مجله دانشکده پزشکی اصفهان
پیاپی 342 (هفته دوم شهریور 1394)

Non-alcoholic fatty liver disease is the most common chronic liver disease in worldwide. Prevalence of the disease is about 35 percent in Iran. Metabolic disorders were seen in patients with nonalcoholic fatty liver. In several studies، vitamin D supplementation led to ameliorate glycemic indicator. The purpose of this study was to investigate the effect of vitamin D supplementation on glycemic indices in patients with nonalcoholic fatty liver. In this randomized parallel clinical trial، 60 patients with non-alcoholic fatty liver disease participated in the intervention and placebo groups. For 10 weeks، the intervention and placebo groups received 50،000 IU Pearle vitamin D or placebo، respectively. Glycemic indices were measured at the beginning and end of the study. Nonalcoholic fatty liver was diagnosed via ultrasound. Data were analyzed using ANCOVA and regression tests in SPSS software. At the end of the study، in intervention group، compared with the placebo group، serum vitamin D levels were significantly increased and insulin resistance and fasting blood glucose levels were significantly decreased (P < 0. 05). But، vitamin D supplementation had not significant effect on other variables. Vitamin D supplementation reduced insulin resistance in patients with nonalcoholic fatty liver. But، more researches must be conducted with large sample sizes and strong designs to confirm these findings.

Hemodynamic changes during and after coronary artery bypass graft surgery and the effects of these changes on postoperative complications are important. As there was not any study to compare the effects of propofol and isoflurane on hemodynamic changes during and after coronary artery bypass grafting، we decided to do this. This clinical trial study was done on 80 patients undergoing coronary artery bypass surgery at the ages of 40 to 70 years in 2014 in Chamran Hospital، Isfahan، Iran. The subjects received isoflurane or propofol in two groups. Hemodynamic changes during coronary artery bypass graft surgery and then every 30 minutes until the end of the surgery and in intensive care unit every two hours to eight hours were compared. Based on the repeated measure ANOVA test، the differences between the two groups in systolic blood pressure (P = 0. 475)، diastolic blood pressure (P = 0. 885)، heart rate (P = 0. 130)، pulse pressure (P = 0. 572) and arterial oxygen saturation (P = 0. 425) in 10 times of measuring (before the pumping starts، at pumping، 30، 60، 90 and 120 minutes later، immediately after the pumping and 2، 6 and 8 hours after admission to the intensive care unit) were not significant. In our study، isoflurane and propofol did not cause significant differences in the hemodynamic variables before، during and after coronary artery bypass graft surgery.

Melasma is an acquired pigmentation disorder in all types of skin especially in women. Researchers are certain to find effective and less recurrence rate treatment. This study compared the effectiveness of Kligman formula alone and its combination therapy with fractional Q switched Nd: YAG laser in the treatment of melasma. In this clinical trial، 50 patients with melasma were randomly divided into two groups of 25. The first group treated with Kligman formula and the second group treated with combination of Kligman formula and fractional Q switched Nd: YAG laser. Area expansion، pigmentation and melasma uniformity، melasma area and severity index score (MASI) score، patient opinion immediately after the completion of treatment and 6 months after starting it، were recorded. The results were analyzed using ANOVA test. In both methods، there were significant differences after treatment in the development of pigmentation and MASI score compared to before it; but no significant differences were observed between the two methods. The inverse relation was observed between the age and the result of treatment and recurrence of melasma in both groups. Dry skin was occurred in one case of combination therapy. In this study، significant improvement was seen in both groups; but، there was no significant difference between the two approaches. It seems that increasing the number and reducing the time between laser sessions can create a more appropriate response. In addition، due to the recurrence of melasma after the end of treatment، there is a need for continuation the treatment using lightening compounds as Kligman formula and Peel felt.

The culture and proliferation of osteoblast-like cells has an important role in clinical and research use and bone biology. The results have shown that culturing cells in a three-dimensional tissue-like microenvironment with engineered geometrical properties gives a better effect on cell culture than two-dimensional ones. The aim of the present study was construction and evolution of a three-dimensional scaffold with suitable features for the cultivation of osteoblast-like cells. Silk-chitosan scaffold was prepared via freeze drying method. Scaffolds structure was analyzed using scanning electron microscopy. The mechanical properties of scaffolds were evaluated via measuring the compressive strength and the degradation of them was investigated via incubating the samples in phosphate buffer salin. The cytotoxicity of silk on MG63 cells was assessed using MTT [3- (4،5-dimethylthiazol-2-yl) -2،5-diphenyltetrazolium bromide] assay and cell adhesion was investigated after cell incubation on silk substrate. Scanning electron microscopy data indicated the appropriate porosity and porous structure (pore size: 200. 90 ± 46. 75 μm) on scaffold surface that might improve nutrient transport، transmission of signal and cell penetration into the scaffolds. The results of mechanical properties showed that the scaffold was appropriate for three-dimensional culture of cells and the compressive strength was 0. 6 ± 0. 8 MPa at scaffold. Degradation test results showed that increasing the weight ratio of the chitosan raised the rate of the scaffold degradation. The results of MTT assay and cell culturing confirmed non-toxicity of silk and its ability to accommodate cell adhesion. Silk-chitosan scaffold prepared via freeze drying methods can be promising for three-dimensional culture of osteoblast-like cells.

The topic of organ donation is the most notable sign of combining medicine and clinical service with people''s insight and beliefs. To plan a key for expanding the culture of organ donation in society، the information and awareness of people from Isfahan (Isfahanians)، Iran، were investigated in this research. Performing a descriptive research on the studied population، a sample of 975 Isfahanians over 15 years old of age was taken via the method of random stratified sampling. Data collecting tool was a self-made questionnaire in 2 sections of background information and awareness questions. Data were analyzed via SPSS17 software using independent sample t and analysis of variance tests. Of 975 participants in the research، 51 (52. 9%) 6 were women and 459 (47. 7%) were men، with the mean age of 30. 45 ± 5. 12 years. The mean awareness score about organ donation was 5. 3 ± 2. 2، about average noting the groupings. In addition، the distribution of classification frequencies of people''s awareness state showed that، most of the participants had average awareness about organ donation. Besides، observing the effective factors on awareness state of participants about organ donation، factors such as gender، age، marital status and occupational state did not have donation noticeable effect on awareness of the people about organ donation (P > 0. 050); on the other hand، education level and income state were effective on the level of their awareness (P < 0. 050). The awareness of Isfahanian society about organ donation is about decent to average. Besides، according to role of the media in acquainting، it seems that media is one of the most important tools in increasing people''s awareness.