مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و یکم شماره 11 (پیاپی 155، بهمن 1392)

Apoptin is a protein from chicken anemia virus that could induce apoptosis specifically in the cancer cells but it has not any effect in the normal cells. Phage therapy is a novel field of cancer therapy and phage nanobioparticles (NBPs) such as λ phage could be modified to deliver and express genetic cassettes into eukaryotic cells safely in contrast with animal viruses. The bacteriophages like Lambda could be manipulated to deliver genetic cassettes into eukaryotic cells and express the gene safely. We developed the safe way for the expression of Apoptin gene via Lambda bacteriophage in the human tumors. At first the Apoptin clone was produced and then transferred into ZAP-CMV plasmid through BamH-I and HinD-III restriction sites. Then this construct inserted into the Lambda phage in the Escherichia coli host cell. The expression of Apoptin in the recombinant construct was evaluated via RT-PCR and Western Blot analysis. The anti tumor function of expressed protein was measured in the BT-474 cells that was hosted by nude mice. Transfection of breast carcinoma cells by Lambda bacteriophage containing λZAP-Apoptin-CMV was inhibited the tumor growth significantly but did not any effect on normal cells. The expression of this protein was very high in tumor cells and prevented the death of tumor bearing nude mice. The penetration and spreading of Apoptin construct by bacteriophage Lambda was significantly high but the Apoptin plasmid had very little expression in BT-474 cell، directly. Transfection with NBPs carrying λZAP-CMV-Apoptin significantly inhibited growth of all the breast carcinoma cell lines in vitro، but had no effect on normal cells. Utilization of recombinant Lambda bacteriophage as a safe expression vector has been confirmed. Apoptin was induced apoptosis specifically in the tumors in vivo. Use of such construct is a very safe way to treat cancer in human. The results presented here reveal important features of λ nanobioparticles to serve as safe delivery and expression platform for human cancer therapy.

To compare the success rate and side effects of letrozole and misoprostol versus misoprostol alone for medical termination of early pregnancy. The patients requesting termination of pregnancy up to 63 days of gestation were randomized into two groups. The letrozole group received letrozole 10 mg daily for 3 days followed by 800 micrograms of vaginal misoprostol، while the placebo group received placebo for 3 days followed by the same dosage of misoprostol. The complete abortion rate and the side effects profiles of the two groups were compared. The primary outcome measure was the abortion rate. A total of 214 women were recruited. Overal complete abortion rate was 81. 3%، complete abortion rate in the letrozole group was not significantly higher than that of the placebo group (84. 1% compared 78. 5%). After receiving 800 mcg misoprostol، 37 case (17. 3%) had complete abortion that 13 cases (12%) of the misoprostol group and 24 patients (22. 5%) of the cominabtion group and after receiving 1600 mcg، misoprostol، in 137 cases (77. 4%) had complete abortion that 71 patients (75. 5%) of the misoprostol group and 66 cases (79. 5%) was obtained for the combination group. This difference was not statistically significant (P> 0. 05). D & C in 40 cases (18. 7%) reported that was not significantly different in the two groups، 17 cases (15. 9 %) in the combination group versus 23 (21. 5%) in the misoprostol group. Side effects such as fever، tachycardia، diarrhea and pain were similar in the two groups there were not significantly fewer women complaining of side effects in the letrozole group than those in the placebo group (P> 0. 05). Combination of letrozole and misoprostol is as effective as misoprostol alone in complete abortion rate. Based on these results، the use of misoprostol in combination with letrozole is safe and not expensive.

