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As an environmental contaminant, Benzo[a]pyrene (B[a]P; BaP) disrupts the antioxidant signaling and thus leads to the induction of oxidative stress and the damage of DNA in the ovary. low-dose atorvastatin (ATV) has antioxidant and anti-apoptotic properties. The present study aimed to survey the effects of prenatal exposure to BaP on ovarian toxicity and also to investigate the protective role of ATV in reducing ovarian toxicity. In this study, rats were divided into seven groups: control, ATV (10 mg/kg), oil, BaP (10 and 20 mg/kg), and ATV + BaP (10 and 20 mg/kg). BaP and ATV were administrated from gestation day 7-16 (GD7 to GD16), orally. 10 weeks after the birth, female offsprings were examined for oxidative stress markers, sex hormones, ovarian and tubular tissue structure, and the apoptosis markers. Data showed that BaP significantly reduced glutathione, increased malondialdehyde level, and disrupted the tissue structure of the ovary. Moreover, estrogen and progesterone levels significantly decreased in the offsprings rats. Also, BaP increased caspase-3 immunoreactivity. Atorvastatin treatment along with BaP in the embryonic period were able to bring the antioxidant status and sex hormones levels relatively close to normal. Besides, histological findings showed that atorvastatin was able to improve ovarian and oviduct abnormalities caused by BaP. Based on the above studies be concluded that atorvastatin in the embryonic during was able to reduce ovarian damage caused by BaP with antioxidant and anti-apoptotic properties.

Developing laboratory assays to evaluate HDL functions and improve cardiovascular disease (CVD) risk assessment has recently emerged as a challenge. The present study was conducted to help predict the risk of coronary artery disease (CAD) by investigating new cardiometabolic risk factors based on substituting paraoxonase 1 (PON1) as a critical enzyme in the functionality of HDL for that of HDL-C.The present study recruited 274 subjects undergoing diagnostic coronary angiography, 92 without significant CAD (non-CAD), and 182 with a severe CAD. The diagnostic accuracy of the new biomarkers in non-CAD versus multi-vessel disease was obtained in descending order of AUC as 0.72 (P 0.001) for log (TG/PON1), 0.70 (P 0.001) for nonHDL-C/PON1, and 0.67 (P 0.001) for LDL-C/PON1. After performing a multivariate adjustment for age, gender, BMI, statin therapy, and diabetes mellitus, the increased odds of CAD remained significant for the new cardiometabolic ratios as independent variables [adjusted OR = 1.47 (1.15-1.88), p = 0.002 for LDL-C/PON1; adjusted OR = 2.15 (1.41-3.5), p = 0.009 for nonHDL-C/PON1; adjusted OR = 5.03 (2.14-13.02), p = 0.004 for log (TG/PON1)]. CAD was diagnosed with an optimal discriminating cutoff of 1.84 for LDL-C/PON1, 2.8 for nonHDL-C/PON1, and 0.48 for log (TG/PON1).To improve CAD's risk assessment, the PON1 activity was proposed as an alternative to HDL-C in the commonly used atherogenic lipid ratios. Substituting the PON1 activity for the HDL-C concentration can provide an index of the HDL activity. The present study sought to exploit the lipoprotein-related risk factors of CAD from a more effective perspective.

Purpose Boarding is a common problem in the emergency department (ED) and is associated with poor health care and outcome. Imam Khomeini Hospital is the main healthcare center in Urmia, a metropolis in the northwest of Iran. Due to the overcrowding and high patient load, we aim to characterize the rate, cause and consequence of boarding in the ED of this center. Methods All medical records of patients who presented to the ED of Imam Khomeini Hospital from August 1, 2017 to August 1, 2018 were retrospectively analyzed. Patients with uncompleted records were excluded. Boarding was defined as the inability to transfer the admitted ED patients to a downstream ward in ≥2 h after the admission order. Demographic data, boarding rate, mortality and triage levels (1–5) assessed by emergency severity index were collected and analyzed. The first present time of patients was classified into 4 ranges as 0:00–5:59, 6:00–11:59, 12:00–17:59 and 18:00–23:59. Descriptive, parametric and non-parametric statistical tests were performed and the risk of boarding was determined by Pearson Chi-square test. Results Demographic data analysis showed that 941 (58.5%) male and 667 (41.5%) female, altogether 1608 patients were included in this study. Five patients (0.3%) died. The distribution of patients with the triage levels 1–5 was respectively 79 (4.9%), 1150 (71.5%), 374 (23.3%), 4 (0.2%) and 0 (0%). Most patients were of level 2. Only 75 (4.7%) patients required intensive care. The majority of patients (84.2%) were presented at weekdays. The maximum patient load was observed between 12:00–17:59. Of the 1608 patients, 340 (21.1%) experienced boarding within a mean admission time of 13.70 h. Among the 340-boarded patients, 20.1% belonged to surgery, 12.1% to orthopedics, 10.9% to neurosurgery and 10.3% to neurology. The boarding rate was higher in females, patients requiring intensive care and those with low triage levels. Compared with the non-boarded, the boarded patients had a higher mean age. Conclusion The boarding rate is higher in the older and female patients. Moreover, boarding is dependent on the downstream ward sections: patients requiring surgical management experience the maximum boarding rate.

Background and aim: Car crashes are among the prevalent incidents seriously threatening public health. This study aimed to assess the survival and quality of hospital care for patients of car accidents in Western Azerbaijan, Iran. Methods: This cross-sectional study was conducted on 1,697 trauma victims admitted to Imam Khomeini hospital in Urmia, Iran, during 2016. The data, including systolic pressure, Glasgow Coma Scale, respiratory rate prior to admittance, severity of injuries based on surgery description, limbs and brain computed tomography scan, and diagnostic ultrasound by an specialist, were collected from medical records. The survival chance of patients was estimated using Trauma and Injury Severity Score (TRISS). To evaluate the quality of hospital service, Z and W statistics were utilized. Results: Out of 1,697 admitted victims, 1,226 (72.3%) and 471 (27.7%) subjects were male and female, respectively. The patients were within the age range of 15-54 years, including 901 (75%) male and 296 (25%) female subjects. The predominant educational levels were under diploma and illiterate in male and female patients, respectively. The mean values of the Revised Trauma Score for the recovered and deceased patients were 7.75±0.38 and 6.19±1.59, respectively; however, the mean values of the Injury Severity Score for the recovered and deceased patients were 14.57±13.72 and 52.03±27.02, respectively, indicating a statistically significant difference between the two groups. The number of observed mortalities was 69; nevertheless, the expected mortalities were 60 cases. Furthermore, the quantified W and Z statistics were -9 and 0.02, respectively. Conclusions: The results showed that the observed mortality exceeded the expected morality indicating the low quality of hospital care.

A ganglion cyst is a small sac of fluid that forms over a joint or tendon (tissue that connects muscle to bone). A 23-year-old woman, right hand dominant, and Laboratory expert, was referred with a 1-year history of a lump in the anterior aspect of her elbow associated with altered sensation in the anterolateral aspect of her left hand. Her elbow was painful and the mass progressive increased in size during the last 1.5 months. There was no history of trauma, injections or manipulation. The patient had no symptoms of fever, ulcers, or numbness. On physical examination, there was a tendered mass about 4 cm in diameter in the anterior aspect of the elbow. X-ray was normal and MRI confirmed a mass along with a radiocapitellar capsule. The cyst and radial nerve were explored through an anterolateral curved incision, with ligation of the radial recurrent vessels. The cyst was on the capsule of the radiocapitellar joint and posterior to the interosseous nerve at the proximal fibers on the edge of the supinator muscle. The cyst was identified as a ganglion clinically, and excised completely. Pathology finding confirmed it. The lateral elbow pain disappeared immediately after surgery, with no neurological deficit. The patient returned to work after 1 month.

