Tehran University Medical Journal

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A case with bilateral spontaneous pneumothorax was presented. Etiology, mechanism, and treatment were discussed on the review of literature. Spontaneous Pneumothorax is a clinical entity resulting from a sudden non traumatic rupture of the lung. Biach reported in 1880 that 78% of 916 patients with spontaneous pneumothorax had tuberculosis. Kjergaard emphasized 1932 the primary importance of subpleural bleb disease. Currently the clinical spectrum of spontaneous pneumothorax seems to have entered a third era with the recognition of the interstitial lung disease and AIDS as a significant etiology. Standard treatment is including: observation, thoracocentesis, tube thoracostomy. Chemical pleurodesis, bullectomy or wedge resection of lung with pleural abrasion and occasionally pleurectomy. Little information has been reported regarding the efficacy of such treatment in spontaneous pneumothorax secondary to non bleb disease

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Breakthrough bleeding (BTB) is the cause of 50% of discontinuations of use by long-acting progestogen-only contraceptive users. BTB appears to be associated with capillaries of abnormal morphology and fragility. Disturbances in vessels integrity, intercellular junctions or alteration of the basement membrane (BM) composition has been proposed to contribute toward the fragility of these capillaries. In a clinical trial study, 34 healthy fertile volunteers were studied before and during use of levonorgestrel releasing subdermal contraceptive implant Norplant. Three endometrial biopsies were taken from each volunteer, one before insertion and 2 at different time intervals after exposure to Norplant. Then 3 major components of BM of endometrial vessels Collagen IV (CIV), laminin and heparan sulphate proteglycan (HSPG) were immunostained and studied. The density of immunostained vessels by each antibody were measured and compared with density of vessels stained by CD34. Double immunostain of CD34 and laminin was also used for demonstration of vessels without BM. Significant decrease in vascular density showing BM components were shown in the study. The density of laminin, CIV, and HSPG-positive vessels were decreased from 176±8, 166±6.6 and 61±6 vessels/mm² (Mean±SEM) in the endometrium of Norplant acceptors before use control samples to 156±6, 144±6.2 and 33±2.9 in the endometrium of Norplant acceptors after 2 to 13 weeks Norplant exposure, respectively (P<0.05). This was occurring at the same time as the overall density of small vessels in Norplant exposed endometrium was showing increase. Significant decrease was also demonstrated over 13 to 42 weeks of use in the densities of laminin and HSPG-positive vessels compared with control (P<0.05), although decrease in the density of CIV positive vessels was not significant. Percentages of vessels showing BM was also calculated in the study. Significant decrease in the percentage of vessels showing BM were demonstrated after 2 to 13 weeks of Norplant use. The percentages of CD34 positive vessels showing laminin, CIV and HSPG-positive BM in control samples were 97±3%, 88±32% and 31±2% (Mean±SEM) which significantly decreased to 79±3%, 75±4% and 20±2% in Norplant users, respectively (P<0.05). Decrease in the percentage of vessels showing BM was thought to be due to disturbances in the integrity of BM in endometrial vessels of women using Norplant, which could be a cause for the fragility of the vessels. The decrease could also be due to decrease in the density of arteriols and increase in the density of venules and appearance of solid cords of endothelial cells. Double immunostaining of the endometrial vessels with anti-CD34 and anti-laminin clearly demonstrated loss of BM or weak staining of BM in the endometrial vessels of Norplant users. Clarification of the local mechanisms which leads to capillary fragility and abnormal endometrial bleeding may lead to the development of better treatments or prevention and ultimately improve the acceptability of these contraceptives.

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Background: Wagener's granulomatosis (WG) is a systemic necrotizing vasculitis characterized by upper and lower respiratory tract involvement and glomerulonephritis in most instances.
Case Report: We report a 36 years old man with DAH secondary to WG, as the presenting feature. He successfully treated with standard immune suppressive agents including pulse methylprednisolone and cyclophospha-mide, along with tranexamic acid as adjunctive therapy for control of active bleeding. Laboratory results showed mild to moderate anemia, increased serum lactate dehydrogenase and very high c-ANCA titer. Chest radiograph showed bilateral alveolar infilterates.
Conclusion: Diffuse Alveolar hemorrhage (DAH) is a dread complication of Wagener’s granulomatosis. Control of acute phase of hemorrhage with tranexamic acid can improve out come of patients.

