Search

Background: Current data indicate that serum vitamin D and susceptible C-reactive protein (hs-CRP) levels, both indicative of the inflammatory state, have the potential to predict the onset and severity of chronic pain. Therefore, the objective was to assess the intensity of pain experienced after breast cancer treatment and its relationship with these two parameters. Method: In this cross-sectional study between 2019 and 2021, 201 patients were enrolled. The McGill Pain Questionnaire was employed to evaluate localized pain intensity at the site six months after the conclusion of cancer treatments. Patients were stratified based on the type of breast surgery, with or without a tissue expander, axillary region surgery, chemotherapy treatment, radiotherapy treatment, serum vitamin D levels, serum hs-CRP levels, and pain intensity. Data analysis was performed using SPSS 21 software with a significance level set at 0.05. Results: Among the patients, 67.6% (136 individuals) reported mild pain, 31.3% (63 individuals) reported moderate pain, and 1% (2 individuals) reported severe pain. The results of this study demonstrated a positive correlation between high serum hs-CRP levels and increased pain intensity, with serum marker levels being higher in patients experiencing more severe pain compared with those with milder pain. However, no statistically significant association was observed between various serum concentrations of vitamin D and pain intensity (P = 0.12). Conclusion: Elevated levels of inflammatory factors, such as hs-CRP, are linked to a higher likelihood of developing chronic post-surgical pain.

Abstract Epithelial‐stromal interplay through chemomechanical cues from cells and matrix propels cancer progression. Elevated tissue stiffness in potentially malignant tissues suggests a link between matrix stiffness and enhanced tumor growth. In this study, employing chronic oral/esophageal injury and cancer models, it is demonstrated that epithelial–stromal interplay through matrix stiffness and Hedgehog (Hh) signaling is key in compounding cancer development. Epithelial cells actively interact with fibroblasts, exchanging mechanoresponsive signals during the precancerous stage. Specifically, epithelial cells release Sonic Hh, activating fibroblasts to produce matrix proteins and remodeling enzymes, resulting in tissue stiffening. Subsequently, basal epithelial cells adjacent to the stiffened tissue become proliferative and undergo epithelial‐to‐mesenchymal transition, acquiring migratory and invasive properties, thereby promoting invasive tumor growth. Notably, transcriptomic programs of oncogenic GLI2, mechano‐activated by actin cytoskeletal tension, govern this process, elucidating the crucial role of non‐canonical GLI2 activation in orchestrating the proliferation and mesenchymal transition of epithelial cells. Furthermore, pharmacological intervention targeting tissue stiffening proves highly effective in slowing cancer progression. These findings underscore the impact of epithelial‐stromal interplay through chemo‐mechanical (Hh‐stiffness) signaling in cancer development, and suggest that targeting tissue stiffness holds promise as a strategy to disrupt chemo‐mechanical feedback, enabling effective cancer treatment.

ObjectiveEsophageal cancer is a therapeutic challenge in most healthcare systems. Most patients present with locally advanced disease at diagnosis. Concurrent chemoradiotherapy (CRT) is the standard treatment for locally advanced esophageal carcinoma. Since achieving a complete pathological response in postoperative specimens following neoadjuvant therapy is associated with improved patient survival, this study was designed to evaluate the pathologic response of localized or locally advanced esophageal carcinoma to induction chemotherapy followed by preoperative concurrent chemotherapy and hypofractionated radiotherapy (HFR).MethodsThis single-arm clinical trial (IRCT20210623051676N1) evaluated patients with squamous cell carcinoma or adenocarcinoma of the esophagus, stage cT2-T4a N0 M0 or cT1-T4a N+ M0. Patients received 3-5 cycles of weekly induction chemotherapy with the paclitaxel (50 mg/m2) and carboplatin (AUC=2) regimen, followed by weekly concurrent CRT with the same chemotherapy regimen. The radiation dose was 40 Gy, delivered over 16 fractions, 5 days per week (2.5 Gray/fraction). Patients underwent surgery 4-6 weeks after completion of CRT. The surgical specimens were evaluated for pathological response. A p-value of < 0.05 was considered significant in all analyses.ResultsOut of 54 patients enrolled in this study, 45 completed the neoadjuvant protocol. Of these 45 patients, 32 underwent surgery and were finally analyzed. The mean age of the patients was 59.9 ± 8.6 years (range, 37-75 years). The location of the tumor was in the mid-thoracic esophagus in most patients (21, 65.6%) and the most common histological type was SCC (29, 90.6%). The median number of induction and concurrent chemotherapy cycles was 5 (4.8 ± 1.3 course, range, 1-10) and 3 (2.6 ± 0.8 course, range, 0-4), respectively. Among 45 patients who completed the neoadjuvant protocol, the most common toxicities were grade 3 neutropenia (15.6%), acute renal failure (4.4%), and odynophagia (37.8%). Nearly two-thirds of the patients experienced complete or near-complete responses (71.9%, 23 patients). Partial response was reported in 6 patients (18.8%) and poor response in 3 patients (9.4%).ConclusionPreoperative induction chemotherapy followed by HFR with concurrent chemotherapy has low toxicity and side effects, good tolerance, and significant efficacy in the treatment of patients with esophageal cancer.Clinical trial registrationhttps://irct.behdasht.gov.ir/trial/59930, identifier NCT05745545.

In today's competitive market, predicting clients' behavior is crucial for businesses to meet their needs and prevent them from being attracted by competitors. This is especially important in industries like telecommunications, where the cost of acquiring new customers exceeds retaining existing ones. To achieve this, companies employ Customer Churn Prediction approaches to identify potential customer attrition and develop retention plans. Machine learning models are highly effective in identifying such customers; however, there is a need for more effective techniques to handle class imbalance in churn datasets and enhance prediction accuracy in complex churn prediction datasets. To address these challenges, we propose a novel two-level stacking-mode ensemble learning model that utilizes the Whale Optimization Algorithm for feature selection and hyper-parameter optimization. We also introduce a method combining K-member clustering and Whale Optimization to effectively handle class imbalance in churn datasets. Extensive experiments conducted on well-known datasets, along with comparisons to other machine learning models and existing churn prediction methods, demonstrate the superiority of the proposed approach.

Introduction: The breast cancer burden is still increasing, both in developing and developed countries. The present study was conducted to determine the survival rate of breast cancer based on tumor biological subtypes in patients referring to three referral oncology centers at Mashhad University of Medical Sciences, Mashhad, Iran.Methods: The present population-based study was conducted at Imam Reza Hospital, Omid Hospital, and Reza Oncology Center, Mashhad University of Medical Sciences, Mashhad, Iran Demographic information, the status of biomarkers in immune-histochemical evaluation, clinical and pathological features of the tumor, type of therapy, recurrence, or death was recorded for each eligible patient.Results: In total, 247 patients were included in the study. The mean age of patients was 48.8 ± 1.3 years. The mean time of survival was 2.64±0.13 years. In detail, the survival rate from the first year to the fifth year was reported as 100%, 96%, 91%, 90%, and 89%, respectively. The survival rate of the luminal B subtype was higher than other subtypes but the difference was not significant (P=0.7). Only in terms of metastasis, there was a significant difference between the alive and dead patients (P=0.0001).Conclusion: Despite no significant relationship between biological markers, the breast cancer subtype, and its survival rate, the overall survival rate of the patients decreased lightly through five years. However, further studies are required to indicate more accurate data about the breast cancer survival rate in our region.

