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Abstract Background Cells taken from mouse embryos before sex differentiation respond to insults according to their chromosomal sex, a difference traceable to differential methylation. We evaluated the mechanism for this difference in the controlled situation of their response to ethanol. Methods We evaluated the expression of mRNA for alcohol dehydrogenase (ADH), aldehyde dehyrogenases (ALDH), and a cytochrome P450 isoenzyme (Cyp2e1) in male and female mice, comparing the expressions to toxicity under several experimental conditions evaluating redox and other states. Results Females are more sensitive to ethanol. Disulfiram, which inhibits alcohol dehydrogenase (ADH), increases cell death in males, eliminating the sex dimorphism. The expressions ADH Class 1 to 4 and ALDH Class 1 and 2 do not differ by sex. However, females express approximately 8X more message for Cyp2e1, an enzyme in the non-canonical pathway. Female cells produce approximately 15% more ROS (reactive oxygen species) than male cells, but male cells contain approximately double the concentration of GSH, a ROS scavenger. Scavenging ROS with N-acetyl cysteine reduces cell death and eliminates sex dimorphism. Finally, since many of the differences in gene expression derive from methylation of DNA, we exposed cells to the methyltransferase inhibitor 5-aza- 2-deoxycytidine; blocking methylation eliminates both the difference in expression of Cyp2e1 and cell death. Conclusion We conclude that the sex-differential cell death caused by ethanol derives from sex dimorphic methylation of Cyp2e1 gene, resulting in generation of more ROS.

Background and Objectives: In the field of health and teachings of hygienics–medicine, a lot of traditions have been transmitted from the Holy Prophet (PBUH) and Imams (A.S) and valuable collections by the titles of Ţibb al-Nabī (PBUH) and Ţibb al-Ἀemmah (A.S) have been provided. What authentic bases they are stand on scientifically, and how they should be dealt with if their concepts are opposed to updated science of medicine, are objectives of this research. Methods: This research is a review study through collecting data digitally, and from libraries and references related to Sunnite and Shiite works. Results: Different views to the position of the Holy Prophet (PBUH) created two different perspectives. The first is of Sunnites who believe the prophet’s (p. b.u.h) status is not to interfere with worldly affairs and occupations including medicine. Therefore, what, in this regard, has been transmitted from His Holiness is His personal opinion, or acquired from the knowledge of the society of the time, and may be correct or not. However, Shiite scholars believe if a tradition proved biographically and contextually, to be issued irrevocably; it is considered as teachings of religion and there is no probable mistake in it. Conclusion: As Shiites believe, to accept, absolutely, the words and sayings issued by the Prophet (PBUH) of Allah is the result of absolute understanding of his clear proofs. Whereas if we believe in disjunction and accept that the Prophet’s (PBUH) sayings on occupations including medicine are faulty and mistakable, we deprive humanity of the most important part of the city of knowledge (the Holy Prophet (PBUH)) and basically, defect the absolute holiness of his sayings; as Sunnites did so.

Prolonged exposure to hyperoxia results in acute lung injury (ALI), accompanied by a significant elevation in the levels of proinflammatory cytokines and leukocyte infiltration in the lungs. However, the mechanisms underlying hyperoxia-induced proinflammatory ALI remain to be elucidated. In this study, we investigated the role of the proinflammatory cytokine high mobility group box protein 1 (HMGB1) in hyperoxic inflammatory lung injury, using an adult mouse model. The exposure of C57BL/6 mice to ≥99% O2 (hyperoxia) significantly increased the accumulation of HMGB1 in the bronchoalveolar lavage fluids (BALF) prior to the onset of severe inflammatory lung injury. In the airways of hyperoxic mice, HMGB1 was hyperacetylated and existed in various redox forms. Intratracheal administration of recombinant HMGB1 (rHMGB1) caused a significant increase in leukocyte infiltration into the lungs compared to animal treated with a non-specific peptide. Neutralizing anti-HMGB1 antibodies, administrated before hyperoxia significantly attenuated pulmonary edema and inflammatory responses, as indicated by decreased total protein content, wet/dry weight ratio, and numbers of leukocytes in the airways. This protection was also observed when HMGB1 inhibitors were administered after the onset of the hyperoxic exposure. The aliphatic antioxidant, ethyl pyruvate (EP), inhibited HMGB1 secretion from hyperoxic macrophages and attenuated hyperoxic lung injury. Overall, our data suggest that HMGB1 plays a critical role in mediating hyperoxic ALI through the recruitment of leukocytes into the lungs. If these results can be translated to humans, they suggest that HMGB1 inhibitors provide treatment regimens for oxidative inflammatory lung injury in patients receiving hyperoxia through mechanical ventilation.