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Background: Leukemia inhibitory factor (LIF) is a group of secreted glycoproteins with molecular weights ranging from 38-67 kD, resulting from differential protein glycosylation. LIF is constitutively expressed at high levels in the human fallopian tube epithelium and has an important role in the motility and vitality of sperm. In the present study, the effect of human recombinant LIF on human sperm motility and survival in vitro was investigated.

Methods: Normal spermatozoa of 30 fertile men were collected and after preparation were incubated in Ham's F10+FCS 10% medium, containing various concentrations (0, 3, 5, 10, and 50 ng/ml) of LIF at 37 ºC under 5% CO2 for 6, 24 and 48 hours. Sperm motion characteristics were measured using a Makler chamber. Sperm survival was determined using the hypoosmotic swelling test. Collected data were analyzed by one-way ANOVA and LSD test using SPSS version 11. The difference in values were considered significant when p<0.05.

Results: Sperm motility was significantly higher after 24 h exposure to 5-10 ng/ml LIF (p<0.05). The survival rate of sperm was significantly prolonged when exposed to 50 ng/ml LIF (p<0.05). Nonprogressive motility and survival rate of sperm were significantly higher after 48 h exposure to 50 ng/ml and 10-50 ng/ml LIF, respectively. (p<0.05). There was no significant difference in progressive sperm motility during the 48 h exposure of sperm to the various concentrations of LIF.

Conclusion: According to our results, the effect of LIF on sperm motility and survival were dependent on the dose of LIF supplementation and the length of incubation.

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Background: Lung leiomyoma and pulmonary arterio-venous malformation (PAVM) are both rare diseases. Occurrence of them in a patient is rare too. Because of their limited signs and symptoms and so serious complications, accurate diagnosis of both diseases is important.
Case report: We present a 73 -year old female with PAVM combine with a coincidental solid mass in left upper lobe. Because of fistula size and combination with a solid mass, the lesion is treated by left upper lobectomy.

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Background: Reflex Sympathetic Dystrophy Syndrome (RSDS) is a rarely described complication which characterized by pain, edema, movement and vasomotor disorders, trophic changes in the skin and patchy demineralization of bone in extremities. There are numerous risk factors such as trauma, surgery, myocardial infraction and drugs. Cyclosporine (CsA) is one of the drugs which can induce RSDS.

Case report: Herein we described a 33- years old man (known case of ALL) with severe painful and edematous extremities, which was being treated with cyclosporine because of Graft Versus Host Disease (GVHD) after bone marrow transplantation. His laboratory tests were normal except for AST and ALT. With impression of Reflex Sympathetic Dystrophy Syndrome triple-phase bone scan was done, Increased uptake and delayed wash-out in vascular and bony phase is considered typical for RSDS. Due to clinical and triple-phase bone scan findings the diagnosis was established. Symptoms of RSDS improved when CsA was discontinued.

Conclusion: According to this case report and the other ones, Cyclosporine should be considered as the etiology of Reflex Sympathetic Dystrophy Syndrome.

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Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 Background: Pleural malignant mesothelioma is an uncommon but extremely invasive tumor which originates from mesothelial cells and usually occures after prolonged exposure to asbestos. The aim of this study was to clinicopathologically evaluation of 40 patients with pleural malignant mesothelioma and the main factors influencing their prognosis.
Methods: In this study patients with definitive diagnosis, who had been followed up for at least three years were studied based on gender, age presenting symptoms, and clinicopathological patterns.
Results: Male to female ratio of the study patients was three to one any the average age of them was 55 years. Chest pain was the most common symptoms in 34(85%) patients. Most of the study patients were in Buchard stage I (37/5%) and the epithelial form was the most common pathological pattern 25(62.5%). 19(47.5%) of cases received only radiotherapy and chemotherapy. Extrapleural pneumonectomy was performed on eight (20%) patients, seven (17.5%) patients underwent decortication and pleurectomy beside adjuvant therapy and 15% of the cases rejected any type of treatment. Surgical mortality occurred in one patient and the most common surgical complication was wound infection. The average survival rate was 12±1.2 months and the main factors influencing it were the patient's physiologic status, pathological form, stage of the disease and the pattern of pleural involvement.
Conclusions: Because the low survival rate after multimodality invasive treatments in mesothelioma, aggressive therapeutic methods were recommended in selected patients