Frankenstein; or, The Modern Prometheus (1818) stands as a seminal work within the realm of English gothic literature. Infused with the spirit of the Romantic movement, Mary Shelley skillfully explores the clashes between nature and culture. This article delves into the evolution of language games during the early nineteenth century, tracing the shift from denotative and perspective-oriented language games to technical language games where the efficiency of objects and knowledge takes precedence. Shelley, in her narrative, challenges the unquestioned authority of knowledge and human reason, rejecting the notion that Reason alone can be the source of human bliss. Instead, the novel consistently highlights the shortcomings of human Reason in addressing the characters’ needs. Entrapped by the deceptive allure of man’s Reason, Frankenstein inadvertently brings forth a monstrous creation that wreaks havoc upon his life and the lives of others. Notably, Frankenstein’s monster serves as a symbolic embodiment of Enlightenment ideals. Shelley proposes an alternative solution rooted in a return to nature and human emotions, positing that these elements can offer genuine happiness and delight to humanity. The novel unfolds as a critical examination of the Enlightenment era and the dominance of technical language games. Additionally, her portrayal of nature complicates the human/nature relationship, problematising the proposed return to a more harmonious coexistence.

This paper deals with Wallace Stevens’s first collection of poetry, Harmonium, in light of Heidegger’s philosophy, with a particular emphasis on Da-sein as the place of negativity. The focus is particularly on Heidegger’s later philosophy, where he defines Man as the juncture where the four constitutive elements (earth, sky, divinities, and mortals) converge to let Da-sein appear as the futural authentic animal whose Being matters to him as his distinctive mark. Stevens’s poetry in Harmonium displays an experimental development along the same lines. The collection consists of poems dealing with the effect that the prospects of death and finitude have on its protagonists. Stevens achieves authentic protagonists who accept the nihilating power of death in order to save themselves from any form of social, poetic, and philosophical closure. This is significant because Stevens conceives a creative potential that not only runs counter to the romantic nostalgia for a return to an innocent past, but also openly embraces the idea of finitude as the only way out of any logocentric and metaphysical forms of thinking. This study, therefore, aims to show how in Harmonium Stevens poetizes an endless creative power that sets upon reproducing the non-closure associated with nihilation and nothingness.

Abstract Pathological dermal scars such as keloids present significant clinical challenges lacking effective treatment options. Given the distinctive feature of highly stiffened scar tissues, deciphering how matrix mechanics regulate pathological progression can inform new therapeutic strategies. Here, it is shown that pathological dermal scar keloid fibroblasts display unique metamorphoses to stiffened matrix. Compared to normal fibroblasts, keloid fibroblasts show high sensitivity to stiffness rather than biochemical stimulation, activating cytoskeletal‐to‐nuclear mechanosensing molecules. Notably, keloid fibroblasts on stiff matrices exhibit nuclear softening, concomitant with reduced lamin A/C expression, and disrupted anchoring of lamina‐associated chromatin. This nuclear softening, combined with weak adhesion and high contractility, facilitates the invasive migration of keloid fibroblasts through confining matrices. Inhibiting lamin A/C‐driven nuclear softening, via lamin A/C overexpression or actin disruption, mitigates such invasiveness of keloid fibroblasts. These findings highlight the significance of the nuclear mechanics of keloid fibroblasts in scar pathogenesis and propose lamin A/C as a potential therapeutic target for managing pathological scars.

Background: A growing amount of data has indicated the possibility that tumor location may play a prognostic role in colon cancer. We set out to investigate the relationship between the location of colon cancer (right-sided vs. left-sided) and the patient’s oncologic outcome. Methods: This retrospective cohort study included 654 colon cancer patients treated and followed up at Namazi and Faghihi hospitals in Shiraz and Imam Reza Hospital in Mashhad, Iran, between 2005 and 2014. The Cox regression multivariate analysis model was used to determine the most important independent predictors of oncologic outcomes. We analyzed the prognostic impact of the primary tumor location and other clinical, pathological, and treatment-related factors.Results: In the univariate analysis, the prognostic factors for disease-free survival (DFS) were the primary tumor stage (P

Background and purpose: Cancer diagnosis is a threatening and traumatic experience. Confusion caused by distressing thoughts about cancer can lead to additional suffering and, along with avoidance, can be a key factor in maintenance of traumatic reactions. The current research aimed at comparing the effectiveness of Unified Protocol (UP) of transdiagnostic intervention and mindfulness based schema therapy (MBST) on posttraumatic avoidance (PA) and chronic illness-related cognitive fusion (CICF) in patients with breast cancer (BC). Materials and methods: A semi-experimental study with pretest-posttest design and a follow-up period of 45 days was performed. Statistical population included all female patients with BC in Mashhad, Iran 2018-2021. Cognitive Fusion Questionnaire-Chronic Illness (CFQ-CI) and Posttraumatic Avoidance Scale (PAS) were administered. Forty one patients were selected using purposive sampling and were randomly divided into two experimental groups and a control group. UP of transdiagnostic intervention and MBST were applied in intervention groups for 10 weekly sessions. The control group attended two educational sessions. Data analysis was done using multivariate covariance analysis and Bonferroni post hoc test. Results: The mean scores for CICF and PA were significantly different between the intervention groups and the control group at post-test and follow-up (P0.05). Conclusion: MBST and UP are suggested to be applied in patients with BC to reduce their psychological problems. (Clinical Trials Registry Number: IRCT20211012128050165N1)

In the early decades of the twentieth century, masculinity created a tangled network of man-woman connections centered on power and control. Additionally, how a man formed relationships was very significant in enhancing his public persona. Scott Fitzgerald’s fiction articulates this complicated and contentious historiography of masculinity and its linkages to the era’s literary tradition. This paper proceeds toward masculinity studies to demonstrate the representation of affective masculinity in Fitzgerald’s This Side of Paradise (1920). The authors argue that Deleuze’s concept of “affect” and its relation to modern discourses of masculinity would enhance our perception of Fitzgerald’s construction of masculinity in his debut novel. The paper analyzes the affective transformation of Amory Blaine as a new man based on his interactions with the female characters of the story. The results of the research show that in Fitzgerald’s definition of masculinity, man is affected and enhanced by the gentle feminine features, and Amory Blaine too acquires a new identity for himself.

Background: Computed tomography (CT) of the brain is associated with radiation exposure to the lens of the eyes. Therefore, it is necessary to optimize scan settings to keep radiation exposure as low as reasonably achievable without compromising diagnostic image information. The aim of this study was to compare the effectiveness of the five practical techniques for lowering eye radiation exposure and their effects on diagnostic image quality in pediatric brain CT. Methods: The following scan protocols were performed: reference scan, 0.06-mm Pbeq bismuth shield, 30% globally lowering tube current (GLTC), reducing tube voltage (RTV) from 120 to 90 kVp, gantry tilting, and combination of gantry tilting with bismuth shielding. Radiation measurements were performed using thermoluminescence dosimeters. Objective and subjective image quality was evaluated. Results: All strategies significantly reduced eye dose, and increased the posterior fossa artifact index and the temporal lobe artifact index, relative to the reference scan. GLTC and RTV increased image noise, leading to a decrease signal-to-noise ratio and contrast-to-noise ratio. Except for bismuth shielding, subjective image quality was relatively the same as the reference scan. Conclusions: Gantry tilting may be the most effective method for reducing eye radiation exposure in pediatric brain CT. When the scanner does not support gantry tilting, GLTC might be an alternative.