Background: Fractures of distal radius are one of the most common fractures seen by physicians and account for 20% of all fractures seen in the emergency room. Various factors contribute in secondary displacement of fracture fragments after anatomic or near anatomic close reduction and cast immobilization in distal radius fractures. This study was designed to examine the correlation between radiographic outcomes in the closed treatment of unstable distal radius fractures and different risk factors. Materials and Methods: One hundred and fifty-seven patients were included in this prospective study. There were 107 women and 50 men; with a mean age of 51 ± 16.7 years (range: 20-86 years). During the follow-up in all radiographs, the following variables were analyzed as instability factors: (1) Age, (2) gender, (3) radial shortening, (4) dorsal comminution, (5) articular step-off, (6) radial inclination, (7) associated ulna fracture, and (8) dorsal angulation. Results: Based on the radiographic criteria for an acceptable reduction, 92 patients (58.6%) failed to maintain an acceptable reduction and classified as group I, while in 65 patients (41.4%), the postoperative radiographs were within an acceptable range and classified as group II. The mean age of patients in group I was higher than group II (P < 0.001). Radial shortening of more than 6.5 mm, loss of radial inclination of more than 6.5 degrees, and age above 52 at presentation were the most important predictive factors for instability. Conclusion: Among the variables, the most important predictors of redisplacement after an acceptable closed reduction were loss of radial height, loss of radial inclination, and age.

A case with scaphoid osteochondroma (exostosis) with wrist pain and tender mass. In this case, mass resection was performed with excellent outcome. Key words: Osteochondroma; Exostosis; Scaphoid.

BACKGROUND: Heel pain is a common condition in adults that may cause significant discomfort and disability. This study was conducted to evaluate the therapeutic effects of corticosteroid injection accompanied by casting, compared with heel pad utilization in treatment of heel pain. METHODS: In this randomized clinical trial study, among patients referred to orthopedic clinics in Isfahan, Iran, from December 2004 to December 2006, 90 patients with heel pain were enrolled. They were randomly assigned into two groups. Heel pad was the only therapeutic method utilized in group A for six months. Corticosteroid injection accompanied by casting was performed for patients in group B. The evaluated information was compared before and after treatment. RESULTS: Among patients in group A, after 6 months of heel pad utilization, heel pain was completely improved in 3 patients (6.7%), relatively decreased in 22 patients (48.9%) and didn't change in 20 patients (44.4%). However, among patients in group B, heel pain was completely improved in 11 patients (24.5%), decreased in 29 patients (64.4%) and didn't change in 5 patients (11.1%) after the treatment completed. CONCLUSIONS: It seemed that corticosteroid injection in companion with casting was a more effective therapeutic method in heel pain treatment than heel pad utilization. KEYWORDS: Corticosteroid injection, casting, heel pad, heel pain.