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Pulmonary resection is one of the most common thoracic surgeries Bronchial stump closure is important topic and still is controversy Bronchial stump closure with stapler is a new method that in addition to rapidity, lowering separation and dehiscence of suture line and lowering contamination of the operative site with bronchial secretions, and lowering the main complication after pulmonary resections which is sustained air leak- main factor in delaying discharge and patients dissatisfaction.
Methods: Two groups of 16 patients in a randomized clinical trial compared. In one group bronchial stump closed with stapler and the other stump closed with hand sewn method. Bronchial closing time, Operative time, time of airleak, time of chest tube, time of discharge and complication recorded and compared.
Results: In the stapler group time of bronchial closing was significantly shorter. Operative time was not different. time of air leak was not statistically different. No patients with long airleak, and the number of patients without airleak was greater. In the stapler group, time of having chest tube was statistically shorter and time of discharge in stapler group was shorter than hand sewn group.
Conclusions: Bronchial closing with stapler in pulmonary resection is a safe method and in addition to rapidity, time of chest tube and time of discharge was shorter. Although Time of air leak was not statistically different but patients in stapler groups had less Days with air leak and long air leak was zero in this group.

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Background: In the recent years, concerns have been raised about the incidence of reproductive disorders in human populations. The present study was aimed to determine the effects of maternal exposure to Di 2 ethylhexylphthalate (DEHP) on postnatal development of ovary in Wistar rat offsprings.

Methods: Forty female Wistar rats were randomly divided in four equal experiment groups an oil vehicle group and three DEHP-treated groups that received 10, 100 and 500 mg/kg/day Di 2 ethylhexylphthalate by gavage during lactation, respectively. The ovaries of pups were removed at 60 days of postnatal development their weights recorded and fixed in Bouin's solution subsequently 6 µm serial paraffin sections were stained with haematoxylin-eosin the structural changes of ovarian follicles and corpora lutea were studied.

Results: There was no significant difference on mean body weights of offsprings among different groups. However, the mean of ovary weight was decreased significantly (p= 0.037) in 500 mg/kg/day DEHP group. Significant decreases were seen in mean number of primary follicles (p= 0.012) and mean number and diameter of secondary (p= 0.023 and p= 0.012, respectively) and antral (p= 0.025 and p= 0.018, respectively) follicles in high dose DEHP-treated group compared to sham group. Also, mean number of corpora lutea decreased significantly (p= 0.023) at 60 days of age in ovary of offspring in 500 mg/kg/day DEHP group. Moreover, significant increases were seen in number of atretic follicles in moderate (p= 0.012) and high (p= 0.036) DEHP-treated groups.

Conclusion: Present study showed that maternal exposure to Di 2 ethylhexylphthalate during lactation affects postnatal development of ovary in offspring Wistar rats and reduces their fertility and reproductive efficiency at puberty.

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Background: Hypothermia is an important determinant of survival in newborns, especially among low-birth-weight ones. Prolonged hypothermia leads to edema, generalized hemorrhage, jaundice and ultimately death. This study was undertaken to examine the factors affecting transition from hypothermic state in neonates.
Methods:  The study consisted of 439 neonates hospitalized in NICU of Valiasr in Tehran, Iran in 2005. The neonates' rectal temperature was measured immediately after birth and every 30 minutes afterwards, until neonates passed hypothermia stages. In order to estimate the rate of transition from neonatal hypothermic state, we used multi-state Markov models with two covariates, birth weight and environmental temperature. We also used R package to fit the model.
Results:  Estimated transition rates from severe hypothermia and mild hypothermia were 0.1192 and 0.0549 per minute, respectively. Weight had a significant effect on transition from hypothermia to normal condition (95% CI: 0.1364-0.4165, P<0.001). Environmental temperature significantly affected the transition from hypothermia to normal stage (95% CI: 0.0439-0.4963, P<0.001).
Conclusion:  The results of this study showed that neonates with normal weight and neonates in an environmental temperature greater than 28 °C had a higher transition rate from hypothermia stages. Since birth weight at the time of delivery is not under the control of medical staff, keeping the environmental temperature in an optimum level could help neonates to pass through the hypothermiastages faster.