This study aimed to evaluate the accuracy and performance of modified blood pressure-to-height ratio (MBPHR) for identifying high blood pressure (HBP) in a large population of children. This multicentric cross-sectional study was conducted on a nationally representative sample of 7349 Iranian students aged 7-12 years living in 30 provinces in Iran. High systolic blood pressure and diastolic blood pressure were defined according to the 2017 American Academy of Pediatrics (AAP) guidelines. The BP-to height ratio (BPHR) was calculated as BP (mmHg)/height (cm), MBPHR3 as BP (mmHg)/(height (cm) + 3 (13-age)), and MBPHR7 as BP (mmHg)/(height (cm) + 7 (13-age). The receiver-operating characteristic curve analysis was used to evaluate the performance of these three ratios for identification of HBP in children compared to the 2017 AAP guidelines as the gold standard. Mean age of participants was 12.29 ± 3.15 years and 3736 (50.8%) were girls. The prevalence of HBP was 11.9% (11.5% in boys, 12.3% in girls). The area under the curve (AUC) was higher for MSBPHR3/MDBPHR3 (0.97/0.98) than MSBPHR7/MDBPHR7 (0.96/0.97) and SBPHR/DBPHR (0.96/0.95) for identifying high Systolic and diastolic BP. The optimal cut-off points for MSBPHR3/MDBPH, MSBPHR7/MDBPHR7, and SBPHR/DBPHR were 0.76/0.50, 0.69/0.46, and 0.81/0.52 respectively. Negative predictive value was nearly perfect for three ratios (≥98%). Positive predictive value was higher for MBPHR3 (52.7%) than MBPHR7 (51.0%) and BPHR (39.8%). Overall, MBPHR3 had better performance than MBPHR7 and BPHR for identification of HBP in Iranian children and it may improve early hypertension recognition and control in primary screening.

Introduction: Trauma is the leading cause of death and disability in developing countries. According to the World Health Organization projections by 2020, accidents alone are the second leading cause of missing year around the world. Therefore, the aim of this study was to compare the ability of trauma severity-assessing methods in determining the prognosis of accident patients referred to Imam Khomeini Hospital of Urmia in 2016. Methodology: In this study, the severity of trauma in traffic accident patients referring to Imam Khomeini Hospital of Urmia was determined using the Injury Severity Score (ISS), Revised Trauma Score (RTS), Trauma and Injury Severity Score (TRISS), and A Severity Characterization of Trauma (ASCOT), in a 1-year period, via the census method on 2015 hospitalized accident victims, and the ability of these methods to predict mortality and morbidity, length of stay in hospital, and hospital length charges were investigated by the receiver operating characteristic curve of regression methods. To this end, the hospital records of accident victims who were hospitalized for at least 1 day or whose deaths were examined along with their autopsy reports were the main components of this study. Results: The mean age of the patients was 33.63 ± 18.53 years, and their age range was 1–96 years. The ratio of males to females was 2.73. In addition, in terms of job status (46.8%), they were free. The majority of women were homemakers (70.8%). In the two gender groups, most accidents occurred within the city, The mean severity of lesions based on ISS system was 16.44 ± 16.28 and 16.8% of ISS injuries were above 25. The mean RTS of the patients was 7.69 ± 0.54, which ranged from 0 to 7.84, and the mean TRISS of the patients was 92.24 ± 15.87. The trauma means via the ASCOT method was 5.35 ± 1.85. The difference in the severity of trauma (calculated by each of the methods of ISS, RTS, TRISS, and ASCOT) was significant between those who survived and those who died. Conclusion: In this study, most of the accidents happened in males, married, undergraduate, and homemaker, and those on the street as well, and the RTS and TRISS methods showed the highest ability in predicting mortality. Given the usefulness and special applications of these methods, their use in designing a national care system in the trauma area is recommended.

Background: Acute appendicitis is one of the most common causes of emergency surgeries, but sometimes the physicians face difficulties in proper diagnosis and management. Counting white blood cells and (CRP) C-reactive protein were important factors along with related clinical symptoms. The purpose of this study was evaluate the diagnostic value of these two factors in the diagnosis of acute appendicitis. Methods: In this descriptive study patients with abdominal pain suspected of acute appendicitis were examined. In patients who received the results of clinical examinations and other diagnostic procedures (sonography, CT scan, etc.) to prove Acute appendicitis was ambiguous and non-determinant, and the score of Alvarado 6-4, a blood sample was taken for checking WBC, CRP and PMN, and was immediately sent to the lab. The laboratory kit used for the above measurements belonged to Bio System Reagents & Instrument Barcelona-Spain, and the sensitivity of this test was 0.15 mg / L according to the Bio System brochure. CRP>10 mg / L and PMN> 70%, WBC> 10000 / cu mm positive were considered. Results: A total of 251 patients with appendicitis with mean age of 26.48 ± 10.5 years were studied. Alvaro criteria in patients with acute appendicitis 3.95 ± 0.22 and 4.9 ± 0.27 in patients with normal appendix (P = 0.5). The result of the pathology were normal in 102 (40.6%) cases, acute appendicitis in 91 cases (36.3%), and aphthous aphastics in 58 cases (23.1%). And, 88 (35.1%) patients had normal WBC and 163 (64.9%) cases had WBC levels more than 10,000 Cumm. Also, 50 patients (19.9%) had normal CRP but in 201 cases (80.1%) the CRP was higher than 10 mg/L. WBC had a sensitivity, specificity, positive predictive value, and negative predictive value of 69.12 %, 59%, 16.19% and 52.27%, respectively in diagnosis of acute appendicitis. CRP had a sensitivity, specificity, positive predictive value, and negative predictive value of 69.12 %, 59%, 16.19% and 52.27% respectively in diagnosis of acute appendicitis. Conclusion: By measuring CRP and white blood cell count, a negative appendectomy can be reduced along with a clinical examination.

Aim:Some evidence exists concerning the relationship between anthropometric measurements and chronic kidney disease. This study aims to investigate the association of neck circumferences (NC), wrist circumferences (WC) and hip (HC) circumferences with kidney function in a pediatric population.Materials and Methods:In this national study, 4.200 students aged 7-18 years were selected by random cluster sampling from 30 provinces of Iran. NC, WC and HC were measured according to standard protocol and were categorized to either low or high according to their age-sex specific median values. The estimated glomerular filtration rate (eGFR) was calculated based on the “updated” Schwartz equation.Results:The response rate was 91.5% (n=3.843). The mean standard deviation of eGFR was 96.71 (19.46), 96.49 (21.69), and 96.59 (20.66) mL/minimum/1.73 m2 for girls, boys and the total population, respectively. Compared to other participants, those in the high NC group had significantly higher eGFR (102.12±21.31 vs 90.65±18.18, p

Background: One of the most essential indicators of quality evaluation of health services is to assess the status of patients' rights, especially in those with mental illness due to their physical and mental conditions, and how health care providers and recipients interact. Objectives: This study aimed to investigate the observance of the Charter of Rights of Patients with Mental Disorders from the perspective of nurses and patients in Panj Azar Hospital in Gorgan in 2020. Methods: This descriptive cross-sectional study was performed in 2020 among 100 patients admitted to the Psychiatric Ward and 200 nurses working in the psychiatric ward selected by simple random sampling. Data were collected using a demographic questionnaire and a self-made questionnaire. Data were entered into SPSS version 18 and analyzed using descriptive statistics, chi-square test, and independent t-test. Results: In this study, the results showed that the mean age of the subjects was 52.7 ± 22.4 years, and the highest age group of the study participants was 21 - 30 years. Overall, 196 (65.3%) participants were married, and 191 (63.7%) recommended others to return to this hospital. The mean scores of observance of the patient's charter from the nurses' and patients' points of view were 59.26 ± 6.26 and 57.98 ± 8.13, respectively. The subgroup with highest score was respect for the right to free choice and decision making in both groups. The level of compliance with the Charter of Patients' Rights was good and average from both nurses patients’ point of view. Furthermore, there was only a significant relationship between the views of nurses and patients in the subgroups of respect for patient privacy, compliance with the principle of confidentiality (P = 0.001), and access to an efficient grievance redressal system (P = 0.001). Conclusions: Overall, it is inferred that in most cases, nurses are aware of the extent of their compliance with their charter of rights, and from the patients' point of view, the level of compliance with the charter of patients was often moderate.