BACKGROUND: The lower limb fractures are common in young and elderly people. The goal of treatment is to return the patient to normal function as quickly as possible, with minimal complications. Plate and screw is a popular and successful technique in treatment of these patients. METHODS: This case-control study was conducted on 108 patients (54 with plate fracture as cases and 54 without plate fracture as controls), who have been admitted in Kashani and St Alzahra hospitals affiliated to Isfahan University of Medical Sciences during 2005.A Check list including age, sex, bone fractured, site of initial fracture, use of external support, distance between plate fracture and plating, infection and etc was completed for each patient; and out coming data was analyzed. FINDINGS: The most common site of plate fracture was in diaphysis and the least in epiphysis of bones. In the case group, 87% of patients had used no external support (splint, cast, brace), 3/7% of patients had infected surgery site, 44% of patients had had early weight bearing after plating, the most common bone was femur , most initial fracture lines were comminuted, in 33/3% of patients, bone graft had been used, 9/3% of first injuries had been open fracture and 92/6% close fracture, 92/6% of patients were male and 4/7% female, the mean age of patients was 31.6 ± 15.36 yr, the average time between plating and plate fracture was 5.5 ± 3.4 months, All plates were broken at the empty hole site against initial fracture line, PH in site of plate fractures was alkaline and 2 patients had an underlying disease (chronic renal failure). CONCLUSION: In this study, site of fracture, use of external support, early weight bearing and type of fracture line were contributing factors in plate failure. We didn't find any relation between plate fracture and fracture type (open or close), PH of fracture site, patient's sex or age. KEY WORDS: Osteosynthesis, Plate failure, associated factors

BACKGROUND: The treatment of comminuted fractures in long bones has continued to be a problem in orthopedic surgery. Recently, fixation without exploration of the fracture site, known as "biologic fixation”, has been introduced. This study was performed to assess the results and complications of this method for the treatment of comminuted fractures of the tibia and femur.METHODS: The study included 41 patients with comminuted fractures of the tibia and femur treated with biologic plating from 2003 to 2006 (25 femur fractures and 16 tibial fractures). After biological fixation joint motion was started but weight bearing was avoided until radiographic evidence of union was shown.RESULTS: The mean time of union in the tibial fractures was 19 ± 2 weeks and 17 ± 2 weeks for the femur fractures. All patients had fracture union without any infection, non-union or implant failure. In one patient with a femur fracture there was a 10° internal rotation deformity. Two of the femoral fractures had shortening of 1 cm, and one patient had shortening of about 2 cm. Compared to similar studies, all results were statistically significant (PCONCLUSIONS: The biologic plating method is a safe, simple and effective method of fixation for comminuted fractures of long bones. It has a high rate of union with minimal complications.KEY WORDS: Biological fixation, plate, comminuted fracture.

Background: This randomized, parallel-group, non-blinded study was designed to determine the role of fibular fixation in the treatment outcomes of combined distal tibia and fibula fractures. Materials and Methods: Sixty patients with distal tibial and fibular fractures were randomly divided in two groups of case and controls. In the case group, fibula was fixed prior to the fixation of tibia. In the control group, tibia was fixed without fibular fixation. Primary outcomes were varus–valgus angulation, anterior–posterior angulation, union and side effects. Follow-up visit and radiographs were taken 2 and 4 weeks as well as 3, 6 and 9 months after surgery. Results: During the follow-up, 11 out of 60 patients in case and control groups were excluded. We recruited 24 and 25 patients in the case and control group, respectively. Intramedullary nailing was used in 8 patients of case and 11 patients of control group. Plate and screw were used in 16 patients in the case and 14 patients in the control group. Varus/valgus and anterior–posterior angulation were not statistically significant between two groups (P ≥ 0.05). The frequency of tibial and fibula union after 1, 3, 6 and 9 months in case and controls groups were not statistically significant (P ≥ 0.05). The frequency of nonunion of tibia and fibula, infection and nerve injury in studied groups were not statistically significant (P ≥ 0.05). Conclusion: We did not observe any significant improvement using fibular fixation in the treatment outcomes of tibia distal fractures.