Colorectal carcinoma is a common malignancy، in treatment of which pelvic radiotherapy plays an important role. But this may lead to azospermia. We designed a study to determine the delivered dose to the testis with thermoluminescence dosimetry (TLD) and compare it to the dose calculated by the Three-dimensional planning software. We measured the testicular doses by TLD; the TLDs were fixed to the scrotum in six points anteriorly and posteriorly in two random fractions of the radiation course. All patients received a 50-50. 4 Gy radiation dose to the pelvis in a prone position with standard fractionation and 3-dimensional planning، through three or four fields. The average dose of the TLD measurements was compared to the average of 6 relevant point doses calculated by the planning software. In 33 patients with a mean age of 56 years، the mean testis dose of radiation measured by TLD was 3. 77 Gy، equal to 7. 5% of the total prescribed dose. The mean of point doses calculated by the 3-dimensional planning software was 4. 11 Gy، equal to 8. 1% of the total prescribed dose. A significant relationship was seen between the position of the inferior edge of the fields and the mean testis dose (P= 0. 04). Also body mass index (BMI) was inversely related with the testicular dose (P= 0. 049). In this study، the mean testis dose of radiation was 3. 77 Gy، similar to the dose calculated by the planning software (4. 11 Gy). This dose could be significantly harmful for spermatogenesis، though low doses of scattered radiation to the testis in fractionated radiotherapy might be followed with better recovery. Based on above findings، careful attention to testicular dose in radiotherapy of rectal cancer for the males desiring continued fertility seems to be required.

Genu valgum deformity is exaggerated valgus alignment of lower extremity mechanical axis in knee with a joint line that slopes superolaterally and is corrected by distal femoral osteotomy. In this study the results of treatment and satisfaction in patients with genu valgum were evaluated according to knee society score (KSS) and changes in pre-operation and post-operation lower extremity mechanical axis were compared to each other. The present study is a cross-sectional study that was performed on 27 patients (30 knees) who have had distal femoral varus osteotomies between 2005 to 2011. Patient’s data were collected from hospital documents، pre-operation and post-operation alignment views and physical exams of operated patients. Radiographs were from the lower extremities and including three joints of hip، knee and ankle (alignment view). Mechanical axis of femur and tibia were drown and they were compared to each other. For measuring patient satisfaction، KSS score was used. All data was collected and evaluated by SPSS 16 software. In this study، 30 knees (in 27 patients) by mean of 30. 7±3. 36 months follow- up، (range، 5-76 months) were evaluated. The mean of ages in patients was 19. 66±4. 35، (range 10-34 years). Ten cases (37%) of valgus were on the right side and 14 cases (52%) on the left side and three (11%) cases were reported on both sides. Based on Student’s t-test، there was a significant difference in post- operation lower extremity mechanical axis. The mean of KSS score was 82. 52 and the score was defined as 60. 7% excellent، 25. 1% good، 7. 1% fair، and 7. 1% poor in patients. According to the results of study، in five patients were non-union and re-operated. Distal femoral varus osteotomy is a reliable procedure in knees with valgus correction. This procedure with precise selection of patients، have acceptable end results.

Rotational deformity after intramedullary nailing is a well-known complication. Femoral malrotation is the most common form of malunion but it is underrecognized in part because of the difficulty in accurately assessing rotation as well as the variation that exists in normal anatomy. The aim of this study was to evaluate femoral malrotation following intramedullary nailing of the femur. We studied 70 patients who had referred to Imam Khomeini Hospital and had undergone antegrade intramedullary fixation for isolated femoral shaft fracture during 3-year period from 2008 to 2011. Inclusion criteria including isolated femoral shaft fracture that had undergone antegrade intramedullary nailing. Exclusion criteria including spontaneous ipsilateral tibial fracture or pelvic fracture، contralateral femoral fracture، femoral fracture that had fixed using plate or external fixator or retrograde intramedullary nailing. During operation، the patients were assessed clinically for rotational deformity and then in the postoperative follow-up period، degree of rotation was identified with CT scan. Postoperative computed tomography measurements of rotation were compared with the opposite side. There were 70 patients، 56 men and 14 women. The average age of the patients was 28. 21±14. 39 patients (55/7%) had external rotation and 31 patients (44/3%) had internal rotation. The mean of malrotation degree in physical examination was 4/67 and The mean of malrotation degree in CT scan was 7. Degree of malrotation deformity، less of 5º، 5 to 10º and 10 to 15º was less of 8. 6%، 75. 7% and 15. 7% respectively. Degree of malrotation didn’t relate to age، sex، fracture location and activity of the patients (P> 0. 05). Rotational deformity in 28% of the patients was equal to more 15º. This complication didn’t relate to fracture location. The patients with external rotation deformity had more symptoms than the patients with internal rotational deformity but there isn’t significant relation in this study.