Background: There are a variety of treatment regimens containing several antimicrobial compounds to treat Helicobacter pylori infection. Objectives: The aim of this study was to eradicate H. pylori infection in patients with gastrointestinal problems after the administration of a four-drug regimen. Methods: This study was performed among 100 patients with gastrointestinal problems visiting Imam Khomeini Hospital in Urmia, Iran. The data were collected using a checklist that included patient information and analyzed by chi-square and t-test. Results: Out of the 100 patients visiting the clinic, 60 (60%) were male, and the rest were women. Also, 67% of the patients had pain type dyspepsia, and 33% of them postprandial distress type. In pathologic study, 38% of the patients had H. pylori infection, with a significantly higher incidence in patients with pain type dyspepsia. Conclusions: The results showed a relationship between the type of indigestion and the improvement of symptoms after receiving a four-drug regimen, indicating the need for proper planning to diagnose and treat the type of indigestion.

Background: Cardiovascular disease (CVD), particularly coronary artery disease (CAD), constitutes the leading cause of death across the world. They are responsible for the highest mortality rate in Iran. The traditional risk factors for CAD are smoking, obesity, hypertension, family history, diabetes mellitus, and hyperlipidemia. Furthermore, enhanced oxidative stress is known as a novel risk factor for CAD. Objectives: The associations of oxidative and antioxidative markers were investigated relative to the occurrence and severity of CAD. Methods: A total of 286 participants, including 141 males and 145 females aged 30 - 70, were classified as CAD case and control groups, based on their coronary angiography results. The CAD severity scoring was done based on the number and extent of lesions in coronary arteries. The activity of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and Total antioxidant capacity (TAC) was assayed using the ferric reducing ability of plasma (FRAP) method. Meantime, malondialdehyde (MDA) was measured as a lipid peroxidation product. Results: The results demonstrated a significant increase in SOD activity (P = 0.019) and the uric acid concentration (P = 0.000) of CAD patients compared to the control group. Although no change was seen in GPx and CAT activity, as well as FRAP and MDA, a significant positive correlation was found between CAT and SOD activity (P = 0.011) and between FRAP and uric acid (P = 0.000) levels. Conclusions: The results suggest that some antioxidants are significantly associated with the severity of CAD, thereby helping predict the risk of cardiovascular events. However, extra studies are needed to endorse the significance of these findings.

Objective. Evaluation of the pruritus features in children with end-stage renal disease (ESRD) who underwent dialysis at an academic tertiary pediatric dialysis center. Methods. This cross-sectional study was conducted at an academic tertiary pediatric dialysis center, Isfahan, Iran. The reviewed medical records of the children included their characteristics, dialysis properties, and laboratory parameters. The 4-item itch questionnaire was utilized to assess distribution, severity, frequency, and associated sleeping disorders. Results. Thirty ESRD patients with pruritus, including 23 males (76.7%) with a mean age of 11.7 ± 3.64 years, were recruited. The most common cause of CKD was nephronophthisis (23.3%). The median total score of pruritus was 5 (range: 3-15). The distribution score of pruritus was directly correlated with the age (Spearman’s rho = 0 .42, P = 0.02 ) and serum level of parathyroid hormone (PTH) (Spearman’s rho = 0.42 , P = 0.04 ). In the reduced multiple logistic regression model, the increasing level of serum calcium was associated with increased odds of having total pruritus score ≥ 5 (OR (odds ratio): 4.5; 95% CI 1.12 to 18.05). In addition, an increase in age for one year was found to be associated with 50% higher odds of having total pruritus score ≥ 5 (OR: 1.5; 95% CI 1.03 to 2.18). Conclusion. Increased level of serum Ca and higher age were associated with increased odds of having more severe pruritus score in children.

Research question Would there be differences in muscle activation between healthy subjects’ (HS) dominant leg and transfemoral amputees’ (TFA) intact-leg/contralateral-limb (IL) during normal transient-state walking speed? Methods The muscle activation patterns are obtained by calculating the linear envelope of the EMG signals for each group. The activation patterns/temporal changes are compared between-population using statistical parametric mapping (SPM). Results Individual muscle activity showed significant differences in all muscles except vastus lateralis (VL), semitendinosus (SEM) and tensor fascia latae (TFL) activities. Significance The information could be used by the therapists to prevent secondary physical conditions and prosthetic companies to improve the mobility of the amputees.

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes serious acute respiratory diseases including pneumonia and bronchitis with approximately 2.3% fatality occurrence.Main bodyThis study argues the main concepts that need to be considered for the gradual reopening of dental offices include treatment planning approaches, fundamental elements needed to prevent transmission of SARS-CoV-2 virus in dental healthcare settings, personal protection equipment (PPE) for dental health care providers, environmental measures, adjunctive measures, and rapid point of care tests in dental offices.ConclusionThis article seeks to provide an overview of existing scientific evidence to suggest a guideline for reopening dental offices.

Introduction: Dyspepsia involves at least one of the cases of belly dysfunction after meals, early onset satiety when a person eats a normal meal, and epigastric pain or burning sensation. The aim of this study was to investigate endoscopic and pathological findings in patients referred to Imam Khomeini Hospital in Urmia, Iran. Methods: One hundred patients who complained of two different types of dyspepsia enrolled and findings were recorded during the endoscopy. Also specimens were taken from all patients during endoscopy and sent to the lab for pathological examination. Pathologic findings of all patients were recorded from Helicobacter pylori (H. pylori) colonies. Results: 60 patients were women (60%) and 40 were men (40%). 67% of patients had pain type dyspepsia and 33% of them had postprandial distress type. There was no significant relationship between gender and type of dyspepsia. Endoscopy findings consisted of 54% antral gastritis, 20% peptic ulcer, 43% esophagitis (mostly includes grade A), 5% hiatal hernia, 5% gastric metaplasia, 15% prepyloric ulcer, 18% duodenal ulcer, 38% positive for H. pylori, and 1% Barrett's esophagus disease which had no significant relationship with dyspepsia. Pathologic study findings showed 38% of patients had H. pylori infection with a significant higher incidence in patients with pain type dyspepsia. Conclusion: According to this study, the incidence of any endoscopic findings in patients with two different types of dyspepsia was not significantly different, but the rate of H. pylori infection in patients with pain type dyspepsia was much more than the postprandial type.

Serum paraoxonase 1 (PON1) and myeloperoxidase (MPO) are HDL-associated enzymes that contribute significantly to the formation of dysfunctional HDL. The present study thus seeks to comparatively analyze the predictive role of PON1, MPO and the MPO/PON1 ratio and to also evaluate which one has a stronger predictive role in their combined utility as an MPO/PON1 ratio in coronary artery disease (CAD).PON1 activity and MPO concentrations were determined in patients with established CAD and those without significant CAD. Receiver operating characteristic (ROC) curves were drawn by plotting true positivity versus false positivity.The ROC curve analyses showed that PON1 (AUC = 61%, p = 0.003) and MPO/PON1 (AUC = 60%, p = 0.01) have a better diagnostic performance than MPO (AUC = 50%, p = 0.42) in detecting patients with CAD. PON1 and MPO/PON1 were found to have a significantly stronger discriminatory power for the age range ≥52 and 60 years (AUC = 69%, p = 0.008 for PON1; AUC = 66%, p = 0.022 for MPO/PON1). The multivariate analysis revealed PON1 as an independent variable that was significantly associated with the multi-vessel disease [odds ratio (OR) = 0.98; p = 0.017]. At the cutoff point of 30 μmol/mL/min for PON1 and 1.85 for MPO/PON1, specificities were 97% and 73% and sensitivities 30% and 54% for discriminating patients with single-vessel disease from non-CAD subjects.The diagnostic performance of PON1 alone was comparable to that of the MPO/PON1 ratio for CAD risk assessment; however, MPO may increase the true positive rate. A larger number of blocked vessels seems to be associated with an increased predictive power for both PON1 and MPO/PON1. Recent data support the fact that PON1 and MPO may potentially be appropriate therapeutic targets for preventing CAD.