Unicameral bone cysts are benign, fluid-filled lesions that occur mostly in long bones (proximal humerus, 50–60%; femur, 30%) of male children aged 5 to 15 years. Occurrence in the scaphoid of an adult is rare. We report 2 such patients who presented with wrist pain, with and without a history of trauma. Both underwent curettage and bone grafting (harvested from the distal radius) and achieved good functional recovery.

Background: In major operations, like femoral bone surgery due to extension of surgical field, we may have severe bleeding and massive transfusion. In this study, we aimed to evaluate the effect of tranexemic acid on reduction of bleeding and transfusion in femoral shaft surgery.. Methods: After obtaining consent, 80 candidates of femoral shaft surgery aged 18-64 years, in score 1 and 2 of The American Society of Anesthesiologists scale (ASA) were entered a double blind prospective clinical trial. Patients randomly divided into 2 groups of receiving 15 mg/kg tranexemic acid in 5 ml solution and receiving 5 ml normal salin as placebo. All patients received standard monitoring and spinal anesthesia was done by injecting bupivacaine. The amount of bleeding was measured and recorded. Findings: There was no significant difference between the two groups in age and sex. Mean blood loss and transfusion requirement in tranexemic acid group was significantly less than the placebo group (P < 0.05). There was no significant difference between the two groups in nausea, vomiting and vertigo. Conclusion: Our results indicated that 15 mg/kg intravenous tranexemic acid (one hour before the operation) was significantly effective in decreasing blood loss and transfusion requirement. Keywords: Tranexemicacid, Blood loss, Transfusion.

Background The levels and clinical relevance of Th17 cells and other interleukin-17-producing cells have not been analyzed in chronic lymphocytic leukemia. The objective of this study was to quantify blood and tissue levels of Th17 and other interleukin-17-producing cells in patients with this disease and correlate blood levels with clinical outcome.Design and Methods Intracellular interleukin-17A was assessed in blood and splenic mononuclear cells from patients with chronic lymphocytic leukemia and healthy subjects using flow cytometry. Interleukin-17A-producing cells were analyzed in formalin-fixed, paraffin-embedded spleen and lymph node sections using immunohistochemistry and immunofluorescence.Results The absolute numbers of Th17 cells in peripheral blood mononuclear cells and the percentages of Th17 cells in spleen cell suspensions were higher in patients with chronic lymphocytic leukemia than in healthy subjects; in six out of eight paired chronic lymphocytic leukemia blood and spleen sample comparisons, Th17 cells were enriched in spleen suspensions. Circulating Th17 levels correlated with better prognostic markers and longer overall survival of the patients. Two “non-Th17” interleukin-17-expressing cells were identified in chronic lymphocytic leukemia spleens: proliferating cells of the granulocytic lineage and mature mast cells. Granulocytes and mast cells in normal spleens did not express interleukin-17. Conversely, both chronic lymphocytic leukemia and healthy lymph nodes contained similar numbers of interleukin-17+ mast cells as well as Th17 cells.Conclusions Th17 cells are elevated in chronic lymphocytic leukemia patients with better prognostic markers and correlate with longer survival. Furthermore, non-Th17 interleukin-17A-expressing cells exist in chronic lymphocytic leukemia spleens as maturing granulocytes and mature mast cells, suggesting that the microenvironmental milieu in leukemic spleens promotes the recruitment and/or expansion of Th17 and other IL-17-expressing cells. The pathophysiology of Th17 and non-Th17-interleukin-producing cells in chronic lymphocytic leukemia and their distributions and roles in this disease merit further study.

