Tehran University Medical Journal

---

Background: Sexual dysfunction in males is characterized by the inability to achieve or maintain an erection sufficient for a satisfactory sexual activity. Erectile dysfunction is a common disorder in males and intracavernosal injection of papaverine followed by color Doppler ultrasonography of the penis is used to diagnose and treat vascular impotence. In this study, we examined the relationship between changes in peak systolic velocity (PSV) and erectile dysfunction with vascular cause after a cavernosal injection of papaverin.

Methods: We performed this self-controlled clinical trial in Shahid Hasheminejad Hospital in Tehran, Iran during 2010 and 2011. The study population consisted of 90 patients with erectile dysfunction. The peak systolic velocity (PSV) of cavernosal arteries was evaluated before and after injection of 40-80 mg papaverine and it was compared in the patients with and without response to injection.

Results: The mean age of participants was 47.7 13.7 years. Response to papaverine injection was positive in 41(45.5%) patients. The mean PSV values were 14.68+5.65 and 53.74+18.8 cm/s before and after the injection, respectively (P<0.001). A PSV cut-off point of 10 cm/s was determined for the condition before injection. The sensitivity and specificity of the value for diagnosis of arterial erectile dysfunction were calclulated as 50% and 100%, respectively.

Conclusion: A PSV cut-off point of 10 cm/s in flaccid status before papaverine injection has a low sensitivity but high specificity for the diagnosis of arterial erectile dysfunction. Future studies with sufficient cases of arterial erectile dysfunction are necessary for final judgments and suggestion a new cut off point.

---

Background: Chlamydia trachomatis is the most common bacterial sexually transmitted infection in the world, but the effect of this infection on male fertility is still controversial. Despite reports of interaction between Mycoplasma genitalium and sperm, this pathogen in semen samples of infertile men is less studied. We studied, the prevalence of Chlamydia trachomatis and Mycoplasma genitalium infection in infertile men.
Methods: Among attending Avicenna Infertility Center, 120 men who had abnormal semen analysis tests were selected and the samples were taken. After detailed analysis of semen quality, DNA was extracted from each sample by chelex. Samples were evaluated for these two pathogens by multiplex PCR. Results were statistically analyzed.
Results: Chlamydia trachomatis and Mycoplasma genitalium was detected in 23/3% and 12/5% of the samples, respectively. Although, Mycoplasma genitalium infection rises by increasing (P=0.640) and decreasing in age of first sexually activity (P=0.203), and also positive cases of Chlamydia trachomatis infection showed increase regarding age increase (P=0.619) and age decrease in first sexually activity (P=0.511), but these differences were not statistically significant.
Conclusion: All in all, regarding to the increased prevalence of Chlamydia trachomatis infection compared with the only similar study in Iran and high prevalence of Mycoplasma genitalium infection in infertile men, this assessment was done. A multiplex PCR protocol rapidly and simultaneously identify these organisms in comparison with uniplex from clinical samples. Based on our results screening for Chlamydia trachomatis and Mycoplasma genitalium infection among infertile men seems to be valuable.

---

Background: Gastric cancer (GC) is one of the most common cancers worldwide and in Iran. Conventional therapies are surgery and chemotherapy. Current studies are evaluating natural compounds in inhibiting growth of cancer cell. In this study isolated peptide melittin with 26 amino acids from bee venom and its impact on the viability and proliferation of gastric cancer cells was investigated.
Methods: At first melittin was purified from honeybee venom using a reversed-phase high performance liquid chromatography (RP- HPLC) and C18 column. In order to investigate whether melittin, a 26 amino acids peptide which is the main components of honeybee venom, inhibits proliferation of human gastric adenocarcinoma cell line (AGS cells), MTT ((3-(4, 5-dimethylthiazol-2-yl)-2, 5- diphenyltetrazolium bromide) assay was performed. Hemolytic assay carried out in order to confirm the biologic activity of the isolated melittin. AGS cells were plated in a 96-well plate and treated with serially diluted concentrations of melittin for 6 and 12 hours. The mortality of the cells was measured via MTT assay at 540 nm.
Results: The obtained chromatogram from RP-HPLC showed that melittin comprises 50% of the studied bee venom. SDS-PAGE analysis of melittin fraction confirmed purity of isolated melittin. Hemolytic activity assay indicates that isolated melittin shows a strong hemolytic activity (HD50=0.5). MTT assay showed that melittin strongly inhibits proliferation of gastric cancer cells at concentrations more than 2µg/ml. This inhibitory effect is dependent to melittin concentration and incubation time.
Conclusion: This study provides evidence that melittin inhibits proliferation of the gastric cancer cells. Results showed that isolated melittin from honey bee venom have cytotoxic effect on AGS cell line with a trend of increasing cytotoxicity with increasing concentration and incubation time.