Background Atherosclerosis, the most common pathologic process underlying cardiovascular disease, defines a state of intensified oxidative stress and impaired antioxidative capacity. Haptoglobin (Hp) polymorphisms include three distinct human genotypes (Hp1-1, Hp2-1, and Hp2-2), managing functional differences related to the risk of developing cardiovascular diseases. The present study proposed to examine Haptoglobin polymorphisms concerning antioxidative enzyme activity in patients with coronary artery disease. Methods This case-control inquiry was managed through 398 samples consisting of 225 men and 173 women aged 30–80 who were suspect of CAD. Patients were classified as CAD cases (255) and controls (143). Hp genotyping was conducted using a polymerase chain reaction (PCR). Total antioxidant capacity (TAC) was examined using the Ferric Reducing Ability of Plasma (FRAP) method, and Erythrocyte CAT and GPx activity were measured as antioxidant enzymes. Results The TG, Chol/HDL, diabetes, GPx enzyme, and FRAP results demonstrate a meaningful variation in patients than controls (p > 0.005). The frequency of haptoglobin polymorphisms was significantly different between patients compared to controls. The frequency of Hp genotypes had a significant association with the severity of vascular stenosis so that the Hp2 allele increased the probability of vascular stenosis (P = 0.03).GPx enzyme activity presented a significant difference in Hp2-2 compared to Hp2-1 and Hp1-1 patients. However, there were no notable variations between the Hp genotypes and the amount of catalase and total antioxidant capacity (p > 0.005). Conclusion This examination confirms that antioxidative enzyme activities are Hp-phenotype-dependent in coronary artery disease. Impaired GPx enzyme activities were prominent among coronary artery disease patients with Hp2-2. Besides, diabetic and high BMI patients with Hp2-2 genotype possess a higher prevalence of coronary artery disease. This study proves the HP2 allele as a genetic determinant in controlling oxidative stress in CAD patients.

Background Pigmented villonodular synovitis (PVNS) is a rare proliferative process in children that mostly affects the knee joint. Case Presentation The study follows the case of a 3-year-old boy presenting recurrent patellar dislocation and PVNS. Due to symptoms such as chronic arthritis, he had been taking prednisolone and methotrexate for 6 months before receiving a definitive diagnosis. After a period of showing no improvements from his treatment, he was referred to our center and was diagnosed with local PVNS using magnetic resonance imaging (MRI). The patient was treated for his patellar dislocation by way of open synovectomy, lateral retinacular release, and a proximal realignment procedure, with no recurrence after a 24-month follow-up. Conclusion PVNS may appear with symptoms resembling juvenile idiopathic arthritis, thus the disease should be considered in differential diagnosis of any inflammatory arthritis in children. PVNS may also cause mechanical symptoms such as patellar dislocation. In addition to synovectomy, a realignment procedure can be a useful method of treatment.

Purpose: To present the qualitative and quantitative ultrasonographic findings of lower eyelid compartments in patients with chronic thyroid associated ophthalmopathy (TAO) compared to normal subjects. Methods: In a prospective study, dynamic and static ultrasonographic investigation, applying high resolution (15 MHz) ultrasound was performed to assess the lower eyelid, in 15 TAO patients that were in chronic phase and 10 normal subjects. The thickness and echogenisity of dermis, orbicular oculi muscle, lower eyelid retractor muscle, lower eyelid fat pads, and their qualitative relationships during vertical excursion of the globe were evaluated in static and dynamic investigation. Correlation of ultrasonic and clinical findings was evaluated. Results: The mean age of the patients was 41.82 ± 7.4 years, and the controls were age-matched (mean age, 42.8 ± 5.6 years). Mean proptosis of the involved eyes was 3.3 mm, and mean lower lid retraction was 2.4 mm in chronic TAO group. Pattern of fat motion was blocky in chronic TAO patients compared to normal jelly motion of the fat in normal cases. In analyzing the range of motion, the difference was significant in the motion of both superficial and deep fat pockets between the two groups (PÂ

Purpose To determine the feasibility of continuous recording of sound and light in the intensive care unit (ICU). Materials and methods Four 1-hour baseline scenarios in an empty ICU patient room by day and night (doors open or closed and maximal or minimal lighting) and two daytime scenarios simulating a stable and unstable patient (quiet or loud devices and staff) were conducted. Sound and light levels were continuously recorded using a commercially available multisensor monitor and transmitted via the hospital's network to a cloud-based data storage and management system. Results The empty ICU room was loud with similar mean sound levels of 45 to 46 dBA for the day and night simulations. Mean levels for maximal lighting during day and night ranged from 1306 to 1812 lux and mean levels for minimum lighting were 1 to 3 lux. The mean sound levels for the stable and unstable patient simulations were 61 and 81 dBA, respectively. The mean light levels were 349 lux for the stable patient and 1947 lux for the unstable patient. Conclusions Combined sound and light can be continuously and easily monitored in the ICU setting. Incorporating sound and light monitors in ICU rooms may promote an enhanced patient- and staff-centered healing environment.

Background To characterize the expression of the membrane transporter NaPi2b and antigen targeted by the MX35 antibody in ovarian tumor samples. The current interest to develop monoclonal antibody based therapy of ovarian cancer by targeting NaPi2b emphasizes the need for detailed knowledge and characterization of the expression pattern of this protein. For the majority of patients with ovarian carcinoma the risk of being diagnosed in late stages with extensive loco-regional spread disease is substantial, which stresses the need to develop improved therapeutic agents. Methods The gene and protein expression of SLC34A2/NaPi2b were analyzed in ovarian carcinoma tissues by QPCR (n = 73) and immunohistochemistry (n = 136). The expression levels and antigen localization were established and compared to the tumor characteristics and clinical data. Results Positive staining for the target protein, NaPi2b was detected for 93% of the malignant samples, and we identified three separate distribution patterns of the antigen within the tumors, based on the localization of NaPi2b. There were differences in the staining intensity as well as the distribution pattern when comparing the tumor grade and histology, the mucinous tumors presented a significantly lower expression of both the targeted protein and its related gene. Conclusion Our study identified differences regarding the level of the antigen expression between tumor grade and histology. We have identified differences in the antigen localization between borderline tumors, type 1 and type 2 tumors, and suggest that a pathological evaluation of NaPi2b in the tumors would be helpful in order to know which patients that would benefit from this targeted therapy.

No real therapeutic modality is currently available for Acute kidney injury (AKI) and if any, they are mainly supportive in nature. Therefore, developing a new therapeutic strategy is crucial. Mitochondrial dysfunction proved to be a key contributor to renal tubular cell death during AKI. Thus, replacement or augmentation of damaged mitochondria could be a proper target in AKI treatment. Here, in an animal model of AKI, we auto-transplanted normal mitochondria isolated from healthy muscle cells to injured kidney cells through injection to renal artery. The mitochondria transplantation prevented renal tubular cell death, restored renal function, ameliorated kidney damage, improved regenerative potential of renal tubules, and decreased ischemia/reperfusion-induced apoptosis. Although further studies including clinical trials are required in this regard, our findings suggest a novel therapeutic strategy for treatment of AKI. Improved quality of life of patients suffering from renal failure and decreased morbidity and mortality rates would be the potential advantages of this therapeutic strategy.