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Background: The aim of this study was to provide a valid Persian version of the Ages and Stages Questionnaires, in order to compensate the lack of developmental screening tools in Iran.
Methods: Forward and backward translation, face and content validity determination, and cultural and linguistic adaptation of the questionnaires were performed, consecutively. Next, a pilot study was carried out on 100 Iranian parents of 4- to 60-month-old children, recruited by consecutive sampling in Tehran, Iran during the year 2006 to determine the degree of clarity for each item and explore cultural adaptations. In order to determine inter-rater reliability, we had parents of 38 children complete the questionnaires. For determining the psychometric properties of the tests, we later recruited a representative sample of 555, 4- to 6-year-old children by consecutive sampling from health care centers in five main geographical areas in Tehran.
Results: Performing cultural and lingual adaptations, our expert team made some inevitable changes to the questionnaires. Almost in all age groups older than 10 months, cultural or linguistic changes were made in items in the “communication” domain. Overall, the questionnaires’ Cronbach alpha was 0.79. The constructive validity of the tests was also satisfactory. Another important finding was determination of the children’s developmental mean scores.
Conclusion: The culturally adapted Persian copies of the Ages and Stages Questionnai-res have proper validity and reliability for being used as developmental screening tools for children in Tehran.

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Background: Nitric oxide (NO) is produced in different body organs in mammals and numerous physiological and pathological properties are attributed to this small molecule. The precursor of this substance in the body, L-arginine, is synthesized by the enzyme nitric oxide synthase (NOS), and it is catalyzed, and is inhibited by a substance called L-NG-nitroarginine methyl ester (L-NAME). In this study we investigated the qualitative and quantitative effects of nitric oxide on cerebellar histopathology in vivo environment via increasing and decreasing its production.
Methods: Forty Wister rats, weighing 200- 250 gr with a mean age of 8 weeks, were divided into 5 groups after making sure the rats were pregnant. Except the control group, the other pregnant groups, respectively received: 2 ml/kg normal saline, 200 mg/kg L-arginine, 20 mg/kg L-NAME and a mixture of the same doses of L-arginine and L-NAME on the third, fourth and fifth days of pregnancy. On day 18 of pregnancy, we anesthetized the rats, excised the cerebellum after craniotomy and fixed the organs in 10% formalin. We later prepared 5 to 6-micron in thickness tissue sections and dyed them by the routine Hematoxylin and eosin (HE) and Masson's Trichrom staining methods before studying them by light microscopy.
Results: There was a significant difference between the rats receiving L-arginine and the rats in other groups (P<0.01).
Conclusion: This study showed that L-NAME is capable of significantly decreasing the injury caused by nitric oxides in rat cerebellum.

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Background : Chemotherapy-induced nausea (CIN) in the anticipatory and acute phase is the most common side effect in cancer therapy. The purpose of this study was to investigate the effect of ginger capsules on the alleviation of this problem.

Methods : This randomized, double-blind, placebo-controlled clinical trial was performed on 80 women with breast cancer between August till December 2009 in Imam Khomeini Hospital, Tehran, Iran. These patients underwent one-day chemotherapy regime and suffering from chemotherapy-induced nausea. After obtaining written consent, samples were randomly assigned into intervention and control groups. Two groups were matched based on the age and emetic effects of chemotherapy drugs used. The intervention group received ginger capsules (250 mg, orally) four times a day (1 gr/d) and the same samples from the placebo group received starch capsules (250 mg, orally) for three days before to three days after chemotherapy. To measure the effect of capsules a three-part questionnaire was used, so the samples filled every night out these tools. After collecting the information, the gathered data were analyzed by statistical tests like Fisher’s exact, Kruskal-Wallis and Chi-square using version 8 of STATA software.

Results : The mean ± SD of age in the intervention and placebo groups were 41.8 ± 8.4 and 45.1 ± 10 years, respectively. Results indicated that the severity and number of nausea in the anticipatory phase were significantly lower in the ginger group compared with placebo group (P=0.0008, P=0.0007, respectively). Also, the intensity (P=0.0001) and number (P=0.0001) of nausea in the acute phase were significantly lower in the ginger group. On the other hand, taking ginger capsules compared with placebo did not result in any major complications.

Conclusion: Consuming ginger root powder capsules (1 gr/d) from three days before chemotherapy till three days after it in combination with the standard anti-emetic regimen can help to reduce the anticipatory and acute nausea.