---

Background: Arterial insufficiency is a well-recognized etiology of erectile dysfunction. Moreover, nowadays it is appreciated that it can herald silent coronary artery disease in involved patients. However color Doppler study of penis with intracavernosal injection (ICI) of Papaverin, as a helpful diagnostic study, is somehow time consuming and technically demanding, as a result, radiologists are reluctant to accomplish. Hence, in a search for more plausible parameters, we were determined to validate PSV in flaccid state for predicting possible arterial insufficiency in patients.

Methods: In a cross sectional study to evaluate diagnostic tests, accomplished in Hasheminejad Urology center in Tehran throughout 2011, we studied 59 patients with the complaint of erectile dysfunction. They were referred to our ultrasound clinics by urologists in order to undergo color Doppler study of penis by ICI of Papaverin. They were studied comprehensively before and after injection. Primary and secondary diagnostic criteria of arterial disease in color Doppler and consequently the physiologic event of full erection were designated as gold standard diagnostic considerations. The resulted data were matched and analyzed with SPSS software.

Results: Fifty nine patients underwent the study, with the mean age of 45.6 ± 13.1 (24 to 74 year old). Twenty two cases revealed normal study (non-organic causes as 37.3%), 29 were classified as venous leakage, and eight of them demonstrate arterial insufficiency in the study. A flaccid state PSV of 10.5 cm/s as cut off had a sensitivity of 93.8%, specifity of 91.3% and negative predictive value of 93.8% to predict arterial disease.

Conclusion: A flaccid state PSV of 10.5 has a suitable statistical value to proclaim arterial insufficiency in cavernosal arteries in patients with erectile dysfunction as a complaint.

---

Background: Acquired paralysis of the diaphragm is a condition caused by trauma, surgical injuries, (lung cancer surgery, esophageal surgery, cardiac surgery, thoracic surgery), and is sometimes of an unknown etiology. It can lead to dyspnea and can affect ventilatory function and patients activity. Diaphragmatic plication is a treatment method which decreases inconsistent function of diaphragm. The aim of this study is to evaluate the outcome of diaphragmatic plication in patients with acquired unilateral non-malignant diaphragmatic paralysis. Methods: From 1991 to 2011, 20 patients with acquired unilateral diaphragmatic paralysis who underwent surgery enrolled in our study in Ghaem Hospital Mashhad University of Medical Science. Patients were evaluated in terms of age, sex, BMI, clinical symptoms, dyspnea score (DS), etiology of paralysis, diagnostic methods, respiratory function tests and complication of surgery. Some tests including dyspnea score were carried out again six months after surgery. We evaluated patients with SPSS version 11.5 and Paired t-test or nonparametric equivalent. Results: Twenty patients enrolled in our study. 14 were male and 6 were female. The mean age was 58 years and the average time interval between diagnosis to surgical treatment was 38.3 months. Acquired diaphragmatic paralysis was mostly caused by trauma (in 11 patients) and almost occurred on the left side (in 15 patients). Diagnostic methods included chest x-ray, CT scan, ultrasonography and sniff. Test prior to surgery the average FVC was 41.4±7 percent and the average FEV1 was 52.4±6 percent and after surgery they were 80.1±8.6 percent and 74.4±1 percent respectively. The average increase in FEV1 and FVC 63.4±4, 61.1±7.8. Performing surgery also leads to a noticeable improvement in dyspnea score in our study. Conclusion: In patients with acquired unilateral non-malignant diaphragm paralysis diaphragmatic plication is highly recommended due to the remarkable improvement in respiratory function tests and dyspnea score without mortality and acceptable morbidity.