Background & aim: Mastectomy as the most common treatment of breast cancer has many effects on the quality of sexual life. Since there are limited studies on quality of sexual life in breast cancer, this study was conducted to compare the effect of counseling based on two models of PLISSIT and BETTER on quality of sexual life in women with breast cancer after mastectomy.Methods: This quasi-experimental study was conducted at Mashhad, Iran in 2021. A total of 78 women who underwent mastectomy were randomly allocated into two equal groups and received 4 weekly sessions of individual counseling of 60-90 minutes based on two models of BETTER and PLISSIT. The research tools included demographic and sexual quality of life questionnaire (SQOL-F). The changes in the mean scores of quality of sexual life between the two groups before and 4 weeks after the intervention were measured. Data were analyzed using SPSS software (version 25) with Kolmogorov-Smirnov, independent t-test, paired t-test, Mann-Whitney and Chi-square test.Results: The mean change score of quality of sexual life before and after the intervention in the group who received counselling based on BETTER model (8.6±5.1) was significantly higher than the group were counselled by PLISSIT model (6.2±5.05) (P

Abstract Background Leiomyosarcoma of visceral organs is uncommon, and pancreatic primary occurrence is even rarer. In terms of curative treatment, patients are generally managed with surgery alone, without significant data on the role or efficacy of adjuvant chemotherapy. Case presentation This manuscript presents a case of a 22‐year‐old female with advanced primary leiomyosarcoma of the pancreas, treated with radical surgery and adjuvant radiation therapy. Conclusion With a low‐survival rate, consideration of radiation therapy in some advanced and unresectable cases could be potentially beneficial.

Key Clinical Message Nested variant of urothelial carcinoma (NV‐UC) is an extremely rare cancer with a nonspecific presentation. It is usually identified at a late stage, which makes the treatment challenging. Herein we report the case of a 52‐year‐old woman with an advanced NV‐UC treated by anterior exenteration after a poor response to neoadjuvant chemotherapy. One year after completion of adjuvant radiotherapy, the patient remains disease‐free.

Abstract Background Chronic kidney disease (CKD) is a health problem due to its increasing prevalence and imposes a significant economic burden on the health system. This study aimed to analyze the cost–benefit of kidney transplantation through the valuation of patients with ESRD for a kidney transplant and its costs to help decide this regard. Material and methods This study was a descriptive-analytical and cross-sectional economic evaluation study of health interventions performed in Imam Khomeini Hospital in Urmia from the patient’s perspective. The records of kidney recipients were used to calculate the direct costs of kidney transplantation based on the government tariff rate in 2021. The willingness to pay for kidney transplantation (benefit) was measured through a questionnaire and with a contingent valuation method from 266 samples of patients with ESRD. The questionnaire designed by the researchers had four scenarios with different chances for kidney transplant success. Validation and test–retest methods were used to check the validity and reliability of the questionnaire. Stata software was used to estimate the regression of the factors affecting the willingness to pay and the kidney transplant demand function. Results The average cost of a kidney transplant was $877.4. The average willingness to pay for a kidney transplant for four scenarios was estimated at $4733. The mean cost–benefit ratio (BCR) and net present value (NPV) for the four kidney transplant scenarios were 5.39 and $3855. The variables of employment status, awareness of kidney function, number of years with ESRD, insurance coverage, and patients’ income significantly affected their willingness to pay. However, the effect of other variables was not significant. The absolute value of price elasticity of kidney transplant demand was also equal to 2.13. Conclusion According to the cost–benefit analysis indexes, the study results showed that a kidney transplant has a net positive benefit for all levels of its probability of success, so the willingness to pay or valuation of patients is about five times the cost of a kidney transplant. Also, the demand for kidney transplantation shows the high sensitivity of the demand for this service to the price. Therefore, preparations for kidney transplantation in patients with ESRD should be considered in situations where the price and cost of transplantation change. The results can help health policy-makers decide to allocate financial resources more efficiently.

This paper analyzes Scott Fitzgerald’s novels in light of Deleuze and Guattari’s critique of capitalism. While Deleuze and Guattari’s capitalist social machine is a break from Marxism, it decodes the traditions that define subjective desires or concepts like beauty and ethics. Under capitalism, subjective desire arises as a capitalist desire and reproduces the capitalist power. In his novels, Fitzgerald addresses the idea of the American dream in a similar way. His characters often embody the contradictions of American experience such as success and failure, dream and nightmare, illusion and disillusionment. This paper critically analyzes Deleuze and Guattari’s reading of desire within Marx’s work and the role of the American dream in a capitalist system as a sort of antiproduction. It seeks to illustrate how the concept of love in Fitzgerald’s novels is tied to the idea of money and how their connection delineates, in the same way, the commodification of the desire that Deleuze traces in his reading of Marx. Accordingly, this paper also argues that similar to philosophy, fiction can be employed to provide a better understanding of our represented world.

Background: This study examined the effect of prenatal and early postnatal ethanol exposure on the structural, functional, and molecular alterations of rat’s offspring kidney on postnatal days 21 and 90. Methods: Pregnant rats on gestation day 7 were divided into the two groups, namely control and ethanol groups. Rats in the ethanol group received ethanol (4.5 g/kg B.W) from gestation day 7 throughout lactation. Nephrin, podocin, vascular endothelial growth factor receptors (VEGFRs) 1 and 2 gene expression were measured by RT-PCR technique. The MMP2 and MMP9 levels in the kidney tissue and plasma cystatin C level were measured by ELISA method. Results: The results revealed a significant alteration in mRNA expression of nephrin, podocin, and VEGFR, as well as MMPs amounts in the kidneys of the offspring. Cystatin C level, the ratio of cystatin C/serum creatinine, serum creatinine, and urine urea showed a significant increase, but urine creatinine and GFR showed a significant decrease in the offsprings of the ethanol group compared to the control group. Histopathological changes such as fibrosis, kidney cells proliferation, leukocytes infiltration, and vacuolization have also seen in the kidney of the offsprings after 21 and 90 days from birth. Conclusion: Taken together, these results provide evidence that pre and early postnatal ethanol exposure renal toxicity is in part associated with alteration of nephrin, podocin, and VEGFRs genes expression, as well as MMPs amount changes. Furthermore, it was found that these molecular alterations were triggered by inflammatory reactions manifested by fibrosis, proliferation, and polymorphonuclear(PMN) leukocytes infiltration.

Background: With 6,020 new cases and 1,150 deaths annually in the United States, vulvar cancer is uncommon, resulting in age-adjusted incidence rates of 2.8 and 1.7 per 100,000 in white and black women, respectively. Vulvar cancer represents about 4% to 6% of malignancies of the female genital tract and 0.6% of all cancers in women. Vulvar cancer predominantly affects postmenopausal women, and it is the most common anogenital cancer in women with more than 70 years of age. HPV infection is associated with a significant number of vulvar cancers. Bartholin Gland carcinoma is a rare form of vulvar malignancy that accounts for less than 5% of all vulvar cancers and 0.001% of all genital cancers. The aim of this study was to report a rare case of Bartholin's cancer in a young patient. Case Report: The patient was a 37-year-old woman p2l2 (history of two pregnancy and two delivery) who had complains of severe pain in perineal area and was referred to the gynecology emergency clinic, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran, in June 2020. In past medical history she had no previous history of medical illnesses or surgical interventions. She had swelling and pain in perineal area since one year ago. Bartholin Gland abscess was diagnosed and she received some oral antibiotics, but did not improve. On the last examination under anesthesia, a firm mass of about 3 cm was palpated in the third distal part of posterior vagina which was at the site of Bartholin Gland and was necrotic. The pathologic report of the mass biopsy confirmed the diagnosis of squamous cell carcinoma. The patient was underwent chemo radiation therapy. At a follow up visit about 5 month later she was cured completely and there was not any symptom of recurrence or metastasis. Conclusion: In dealing with any patient with diagnosis of Bartholin Gland abscess, in the case of resistance to medical treatment, further evaluation and biopsy of the mass should be considered to rule out Bartholin's gland cancer.