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Background: Currently, autologous and allogeneic adipose tissues represent a ubiqui-tous source of material for fat reconstructive therapies. However, these approaches are limited, and often accompanied by a 40-60% reduction in graft volume following transplantation, limited proliferative capacity of mature adipocytes for ex vivo expansion, and extensive adipocyte damage encountered when harvested with conventional liposuction techniques. Recently, cell-based approaches utilizing adipogenic progenitor cells for fat tissue engineering have been developed and were reported to promote both short-term in vivo adipogenesis and to repair defect sites. The aim of this study was to isolate stem cells from fat tissue than examine the growth of stem cells by invitro tests. Methods: For human adipose stem cell isolation (hASC), subcutaneous adipose tissue sites were obtained from female subjects undergoing elective procedures. Tissues were washed 3-4 times in phosphate buffered saline (PBS) and suspended in an equal volume of PBS supplemented with 1% FCS and 0.1% collagenase type I. The tissue was placed in an agitated water bath at 37 1C. The supernatant containing mature adipocytes, was aspirated. Portions of the SVF were suspended in DMEM medium. hASCs were selected based on their ability to adhere to tissue culture plastic and subsequently expanded to 75-90% confluence. Adipose stem cells were isolated and cultured on DMEM. To assess mesenchymal origin of stem cells we used flow-cytomery technique as well as differentiation to osteocyte and chondrocyte lines. Results: The nature of the mesenchymal cells was confirmed by flow -cytometry tech-niques, based on the expression of CD90, CD105, CD166, and lack of expression of hematopoietic markers of CD34, CD31, and CD45. The successful differentiation of our stem cells to osteocyte, chondrocyte had been showed by specific Alizarin-Red and Toluidine-blue staining of cells. Conclusion: Although we have not the results of in vivo tests to support in vivo adipo-genesis either alone or in combination with natural or synthetic matrix, the results showed that stem cells isolation from adipose tissue was successful, and we provided an environment for differentiation of stem cells.

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Background: With the aim of regenerating healthy tissues, different tissue engineering strategies pointed to extracellular matrix (ECM)-based scaffolds in tissue engineering and regenerative medicine and wound healing. It is a multidisciplinary science works to create biocompatible scaffolds with perfect physical parameters, mechanical integrity and high porosity to promote cell growth, migration and angiogenesis. With the increased incidence of obesity, subcutaneous adipose tissue is abundant and readily accessible. Liposuction surgeries yield from 100 mL to 3 L of lipoaspirate tissue. We present our prepared acellular ECM powders derived from human adipose tissue obtained from lipoaspirate, which contains large amounts of collagen suitable for induction of adipogenesis. Methods: The study had been carried out from December 2012 to March 2013 in Tissue Bank and Research Center in Imam Khomeini Hospital Tehran, Iran. Fresh human adipose tissue was obtained by liposuction of abdominal fat pad in a private Day Clinic. By using wasted material of liposuction, we obtained 100 to 200 cc fat tissue from each patient. After physical (freeze-thaw-slicing-manual massage) and chemical (enzymatic-detergent-acid digestion) treatment, an acellularized matrix was created from fat tissue. The final material lyophilized and ground to powder. We analyzed ultra structure and biochemical properties of obtained ECM powder by using electron microscopy, immunohistochemistry (IHC) examination and proteomic studies. Results: After mechanical and chemical process of decellularization, scanning electron micrographs of the samples showed smooth and contiguous collagenous components throughout the scaffold. IHC showed strong positive labeling for collagen IV and no evidence of nuclear material in the specimen. Separation of protein complex by Blue Native Polyacrylamide gel electrophoresis (BN-PAGE) has proven type I collagen triple helices associate to form banded fibrils. RNA preparation and Gene Expression Analysis (RT-PCR) by using specific primers for laminin, fibronectin, collagen type I and IV, desmin, and actin showed strong staining of our fat tissue scaffold with collagen type I, fibronectin, collagen IV and laminin. Conclusion: The results show that our decellularization method produced an adipose ECM scaffold rich of collagen fibers, suitable and effective substrate for use in soft tissue engineering and regenerative medicine.