---

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. Chronic infections have been mentioned as one of the different etiologic factors related to PCOS. Due to the high prevalence of Helicobacter pylori infection especially in developing countries, its probable role in the pathogenesis of PCOS and the limited information available in this area, serologic study of H.Pylori infection in patients with PCOS, was performed. Methods: This research was performed as a case control study from Dec 2010 until May 2012 in 82 patients (and their spouses) with polycystic ovary syndrome (case group) and 82 non PCOS patients (control group) with an age range of 20-40 referred to Vali-e-Asr Hospital infertility clinic. Both groups and their husbands filled a questionnaire and were examined by testing their serum H.Pylori IgG and IgA antibody levels. Statistical testing and analysis was performed by t-student and λ2 tests. Results: Mean age of the women and men and also other demographic characteristics except their profession showed no significant difference (P>0.05) in the two groups (PCOS and non PCOS). H.Pylori antibody IgG serum level was positive in 78% and 76.5% and H.Pylori antibody IgA level in 30.5% and 37% of PCOS versus non PCOS patients respectively which showed no statistically significant difference (P>0.05). There was also no significant difference between the H.Pylori antibodies levels in the spouses in the two groups (P>0.05). Conclusion: This study showed no significant difference in serologic examination re-sults in PCOS versus non PCOS patients. The finding of high prevalence of H.Pylori IgG and IgA positive levels in both PCOS and non PCOS patients can be probably re-lated to the high prevalence of H.Pylori infection or exposure in Iranian population and therefore suggest an issue for further investigation.

---

Background: Genu valgum deformity is exaggerated valgus alignment of lower extremity mechanical axis in knee with a joint line that slopes superolaterally and is corrected by distal femoral osteotomy. In this study the results of treatment and satisfaction in patients with genu valgum were evaluated according to knee society score (KSS) and changes in pre-operation and post-operation lower extremity mechanical axis were compared to each other. Methods: The present study is a cross-sectional study that was performed on 27 patients (30 knees) who have had distal femoral varus osteotomies between 2005 to 2011. Patient’s data were collected from hospital documents, pre-operation and post-operation alignment views and physical exams of operated patients. Radiographs were from the lower extremities and including three joints of hip, knee and ankle (alignment view). Mechanical axis of femur and tibia were drown and they were compared to each other. For measuring patient satisfaction, KSS score was used. All data was collected and evaluated by SPSS 16 software. Results: In this study, 30 knees (in 27 patients) by mean of 30.7±3.36 months follow- up, (range, 5-76 months) were evaluated. The mean of ages in patients was 19.66±4.35, (range 10-34 years). Ten cases (37%) of valgus were on the right side and 14 cases (52%) on the left side and three (11%) cases were reported on both sides. Based on Student’s t-test, there was a significant difference in post- operation lower extremity mechanical axis. The mean of KSS score was 82.52 and the score was defined as 60.7% excellent, 25.1% good, 7.1% fair, and 7.1% poor in patients. According to the results of study, in five patients were non-::::union:::: and re-operated. Conclusion: Distal femoral varus osteotomy is a reliable procedure in knees with valgus correction. This procedure with precise selection of patients, have acceptable end results.