Objective: Previous clinical trials have suggested that herbal medicines can improve the quality of life (QOL) and survival of cancer patients. This study was aimed to evaluate the effects of a polyherbal compound (PHC, formulated as syrup) consisting of Allium sativum, Curcuma longa,Panax ginseng, and Camellia sinensis on the quality of life (QOL) and survival in patients with upper gastrointestinal cancers.Materials and Methods: A randomized placebo-controlled trial was carried out on patients with esophageal or gastric cancer who had finished their oncological treatments. The patients were randomly assigned to PHC (n=20) or placebo (n=20) group. The PHC group was treated with the PHC for 12 weeks, while the placebo group received 70% sucrose syrup. The QOL was assessed at baseline and after 12 weeks. The patients were followed for up to 24 months to determine overall survival.Results: PHC significantly improved cancer-related symptoms, physical performance, and psychological and social functions of the patients (p

Background: Transverse vaginal septum is a rare mullerian anomaly. Patients with a complete transverse vaginal septum generally complain of primary amenorrhea. Here, we presented a rare case of high transverse vaginal septum with abdominal mass during infancy in addition to chronic pelvic pain and cyclic hematuria during adulthood.Case presentation: The patient was a 26-year-old female with complain of severe abdominal and pelvic pain with significant weight loss. She had a history of surgery for correction of hydrometrocolpos (fluid accumulation in the uterus and vagina) because of transverse vaginal septum at infancy period. She had no gynecologic follow-up until the age of 26 years. At the last surgical evaluation, diffuse pelvic endometriosis with advanced metastatic colon cancer was noted.Conclusion: After diagnosis of transverse vaginal septum during infancy period, detailed counseling should be performed about the other treatment and follow-up which is needed to prevent severe complications that could affect the quality of life.

Abstract After several billions of years, nature still makes decisions on its own to identify, develop, and direct the most effective material for phenomena/challenges faced. Likewise, and inspired by the nature, we learned how to take steps in developing new technologies and materials innovations. Wet and strong adhesion by Mytilidae mussels (among which Mytilus edulis—blue mussel and Mytilus californianus—California mussel are the most well‐known species) has been an inspiration in developing advanced adhesives for the moist condition. The wet adhesion phenomenon is significant in designing tissue adhesives and surgical sealants. However, a deep understanding of engaged chemical moieties, microenvironmental conditions of secreted proteins, and other contributing mechanisms for outstanding wet adhesion mussels are essential for the optimal design of wet glues. In this review, all aspects of wet adhesion of Mytilidae mussels, as well as different strategies needed for designing and fabricating wet adhesives are discussed from a chemistry point of view. Developed muscle‐inspired chemistry is a versatile technique when designing not only wet adhesive, but also, in several more applications, especially in the bioengineering area. The applications of muscle‐inspired biomaterials in various medical applications are summarized for future developments in the field.

Background: Breast cancer is the most frequent malignancy and the leading cause of cancer-related death among women all around the world. In Iran, the mean age of the patients is approximately 10 years younger than that in other countries. We conducted the present study to assess the risk factors of breast cancer among Iranian women in Mashhad. Method: This case-control study was carried out between February 2016 and January 2018 on 460 women (230 cases and 230 controls) in the academic hospitals of Mashhad. The data from our cases and controls were collected and analyzed using SPSS version 18.0 software (SPSS Inc., Chicago, IL, USA). We employed logistic regression models and frequency tables to estimate odds ratio (OR) and to examine the predictive effect of each factor on breast cancer risk. P < 0.05 was considered to be significant. Results: According to multivariate analysis, there was significant associations between breast cancer risk and body mass index (BMI) (Odds ratio (OR), 1.1; 95% Confidence interval (CI), 1.0-1.2), age at menarche (OR, 0.56; 95% CI, 0.47-0.68), menopausal age (OR, 1.1; 95% CI, 1.0-1.1), family history of non-breast malignancies (OR, 7.9; 95% CI, 2.2-21.1), and oral contraception pills (OR, 3.1; 95% CI, 8.34- 1.16). Conclusion: This study revealed that age at menarche, family history of nonbreast cancer malignancies, BMI, menopausal age, and oral contraception pills were significantly associated with breast cancer.

IntroductionNo standard method has been defined to evaluate the therapeutic response of esophageal cancer to neoadjuvant chemoradiotherapy (CRT). This study aimed to determine the predictive value of endoscopic evaluation and biopsy after CRT in predicting the complete pathological response to neoadjuvant CRT in patients with esophageal squamous cell carcinoma (SCC).Materials and MethodThis prospective, descriptive study was conducted on patients with stage II and III esophageal SCC who could undergo esophagectomy. Patients underwent neoadjuvant CRT. Four to six weeks after the end of treatment, re-endoscopy was performed and a biopsy was taken in the presence of a tumor lesion. In the absence of a tumor lesion, the marked site of the esophagus was removed as a blind biopsy. Gastrologist observations during endoscopy and the result of the pathological examination of an endoscopic biopsy were recorded. The patient underwent esophagectomy. The pathology obtained from endoscopic biopsy was compared with the pathology response obtained from esophagectomy.ResultsSixty-nine patients were included in the study, of which 32 underwent esophagectomy. In an endoscopic examination after CRT, 28 patients had macroscopic tumor remnants and 4 patients did not. Pathological examination of the samples obtained from endoscopy showed no tumor remnants in 10 patients (31.3%), and in 22 patients (68.7%), living tumor remnants were seen in the biopsy specimen. Pathologic evaluation of the samples obtained by surgical resection showed that in 13 patients, there were no viable carcinomas in the esophagus or lymph nodes removed, and the rate of pathologic complete response was 40.6. Sensitivity, specificity, positive predictive, and negative predictive values of endoscopic observations were 94.7, 23, 64.2, and 75%, respectively. Preoperative biopsy sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 68.4, 30.7, 59, and 40%, respectively.ConclusionConsidering the negative and positive predictive values of endoscopic observations and biopsy after neoadjuvant CRT, it seems that these two methods alone are not suitable for assessing the pathologic complete response after neoadjuvant treatment.

< p >AbstractIn this study, attempts were made to understand the views of the two legal systems of Iran and the European Union on the revocation and feasibility of it in the donation. The purpose of this study, while familiarizing with the draft EU civil law, was to examine the comparative approach of the revocation and the effects of it in two systems. Finally, while suggesting an opinion on the Iranian and European legislature''s approach and its cases, we have achieved the result that, despite the similarity in the target, Due to the acceptance of the principle of the ability to revocation, the Iranian legislators have made exceptions to the impossibility of revocation; While in the EU law, due to adopting a non-revocation approach, the cases of revocation have been established somewhat limited but reasonable including: Ingratitude, Impoverishment and Change of essential circumstances of the time of concluding the contract after the hangover. This comparative approach to the subject has been widespread in the field of action and opinion and, while imparting the minds of the Iranian legislator, can fill some legal vacuum or bring about a reform of the law.Keywords:Revocation, Donation, Donor, Donee, Dcfr.