Meningitis is one of the serious and dangerous infections in the infancy and childhood and rapid diagnosis of meningococcal disease is important، especially in infants. C-reactive protein (CRP) is a protein found in blood and is an acute phase protein. CRP sensitive reactive that used for diagnosis of infection. This study conducted to assessment of the relationship between cerebrospinal fluid C-reactive protein، and neonatal meningitis، as well as diagnostic value of test.

Forty nine hospitalized infant that suspected to meningitis were enrolled in this analytic cross sectional research via non probable accessible sampling. 28 patients (52. 7%) of all the patients were male and 21 patients (42. 8%) were female. The average age of the patients was 22. 6±11. 88 days. Data from clinical examinations and laboratory tests entered in a questionnaire and all of samples divided in two bacterial (septic) and non-bactria (aseptic) meningitis group. All data including cerebrospinal fluid CRP of newborns were statistically analyzed.

In total، the mean and standard deviation of age was 22. 6±11. 88 days. 57. 2% of infants were male and 42. 8% were female. In total، 40. 82% of infants were diagnosed with septic meningitis. There was no significant difference between septic and aseptic groups in terms of sex (P= 1. 00) also in terms of age (P= 0. 1). The mean and standard deviation of CRP level in septic meningitis group was 0. 95±0. 68 mg/L and in aseptic group was 0. 16±0. 36 mg/L. The CRP level difference in septic meningitis group compare with aseptic group was statistically significant (P<0. 000). The finding showed that cut off point for CRP level as a diagnostic test was 0. 17 mg/L، sensitivity was 95% and specificity was 86%.

In the present study، newborns with septic meningitis had higher cerebrospinal fluid CRP level than newborns with aseptic meningitis، and CSF-CRP can be used in rapid diagnosis of septic and aseptic meningitis. Although this result has been seen in many studies، but more research is needed.

Although a few studies have shown the positive correlation between patients’ serum concentration of 25 OH-Vitamin D3 and type II diabetes mellitus، metabolic syndrome، and insulin resistance، there are controversies regarding the relationship between 25 OH-Vitamin D3 as a risk factor for cardiovascular atherosclerotic diseases that has to be cleared. The aim of this study was to evaluate the association between the rate of 25 OH-Vitamin D3 and the presence and severity of coronary artery disease (CAD) in Patients with suspected CAD. This study was a cross sectional study that has been conducted in the department of cardiology in Imam Khomeini Hospital complex in collaboration with endocrinology research center. In this study 178 patients with suspected coronary artery disease (CAD) were enrolled. Based on their history and clinical findings coronary angiography was performed in all patients. Severity of CAD has been assessed by using Gensini score، based on their coronary angiography findings. The relationship between severity of CAD and their serum level of 25 OH-Vitamin D3 was evaluated. Serum level of 25OH- Vitamin D3 was measured by the enzyme-linked immunosorbent assay (ELISA) method by Euroimmiune kits (from Germany). Of 178 patients، 50 (28. 1%) were female and 128 (71. 9%) were male. Mean±SD of their ages was 56. 2±11. 8 years old. Significant coronary artery stenosis (stenosis more than 50% luminal diameter) was observed in 91 (51. 1%) of patients. Mean±SD of serum level of vitamin D3 in patients with CAD was 45±35 nm/l and in patients without CAD was 55±44 nm/l (P= 0. 047). Mean±SD of Gensini score was 26. 3±21. 1، as well. Therefore correlation coefficient between 25 OH-Vitamin D3 and Gensini score was -0. 262 (P= 0. 043). Although there is a trend toward association between deficiencies of 25 OH-Vitamin D3 and the presence of CAD but their association is not statistically significant. For achieving more convincing findings larger studies are needed.

