects on the HT-29 cell line in 2019 at the Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

This study was an experimental investigation of Blastocystis sp., subtypes 1-3 and 6, which were isolated from stool samples of 30 symptomatic and subtypes 1-3 from 25 asymptomatic subjects. After purifying and counting the microorganisms, lysate of Blastocystis sp., was prepared from 1 × 105 of the microorganism by three freeze- thaw cycles in liquid nitrogen and a 37°C water bath. Then, the lysates of subtypes of Blastocystis were co-incubated with the HT-29 cell line for 48h. Finally, the cell proliferation rate was measured using an MTT dye assay. For measuring the statistical differences in the cell proliferation based on subtypes as well as symptoms, One- way ANOVA test incorporated with GraphPad Prism was applied.

The results clearly indicated that all Blastocystis sp., subtypes, compared to non-treated control (NTC), had a cytopathic/inhibitory effect on HT-29 cells growth. The lowest cytopathic effect was seen in ST1 isolated from symptomatic patients (17.11%), while the highest was seen in ST1 isolated from asymptomatic patients (25%). Indeed, ST2 showed milder cytopathic effects in the HT-29 cell line compared to ST1, 3, and 6. However, there was no statistical correlation between subtypes as well as symptoms and cytopathic effect.

Although there was no statistically significant correlation between subtypes and the cytopathic effect, immunologic responses of hosts seem to play a critical role against Blastocystis sp. Our findings showed milder effects of Blastocystis sp., ST2 compared to the other subtypes; however, intra-subtype variations in the pathogenicity of the protist remain unclear, and further investigations are needed.

Breast cancer is the most common type of cancer in women, in iran. Hence, determination of the optimal treatment and contributing factors are important. The main aim of the current study was to determine the association between tumor- infiltration lymphocytes (TIL) and complete pathological response in breast cancer patients after neoadjuvant chemotherapy.

In this comparative retrospective study, 73 consecutive patients with breast cancer who underwent core needle biopsy and then neoadjuvant chemotherapy in Shohada Tajrish hospital, Tehran, Iran, from 2011 to 2019 were enrolled. Then, the association between TIL and complete pathological response in patients was determined.

The results in this study demonstrated that 13.3% and 35.7% of those with TIL less than 10 and more than 10, respectively had a complete pathological response that showed a statistically significant difference (P = 0.025).

Tumor Infiltration of lymphocytes and complete pathological response in breast cancer patients who underwent neoadjuvant chemotherapy are interrelated, and TIL may be used to predict the response.

Staphylococcus epidermidis is an opportunistic pathogen that is involved in the development of infections associated with the use of implants and medical devices. Biofilm formation is one of the most important virulence factors of this microorganism, which vastly depends on various factors, including different proteins. In the present study, the expression levels of three proteins including rpoS, relA and mazF at different time intervals during the course of biofilm formation in Staphylococcus epidermidis were investigated.

In the present case- control study PCR assay was used to detect rpoS, relA and mazF genes in Staphylococcus epidermidis ATCC 12228. Biofilm production was investigated by the microtiter plate (MTP) method. Real- time PCR was used to determine the expression levels of studied genes after 2, 8, and 24 h during the course of biofilm formation. Data were analyzed using GraphPad Prism 8 statistical software (GraphPad Software, Inc.).        One- way analysis of variance was used to evaluate the mean expression changes of the studied genes, and                   P-value < 0.05 was considered significant.

Staphylococcus epidermidis contained all the studied genes and had a strong biofilm formation power. The studied genes showed different expression levels at different time intervals during biofilm formation by real- time PCR method. Expression levels of rpoS gene were the highest at 24 h (6.7 ± 0.252) (p < 0.001), whereas mazF gene showed the highest expression level at 8 h (6 ± 0.208) (p < 0.001) during the course of biofilm formation. In addition, the expression level of relA gene peaked at 2h (3.9 ± 0.361) (p < 0.001) and then progressively decreased at 8 (1.7 ± 0.265) and 24h (1.2 ± 0.153) (p < 0.05). The results of the comparison of rpoS gene expression changes compared to relA gene (2.667 ± 1.175) and also mazF gene (0.2333 ± 1.175) using Dunnett's multiple comparisons test was not significant (p ˃ 0.05).

Our results suggest the importance of rpoS, relA, and mazF proteins in establishing and developing the biofilm structure in the studied strain. In addition, our results showed the important role of rpoS protein during biofilm formation and the importance of relA protein at the beginning of biofilm formation stages.

Type 2 diabetes mellitus (T2DM) has turned into one of the main complications of the recent century, as this chronic metabolic disease could provide a platform for the formation of several diseases such as cardiovascular diseases, neuropathies, nephropathy, and cancer. Angiogenesis has attracted tremendous attention. This research was conducted in 1400 in Mashhad, and its purpose was to evaluate the level of vascular endothelial growth factor and the effect of T2DM on liver and kidney functional factors.