Background: Differentiated thyroid cancer (DTC) is the most prevalent endocrine cancer. Evidence showed a significant association between diet and DTC. Thus, this study aimed to assess the relationship between dietary intakes and DTC. Methods: This case-control study was accomplished among 300 adult patients and 300 matched (age and gender) controls in Mashhad city, Iran. Dietary assessment was conducted and the relationship between dietary intakes and DTC were examined by a validated food-frequency questionnaire and logistic regression analysis, respectively. Results: After adjusting for the confounders, a protective effect was observed for the highest tertile of low-fat dairy (OR=0.3, 95% CI=0.17-0.53, P < 0.001) and fruits' intakes (OR=0.28, 95% CI=0.15-0.52, P < 0.001) on DTC. However, the highest tertile of sugar intake was significantly related to greater DTC chance (OR=4.01, 95% CI=2.07-7.79, P < 0.001). A protective role was also found for vegetables in the second tertile of consumption (OR=0.3, 95% CI= 0. 0.17-0.54, P < 0.001) and for tea in the second and third tertiles (OR=0.2, 95% CI= 0.11-0.53, P < 0.001; OR=0.42, 95% CI=0.26-0.69, P = 0.001 respectively). However, the second and third tertiles of the roasted or fried meat consumption were significantly associated with higher DTC chance (OR=1.66, 95% CI= 1.007-2.76, P = 0.04; OR=1.92, 95% CI=1.07-3.42, P = 0.02 respectively). No significant association was detected for other dietary intakes. Conclusions: Consumption of low fat dairy, fruits, vegetables, and tea had a protective effect on DTC; whereas, roasted or fried meat and sugar consumption was significantly associated with higher DTC chance. Further studies are needed to confirm these results.

Background and Objectives: Transaxillary access is one of the latest innovations for minimally invasive aortic valve replacement (MICS-AVR). This study compares clinical performance in a large transaxillary MICS-AVR group to a propensity-matched sternotomy control group. Materials and Methods: This study enrolled 908 patients undergoing isolated AVR with a mean age of 69.4 ± 18.0 years, logistic EuroSCORE of 4.0 ± 3.9%, and body mass index (BMI) of 27.3 ± 6.1 kg/m2. The treatment group comprised 454 consecutive transaxillary MICS-AVR patients. The control group was 1:1 propensity-matched out of 3115 consecutive sternotomy aortic valve surgeries. Endocarditis, redo, and combined procedures were excluded. The multivariate matching model included age, left ventricular ejection fraction, logistic EuroSCORE, pulmonary hypertension, coronary artery disease, chronic lung disease, and BMI. Results: Propensity-matching was successful with subsequent comparable clinical baselines in both groups. MICS-AVR had longer skin-to-skin time (120.0 ± 31.5 min vs. 114.2 ± 28.7 min; p < 0.001) and more frequent bleeding requiring chest reopening (5.0% vs. 2.4%; p < 0.010), but significantly less packed red blood cell transfusions (0.57 ± 1.6 vs. 0.82 ± 1.6; p = 0.040). In addition, MICS-AVR patients had fewer access site wound abnormalities (1.5% vs. 3.7%; p = 0.038), shorter intensive care unit stays (p < 0.001), shorter ventilation times (p < 0.001), and shorter hospital stays (7.0 ± 5.1 days vs. 11.1 ± 6.5; p < 0.001). No significant differences were observed in stroke > Rankin 2 (0.9% vs. 1.1%; p = 0.791), renal replacement therapy (1.5% vs. 2.4%; p = 0.4762), and hospital mortality (0.9% vs. 1.5%; p = 0.546). Conclusions: Transaxillary MICS-AVR is at least as safe as AVR by sternotomy and can be performed in the same time frame. Its advantages are fewer transfusions and quicker postoperative recovery with a significantly shorter hospital stay. The cosmetic result and unrestricted physical abilities due to the untouched sternum and ribs are unique advantages of transaxillary access.

Background and Objectives: Transaxillary access is a straightforward “single incision—direct vision” concept, based on a 5 cm skin incision in the right anterior axillary line. It is suitable for aortic, mitral and tricuspid surgery. The present study evaluates the hospital outcomes of the transaxillary access for isolated mitral valve surgery compared with full sternotomy. Patients and Methods: The final study group included 480 patients. A total of 160 consecutive transaxillary patients served as treatment group (MICS-MITRAL). Based on a multivariate logistic regression model including age, sex, body-mass-index, EuroScore II and LVEF, a 1:2 propensity matched control-group (n = 320) was generated out of 980 consecutive sternotomy patients. Redo surgeries, endocarditis or combined procedures were excluded. The mean age was 66.6 ± 10.6 years, 48.6% (n = 234) were female. EuroSCORE II averaged 1.98 ± 1.4%. Results: MICS-MITRAL had longer perfusion (88.7 ± 26.6 min vs. 68.7 ± 32.7 min; p < 0.01) and cross-clamp (64.4 ± 22.3 min vs. 49.7 ± 22.4 min; p < 0.01) times. This did not translate into longer procedure times (132 ± 31 min vs. 131 ± 46 min; p = 0.76). Both groups showed low rates of failed repair (MICS-MITRAL: n = 6/160; 3.75%; Sternotomy: n = 10/320; 3.1%; p = 0.31). MICS-MITRAL had lower transfusion rates (p ≤ 0.001), less re-exploration for bleeding (p = 0.04), shorter ventilation times (p = 0.02), shorter ICU-stay (p = 0.05), less postoperative hemofiltration (p < 0.01) compared to sternotomy patients. No difference was seen in the incidence of stroke (p = 0.47) and postoperative delirium (p = 0.89). Hospital mortality was significantly lower in MICS-MITRAL patients (0.0% vs. 3.4%; p = 0.02). Conclusions: The transaxillary access for MICS-MITRAL provides superior cosmetics and excellent clinical outcomes. It can be performed at least as safely and in the same time frame as conventional mitral surgery by sternotomy.

Background and Objectives: Marfan syndrome (MS) is a genetic disorder with autosomal dominant inheritance that affects the connective tissue and consequently many organ systems. The cardiovascular manifestations of MS are notorious and include aortic root dilatation or acute aortic dissection, which can cause morbidity and early mortality. However, surgical treatment of aortic pathology may be complicated by musculoskeletal deformity of the chest wall, as in pectus excavatum. In this regard, single-stage combined Bentall and Ravitch surgery is an extreme rarity that has also been scarcely reported in the literature. Patients and Methods: We present the medical history and single-stage Bentall and modified Ravitch surgical treatment of an 18-year-old male MS patient with symptomatic and severe pectus excavatum (PEX) in conjunction with a pear-shaped aortic root aneurysm. To discuss our case in the context of a synopsis of similar published cases, we present a systematic review of combined Bentall surgical aortic aneurysm repair and Ravitch correction of PEX. Results: A total of four studies (one case series and three case reports) and a case from our institution describing a single-stage combined Bentall and Ravitch operation were included. Patients were 22 ± 5.9 years of age (median = 22.5 years) and predominantly male (60%). All cases reported a midline vertical skin incision over the sternum. The most common surgical approach was midsternotomy (80%). In all cases metal struts were used to reinforce the corrected chest wall. Postoperative mortality was zero. Conclusions: Single-stage combined Bentall and Ravitch surgery is an underutilized surgical approach. Its use in MS patients with concomitant PEX and ascending aortic aneurysm that require surgical treatment warrants further investigation. Midsternotomy seems to be a viable access route that provides sufficient exposure in the single-stage surgical setting. Although operative time is long, the intraoperative and postoperative risks appear to be low and manageable.