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Cancer/Testis antigens (CTAs) as a group of tumor antigens are the novel subjects for developing cancer vaccine and immunotherapy approaches. They aberrantly express in tumors with highest normal expression in testis, and limited or no expression in normal tissues. There are important similarities between the processes of germ-cell and cancer cell development Spermatogenesis begins at puberty when expression of novel cell-surface antigens occurs when the immune system has been refined the ability to distinguish self from non-self. Whereas macrophage and lymphocytes are commonly found within interstitial spaces of the testis, these antigen-presenting cells are rarely seen within the seminiferous tubules. These observations have led to the concept of the immune privileged site for testis. Localized normal expression of the CT genes in testis that makes them immunogenic for immune system, in one side, and their abnormal expression in different kinds of cancer cells, in the other side, has make them as promising target for developing cancer vaccines and new cancer therapeutics approaches. In malignancies, gene regulation is disrupted which results aberrant expression of CT antigen in a proportion of tumors of various types. For some CTAs, data support their fundamental role in tumorigenesis. Several authors believe it is not clear whether they have an essential role in tumorigenesis or they are by-products of chromatin variations in cancer. There is a growing list of CTAs within them advanced clinical trials are running by using some of them in cancers like lung cancer, malignant melanoma and neuroblastoma. In this review we discuss the gene TSGA10 as an example of CT genes. TSGA10 expresses in its highest levels in elongating spermatids and localized in the fibrous sheath of mature sperm. This gene is proposed as a serological biomarker in cutaneous lymphoma. Its abnormal expression has been reported in different cancers such as acute lymphoblastic leukemia, breast, brain, gastrointestinal and a range of other cancers either in mRNA or protein levels. It has an important role in angiogenesis in cancer tumors because of its effects in the gene hypoxia-inducible factor (HIF1). Absence or lack of TSGA10 expression has been reported in ascosporic infertile men.

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Background: Breast cancer is the most common cancer in women around the world. It has been known for over a century that androgens and androgen receptor (AR) play a role in normal and neoplastic breast cells. The aim of this study was to determined the AR expression on tumor cells and its correlation with other prognostic and predictive factors as well as contribution of AR in patients overall survival (OS) and disease- free survival (DFS). Methods: This retrospective cross-sectional study performed on 189 patients who referred to Medical Oncology Ward of Cancer Institute, Tehran University of Medical Sciences, from April 2007 to February 2010. We performed an immunohistochemistry study for AR (AR441 clone, Dako, Germany) (10% cut-off point) and Ki-67 MIB-1 clone, Dako, Germany) on paraffin embedded blocks. Other data were extracted from patients’ documents. Results: Overall, AR expression was 49.1%. Mean age of the patients with and without AR was 47.86 and 48.49 years, respectively. AR positive tumors presented more in stage I/II than III/IV (P=0.02) and AR were more positive for estrogen receptor positive, lower grade of tumor (grade I/II versus III) and lower Ki-67 (P=0.01). AR positivity had neither correlation with progesterone receptor, HER2/neu, P53 expression or menopausal status. OS and DFS were higher in AR positive patients but did not reach statistical significance. In triple-negative breast cancer (TNBC) group, 25% of tumors showed AR expression. AR had non-significant positive correlation with OS in TNBC cancer patients. OS and DFS had significant statistic positive correlation with ER, PR and stage regardless of AR status. Conclusion: Based on this study, although androgen receptor expression showed correlation with other prognostic factors for survival in patients, we didn’t find statistically significant independent relationship between AR and overall survival in patients. As far as there isn’t any targeted therapy for triple-negative breast cancer (TNBC), prospective basic and clinical studies regarding AR inhibitors in the treatment of TNBC seems to be logical and valuable.

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Background: After primary infection, the number of CD4 T-cells decreases with disease progress. The patient’s immunological status could inform by The CD4 T-cell counts over the time. The main purpose of this study is to assess the trend of CD4 cell count in HIV+ patient that received Antiretroviral Therapy (ART) by using a multistate Markov model to estimate transition intensities and transition probabilities among various states.

Methods: A total of 122 HIV+ patients were included in this cohort study who are undergoing Antiretroviral Therapy treatment in the Iran AIDS center in Imam Khomeini Hospital in Tehran that inter during March 1995 to January 2005 and then fallow up to October 2014. All adults with at least two follow-up visits in addition to their pre-ART treatment were considered to be eligible for inclusion in the study. Continuous-time Markov processes are used to describe the evolution of a disease over different states. The mean sojourn time for each state was estimated by multi state Markov model.

Results: Sample included 22 (18%) female with a mean age of 43.32 (standard deviation 8.33) years and 100 (82%) male with a mean age of 45.28 (standard deviation 8.34) year. Age was divided in to two categories, 40 years old and lower than that 66 (54.1) patents and persons older than 40 years old 56 (45.9) patents. A total of 122 patients were included. 29 patients died during follow-up. One year transition probability for staying in state 1 of CD4 cell count was 51%. This probability for six year was 33%. The mean sojourn time for sate 4 was 21 month. The hazard ratio of transition from state 3 to state 4 was 4.4 in men related to women.