---

Background: Normal vaginal delivery is the best method of delivery. Vaginal delivery is followed by the best pregnancy outcomes. Reducing the rate of cesarean delivery has been a health goal for the United States with economic and social advantages. This study has been conducted with aim of maternal and neonatal outcomes of Normal Vaginal Delivery (NVD) and comparing with cesarean delivery. Methods: This descriptive- analytic study was conducted in Ghaem University Hospital in Mashhad during years 2007 until 2013. Five hundred thirty six full term infants aged 3- 14 day, born either by NVD as control group or cesarean delivery as case group par-ticipated in this study. Sampling was a convenient method. The data in questionnaire containing maternal information (maternal age, mode of delivery, maternal weight, du-ration of delivery, duration of maternal hospitalization, let down reflex, breast feeding status) and neonatal information (age, sex, Apgar score, urination frequency and defe-cation frequency) were collected by a researcher. Results: According to the findings of this study, the infant’s age (P=0.425), admission weight (P=0.278), jaundice access (P=0.162), urination frequency (P=0.165), maternal weight (P=0.869) showed no statistically significant difference between two delivery methods. Time of the first breast feeding after childbirth (P=0.000), defecation fre-quency (P=0.000), maternal age (P=0.000), maternal parity (P=0.003), duration of de-livery (P=0.000), duration of maternal hospitalization (P=0.025), feeding position (P=0.029), let down reflex (P=0.012), mastitis (P=0.025) and breast problems (P=0.027) showed statistically significant difference between the groups. It means defecation frequency, duration of maternal hospitalization, Apgar score, mastitis and breast problems were more in cesarean group, but early breast feeding after delivery, duration of delivery, proper breastfeeding position and let down reflex were more in NVD group. Conclusion: The results of this study showed in comparison with cesarean delivery, normal vaginal delivery provides better outcomes in terms of breast problems, breast feeding status, duration of labor and duration of maternal hospitalization for both mother and infant. So, adopting careful instructions in management and administration of deliveries will help the prevalence of making decisions for normal vaginal delivery and the recovery of delivery outcomes.

---

Background: The occurrence of Atrial Fibrillation (AF) is linked to an increased inflam-matory response after cardiac surgery that is significantly decreased by anti-inflammatory treatments. The present study aimed at administrating Colchicine as a way to reduce the incidence of post- Coronary Artery Bypass Graft (CABG) atrial fibrillation. Methods: In this double-blind, parallel clinical trial, 216 patients with coronary artery disease who underwent CABG surgery, by using a table of random numbers are divided into intervention and control groups to receive placebo or Colchicine. The clinical and surgical characteristics of the patients in two groups were similar. The intervention group received 1.0 mg of Colchicine tab, the night before surgery and on the morning of surgery. This drug followed by 0.5 mg twice a day for five days after surgery. On the other hand patients in the control group received only placebo (ineffective pill with similar size to Colchicine). After operation two groups were compared regarding important outcomes such as postoperative arrhythmia, ICU stay and hospital stay. The data were assessed using SPSS software (version 17) and t-test and 2 statistical tests. Results: One hundred fifty six men and sixty women with a mean age of 59.9±9.3 years were enrolled in the study in two Colchicine and placebo groups (each consisting of 108 patients). The incidence of postoperative atrial fibrillation was 14.8% in the Col-chicine group and 30.6% in the control group (P= 0.006). ICU stay in the Colchicine group were 2.4±1.3 days versus 3.1±1.5 days in controls (P< 0.001) and hospital stay in the Colchicine group were 6.6±1.5 days versus 8.1±2.0 days in controls (P< 0.001). Conclusion: Colchicine is an anti-inflammatory medication and has very few side effects at low doses. According to the 48% reduction in the incidence of atrial fibrillation in Colchicine patients undergoing coronary artery bypass grafting surgery, this drug can be prescribed as a prophylaxis for prevention of post-CABG atrial fibrillation.