In this cohort study, Blood samples were collected from 30 T2DM patients and 30 healthy individuals. After obtaining the serum, the levels of several biochemical parameters (FBS, triglyceride, cholesterol, Na, and K), Thyroid hormones, and liver markers (SGOT, SGPT, and Alkaline phosphatase were evaluated. Moreover, the expression levels of vascular endothelial growth factor (VEGF) was also determined in T2DM patients and healthy counterparts by using SPSS statistical software and t-test.

The results showed that blood sugar; triglyceride, thyroid stimulating hormone, thyroxine, and alkaline phosphatase enzyme levels had significant changes in diabetic patients compared to healthy people (P < 0.001, P < 0.05, P < 0.05. P < 0.05) while cholesterol, sodium, potassium levels did not change significantly. Also, there was a significant difference in serum vascular endothelial growth factor and kidney function factors (urea and creatinine) in type 2 diabetic patients compared to healthy people (P < 0.05, P < 0.05, P < 0.01).

Type 2 diabetes leads to a decrease in thyroid hormones and an increase in vascular endothelial growth factor, which is a factor in increasing ectopic angiogenesis in patients while affecting renal function factors.

Due to the importance of the cost of traffic injuries, in addition to mental and social suffering, the increasing trend of accident statistics,and the lack of information about the cost estimation based on a willingness to pay model, this research was conducted on the findings of traffic injuries in 2021.

The research was done by the descriptive and exploratory method. In the year of 1400, 385 samples were randomly selected from the collection of road users (which included passengers, drivers of four-wheeled motor vehicles, motorcyclists, and pedestrians), and the road traffic injury costs were estimated using the willingness to pay model and the method (contingent value, stated preference, revealed preference) .Data analysis was performed using Weibull and Bayesian models and descriptive statistics.

In 2021, there were 16,778 deaths. The cost of one person's death was estimated at 19.7 billion tomans, and the total costs were estimated at 330,754 billion tomans. The cost for the injured was estimated at 76,527 billion tomans, and based on the gross national income; it includes about 11.14 percent of the total gross income.

It seems that the cost of road traffic injuries in the country was high in 2021 and in addition to mental and social suffering; there is a cause for concern. It is suggested that programs for the prevention and control of traffic injuries be carried out.

Professional behavior of residents plays an important role in improving hospital performance and patient satisfaction. In this study, we investigated the rate of changes in residents' adherence to protocols and patient satisfaction by changing the method of evaluation of residents' professional behavior.

In this observational study, this was designed and implemented by before and after, 384 specialized residents in Imam Hossein Hospital were included in the study. In two consecutive 5-month periods, residents' performance was evaluated first based on "Residents' Professional Behavior Evaluation Questionnaire Communicated by the Ministry of Health" and then on "New Protocol of Residents' Professional Ethics". Data were analyzed by SPSS software. To describe the data, mean and median indices were used. Wilcoxon and McNemar tests were used to analyze the data.

Attendance of assistants in hospital conferences during the same period increased from 1038 people to 1669 people in the second round of the study (p < 0.001). Observance of religious and ethical standards in examination and treatment measures in outpatients increased from 79.6% to 90.7%, which was significant. (P = 0/016) Before the implementation of the new protocol, 81.51% of non-emergency consultations were performed in less than 24 hours, which increased to 90.84% after the implementation of the plan (p < 0.032). The rate of patient assignment index in the emergency department improved to an acceptable level. Indicators related to emergency outpatients, such as physician's attitude, adequate patient attention, and appropriate coverage, improved Also. In hospitalized patients, indicators such as observance of sharia rules in examination and treatment were improved, but these improvements were not significant.

It seems that the changed style sheet would improve the ethics and professional character of the assistants. It is recommended to conduct similar research at other universities. In this regard, it seems that changes in evaluation indicators as well as assigning part of the evaluations to the deputy of hospital education, can be effective in improving patient satisfaction level and more adherence of residents to ethical standards.

The statistical yearbook of forensic medicine shows an annual increase in the number of cases referred to medical commissions due to complaints of "misdiagnosis in abortion cases. Although perhaps one of the reasons for the increase in the number of complaints is the increase in the number of clients, considering the updating of maternal and fetal indications for therapeutic abortion and the development of new guidelines, the performance evaluation of forensic experts in relation to the extent of compliance with the latest approved laws in order to find the causes of the trend The rise of complaints seems necessary.

In this Existing data study, all the opinions issued in the cases referred to the medical commissions department of Tehran province due to the complaint of "diagnostic error in abortion cases" from March 2016 to March 2020 were reviewed. Diagnostic error in complaint files regarding abortion treatment regarding fetal indications means not requesting timely tests or sonograms related to the complaint, such as echocardiography of the fetal heart - gene screening test - genetic tests (karyotype - cytogenetic - rapid test) Consultation request with a perinatologist - consultation requests with the relevant specialist depending on the type of maternal disease or fetal anomaly, etc.) by the obstetrician and gynecologist; failure to diagnose fetal abnormalities by radiologists or Perinatologists;              Non - diagnosis and incorrect reporting in the cases of gene testing - genetic tests (karyotype - cytogenetic - rapid test by genetics specialist and laboratory and regarding maternal indications for abortion therapy, failure to timely diagnose the mother's underlying disease by specialist and subspecialist doctors in the field Medical treatment depends on the type of mother's illness.