Osteoporosis is a severe malady and its primary diagnosis is highly significant now. The appropriate diagnosis of osteoporosis leads to more appropriate management in terms of prevention and sufficient pharmaco-logic or surgical treatment. In this study, the researchers focused on the primary biomedical Osteoporosis classification techniques. Such techniques are categorized into four groups including Radiographic Techniques, Bio-Markers Classification, Invasive Techniques, and Biosensors Classification. Authors in this study attempted to explain the direction of future studies in the field of Osteoporosis diagnosis by presenting an accurate classification of Osteoporosis diagnostic techniques. Finally the role of stress and bone displacement in osteoporosis is simulated.

Purpose: Deep sunken superior sulcus of the upper eyelid can result from aging, genetic, prostaglandin use, and prior aggressive upper blepharoplasty. If severe, it can cause exposure keratopathy, lagophthalmos, and giant fornix syndrome. We herein report on another milder manifestation of deep superior sulcus and its treatments. Methods: Case report. Results: Deep sunken superior sulcus syndrome caused to soft contact lens displacement and wear intolerance and was treated with upper eyelid suclus hyaluronic acid gel injection. Conclusions: Contact lens wear intolerance is likely more common in patients with deep sunken superior sulcus syndrome and can potentially be treated with superior sulcus hyaluronic acid gel injection. Keywords: Eyelid filler, Sunken eye, Cosmetic eyelid surgery, Non-surgical, Contact lens, Hyaluronic acid gel

Introduction Interleukin‐6 (IL‐6) is among the inflammatory mediators exhibiting elevated levels in ischemic stroke (IS) patients. The present study set out to evaluate the relationship between serum levels of interleukin‐6 with long‐term and at‐hospital outcomes of acute ischemic stroke in patients hospitalized at Imam Khomeini Hospital, Urmia, Iran, from 2017 to 2018. Method and materials This cross‐sectional descriptive study enrolled 29 and 31 acute stroke patients for long‐term and at‐hospital observation, respectively. Evaluation of stroke severity was performed using the National Institute of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) on days 1, 5, and 90. Serum IL‐6 level was measured via enzyme‐linked immunosorbent assay (ELISA) on days one and five. Results In the present cohort study, the following population were enrolled: for long‐term evaluation, 11 (38%) men and 18 (63%) women with a mean age of 64.5 ± 14.9 years, and for at‐hospital evaluation: 11 (37.5%) men and 20 (64.5%) with a mean age of 65.25 ± 14.37 years. A significant positive correlation was observed between IL‐6 levels with NIHSS and mRS scores of the patients from time of admission until the end of the follow‐up period (long‐term: p, It shows that IL‐6 contributes to determination of severity of ischemic stroke and may be useful in predicting patient prognosis.

Angiotensin II (Ang II) might induce pro-inflammatory effects directly in the vascular wall independently of its haemodynamic effects. The aim of our study was to investigate the putative direct pro-inflammatory and vasomotor effects of Ang II and compare to those of lipopolysaccharides (LPS) in mouse isolated mesenteric resistance-sized arteries (MRA) supported by experiments in cultured human primary endothelial and vascular smooth muscle cells. Results showed that 24-hr organ culture of mouse MRA with 10 nM Ang II had, unlike 100 ng/mL LPS, no effects on IL-6 or MCP-1 secretion, VCAM1 mRNA expression or endothelial function, while Ang II significantly decreased maximal vasomotor responses to phenylephrine. In support, 24-hr organ culture of mouse MRA significantly suppressed Agtr1a mRNA and augmented Tlr4 mRNA along with attenuated vasomotor responses to Ang II. Moreover, contrary to LPS and TNF-α, Ang II and [Sar1]-Ang II had no concentration- or time-dependent effects on IL-6 and MCP-1 secretion in human umbilical vein endothelial cells (HUVEC) and human aortic smooth muscle cells (HASMC). AGTR1 or AGTR2 mRNA expression was undetectable in HUVEC, whereas HASMC expressed only AGTR1 mRNA. In summary, contrary to previous studies and the observed effects of LPS, we could not demonstrate direct vascular pro-inflammatory effects of Ang II ex vivo or in vitro. As indicated by our results, down-regulation or desensitization of AT1 R during culture may explain our findings.

Transforming growth factor beta-3 (TGF-β3) has been shown to decrease scar formation after scheduled topical applications to the cutaneous wounds. This study aimed to continuously deliver TGF-β3, during the early phase of wound healing, by engineering a dermal equivalent (DE) using TGF-β3 expressing bone marrow stromal cells (BM-SCs) and human dehydrated amniotic membrane (hDAM). To engineer a DE, rat BM-SCs were seeded on the hDAM and TGF-β3 was transiently transfected into the BM-SCs using a plasmid vector. Pieces of the dermal equivalent were transplanted onto the full-thickness excisional skin wounds in rats. The process of wound healing was assessed by image analysis, Manchester Scar Scale (MSS), and histopathological studies 7, 14, 21, and 85 days after the excision. The results confirmed accurate construction of recombinant pcDNA3.1-TGF-β3 expression system and showed that the transfected BM-SCs seeded on hDAM expressed TGF-β3 mRNA and protein from day 3 through day 7 after transfection. After implantation of the DE, contraction of the wounds was measured from day 7 through 21 and analyzed by linear regression, which revealed that the rate of wound contraction in all experimental groups was similar. Histologic evaluation demonstrated that transfected BM-SCs decreased retention and recruitment of the cells during the early stage of wound healing, decreased the formation of vascular structures and led to formation of uniformly parallel collagen bundles. MSS scores showed that TGF-β3 secreting cells significantly improved the cosmetic appearance of the healed skin and decreased the scar formation. From these results, it could be concluded that transient secretion of TGF-β3, during the early phase of healing, by BM-SCs seeded on hDAM can improve the cosmetic appearance of the scar in cutaneous wounds without negatively affecting the process of wound repair.

Many epidemical and biological studies have proposed that human papillomavirus (HPV), primarily high-risk HPV16/18, is an etiological factor for a subset of head and neck (HN) cancers. On that premise, we systematically reviewed relevant articles and improved the understanding of HPV-related cancers. This article comprehensively described the characteristics of HPV-associated HN tumors according to demography, histopathology, molecular biology, and prognosis. Meta-analyses were conducted to combine the studies that reported the association between HPV status and these variables using Rev Man 5.0. The pooled results showed that HPV-positive tumors were not only poorly differentiated (OR = 2.77, 95% CI: 2.3-3.32) and smaller (OR = 2.21, 95% CI: 1.75-2.8) but were also strongly associated with oropharynx (OR = 5.8, 95% CI: 4.01-8.38) and node involvement (OR = 2.77, 95% CI: 2.3-3.32). HPV-related tumors showed significantly more p16 overexpression (OR = 34.55, 95% CI: 20.91-57.09) and less TP53 mutations (OR = 0.27, 95% CI: 0.18-0.41) than HPV-negative tumors. The patients with HPV-positive cancers had different clinical behaviors, such as a reduced risks of death (HR = 0.32, 95% CI: 0.29-0.36). This study supported the view point that HPV is a favorable indicator of prognosis and that HPV-related HN tumors are distinct from traditional tumors. This etiological relationship could impact future strategies of diagnosis, prevention, therapy, and prognosis for this subset of patients. J. Med. Virol. 89:710-725, 2017. © 2016 Wiley Periodicals, Inc.

