مجله دانشکده پزشکی اصفهان
پیاپی 111 (آبان 1389)

The Best treatment for displaced intracapsular fracture of the femoral neck in active and lucid elderly patients is still controversial. The main aim of our study was to determine wether a primary THA as compared to IF give a better outcome. In this Randomized Clinical Trial study among patients referred to Isfahan University Hospitals in Isfahan-Iran,80 patients with displaced intracapsular fracture of the femoral neck ware enrolled in our study. Studied patients were randomly assigned into two groups. Internal fixation was the only therapeutic method that was utilized in first group, However, total hip arthroplasty was done in second group, then patient were evaluated. The severity of pain, Hip function (Harris Hip Score) and health related quality of life were assessed one year ofter the procedure. the severity of pain and rate of complication and need to reoperation were signficantly lower in patients treated with THA. Quality of life and hip function were significantly better in this patients. It seemed that THA is a more effective method in treatment of the femoral neck fracture in elderly patients.

Emerging prevalence of obesity and subsequently metabolic syndrome induced increment in non-alcoholic fatty liver disease (NAFLD). Incidence no definite treatment is still available for NAFLD and different groups of drugs were used to treat this condition and it’s related hypertranaminasemia. This study aimed to compare efficacy of vitamin E with or without ursodexycholic acid (UDCA) as two routine treatment modalities in NAFLD.

The study was done in a parallel-arms clinical trial; one using 400 IU vitamin E alone and another associated with 250 mg UDCA TDS. The patients enrolled in the study if they had ultrasound report of NAFD and abnormal ALT level, and were randomized in two groups, than followed for 6 months. ALT decrease to less than 1.5 times upper limit normal was assumed as the target therapeutic response.

Age of two groups (58.5 ± 4.2) did not differ, neither the gender portion varied (54% were male). Body mass index was not different in two groups before the intervention and did not change significantly during the study (28.8 ± 1.2 kg/m2). In the combination treatment group, 13 cases and in the single therapy, 4 persons reached to therapeutic target (P = 0.46). Mean of ALT and AST variations following intervention did not differ in two groups, but transaminase levels significantly decreased at least for 30 IU/L after treatment (P = 0.02).

Single therapy with vitamin E or combined therapy with UDCA caused recovery of NAFLD in 60% of patients; although adding UDCA had no significant effect on treatment outcome. Small sample size could cause a pitfall in this study that limits ability to establishing equivalence of two modalities.

P33 (ING1b) is a tumor suppressor protein involved in growth control and apoptosis. Suppression of P33 expression is associated with the loss of cellular growth control suppression. Colorectal cancer is the second most common malignancy in the world. Detection of the disease at an early stage can reduce mortality. To investigate the role of P33 in colorectal carcinoma pathogenesis, we evaluated P33 expression in colorectal cancer patients by immunohistochemistry. P33 protein expression from 70 colorectal cancer specimens and their matched normal colorectal sections from the series of colorectal cancer patients was examined in paraffin–embedded material by immunohistochemistry. The proportions of cellular staining for P33 were estimated under light microscopy by using Motic Advanced Plus 2 soft ware. P33 was expressed in all tissues, and was mainly localized in the nuclei of epithelial cells. P33 was down-regulated in the colorectal cancer specimens, compared with the matched tissues (P = 0.002). Expression of P33 in cancer tissues was significantly lower than normal tissues. This study showed that P33 expression may be associated with pathogenesis of colorectal cancer.

Proper structure and function of mammal’s central nervous system (CNS) is based on inborn neuronal function. Sensory experience-based development deeply affects these processes in the critical period. The aim of this study was to investigate the effects of change in visual experience in critical period of brain development on rat’s spatial learning and memory using Morris water maze (MWM). This experimental study was carried out on 30 Wistar male rats at 45 days old randomly distributed in 3 groups (n=10 for each group); the CO (Control) group was in 12 h light/12 h dark cycle through birth to the end of the study; the LR (Light Reared) group was in complete light (24 hours) and the DR (Dark Reared) group was in complete darkness. Using MWM, the animals learned to find a hidden platform for 4 trials/day at 5 days. After removing platform, spatial memory was tested at day 5 in one trial. The spent time and distance in the correct quadrant measured and analyzed by repeated measure ANOVA test. In the learning stage, the CO rats spent less time and distance to find the hidden platform than the other groups (P < 0.0001). There was no difference between all groups in probe trial. Change in visual experience impairs rat's spatial learning and spatial memory formation would not been influenced.