---

Background: Early detection of fetal gender can provide an alarm for parents who complicated by genetic disorders. Moreover, the invasive tests are used for detecting any sex-specific genetic syndromes before 12 weeks of gestation. This study was de-signed to discover any association between placental location and fetal gender between 11 to 13+6 weeks of gestation. Methods: A cross-sectional study was conducted on 200 singleton pregnant women. They were referred for Down syndrome screening sonography to prenatal clinic, Imam Khomeini Hospital a tertiary referral university affiliated hospital, Ahvaz, Iran, in 2013. Women were included if they are singleton and at 11 to 13(+6) weeks gestational age. Exclusion criteria were multifetal, ectopic pregnancies, or dead fetus. Information about placental location (upper, middle, below, anterior, posterior), gravidity, and fetal gender were recorded. All participants of our study were evaluated by one trained gy-necologist in ultrasound examinations during nuchal translucency (NT) examinations. Ultrasonography was performed using the Accuvix V10 OB/GYN ultrasound. All patients were followed-up till delivery for confirming the predicted gender. Information regarding gender of newborn were collected using medical chart review or by phone contact. Results: Among 200 placenta which had been assessed, 103 (51.5%) were anterior and 97 (48.5%) were posterior. Our results showed that 75 (72.8%) from girl cases had an anterior placenta, while just 28 (27.2%) from boy cases had an anterior placenta (P< 0.001). In addition, there was significant association between placental location regard-ing below, middle, and upper and fetal gender. Conclusion: According to our results, an anterior and posterior positions of the placen-ta had significant relation with fetal gender. Our findings are consistent with previous studies regarding prediction of fetal gender using placental location. We suggest that more research with large sample size is required as well as investigations with more de-tails about placental locations.

---

Background: Red Blood Cell's (RBC)’s folate may be related to decreased risk of colorectal adenoma. Methylenetetrahydrofolate reductase (MTHFR) is a key regulatory enzyme in folate metabolism. The MTHFR C677T polymorphism is located in the Exon 4 region and is associated with the change of folate level. This study evaluated the associations between RBC’s Folate levels and colorectal adenoma risk, taking into account whether this associations is modified by MTHFR Polymorphism. Methods: In a case-control study conducted from January to October 2007 in Endoscopy-Colonoscopy ward of Shahid Faghihi Hospital, Shiraz. Participants were 177 case of colorectal adenoma who had pathologic-confirmed adenomatous polyps in full colonoscopy examination and 366 controls without polyps in full colonoscopy. Fasting venous blood were drawn from patients in order to determine RBC’s folate and to identify the MTHFR polymorphism by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. Results: Gender Distribution in the patient group were 57.6% male and 42.3% female and control group consisted of 55.1% male and 43.9% female. 50.2% of cases and 49.2% of controls were in the age group “45 years and above”. The T allele frequency was 56.6% in control group and 34.4% in colorectal adenoma patients. There was a significant association between T allele in -677 position of MTHFR gene and colorectal adenoma susceptibility (OR: 1.85, 95% CI: 0.76-4.24, P<0.001). Mean concentration of RBC’s folate was not statistically significant among three groups with TT genotype (mutation homozygote), CT genotype (heterozygote), and CC genotype (wild-type homozygote) (P>0.05) but mean concentration of RBC’s folate was the lowest in TT genotype compare with two other genotype. Odd's Ratio for low (<140ng/ml) versus high level of RBC’s folate in participants with TT genotype was (OR: 2.08, 95% CI: 0.10-2.19, P<0.05) as compare with the CC ones. Conclusion: The result of this study suggested an inverse association between RBC's folate concentration and colorectal adenomas risk, which may be more relevant for those with the MTHFR TT genotype.