Background Internal eyelid spacer graft is routinely placed during lower eyelid retraction surgery, which may be unnecessary. Objectives To evaluate the efficacy of lower eyelid retraction surgery without internal graft in select cases. Methods Retrospective analysis of patients undergoing reconstructive lower eyelid retraction surgery without internal graft, by one surgeon from 2013 to 2015. Surgical technique included transconjunctival lower eyelid retractor lysis, canthoplasty, and temporary tarsorrhaphy, with or without subperiosteal midface-sub oribularis oculi fat (SOOF) lifting and scar lysis. Eyelids with true lower eyelid middle-lamella shortage were excluded. Analysis included 17 surgeries (11 patients). Eight of 11 patients had undergone at least one previous lower eyelid surgery with resultant lower eyelid retraction and sclera show. Preoperative and postoperative photographs at longest follow-up visit were analyzed with standardized measurements. Patient satisfaction was recorded using questionnaire. Results Etiologies of lower eyelid retraction included prior lower blepharoplasty, thyroid eye disease, and chronic facial palsy. All 11 patients (17 procedures) demonstrated improvement of lower eyelid position. The mean improvement of marginal reflex distance was 2.2 mm (range, 1.6-2.8 mm). There was one case of mild overcorrection. The average follow-up was 7 months (range, 6 months-2 years). Midface lift was performed for 14 of 17 eyelids. Conclusions This study demonstrates improvement of lower lid position after lower eyelid retraction surgery without internal eyelid spacer graft in select patients. Most patients in our study had undergone previous lower eyelid blepharoplasty and required midface-SOOF lifting. The author proposes that “routine” placement of lower eyelid internal spacer/graft may not be necessary during lower eyelid retraction surgery.

Lateral brow ptosis is a common aging phenomenon, contributing to the lateral upper eyelid hooding, in addition to dermatochalasis. Lateral brow lift complements upper blepharoplasty in achieving a youthful periorbital appearance. In this study, the author reports his experience in utilizing a temporal (pretrichial) subcutaneous lateral brow lift technique under local anesthesia. A retrospective analysis of all patients undergoing the proposed technique by one surgeon from 2009 to 2016 was conducted. Additional procedures were recorded. Preoperative and postoperative photographs at the longest follow-up visit were used for analysis. Operation was performed under local anesthesia. The surgical technique included a temporal (pretrichial) incision with subcutaneous dissection toward the lateral brow, with superolateral lift and closure. Total of 45 patients (44 females, 1 male; mean age: 58 years) underwent the temporal (pretrichial) subcutaneous lateral brow lift technique under local anesthesia in office setting. The procedure was unilateral in 4 cases. Additional procedures included upper blepharoplasty (38), ptosis surgery (16), and lower blepharoplasty (24). Average follow-up time was 1 year (range, 6 months to 5 years). All patients were satisfied with the eyebrow contour and scar appearance. One patient required additional brow lift on one side for asymmetry. There were no cases of frontal nerve paralysis. In conclusion, the temporal (pretrichial) subcutaneous approach is an effective, safe technique for lateral brow lift/contouring, which can be performed under local anesthesia. It is ideal for women. Additional advantages include ease of operation, cost, and shortening the hairline (if necessary).

Introduction: Although some descriptive and cross-sectional studies have been reported about bone mass in chronic kidney disease (CKD) children, only a few studies investigated markers of bone turnover and the bone mass measurements. Objectives: The aim of this study was to evaluate the association between bone mineral density (BMD) and biochemical markers of bone turnover in hemodialysis (HD) children. Patients and Methods: The children who had received dialysis for at least the preceding 6‐month were included. BMD was measured for total body, the lumbar spine and the femoral neck and the blood samples were tested to assess biochemical bone turnover markers. Results: The study group was comprised of 27 patients with CKD, 9 males (33%) and 18 females (67%) with the mean±SD age of the subjects 14.9±4.5 years. Positive significant correlations of parathyroid hormone (PTH) with total body bone densitometry Z-score, lumbar spine and femoral neck Z-score(r=0.43, P=0.06; r=0.41, P=0.08 and r=0.45, P=0.05, respectively) was noted. In addition, positive significant correlations calcium and total body, lumbar spine and femoral neck Z-score (r=0.52, P=0.02; r=0.28, P=0.23 and r=0.36, P=0.12, respectively) was seen. Interestingly, a positive significant correlation between alkaline phosphatase (ALP) and lumbar spine Z-score was found (r=0.46, P=0.04), while the correlation of this parameter with total body and femoral neck Z-score was not significant (P>0.05). Conclusion: In our study, majority of patients with CKD had low level of BMD. In addition, lower levels of calcium (Ca), phosphorus (P), PTH and 25 (OH) vitamins D in patients with abnormal BMD Z-scores were detected.

Background Lower limb amputation is a major public health issue globally, and its prevalence is increasing significantly around the world. Previous studies on lower limb amputees showed analogous complexity implemented by the neurological system which does not depend on the level of amputation. Research question What are the differences in muscle synergies between healthy subjects (HS) and transfemoral amputees (TFA) during self-selected normal transient-state walking speed? Methods thirteen male HS and eleven male TFA participated in this study. Surface electromyography (sEMG) data were collected from HS dominant leg and TFA intact limb. Concatenated non-negative matrix factorization (CNMF) was used to extract muscle synergy components synergy vectors (S) and activation coefficient profiles (C). Correlation between a pair of synergy vectors from HS and TFA was analyzed by means of the coefficient of determination (R2). Statistical parametric mapping (SPM) was used to compare the temporal components of the muscle synergies between groups. Results the highest correlation was perceived in synergy 2 (S2) and 3 (S3) and the lowest in synergy 1 (S1) and 4 (S4) between HS and TFA. Statistically significant differences were observed in all of the activation coefficients, particularly during the stance phase. Significant lag in the activation coefficient of S2 (due mainly to activated plantarflexors) resulted in a statistically larger portion of the gait cycle (GC) in stance phase in TFA. Significance Understanding the activation patterns of lower limb amputees’ muscles that control their intact leg (IL) and prosthetic leg (PL) joints could lead to greater knowledge of neuromuscular compensation strategies in amputees. Studying the low-dimensional muscle synergy patterns in the lower limbs can further this understanding. The findings in this study could contribute to improving gait rehabilitation of lower limb amputees and development of the new generation of prostheses.

Background: Traffic accidents are recognized as the main cause of mortality and morbidity worldwide particularly in developing countries and it causes major health problems that endanger human health. This study aims to determine the disability period and the severity of traumatic injuries caused from traffic accidents. Patients refereed to Imam Khomeini University Hospital in Urmia during year 2016 were enrolled. Methods: This cross-sectional study was carried out on 1705 traffic accident victims which referred to Imam Khomeini University Hospital in Urmia during 2016. The data were collected using a checklist containing demographic characteristics, type of accident, and severity of injury and finally the length of disability period. Length of disability achieved by following up through telephone call. To determine the ISS score, according to the expert’s opinion, ranked 1-6 and evaluated. Results: In this study 1231 (72.1%) patients were enrolled. The average age of the patients was 33.63 (30.00) Seventy seven (0.04%) had fatal injuries, 593 (42.5%) of them returned to their normal activity after two months. The mean and standard deviation of return to normal was 86/78 (104/224). The majority of injured patients had a mild limb injury, while most injuries were life-threatening. Conclusions: In this study, most of the injured were male, married, young and concerned about compensation for financial losses, and most of the fatal injuries had a critical health hazard, which generally required crucial steps to improve health for quick return to work and reduce harm. Keywords: Injuries, Disability, Accidents

Background The aim of the present study was to determine whether postprocedural antibiotic reduces the risk of infection related to the cardiac implantable electronic device (CIED) implantations. Methods The present investigation is a randomized, prospective, single-blinded controlled trial. All consecutive patients who presented for new CIED implantation, generator replacement, or upgrade were randomized into the following three groups: (A) no antibiotic, (B) intravenous (IV) antibiotic for 1 day, (C) 1 day IV plus 7 days oral antibiotic. Follow-up was performed on 10-12 days; 1, 3, 6 months; and then every 6 months for 2 years. The primary endpoint was any evidence of infection at the generator pocket or systemic infection related to the procedure at short-term (6-month) and long-term (2-year) follow-ups. Results Of the 450 patients (72 patients with cardiac resynchronization device) included in the study, the primary endpoint of short-term infection was reached in one patient (0.2%) in group A and no patients in groups B and C. The endpoint of long-term infection was reached in nine patients (2%) with equal frequency between three randomized groups (three patients in each group). On multivariable analysis, the only independent predictor of infection was defibrillator implantation (odds ratio, 8.5; 95% confidence interval, 1.6-45). Conclusions The results of this prospective study showed no benefit for the postoperative antibiotic for the prevention of CIED infection.