Background: Gastric cancer is the second global leading cause of death from cancer and the most common gastrointestinal cancer in Iran. This condition is usually diagnosed at advance stages where treatment options are limited. Recently, heat shock proteins (HSPs) have been reported to be overexpressed in a wide range of malignancies and considered as promising candidate biomarkers and therapeutic targets for gastric adenocarcinoma. The aim of the present study was to compare HSPs protein expression between non-tumoral and tumoral sections from patients with gastric adenocarcinoma and determine HSPs protein expression correlation with histological stage, tumoral grade and prognosis. Methods: Immunohistochemistry was used to assess the expression levels of HSP-27, 70 and -90 proteins on both tumoral and non-tumoral (margin of tumor as control group) sections in 80 patients with gastric adenocarcinoma. Further analyses were histology, grade and stage of tumor (Tumor, node, and metastasis), HSPs expression level, clinicopathological significances, and survival rate. Results: The expression of HSPs was significantly increased in tumoral sections compared with non-tumoral sections (P

Aim and Background: Breast cancer, one of the most important cancers, creates many challenges for women who are suffering from it. The aim of present study the study of the efficacy of Comparison of The effectiveness of cognitive-behavioral group therapy and acceptance and commitment group therapy on Self-efficacy in breast cancer patients. Methods and Materials: In a semi experimental study, pre-test, post-test and follow-up with the control group, 60 subjects who were admitted to the study were selected by available sampling method. The subjects were matched on demographic factors and divided in 3 groups of 20 persons. For the group based on acceptance and commitment, 8 training sessions were held and 10 training sessions were held for the group based on cognitive-behavioral therapy, while no intervention was provided for the control group. At the end of the training sessions, The self-efficacy scale (post-test) was performed in each of the 3 groups. Also, 2 months after treatment, 3 groups completed again The self-efficacy scale in the follow up phase. Data analysis was performed using the Repeated Measurement Test and Multivariate Covariance Analysis. Findings: The results demonstrated that both group therapies Improve self-efficacy among patients (P>0.001). Also, the results showed that there is no significant difference between two methods in Improve self-efficacy in patients with breast cancer. (P>0.05) Conclusions: Acceptance and commitment therapy and cognitive - behavioral therapy are effective in Improve self-efficacy in patients with breast cancer.

The high role of the judicial interpretation in the legal system is not overlooked. This research attempts to find the approach of interpretation that Supreme Court obtains in the role and supervisory position of judiciary in interpretation procedure. Yet the problem is how the approach and the interpretative method of the Supreme Court can lead to adjudication or hostility. According to the importance of the unity of interpretation and position of the precedent of the Supreme Court in judicial system, it seems that the Supreme Court has not been effective in interpretation and protecting rights and freedoms. The precedent of the Supreme Court shows that legal formalism and reliance on textualism and literal interpretation of the approach have not been completely dominant and prevalent by the Court and dynamic interpretation in some cases in line with the conditions of cases has been regarded by the Supreme Court. It is important to note that whenever the Court made use of such dynamic and purposeful interpretations, the results lead to adjudication.

Ovarian tumors are rare in childhood and adolescent age. A 14-year-old girl presented with abdominal distention and mild cyclical abdominal pain since 3 months ago. There was an abdominal distention, and huge firm mass was palpated from pelvis to epigastric region. Abdominal ultrasonography revealed normal uterus and large multiloculated adnexal mass with multiple fine septations. Laparotomy was performed, and the ovarian mucinous borderline tumor was reported in frozen section biopsy. Exploration of other abdominopelvic organs revealed no other pathological signs. The final pathological report showed the right ovarian mucinous borderline tumor. Although the mucinous ovarian borderline tumor is a rare condition in adolescent age, pelvic mass, especially with solid or nodular component, must arise this diagnosis, and exploratory laparotomy with comprehensive surgical staging with regard to fertility preservation is warranted.

Introduction: Maintaining and enhancing the quality of life (QOL) of living kidney donors are an essential measure for expressing health outcomes and consequences. Objectives: This study aimed to investigate kidney donors’ QOL at the transplant center of the Imam Khomeini hospital, Urmia, Iran. Patients and Methods: This retrospective cohort study was conducted on 30 kidney donors between the years 1997-2014 at the Imam Khomeini Hospital, Urmia. To this end, a QOL questionnaire was completed and data analysis was performed with SPSS version 22. Results: In this study, 90% (27) of the donors were male. The mean age of the donors at the time of examination and the duration of nephrectomy was 38 ± 9.48 and 7.36 ± 4.62 years, respectively. Fifty percent of the donors had a leave of absence more than 4 weeks after nephrectomy. The mean score of physical function, physical role, emotional role, vitality, mental health, social functioning, bodily pain, and general health was 77.66±25.88, 69.16±35.16, 54.44±45.04, 61.33±17.06, 64.26±19.56, 66.25±22.54, 81.25±18.75, and 61.83±21.83, respectively. However, none of the variables had a significant statistical relationship with QOL (P

Introduction: Concerns about the occurrence of premature kidney failure have been expressed a few years after the kidney donation in the donor due to increase in compensatory blood flow in the remaining kidney nephrons. Objectives: This study aimed to study the kidney function remaining in living kidney donors and its related factors. Patients and Methods: Data were collected from 30 kidney donors in Imam Khomeini hospital in Urmia and evaluated using SPSS-22 software. Results: The mean duration of nephrectomy was 36.36 ± 6.22 years. The mean serum creatinine was significantly increased at the time of examination than before donation, and the glomerular filtration rate (GFR) decreased significantly (P

Background: Cancer antigen 15-3 and carcinoembryonic antigen are used in clinical and laboratory diagnosis of metastatic breast cancer. Previous studies have noted conflicting results about the association between carcinoembryonic antigen and cancer antigen 15-3 in metastatic breast cancer. The present study examined serum tumor marker levels of carcinoembryonic antigen and cancer antigen 15-3 among patients with different subtypes of metastatic breast cancer.Methods: In this cross-sectional study, we assessed metastatic breast cancer patients diagnosed between 2005 and 2012 who referred to academic Hospitals affiliated with Mashhad University of Medical Sciences. The patients were selected by systematic randomization sampling. Demographic, clinical, pathological, and therapeutic data were collected from patients’ hospital records. Statistical analyses were performed by Statistical Package for the Social Sciences version 16.0 software.Results: A total of 298 eligible patients enrolled in the study. Patients’ median age was 48.39±12.57 years. Elevated serum levels of carcinoembryonic antigen were identified in 65.17% of patients and cancer antigen 15-3 in 57.29% of patients. Based on molecular subtype categorization, 109 (39.5%) patients were human epidermal growth factor receptor 2 negative and 105 (38.0%) patients were in the luminal group. There was no significant correlation between serum carcinoembryonic antigen and cancer antigen 15-3 with subtypes of the tumor. The most common sites for metastasis were bones and liver, respectively. However, there was no significant correlation between serum carcinoembryonic antigen and cancer antigen 15-3 with the site of metastasis. There was a significant association between serum carcinoembryonic antigen level and stages IIA and IV.Conclusion: One of the most significant findings of the current study was the increased serum carcinoembryonic antigen and cancer antigen 15-3 levels in most metastatic breast cancer participants. We postulate that regular measurement of serum cancer antigen 15-3 and carcinoembryonic antigen could be useful for earlier detection and prediction of outcomes.