---

Fibronectin (FN) is one of the essential component of the extra cellular matrix and their important role is as regulator of cellular activities and also fibronectin is an important scaffold for maintaining tissue. Fibronectin conformational changes expose additional binding sites that participate in fibril formation and in conversion of fibrils into a stabilized, insoluble form. In fact fibronectin is a connected glycoprotein disulfide dimer with sedimentation coefficient of approximately S 13 and 440 kDa molecular mass which is exist in many extracellular matrix and plasma with concentration of approximately 300 µg/ml that during the regeneration body tissues acts in severely regulated stages until regenerate the damaged tissue. Fibronectin has domains for interacting with other extra cellular matrix proteins, cell surface receptors, glycosaminoglycans (GAGs), and other FN molecules. This combination of domains allows FNs to bind simultaneously to cells and to molecules within the surrounding matrix. Also fibronectin have binding sites for collagen/ gelatin, heparin, fibrinogen, and other molecules. In the present study important roles of fibronectin in development, regeneration especially in nerves system and important role of it in treatment of some diseases have been reviewed. Present study has reviewed 77 publications by using of PubMed, NCBI, Elsevier, EBSCO and Nature databases for describing the important roles of fibronectin in biological systems. Studies have shown that fibronectin has diverse roles such as: cellular adhesion, embryonic differentiation, assembly of extra cellular matrix, connecting and cell growth, transformation as well as cell migration that each of this roles depends to fibronectins action site. Considering the important role of fibronectin in attachment of cancer cells to basal lamina, spread neoplasm, tissue regeneration and formation of extra cellular matrix better identification the properties as well as physiological applications of fibronectin in tissues and bodies of animals can provide the better understanding of physiological mechanisms and pathophysiological effects of cells on each other, and also provides the new ways for treatment a variety of diseases.

---

Background: Breast cancer is the most common non- skin cancer among women and it’s the second leading cause of cancer related death in women. Ubiquitin and ubiquitin like proteins are member of signal transduction pathways which have several cellular functions. It has shown that Ubiquitin like protein D (UBD) has accelerated the cancer progress. The aims of this study is evaluation of UBD gene expression in women suffering from breast cancer and its correlation with disease progression. Methods: In this study 30 FFPE (Formalin-fixed, paraffin-embedded) samples 20 cases from breast cancer and 10 cases from mammoplasty were collected from Parsian and Kasra Hospitals in Tehran after confirmation by pathologist. For each sample collection characters included ER-positive, lymph node negative, tumor size less than 5 cm in diameter were considered. Samples belonged to May 2010 up to April 2012. At first paraffin was removed by adding xylene then xylene removed with replacing ethanol 98%. After removing ethanol, RNA was extracted from samples by using RNX plus solution and cDNA synthesis were performed by using Moloney murine leukemia virus (M-MuLV) enzyme. UBD gene expression were examined in all samples cDNA by relative Real Time PCR. In this study GAPDH gene expression was also used as internal control. Results: UBD gene expression was obtained by calculating ΔΔCT and RQ. The average incensement of UBD gene expression in comparison of normal samples was 11 times. The results have shown that the level of UBD expression was related to the development and extend of the disease. In patients with stage 1 of disease, UBD gene expression had 2.73 times increase (P=0.001) compared to the control samples. However in stage 4 of disease, this number has increased up to 19.4 times (P=0.0005) more than normal. Conclusion: Considering the results of this study, it could be said that UBD gene expression as useful biomarker has an important role in detection of breast cancer. In addition as UBD gene expression levels increased stages of disease increased too. So that evaluation of UBD gene expression can be useful in early detection of disease.

---

Background: Coriander with the binominal name of Corianda Sativum, is one of the oldest medicinal plants ever known to man. Anti-inflammatory, anti-microbial, and anti-fungal effects of its oil has been mentioned in numerous studies. This study examines the impact of coriander cream on wound healing of the second-degree singe burn.

Methods: In this experimental study which was performed in the animal lab of the Hazrat Fatemeh Hospital in Tehran, 48 adult male rats with an approximate weight of 250-300 grams, with deep burns of 2 cm 4×2 dimensions were prepared and divided into 4 groups of 12. We used silver sulfadiazine cream, alpha ointment, coriander cream and vaseline gauze (control group) dressings in burn wound of the groups 1 to 4 respectively. At the end of the study (30 days), rats were euthanized with a high dose of thiopental and the wounds were evaluated on days 10 and 17 with a punch biopsy. Samples were fixed with 10% formalin on histopathology slide using haematoxylin and eosin (H&E) staining (to assess and determine the presence of inflammatory cells). The amount of fibrin and collagen at the site were evaluated using a software program ImageJ, version 1.45 (National Institutes of Health, Bethesda, Maryland, USA).