Non-small-lung cancer (NSCLC) is the leading cause of cancer death. Early detection of NSCLC could pave the way for effective therapies. Analysis of molecular genetic biomarkers in biological fluids has been proposed as a useful tool for cancer diagnosis. Here, we aimed to develop a panel of noncoding RNAs (ncRNAs) in sputum for NSCLC early detection. Expression of 11 ncRNAs were analyzed by real-time polymerase chain reaction in sputum samples of 30 NSCLC patients and 30 sex- and age-matched cancer-free controls. Stability of endogenous microRNAs (miRNAs) in sputum was evaluated after 3 and 6 days at 4°C, 6 months, and 1 year at -80°C. Nine ncRNAs showed significant differences of their expression in sputum between NSCLC patients and controls. A logistic regression model with the best prediction was built based on miR-145, miR-126, and miR-7. The composite of the three miRNAs produced 90% sensitivity and specificity in distinguishing NSCLC patients from the controls. Results indicate that miRNAs could be useful biomarkers based on their stability under various storage conditions and maintain differential changes between cancer and control groups. Moreover, measurement of miRNAs in sputum could be a noninvasive approach for detection of lung cancer.

Over the past few years, visual prostheses (namely, Argus II retinal implant) and gene therapy have obtained FDA approval in treating blindness resulting from retinitis pigmentosa. Compared to gene therapy; Argus II is less costly with a demonstrated favorable outcome, though the vision is yet artificial. To obtain better results, expectation counseling and preoperative retinal assessment are critical. The global experience with Argus II has enrolled no more than 300 cases so far. The first Argus II retinal prosthesis in Iran was successfully implanted in Shiraz (October 2017). To date, Argus II artificial retina is implanted in four patients in Iran. Beside successful surgery and post-operative care, rehabilitation efforts with validated outcome measures including visual rehabilitation together with neurovisual, visuo-constructive and cognitive rehabilitation/empowerment approaches are expected to boost the functional outcome. A multidisciplinary approach within a cross-functional team would optimize strategies toward better patient outcomes. As such, establishing a collaborative network will foster organized research efforts to better define outcome assessment and rehabilitation strategies. This technology report paper has been an attempt to provide an overview of Argus-II retinal implant global experience as well as the clinical outcome of the so far cases in Iran. Insights from this report were communicated during the first "Brain Engineering and Computational Neuroscience Conference," 31 January-2 February 2018 in Tehran.

Purpose: To provide the clinical recommendations for the administration of intravitreal anti-vascular endothelial growth factor (VEGF) drugs especially bavacizumab for ocular vascular diseases including diabetic macular edema, neovascular age-related macular degeneration, myopic choroidal neovascularization, retinal vein occlusion and central serous chorioretinopathy. Methods: Twenty clinical questions were developed by the guideline technical committee. Relevant websites and databases were searched to find out the pertinent clinical practice guidelines to answer the questions. The technical committee provided possible answers (scenarios) according to the available evidences for each question. All scenarios along with their levels of evidence and the supported articles were sent to the experts for external review. If the experts did not agree on any of the scenarios for one particular clinical question, the technical committee reviewed all scenarios and their pertinent evidences and made the necessary decision. After that, the experts were asked to score them again. All confirmed scenarios were gathered as the final recommendations. Results: All the experts agreed on at least one of the scenarios. The technical committee extracted the agreed scenario for each clinical question as the final recommendation. Finally, 56 recommendations were developed for the procedure of intravitreal anti-VEGF injection and their applications in the management of ocular vascular diseases. Conclusion: The implementation of this guideline can standardize the management of the common ocular vascular diseases by intravitreal injection of anti-VEGF agents. It can lead to better policy-making and evidence-based clinical decision by ophthalmologists and optimal evidence based eye care for patients.

BACKGROUND: Laryngeal mask airway is still accompanied by complications such as sore throat. In this study, effects of three methods of reducing postoperative sore throat were compared with the control group. METHODS: 240 patients with ASA I, II candidates for cataract surgery were randomly divided into four same groups. No supplementary method was used in the control group. In the second, third and fourth groups, lidocaine gel, washing cuff before insertion, and washing mouth before removing laryngeal mask airway were applied, respectively. Anesthesia induction was done with fentanyl, atracurium, and propofol and maintained with propofol infusion. The incidence of sore throat was evaluated during the recovery, 3-4 h later and after 24 h using verbal analog scale. The data were analyzed by t-test, analysis of variance and chi-square using SPSS V11.5. RESULTS: Age, gender, duration of surgery and cuff pressure were the same in all the four groups. Incidence of sore throat at recovery room was highest in the control group (43.3%) and lowest in the washing mouth group (25%). However, no significant statistical difference was observed between these four groups (recovery, p = 0.30; discharge, p = 0.31; examination, p = 0.52). In this study, increased duration of operation had a significant relationship with the incidence of sore throat (p = 0.041). CONCLUSION: Sore throat is a common postoperative problem, but no special method has been found completely efficient yet. In this study, cuff washing, lidocaine gel, and mouth washing before removing laryngeal mask airway were not helpful for sore throat. JUSTIFICATIVA: A máscara laríngea ainda é relacionada a complicações como a dor de garganta. Neste estudo, os efeitos de três métodos para reduzir a dor de garganta, no período pós-operatório, foram comparados com o grupo controle. MÉTODOS: Duzentos e quarenta candidatos,com estado físico ASA I-II, foram aleatoriamente divididos em quatro grupos iguais para a cirurgia de catarata.com estado físico ASA I-II, candidatos para a cirurgia de catarata foram aleatoriamente divididos em quatro grupos iguais. Nenhum método complementar foi usado no grupo controle. No segundo, terceiro e quarto grupos, os métodos utilizados foram: Aplicação de gel de lidocaína, lavagem do manguito antes da inserção e lavagem da boca antes de remover a máscara laríngea, respectivamente. A anestesia foi induzida com fentanil, atracúrio e propofol e mantida com propofol. A incidência de dor de garganta foi avaliada durante a recuperação, 3-4 h depois e após 24 h usando uma escala verbal analógica. Teste-t, análise de variância e teste do qui-quadrado foram usados para a análise dos dados por meio do programa estatístico SPSS V11.5. RESULTADOS: Idade, gênero, tempo de cirurgia e pressão do manguito foram semelhantes em todos os quatro grupos. Na sala de recuperação, a incidência de dor de garganta foi maior no grupo controle (43,3%) e mais baixa no grupo lavagem da boca (25%). No entanto, não houve diferença estatisticamente significante entre os quatro grupos (recuperação, p = 0,30; alta, p = 0,31; exame, p = 0,52). Neste estudo, o tempo mais longo de cirurgia apresentou relação significativa com a incidência de dor de garganta (p = 0,041). CONCLUSÃO: Dor de garganta é um problema pós-operatório comum, mas nenhum método em especial foi considerado totalmente eficiente. Neste estudo, a lavagem do manguito, a aplicação de gel de lidocaína e a lavagem de boca antes de remover a máscara laríngea não foram úteis para evitar a dor de garganta.