Helicobacter pylori has been classified as the class I carcinogenic agent by world health organization. Colonization of the human stomach with H. pylori is a risk factor for gastroduodenal diseases. The secreted vacA toxin is an important H. pylori virulence factor that causes multiple alterations in gastric epithelial cells and T cells. Several families of vacA alleles have been described، and H. pylori strains containing certain vacA types (s1 and m1) are associated with an increased risk of gastric disease، compared to strains containing other vacA types (s2 and m2). We examined the association between H. pylori vacA s alleles and gastroduodenal diseases in Iran. A total of 149 H. pylori strains were obtained from patients with gastritis، peptic ulcer، and gastric cancer referring to endoscopy units of several cities in Iran. Biopsy culture and DNA extraction were performed and the frequency of vacA s alleles was investigated by using PCR amplification. Linear regression and binary logistic regression models were used to analyze the association between vacA (vacuolating cytotoxin A) s alleles and gastroduodenal diseases. There was no significant association between the frequency of vacA s alleles and gastroduodenal diseases (gastritis or peptic ulcer disease and gastric adenocarcinoma (P> 0. 05)). It is proposed that the H. pylori vacA s1 genotype could not be considered as an important determinant of gastroduodenal diseases in Iranian population and probably if s1 allele is associated with other virulence alleles of this gene، it will cause diseases.

Surgeons and anesthesiologists working in orthopedic operating theatres are exposed to significant noise pollution due to the use of powered instruments. This may carry a risk of noise-induced hearing loss. The present study was designed to quantify the noise pollution experienced by anesthesiologists at Imam Khomeini Hospital which is one of the largest Iranian hospitals. Prior to beginning of any operation a sound level meter was worn by the anesthesiologist at the level of chest pocket. Basal sound level was recorded. All changes in the sound level of 25 operation rooms and two related pass ways were recorded and the mean sound level along with maximum sound level were noted. These data were analyzed by SPSS version 17. For comparing the mean values، the One way ANOVA and Post-Hoc analysis was used. Noise exposures were compared with occupational health guidelines. Our comparative data showed that orthopedic operation room had the highest level of noise، indicating that orthopedic operation room is significantly suffered by the most types of noise with the P value of 0. 002. This is contrast to the sound levels at the other operation rooms which were at same range and were not significantly different. Comparison of the maximum sound level between these 27 places showed that orthopedic and one of general surgery room had top two maximum sound levels. Overall total noise dose during all types of surgeries was measured as twice of permitted dose and also orthopedic and general operation rooms experience brief periods of noise exposure in excess.

Traumatic amputation of upper limb above the level of the elbow، are rare injuries that a surgeon may be faced with a handful of cases during his career. Even with advanced techniques in microvascular surgery، the survival of the transplanted limb that cut off completely from the arm is relatively weak. Four injured people (patient) in Imam Khomeini Hospital during 1999-2013 in Tehran University of Medical Sciences were treated. Two patients had complete amputation of limb and other patients suffered from complete cutting in artery and vein along with neurological and soft tissue damages. There was not any ischemia or gangrene. However، efficiency of limbs with damages in peripheral nerves was not significant. The main reason was lack of immediate repair of the damaged nerves. In the recent examination، after discharge، the performance of the limb is firstly related to the conditions of the nerve system and secondly it depends on the severity of the injury in each of the muscles. However، none of the patients were dissatisfied of any situation and they were prepared to make any cooperation for improving the condition of their transplanted limb. Transplantation of the amputated limb can be done in spite of limited resources. Any delay in repairing damaged nerves will result great reduction of final organs’ performance. A limb، made from the own body، always take precedence to prosthesis، even when the efficiency is low.