Results: The mean of wound surface area in the first photography was no significant (P= 0. 135). The rate of wound healing in alpha ointment and coriander cream had better outcomes than either of the other two groups (P= 0.000). The healing of the wound in silver sulfadiazine group was significantly less than other groups. Pathology results showed a statistically significant difference between the four groups (coriander, alpha, SSD and control), based on the Kruskal-Wallis test. These relate to (1) polymorphonuclear in the first (P= 0.032) and the second series (P= 0.003), (2) Angiogenesis in the second series (P= 0.004). (3) Fibrosis in the first series (P= 0.024) and the second series (P= 0.000).

Conclusion: The results of this study showed that wound healing improvement in coriander cream group was better than the control group and silver sulfadiazine group and similar to alpha ointment group.

---

Background: Infertility is defined as failure to achieve pregnancy after one year of unprotected sexual intercourse. Infertility can be related to male or female factors. Varicocele is the most common cause of infertility in men that is correctable with surgery. The purpose of this study was to determine the effects of recombinant follicle-stimulating hormone (rFSH) on semen parameters in infertile men.

Methods: This randomized clinical trial was done on 96 infertile men admitted to the Women's General Hospital Mohebe-Yas from September 2014 to September 2015. Inclusion criteria were to include varicocelectomy for unilateral idiopathic varicoceles and consent to participate in the study. Allergy to the drug combination and patient dissatisfaction were exclusion criteria. Patients participating in the study were divided into two groups randomly, one group received recombinant FSH three times a week and the other group received a placebo (normal saline) in the same way. After three months, the improvement of semen parameters, including motility, morphology and sperm count as well as the complications were determined in both groups. The data were analyzed with statistical software SPSS version 13 (Chicago, IL, USA).

Results: A total of 96 patients were enrolled in two groups of 48 men and women both groups were matched in terms of underlying factors. The rate of improvement in the morphology and motility of sperm in the treated group was significantly more than the placebo group (P= 0.0001) but the changes in sperm count were not significantly different between the groups (P= 0.495).

Conclusion: In summary, based on the results obtained in this study, it can be concluded that recombinant FSH is effective on improving semen parameters in infertile men after varicocelectomy compared with a placebo group and its major impact is on the morphology and motility of sperm.

---

Background: Jaundice is the most common cause of neonatal admission within the first month after birth. Therefore, by identifying the causes of jaundice based on the infant’s age at disease onset and age at hospital admission and providing the required training, jaundice can be managed and its associated complications can be prevented. This study was performed to evaluate the causes of neonatal jaundice, based on the infant’s age at disease onset and age at hospital admission.

Methods: In this cross-sectional study, out of 3,130 infants with jaundice, referring to Ghaem Hospital, Mashhad, Iran, from 2003 to 2015, 2,658 newborns were selected. Causes of jaundice are determined based on hematocrit, direct and indirect bilirubin, Coombs test, reticulocyte count, blood group and Rh of mother and neonate, thyroid tests, glucose-6-phosphate dehydrogenase (G6PD) enzyme testing, urinalysis, urine culture, and If necessary, Na, blood urea nitrogen, creatinine and other tests depending on the doctor's supervision. After confirming jaundice in infants, based on the physician’s diagnosis and laboratory results, a researcher-made questionnaire including the infant’s characteristics, was completed.

Results: Based on our study, 27.9% of infants had identified as causes of jaundice. Known causes of jaundice were blood group incompatibility (40%), infection (19%), G6PD enzyme deficiency (12%), endocrine disorders (8%), neonatal hypernatremic dehydration (7%), polycythemia (6%), congenital heart disease (CHD) (4%), occult bleeding (3%) and Crigler-Najjar syndrome (2%). The most common time of hospital admission of jaundice was 4-6 days after birth due to blood incompatibilities, occult bleeding, endocrine disorders, hypernatremic dehydration, CHD, polycythemia and G6PD enzyme deficiency. Moreover, the most common time of admission due to infection was after the first week of birth.