Background: The psychological distress is a kind of mental stress that people experience due to various causes. This study was performed aimed to investigate the psychological distress in cancer patients. Methods: This cross-sectional study was performed during one year on the patients who referred to two academic hospitals of Mashhad University of Medical Sciences for treatment or follow-up. Psychological distress questionnaire was used to collect data. Results were analyzed using SPSS version 16. P

Introduction: The need for English proficiency as an international language and the means to obtain new scientific information is highly felt. Undoubtedly, one of the most important factors affecting language learning is the teaching method. Hence, the purpose of this study was to explore the effects of traditional teaching, blended learning, and virtual education on students’ achievement and their attitudes in Jondishapoor University of Medical Sciences. Methods: This quasi-experimental research examined the independent variable teaching methods (traditional teaching, blended learning and virtual education) and the two dependent variables academic achievement and attitude towards the approaches. 37 nursing students taking English course were randomly divided into three groups. A researcher-made 45-item questionnaire whose validity and reliability had been confirmed was used to measure attitude. Data were analyzed using ANOVA and post-hoc Tukey test. Results: Results indicated that there were significant differences among the teaching methods in the achievement test scores in favor of blended learning. In addition, students’ attitudes towards the blended method was more positive compared to traditional and virtual methods (p

Background: A horseshoe kidney is the most common renal fusion anomaly and occurs in 0.2% to 0.3% of the population. Horseshoe kidneys are fused by the formation of an isthmus between the lower poles of the left and right kidneys during development. The insertion of the ureter in the renal pelvis is displaced super-laterally, probably as the result of incomplete renal rotation, and is associated with a significant rate of ureteropelvic junction (UPJ) obstruction. Case Presentation: We report a patient with single kidney at right side with obstruction in upper ureter. Before the surgery our plan was transureteroureterostomy according to failure of previous surgeries, dismembered pyeloplasty and ureterocalicostomy, but after mobilizing the proximal ureter we noticed that transureteroureterostomy was impossible because of short fibrotic ureter. Other choices such as Boari flap technique with psoas hitch is impossible because of small fibrotic bladder, so we decided to use appendix as ureter substitute. Conclusions: According to our experience and previous studies, we can use appendix as a ureter substitution in refractory proximal and middle ureter stenosis, but in our case we anatomized proximal ureter to appendix instead of anastomosis of pelvic to appendix.

Background: Chemotherapy induced nausea and vomiting (CINV) is a side effect, and has negative effect on quality of life and continuation of chemotherapy. Despite new regimen and drugs, the problems still remain and standard guidelines, effective treatment and supportive care for refractory CINV are still not yet established. Persian medicine, the old Iranian medical school, offer Persumac (prepared from Rhus Coriaria and Bunium Persicum Boiss). Objective: The specific objectives were to assess the effect of Persumac on the number and severity of nausea and vomiting in refractory CINV in acute and delayed phase. Methods: This randomized, double blind, crossover clinical trial study was carried out on 93 patients with breast cancer and refractory CINV, who received outpatient high emetogenic chemotherapy in Imam Reza hospital, Mashhad, Iran from October 2015 to May 2016. The study has three stages: in stage I patients received a questionaire and completed it after chemotherapy. In stage II they were randomly divided into intervention group with Persumac and control group with placebo (lactose were used). In stage III, wash out and crossover was conducted. Both groups in all stages received standard antiemetic therapy for CINV. The following were set as the inclusion criteria of the study: female, Age ≥18 years, clinical diagnosis of breast cancer, history of refractory CINV, normal blood tests and at least three courses of chemotherapy remaining. Exclusion criteria of this study were: Total or upper abdominal radiation therapy along with chemotherapy, drugs/therapy for nausea and vomiting not prescribed in this study, hypersensitivity to Sumac or Bunium Persicum, use of sumac and Bunium Persicum in seven days prior to the intervention, clinical diagnosis of digestion disorders, non-chemotherapy induced nausea and vomiting, milk allergy, loss of two consecutive or three intermittent doses of Persumac or placebo. Outcomes were gathered by Persian questionnaire. Number and severity of nausea and vomiting was measured with a self-reporting tool; visual analog scale. Results: Demographic data and other characters in both groups have no significant diffrence. Eighty of 93 eligible patients in stage I completed the study and in stage II, eleven declined participation for stage III (crossover). P value of carry over, period and treatment effects demonstrated that they had not affected the results before and after crossover. The mean severity of nausea in acute phase was in stage I: 4.83 ± 1.40, stage II: 4.54 ± 2.0 and stage III: 4.15 ± 0.92 in sequence AB (first Persumac and then placebo in crossover), and in sequence BA (first placebo and then Persumac in crossover) was respectively 4.83 ± 1.40, 4.54 ± 2.0, 4.15 ± 0.92 with p value of carry over effect: 0.03 and period effect: 0.22. Except for severity of nausea in acute phase, the mean number http://www.ephysician.ir Page 3536 and severity of nausea and vomiting scores significantly decreased in acute and delayed phase of CINV. Conclusion: Persumac may control the refractory CINV. The implicable and clinical importance of this research is that another option exists for refractory CINV. Higher doses, different cancers, patients with more various features, and more complete methodology and tools can provide appropriate designs for new research on this topic. Trial registration: This trial was registered at the Clinical Trials.gov ID: NCT02787707. Funding: This study is part of a Ph.D. thesis and under grant; No: 930735 of Research Chancellery of MUMS

Breast cancer is the most common malignancy of females. Breast cancer is a heterogenic disease; it consists of several subtypes based on the expression of different genes. Risk factors associated with each subtype is not completely understood, yet. Moreover, recognizing the cancer subtypes may alter the treatment plan. The aim of this study was to evaluate different breast cancer subtypes in women more than 65-year-old. This was a cross-sectional study done on patients with breast cancer aged 65 years and older presenting to clinics of Emam Reza and Omid Hospitals, Mashhad, Iran between 2005 and 2015. Statistical analysis was carried out using SPSS ver. 16. P

This paper is an attempt to critically analyze Parinoush Sani’ee’s Sahm-e Man (translated into English as The Book of Fate) from a New-historical perspective. Beginning from before the 1979 Iranian Revolution, and going forward through the reign of the Islamic Republic to the current years, the time-line of the story shows five decades of changing fortunes of Sani’ee’s main character. Reading her book in the light of New-historicism, this paper tries to show how the story reflects Foucauldian notions of resistance, power relations, normalization, and self-formation in the five phases of Massoumeh’s life. Considering Foucault’s arguments on how power imposes ideology on the citizens, the paper also tries to reflect how it changes in each phase of Massoumeh’s life and how it normalizes her to make her into a docile subject whom it can best control. Added to that, the paper tries to demonstrate her success in resisting the power and acquiring an ethical self through practicing a care for her ‘self’. However, in spite of all her resistances to power and normalization, in the last phase of the story when the novel’s discourse is more emotional, Massoumeh gives up resistance and accepts normalization, and for the sake of her children’s satisfaction, rejects Saiid’s proposal, and like most of the widows in her age, decides to live alone to the end of her life.