چکیدهمقدمه: شکستگی کالیس (Colles) یکی از شایع‎ترین شکستگی‎های اندام در افراد بالغ است، زمانی که این شکستگی با ثبات باشد، درمان استاندارد شامل جااندازی بسته تحت بی‎حسی موضعی و یا بی‎حسی موضعی و یا بی‎هوشی عمومی و سپس گچ‎گیری، می‎باشد. این مطالعه به منظور مقایسه نتایج درمان غیر جراحی شکستگی کالیس تحت بی‎حسی موضعی و بی‎هوشی عمومی انجام گرفت. مواد و روش‌ها: در این کارآزمایی بالینی که به روش مداخله‎ای تصادفی انجام پذیرفت، 100 بیمار با شکستگی کالیس پایدار از مهرماه 85 لغایت مهرماه87 در مرکز درمانی کاشانی شهرستان اصفهان وارد مطالعه شدند. بیماران به طور تصادفی ساده به دو گروه مساوی الف و ب تقسیم گردیدند. در گروه الف، بیماران تحت درمان بی‎حسی موضعی و در گروه ب تحت بی‎هوشی عمومی قرار گرفتند. در پایان اطلاعات مربوط به نوع شکستگی، عوارض جااندازی، هزینه درمان و نتایج درمان در هفته‎های اول، دوم و سوم بعد از شروع درمان و سپس انتهای درمان بررسی شد. آن گاه نتایج به دست آمده از این 2 روش قبل و بعد از درمان با یکدیگر مقایسه شدند. یافته‌ها: آنالیز داده‎ها هیچ تفاوت معنی‎داری را بین عوارض این دو روش درمانی نشان نداد. علاوه بر این، هیچ تفاوت معنی‎داری بین معیارهای جااندازی 2 گروه یافت نشد، بین جنس و شکستگی کالیس نیز ارتباط مشخصی به دست آمد. آنالیز داده‎ها نیز نشان داد که هزینه درمان در گروه ب، 3 الی 4 برابر بیشتر از گروه الف می‎باشد. بحث: درمان جااندازی به روش بی‎حسی موضعی با توجه به هزینه کمتر و جااندازی قابل قبول بدون عارضه مشخص، بهتر از جااندازی به روش بی‎هوشی عمومی بود. پژوهشگران این مطالعه، استفاده از بی‎حسی موضعی جهت جااندازی شکستگی کالیس را توصیه کردند. کلید واژه‌ها: شکستگی کالیس، جااندازی بسته، بی‎حسی موضعی.

Introduction: Chronic anterior knee pain is one of the most common complaints, especially in our society. It consists of a large number of patients in orthopedic clinics. This pain might have serious negative effects on students’ educations, on the other hand, limits their physical activities that is essential for their age. In contrast to adults, such pain etiologies may vary in many ways for teenagers. Some are easily curable and others not. In time evaluation and diagnosis can lead to a faster and more efficient treatment. The aim of this study was to evaluate chronic anterior knee pain in Iranian teenagers. Materials and Methods: In this cross-sectional study, among patients referred to Isfahan Hospitals from December 2005 to December 2007, 198 teenagers (8 to 18 years-old) who suffered from untreated chronic anterior knee pain were enrolled. All of them were examined by an orthopedic specialist. The patients' demographic information such as age, sex, physical activity type, underlying diseases if any, knee trauma history if any, pain duration, laboratory and radiological findings, and other diagnostic findings and the final diagnosis were recorded in questionnaires. Then, the relations between disease etiology and these factors were sought. Results: Chronic anterior knee pain was more frequent in boys compare with girls (53.1% vs. 46.9%). At the ages around puberty, chronic anterior knee pain was more common. The most prevalent etiologies were patella-femoral dysplasia, malalignment of lower limbs, knee menisci and ligaments tearing, osgood-schlatter disease, juvenile rheumatoid arthritis (JRA) and osteochondritis dissecans, respectively. Conclusion: In our study like many other ones, patella-femoral dysplasia and malalignment of lower limbs are the most prevalent causes among other etiologies. Such causes like malalignment of lower limbs and JRA are found more in girls and osgood-schlatter disease and osteochondritis dissecans are more common in boys. JRA and osteochondritis dissecans were considered as rare causes for chronic anterior knee pain; however in our study they played an important role. Finally we can diagnose these causes and treat them properly by this mean, we’ll be able to teach the patients how to prevent such diseases