Out of a total of 22 existing cases, the opinions issued in all cases were in accordance with the latest laws approved in Iran. The highest number of complaints (40.9%) was from gynecologists and obstetricians. Review of issued ideas indicated 6 cases (27.3%) of disciplinary error, 15 cases (68.2%) of acquittal, and 1 case (4.5%) of the impossibility of issuing a theory due to the lack of evidence and documentation in the file.

It seems that the views issued by the Tehran Medical Commission do not conflict with the laws of medical abortion. It recommends conducting more studies in other medical commissions.

A common treatment for patients with type 1 diabetes, in which pancreatic beta cells are destroyed by the immune system attack, is insulin injection. Because this treatment is not able to maintain complete glucose homeostasis compared to the function of endogenous insulin secreted by the pancreas; in the field of pancreatic tissue engineering, various treatment strategies have been proposed, which this article introduces and reviews.

The present article is a review study that was performed using the search of keywords including Tissue Engineering, Pancreas, Type 1 Diabetes, and Three-dimensional Bioprinting, Insulin Producing Cells, Artificial Organ, and Endocrine Pancreas Bioprinting in the available databases of PubMed / MEDLINE and Web of Sciences to search for relevant articles and books at least 20 years ago until December 2003 and reviewed 53 articles and two related books.

A total of 53 articles and two books obtained from the search, which were in line with the objectives of the present study, were selected and the analysis of their results was presented in fluent and practical language. Based on the results, the use of β-like cells derived from stem and accessory cells, scaffolds, cell encapsulation and transplantation methods in different areas away from the immune system, can be considered as promising methods in treatment of type 1 diabetes.

Newapproaches related to the field of pancreatic tissue engineering include various solutions such as the use of embryonic and adult stem cells, the use of natural and synthetic scaffolds to guide and organize the targeted tissues, the use of 3D bioprinters, insulin secreting organoids and pancreas on a chip which are the most effective and promising methods to overcome these challenges.

To manage and control malaria- one of the most important infectious diseases in tropical and subtropical regions- a quick and accurate malaria diagnosis method is necessary as a high priority. For this purpose, several methods have been developed. Currently, examining the peripheral blood slide with an optical microscope as a gold standard method, and rapid diagnosis method are used in malaria endemic areas. This article reviews the existing methods and the possible future options to improve the diagnosis of malaria.

To prepare the present review article, English language articles with no limitation in publication date were reviewed by searching keywords including malaria diagnosis, microscopic and molecular methods, RDT,Nested- PCR, and LAMP in PubMed and Google Scholar databases. Among the collected articles, the most relevant research articles were selected and reviewed.

Despite its limitations, direct observation of peripheral blood smears with a light microscope is still considered the gold standard method for malaria diagnosis. Another malaria diagnosis method is the rapid diagnostic test (RDT), which is a quick and cheap alternative for malaria diagnosis in endemic areas. Regarding malaria elimination programs, the diagnosis of Plasmodium in individuals without symptoms of malaria is challenging as they are generally not detected by routine methods such as peripheral blood smear and rapid diagnostic tests. For this reason, molecular methods are suitable for use in the endemic areas under elimination. Novel techniques that are beneficial in malaria research can replace the usual diagnostic methods in the future.

Seronegative Rheumatoid Arthritis is an inflammatory disease with a progressive course that generally affectsjoints, tendons, and bursae, and leads to the destruction and stiffness of involved joints. Different therapeutic regimens and ways for the treatment of this disease are presented that reduce symptoms and signs of the disease. But, most treatmentsmay have many complications and cannot treat the deformities induced by this disease completely. Thus, paying attention to the theory that a specific anti - oxidant rich diet probably can affect the course of this disease is required.

Case Report: 

The patient is a 65 y/o female with complaints of pain in knees, legs, and feet and severe limitation in flexion of knees and ankles for about 30 years. She has been under many treatment regiments including Non- steroidal anti- inflammatory drugs and prednisolone, and also replacement of left patella that have not effective response. Her disease had progressive coarse when she was referred for consultation on the 9th of April 2019. In clinical examination, she had severe inflammation, stiffness and inability in flexion of knee joints as muscle and soft tissue of legs was inflamed, stiffn, and not mobile, bilateral inflammation, pain and tenderness of theankles, wrists and thickness with the tenderness of palmar fasciae were also observed. According to Razi, “We can treat and prevent diseases with diet (24) “. In this new way of treatment, the patient was treated with a combination of a diet rich with anti- oxidant, vitamins and low dose of NSAID. The patient was having a rapid response to this way of therapy, and her joint limitation regressed completely and diameters of both knees was decreased. She was able to sit cross- legged and on two knees after about 30 years of this debilitating disease.

This report may attract the attention of researchers and physicians to the effects of in- vivo cell therapy and an anti- oxidant- rich diet and the absence of inflammation inducing diet that may result in reducing the inflammation and the signs of Rheumatoid Arthritis and correcting the tolerance of immune cells that is the main pathogenesis of this disease