Conclusion: The use of antiretroviral therapy in the treatment of HIV infected persons reduce viral replication and increase in CD4 T lymphocyte count, and delay the progression of disease. This paper is shown the progression of this trend.

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Background: Sexual dysfunction could be under the influence of some underlying medical problems. The purpose of this study is to examine the relationship between medical problems and sexual function in post-menopausal women.

Methods: This is a community-based, descriptive-correlation study of 405 post-menopausal women residing in Chalus and Nowshahr cities, North of Iran, aged 40 to 65 years old from October 2013 to May 2014. A multistage, randomized sampling was conducted. The data was acquired through interviews using the Female Sexual Function Index (FSFI) questionnaire and a researcher-made questionnaire, and was analyzed using descriptive and analytical tests such as multiple linear regression and logistic regression models.

Results: 51.4% of the subjects had medical conditions. Cardiovascular disorders were the most common diseases among the subjects. 61% of the women were suffering from female sexual dysfunction (FSD). Sexual dysfunction in patients with medical conditions was significantly higher (P= 0.037). Scores of arousal (P= 0.000), orgasm (P= 0.018), and satisfaction (P= 0.026), as well as the FSFI total score (P= 0.005), were significantly lower in subjects with cardiovascular disorders. Scores of desire (P= 0.001), arousal (P= 0.006), lubrication (P= 0.010), orgasm (P= 0.004), and satisfaction (P= 0.022), as well as the FSFI total score (P= 0.017), were significantly lower in subjects with diabetes. Scores of pain were significantly lower in subjects with musculoskeletal disorders (P= 0.041), they experienced more pain during intercourse. In domains of arousal (P= 0.030), satisfaction (P= 0.040), and pain (P= 0.044), the scores of those taking antihypertensive medications were significantly lower than the scores of the rest of the subjects. Scores of desire (P= 0.001), arousal (P= 0.006), orgasm (P= 0.006), and satisfaction (P= 0.048), as well as the FSFI total score (P= 0.006), were significantly lower in those taking antidiabetic drugs. And lastly, the mean satisfaction score in women whose spouse had medical conditions was significantly lower (P= 0.040).

Conclusion: Cardiovascular disorders, diabetes, and musculoskeletal disorders could have a negative impact on sexual function in post-menopausal women. Thus, these diseases must be considered and treated in order to improve women’s health, particularly their sexual function.

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Background: Metformin has been suggested as anti-cancer in retrospective studies. We design a prospective controlled study about metformin efficacy in the window time between biopsy and definite surgery with changes of Ki-67 as the primary endpoint.

Methods: The primary cohort had composed of 50 pathologically diagnosed invasive breast cancers, accrued in Medical Oncology Department of Iran Cancer Institute from February to November 2014. Patients neither had indication of neoadjuvant chemotherapy, nor involved with diabetes mellitus. They followed during the time period of biopsy and definitive surgery with taking tests on pathology specimens for ER, PgR, HER-2/neu and Ki-67 index. We checked fasting insulin and glucose level as well as quality of life and adverse effects in both times in the intervention group. Metformin (1500 mg/day) was prescribed to intervention group from pathology report to the night before surgery.

Results: From 45 patients, 25 had been received metformin for median time of 2.8 weeks. Controlled group included 20 patients who followed in the window time. There were no statistically significant differences between two groups regarding baseline clinical and tumor characteristics such as age, stage, grade, ER, PgR, HER2 status, time and type of surgery. However, immunohistochemistry study showed decrease of median Ki-67 from 35.14 to 29.6% in the intervention group and increase from 24.5 to 30.6 in the control group. Both of these results were statistically significant. Patients tolerated metformin very well, but mild gastrointestinal symptoms were seen in 30% of cases. There was a correlation between metabolic factor of HOMA score (fasting insulin level fasting blood sugar/405) and changes in Ki-67.

Conclusion: In the present study metformin prescription in the short period of time between Biopsy and definite surgery had shown inhibition of breast cancer cell growth. We found relationship between metformin anti-proliferative effect and glucose and insulin metabolism. To find direct apoptotic stimulation of metformin and long-term results of this drug further studies in the adjuvant settings with cooperation of pharmacokinetic groups are recommended.