Objective: Congestive heart failure (CHF) has become one of the most important health care problems in western countries. This article focuses on the outpatient diagnosis and management of heart failure. We want to compare the outcome of patients who were treated with high dose diuretics in the emergency department (ED) without admission with patients who were admitted to hospital for standard treatment. Methods: This was a randomized prospective clinical trial study. The patients who came to the ED from March 20, 2008 up to August 20, 2008 were divided into two groups randomly. The length of ED stay in the experimental group was documented. Also, readmission and mortality in 6 months and satisfaction in both groups were taken into consideration. All data were analyzed using SPSS 15.0. Results: In experimental group, the rate of recurrent admission, expiration, discharge, clinic visit, and clinic admission was 8%, 4%, 29%, 18%, and 0% respectively. On the other hand, in control group it was 16%, 40%, 18%, 22%, and 2% respectively. Additionally, there was a significant difference between these groups (P = 0.00). Conclusion: This study is the first regional prospective trial to comprehensively examine the therapeutic management in patients with CHF. This study, comparing the high dose diuretic efficacy in the decreasing of hospital stay and readmission; and decreasing mortality rate with routine therapy, showed that there was a significant difference between these two strategies in the mortality rate, readmission, and length of hospital stay (P = 0.00).

Introduction: The molecular mechanisms involved in pathogenesis of esophageal cancer have been the main concern of several studies. In this study, we aimed to investigate the changes of serum prooxidant-antioxidant balance (PAB) value as a redox index, as well as serum C-reactive protein (CRP) compared to healthy control group. Materials and Methods: In a cross-sectional study, blood samples were drawn from 25 patients with esophageal cancer and 25 healthy subjects. Serum CRP and PAB value were measured in all samples according to relevant protocols. Results: Serum CRP was significantly higher in our patients (14.3 ± 3.2 mg/L) compared to healthy control group (4.6 ± 1.4 mg/L), with a p-value of less than 0.001. The value of PAB in our patients (133.9 ± 21.7) was also higher than that of healthy subject (51.3 ± 11.2), indicating a redox perturbation in favor of oxidants. Conclusion: There was a significant increase in both serum PAB value and CRP in patients with esophageal cancer compared to the control group, which indicated both oxidative stress and inflammatory response in patients with esophageal cancer, respectively.

Background: The objective of this study was to evaluate graft survival among the recipients of second renal transplant in Imam Khomeini centre hospital in Urmia. Methods: The study population consisted of 50 patients receiving renal grafts for the second time between 1988 and 2008 in Imam Khomeini centre hospital in Urmia. Two survival outcomes, first and second graft survival, were analyzed. Graft survival was defined from date of transplant until its rejection. For the purpose of graft survival analysis, graft failure was defined as return to dialysis, and death due to the functioning graft. Data were collected through individual patient questionnaires. Demographic and clinical factors, transfusion history, type of immunosuppressive drugs, levels of serum creatinine, triglyceride, cholesterol, and LDL at 3 and 6 months after transplantation were collected. Cox-proportional hazard model and Kaplan-Meier were used to data analysis. Results: First graft survival at 1, 2, 3, and 5 years was 74%, 66%, 53%, and 41%, respectively. Second graft survival at 1, 2, 3, and 5 years was 81%, 74%, 70%, and 61%, respectively. Causes of graft loss in first renal transplantation were 6% sever acute graft rejection, 12% acute graft rejection and 82% chronic graft rejection. In the multivariate analysis, only serum creatinine, blood pressure, and immunosuppressive drugs predicted first graft loss and serum creatinine, immunosuppressive drugs, and related donor family predicted second graft rejection. Conclusion: The serum creatinine and immunosuppressive drugs including cyclosporine, cellcept, and prednisolone are the most influential factors on graft survival.

نهاد مهریه از مختصات نظام حقوقی اسلام است و در سایر سیستم های حقوقی، مانند ندارد. در عقد نکاح مرد مکلف است تا مالی را به زن تملیک نموده یا آن را مثابه یک تعهد مالی بر عهده گیرد. این تعهد مالی مانند سایر دیون، می تواند از جانب شخص ثالثی تضمین گردد. ضمان از پرداخت مهر مشمول قواعد عمومی عقد ضمان است؛ ولی نظر به جنبه عاطفی رابطه طرفین نکاح و تاثیر مهر و تضمین آن بر بنیان خانواده موضوعاتی مطرح می گردد که نمی توان و نباید برای حل آن به قواعد منطقی روی آورد. در این مقاله برآنیم تا ضمن مطالعه مبانی و نظریات پیرامون تکلیف مرد به پرداخت مهریه، رژیم حقوقی حاکم بر ضمانت از پرداخت مهریه را مطالعه نماییم.

Introduction: Cyclosporin A (CsA) is a potent immunosuppressive drug. However, it has adverse effects that include elevation of plasma low-density lipoprotein (LDL). This study was designed to determine the effect of garlic on CsA-induced hyperlipidemia in male rats. Materials and Methods: Baseline serum blood samples from forty 10-month-old, male Wistar rats were obtained. They received intraperitoneal (IP) injection of CsA (25 mg/kg) for 28 days. Blood samples were again obtained after the 28-day treatment. Sixteen of 40 rats showed increased serum LDL levels. These 16 were divided into 2 groups of 8 rats each. In the first (experimental) group, 8 rats received garlic (tablets, 400 mg/d), CsA (25 mg/kg IP), and regular diet for 28 days. In the second (control) group, 8 rats received the same regimen without the garlic tablets. At the end of the experiment, blood samples were taken from animals in both groups, and LDL levels were assessed. Results: The mean baseline LDL level in animals in the control group was 17.75 ± 4.1 mg/dL. This increased to 21.5 ± 1.6 mg/dL after 28 days of CsA administration. After 28 more days, the mean LDL level increased to 25.4 ± 4.9 mg/dL (P = .004). In animals in the experimental group, the baseline LDL level was 23.8 ± 3.7 mg/dL, which increased to 31.3 ± 1.6 mg/dL after the first 28 days (P < .001). After the second 28 days, it decreased to 26.0 ± 4.8 mg/dL (P = .06), and among 4 animals, the LDL level decreased more than 49%. Conclusion: In a Wistar rat model, animals given cyclosporin A subsequently treated with garlic demonstrated reduced LDL levels compared with controls. This treatment may be useful in patients receiving organ transplantations.

Purpose: To analyze urinary calculi composition and its relationship with gender, age, calculus weight, color, and location.Materials and Methods: Two hundred and forty one patients with urinary calculus, who had undergone open lithotomy from June 1999 to April 2001, were enrolled in this prospective study which was performed by Tehran and Oroomieh Medical Sciences Universities. The calculi compositions were analyzed by infrared spectroscopy in Bonn University. Statistical analyses were made by paired t testResults: One hundred and forty five males with a mean age of 40.4 years and 96 females with a mean age of 42.5 years were enrolled in this study. Mean calculus weight was 4.28 gr. Mean calculus number was 4.33. Thirty four (14.1%) calculi were pure (carbonate apatite: 2, brushite: 1, uric acid: 19, cystine: 3, weddellite: 6, mono-NH4-urate: 2, struvite: 1), 207(85.6%) were mixed and none of them contained octa-ca-phosphate, apatite, newberyte, 2,8-dihydroxyadenine, mono-Na-urate, or xanthine. Weddellite was found in 77% of calculi. It comprised more than 50% of them in 26% of cases. Whewellite crystals were found in 78% of calculi. It comprised more than 50% of them in 46% of cases. The most common pure calculus was uric acid and the most common component of calculi was whewellite followed by weddellite.Conclusion: Although there is no comprehensive study on urolithiasis incidence and prevalence in Iran, it can be concluded that whewellite and weddellite may be the most common components of urolithiasis in Iran and uric acid calculi are the most common pure calculi. There was no significant difference in calculi composition in our study.