This study aimed to determine the correlation between of ESR, C3, C4, anti-dsDNA, and lupus activity and also the construct and criterion validity of the British Isles Lupus Assessment Group (BILAG) index for assessing disease activity in systemic lupus erythematosus (SLE). Patients with SLE were recruited into a cross-sectional study. Data were analyzed for estimating of SLE disease activity [scores on the BILAG index and Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K)]. Overall BILAG scores were determined by the highest score achieved in any of the individual systems in the respective index. Erythrocyte sedimentation rates (ESRs), C3 levels, C4 levels, anti-double-stranded DNA (anti-dsDNA) levels, and SLEDAI-2K scores were used in the analysis of construct validity. Statistical analyses were performed using ordinal logistic regression for construct validity. Of the 100 patients with SLE, 90% were women. Their mean ± SD age was 31.1 ± 9.8 years. Increasing overall scores on the BILAG index were associated with increasing ESR level, decreasing C3 levels, decreasing C4 levels, and elevated anti-dsDNA levels, and increasing SLEDAI-2K scores (all P < 0.01). These findings showed that the ESR, C3, C4, and anti-dsDNA should be used in the evaluation and management of patients with SLE. Also the results show that the BILAG Index has construct validity.

The aim of this study was to investigate the correlation between the cardiac and hepatic iron-overload as assessed by magnetic resonance imaging t2 star (MRIT2-star) technique and serum ferritin level in patients with thalassemia major. In this cross-sectional study we evaluated 170 patients in Sayed Shohada Hospital in Isfahan in the year of 2009, cardiac and hepatic iron-overloaded values were calculated in patients using magnetic resonance imaging t2 star techniques. Serum ferritin level and left ventricular ejection fraction (LVEF) were determined for all patients. We studied 170 beta-thalassemic patients, 90 (52.9%) females and 80 (47.1%) males, mean age 20.6 ± 6.2 years. Mean cardiac iron-overloaded was 22.7 ± 14.7, mean hepatic iron-overloaded was 3.2 ± 2.4, mean serum ferritin level was 2310 ± 1554 and mean left ventricular ejection fraction was 60.5% ± 7.7 percent. Pearson’s tests gave a significant correlation coefficient between cardiac iron-overloaded and hepatic iron-overloaded (r = 0.29, P < 0.001). There were weak inversely associated between serum ferritin level with hepatic iron (r = -0.32, P < 0.001) and cardiac iron (r = -0.21, P = 0.006). Myocardial iron deposition can be reproducibly quantified using myocardial and this is the most significant variable for predicting the need for ventricular dysfunction treatment. The finding of this study demonstrated a significant correlation between cardiac and hepatic iron-overloaded level in patients with thalassemia major.

After bone fractures from traffic trauma, many patients suffer from non-healing bone defects and its cosmetic and psychological complications. So, it is important to identify modern and effective methods to improve healing of bone defects. One of these, is using bone cells from the patient, culturing these cells on appropriate scaffold, and finally transferring them to injured area. The main objective of this study was to compare the rate of osteoblast proliferation in alginate beads, and hydroxyapatite-tricalcium phosphate (HA-TC) scaffold. Bone tissue specimens were obtained from 4 patients undergoing craniotomy surgery operations in Alzahra teaching hospital, Isfahan. Bone specimens were cut in to small pieces and put in Petri dishes having culture medium and transferred to the incubator. The mean interval of osteoblast outgrowth from bone pieces was observed to be 10-12 days, later on. The cell cultures reached confluence, averagely after 2 weeks time. First passage cells were detached from Petri dishes using Trypsin_EDTA and were divided in two portions. One portion was used for hydroxyapatite-tricalcium pohosphate scaffold, and the other was added to alginate gel. After a 2-weeks period, the data were collected and analyzed. The osteoblasts in hydroxyapatite-tricalcium phosphate scaffold and alginate gel had round morphology. Van kossa staining demonstrated mineralized matrix in both groups. The number of harvested cells in 2 weeks after culture was significantly higher in Alginate group (P < 0.001). In addition, MTT assay showed significant difference in the mean of viability rates between both groups in day 14 (P < 0.001). This study showed that Alginate gel support better proliferation and viability of osteoblasts in comparison with the hydroxyapatite-tricalcium pohosphate scaffold. The probable cause of these differences can be searched in Alginate bioproperties. Porosity of Alginate gel provides conditions in which cellular and methabolic activities could be accelerated.

Due to controversies in different studies about the effects of dark chocolate consumption on cardiovascular risk factors, this study aimed to review the current evidence on chocolate consumption and cardiovascular risk factors. By the use of dark chocolate, dark chocolate and cardiovascular disease, and dark chocolate and atherosclerosis, as keywords, we searched in PubMed through 1990 till 2008. Just clinical trials on apparently healthy people or those suffering from lipid disorders were included. In most studies, consumption of chocolates with plant sterols induced a reduction in serum total cholesterol and LDL in hypercholesterolemic individuals. Positive effects of dark chocolate on reduction of platelet aggregation has been reported in some investigations while others found neutral effects of white and dark chocolate on platelet aggregation. The effect of dark chocolate intake on insulin sensitivity and reduction of insulin resistance are mentioned in some but not all studies. Dark chocolate consumption significantly reduced blood pressure. A reduction in biomarkers of oxidative stress like 8-isoprostane and MDA has also been reported in some trials. Most of the clinical trials indicated favorable effects of dark chocolate and cocoa consumption on cardiovascular risk factors. More research is needed to identify the related mechanisms of action.