Osteochondroma or exostosis is a bony developmental anomaly, which arises from exophytic outgrowth on bone surfaces in a characteristic manner. Osteochondroma is asymptomatic and grows away from the nearby joint. This paper reports an unusual presentation of osteochondroma in which the patient was surprisingly completely symptomatic. The lesion grew toward the nearby joint and the radiographic findings were not compatible with surgical findings

Background: There is conflict of interest in the treatment of intracapsular femoral neck fractures and the outcomes. The aim of this study was evaluation the treatment outcomes of closed and open reduction and internal fixation with screw in 18-50-year-old patients. Materials and Methods: This clinical randomized study was conducted in Ayatollah Kashani Center in Isfahan from Nov 2010 to Nov 2011. In 42 patients selected in a randomized manner, fractures were reduced by closed reduction or open if necessary and C-ARM was controlled in AP and lateral plans. Movement range and femur pain severity were evaluated according to Visual analogue Scale (VAS) score at 3 and 6 months after surgery. Data were analyzed by SPSS 18. Chi-square, t-test, one-way analysis of variance (ANOVA), and descriptive statistics such as frequency distribution, mean, and mean deviation were used. Results: Forty-two patients with femoral neck fracture were treated by open [31 patients (73.8%)] or closed reduction [11 patients (26.2%)] and also osteosynthesis. Their mean age was 47.3 ± 9.8 years; 29 of them were males and 13 were females. Twelve patients had bad range of motion (ROM) (28.6%), 16 had intermediate ROM (38%), and 14 had good ROM (33.4%). After 6 months, 12 patients (28.6%) had bad ROM, 10 (23.8%) had intermediate ROM, and 20 (47.6%) had good ROM. There were 11 cases of non-union (35.5%) in the open reduction group and 4 in the closed group. Conclusion: This study showed that femoral neck fracture is associated with several complications, especially if open reduction was necessary. So, the surgical method and necessary equipments such as radiolucent bed, C-ARM machine, and implant cannulated screw set should be considered.

Fibro-osseous pseudotumor of the digit is an unusual ossifying soft tissue lesion, which is usually an ill-defined soft tissue mass in radiography, with focal calcification, especially in the proximal phalanx. It predominantly affects young adults and, unlike myositis ossificans, is more common in women. The current case is a 30-year-old man who presented with pain and swelling on the dorsum of middle phalanx of the left index finger without history of trauma. Diagnosis of this lesion requires a high index of suspicion and should be differentiated from myositis ossificans, turret exostosis, and extra-skeletal osteosarcoma, which are discussed. This lesion is considered benign and has an excellent prognosis following complete removal and local recurrence is unusual. No cases of malignant change are on record.

Understanding the importance of the role of teachers in creating change in the field of education, especially in the practice and skill dimensions, the purpose of this study was to design a framework for the professional competencies of entrepreneurial teachers. It was qualitative research with case study design. The potential research participants included the successful entrepreneurs in the field of education, especially teachers who had the necessary experience and expertise in this field, and the curriculum specialists. Participants were selected with a purposeful approach using snowball sampling method and the theoretical data saturation criterion to determine the number of participants. To extract the framework of professional competencies of entrepreneurial teachers, semi-structured interviews and review of related sources and texts were used. Also, using the content analysis method, basic, organizational and comprehensive themes were obtained and to validate the data, their credibility and dependability were checked. The initial framework consisted of 57 basic themes and 4 organizing themes (personality competencies, teaching competencies, social competencies and professional competencies) were organized around the comprehensive theme of professional competencies of entrepreneurial teachers. It should be noted that the extracted themes were interrelated and interwoven, so that if the teachers want to be included in the professional competencies of entrepreneurial teachers’ framework, they must have these competencies together, grow and develop them together, and the educational system must provide the conditions and contexts appropriate with this organized framework.