BACKGROUND: Laryngeal mask airway is still accompanied by complications such as sore throat. In this study, effects of three methods of reducing postoperative sore throat were compared with the control group. METHODS: 240 patients with ASA I, II candidates for cataract surgery were randomly divided into four same groups. No supplementary method was used in the control group. In the second, third and fourth groups, lidocaine gel, washing cuff before insertion, and washing mouth before removing laryngeal mask airway were applied, respectively. Anesthesia induction was done with fentanyl, atracurium, and propofol and maintained with propofol infusion. The incidence of sore throat was evaluated during the recovery, 3-4 h later and after 24 h using verbal analog scale. The data were analyzed by t-test, analysis of variance and chi-square using SPSS V11.5. RESULTS: Age, gender, duration of surgery and cuff pressure were the same in all the four groups. Incidence of sore throat at recovery room was highest in the control group (43.3%) and lowest in the washing mouth group (25%). However, no significant statistical difference was observed between these four groups (recovery, p = 0.30; discharge, p = 0.31; examination, p = 0.52). In this study, increased duration of operation had a significant relationship with the incidence of sore throat (p = 0.041). CONCLUSION: Sore throat is a common postoperative problem, but no special method has been found completely efficient yet. In this study, cuff washing, lidocaine gel, and mouth washing before removing laryngeal mask airway were not helpful for sore throat.

Right heart catheterization (RHC) remains the gold standard for hemodynamic assessment of the right heart and pulmonary artery. However, this is an invasive tool, and noninvasive alternatives such as transthoracic echocardiography (TTE) are preferable. Nonetheless, the correlation between measurements by TTE and RHC are debated. In this study, we prospectively examined the correlation between systolic and mean pulmonary artery pressures (sPAP and mPAP) measured by RHC and TTE in patients with hemodynamically significant rheumatic mitral stenosis (MS). Material and Methods: Three hundred patients with hemodynamically significant MS undergoing TTE who were scheduled to undergo RHC within 24 hours were analyzed. PAP measurements were taken for all patients by RHC (sPAPRHC, mPAPRHC). Maximum velocity of tricuspid regurgitation (TR) jet obtained by continuouswave Doppler with adding right atrial (RA) pressure was used for measuring sPAP by TTE (sPAPTRVmax). Mean PAP was measured using either pulmonary artery acceleration time (mPAPPAAT) method or by adding RA pressure to velocity–time integral of TR jet (mPAPTRVTI). Results: A good correlation between sPAPRHC and sPAPTRVmax (r = 0.89, P < 0.001), between mPAPRHC and mPAPPAAT (r = 0.9, P < 0.001), and between mPAPRHC and mPAPTRVTI (r = 0.92, P < 0.001) was found. Sensitivity and specificity of sPAPTRVmax in detecting pulmonary hypertension (PH) were 92.8% and 86.6% and of mPAPPAAT were 94.1% and 73.3%, respectively. Conclusion: The noninvasive assessment of sPAP and mPAP by TTE correlates well with invasive measurements and has an acceptable specificity and sensitivity in detecting PH in patients with hemodynamically significant MS. (Echocardiography 2015;00:1–7)

Purpose: Recent developments in the field of cell therapy have led to a renewed interest in treatment of acute kidney injury (AKI). However, the early death of transplanted mesenchymal stem cells (MSCs) in stressful microenvironment of a recipient tissue is a major problem with this kind of treatment. The objective of this study was to determine whether overexpression of a cytoprotective factor, nuclear factor erythroid-2 related factor 2 (Nrf2), in MSCs could protect rats against AKI. Methods: The Nrf2 was overexpressed in MSCs by recombinant adenoviruses, and the MSCs were implanted to rats suffering from cisplatin-induced AKI. Results: The obtained results showed that transplantation with the engineered MSCs ameliorates cisplatin-induced AKI. Morphologic features of the investigated kidneys showed that transplantation with the MSCs in which Nrf2 had been overexpressed significantly improved the complications of AKI. Conclusion: These findings suggested that the engineered MSCs might be a good candidate to be further evaluated in clinical trials. However, detailed studies must be performed to investigate the possible carcinogenic effect of Nrf2 overexpression.

Purpose of study: The current study has been performed in order to compare social physique anxiety and Body Dismorphic Disorder between a group under medical cosmetic treatments and a control group. Methods: The study population consisted of 200 subjects, undergoing medical cosmetic therapy and 200 not receiving any medication considering this matter, which were selected by hand-to-hand and simple random sampling. In this post-causal study, to gather the information required for Heart’s social physical anxiety criterion, Philips’ Body Dysmorphic Disorder diagnostic questionnaire was distributed amongst the subjects. Findings: A significant difference and opposition, considering the degree of social physical anxiety (p=0.04), the number of persons with Body Dysmorphic Disorder (P=0.05) and those who showed a tendency towards cosmetic surgery (P=01), was observed between the main group of subjects and the control group. In both groups, those who had physical disorders, abnormalities or deformities, experienced higher levels of social physique anxiety. This value was reported higher in the subjects of the control group. Conclusion: The results indicate that the subjects of the group which had visited a center in order to receive cosmetic treatments, experience lower levels of social physique anxiety. Having Body dysmorphic Disorder and not receiving the required cosmetic treatments and medications, were determined the most important factors in predicting social physical anxiety levels, whilst other attributes, such as gender and the patient’s tendency towards undergoing a cosmetic surgery, are not effective in the prediction of such a value.

One of the major obstacles in cancer therapy is the lack of anticancer agent specificity to tumor tissues. The strategy of cell-based therapy is a promising therapeutic option for cancer treatment. The specific tumor-oriented migration of mesenchymal stem cells (MSCs) makes them a useful vehicle to deliver anticancer agents. In this study, we genetically manipulated bone marrow-derived mesenchymal stem cells with their lipocalin 2 (Lcn2) in order to inhibit liver metastasis of colon cancer in nude mice. Lcn2 was successfully overexpressed in transfected MSCs. The PCR results of SRY gene confirmed the presence of MSCs in cancer liver tissue. This study showed that Lcn2-engineered MSCs (MSC-Lcn2) not only inhibited liver metastasis of colon cancer but also downregulated the expression of vascular endothelial growth factor (VEGF) in the liver. Overall, MSCs by innate tropism toward cancer cells can deliver the therapeutic agent, Lcn2, and inhibit cancer metastasis. Hence, it could be a new modality for efficient targeted delivery of anticancer agent to liver metastasis.

Background: Tumors of the central nervous system (CNS) are a heterogeneous group of neoplasms with different prevalence in different sex and age groups and various parts of CNS. Objectives: Determining the relative frequency of different types of CNS tumors in different ages, sex and CNS anatomical locations. Materials and Methods: This retrospective study was performed using pathological reports of CNS tumors from patients in three main referral neurosurgical hospitals in Guilan, Iran from 1999 to 2009, which provided the following demographical data: patient age at the time of hospital admission, gender, histological diagnosis and the anatomical location of tumors. Results: From a total of 365 cases, 292 were brain tumors (80%) and the remaining 20% were diagnosed as spinal tumors. There were 27 different types of CNS tumors in the present study, with astrocytomas (28.5%) and meningiomas (27.1%) being the most common types among brain tumors and schwannomas (35.1%) being the most common among spinal cord tumors. Frontal lobe (17.5%) was the most common anatomical location for brain tumors, and thoracic region was the most common region affected by spinal cord tumors (41.1%). Metastatic or secondary tumors accounted for 3.8% of the CNS tumors in our study. Contrary to most other studies, the frequency of CNS tumors was higher in females than males and was most frequent in the 5th decade of life. Conclusions: This study demonstrated the high frequency of CNS tumors with astrocytic origin. The most common tumor was astrocytoma, with meningioma being the second most prominent one.