Conclusion: The most common age of onset of jaundice was first three days of birth for blood incompatibility, although they were admitted two days later. Therefore, neonatal admission at appropriate time at onset of jaundice and receiving prompt treatments can reduce the probable complications (e.g., kernicterus).

---

Background: Graft survival has been considered the major problem in reconstructive surgery. Clinical studies have helped us to understand the role of PRP in increasing skin survival. Our goal in this study was to examine the treatment effects of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) on autologous full thickness skin graft survival in male rats.

Methods: This experimental study was performed on 36 rats of Sprague-Dawley race with weighing approximately 250 to 300 gr on May 2015 in animal laboratory of Hazrat Fatima Hospital. After anesthesia, rats were divided into 3 groups. We injected platelet-rich plasma (PRP) in the first group, platelet-rich fibrin (PRF) in the second and saline in the third group after removing the skin. Microscopic analysis was performed with camera (Canon powershot SX200, Tokyo, Japan) on days 7, 14, 21 and 28 after surgery. We used image analysis system (ImageJ, ver. 1.45) to examine necrosis and survival rate. Samples were studied with H&E staining on day 28 microscopically for histological analysis of vascular density and angiogenesis.

Results: Our findings showed the area of necrosis in animals injected with PRP on days 7 and 14, was meaningfully less than control group (P= 0.0001). There was no meaningful difference between control and PRP groups (P> 0.05). The area of necrosis in animals injected with PRF did not have any significant difference with control group from beginning to 21st day (P< 0.0001). there was no meaningful difference in vascular density between control and PRP group, whereas in animals injected with PRF the vascular density was significantly less than control group (P= 0.002).

Conclusion: According to our results in this study, we can conclude that using autologous PRP can enhance the process of healing soft tissue injury and be affective at increasing graft survival. This method is suggested to be conducted for patients highly at risk of graft loss and also for those who are in need of early treatments.

---

Background: Systemic sclerosis (SSc) is an autoimmune rheumatic connective tissue disease. In normal wound healing process, fibroblasts are activated, proliferated and involved in tissue repair, and then removed by apoptosis. In systemic sclerosis, patient’s fibrosis occurs when fibroblasts become resistant to apoptosis and secrete a large amount of collagen and other extracellular matrixes. As the primary causes the disease are very complex and often unknown, it is necessary to consider or target the secondary causes of disease, such as the unresponsiveness of activated fibroblasts to apoptosis as the major factor in the creation and deployment of illness. In this study, we examined the expression levels of two key pro-apoptotic genes, Fas and Apaf-1, which are respectively involved in external and internal pathway of apoptosis.

Methods: In a case-control study skin biopsy samples were obtained from 19 patients with diffuse SSc, and 16 healthy controls. Dermal fibroblasts were cultured and total RNA was isolated from cell populations using High Pure RNA Isolation Kit (Roche Applied Science, Mannheim, Germany), followed by cDNA synthesis using RevertAid First Strand cDNA Synthesis Kit (Thermo Fisher Scientific Inc., Massachusetts, USA). Real-time PCR was performed using SYBRGreen gene expression master mix (Takara Shuzo, Co., Ltd, Shiga, Japan) and specific primers for Fas and Apaf-1. Real-time data were analyzed using the (2^-ΔCT)×1000 method. Statistical analysis was accomplished by using the SPSS software, v22 (IBM, Armonk, NY, USA). The P value less than 0.05 were recognized as a significant threshold. All data are represented as the mean ± SEM.

Results: Our results showed no significant difference in Fas (P=0.8) and Apaf-1 (P=0.17) mRNA expression levels between skin fibroblasts of systemic sclerosis patients and healthy controls.

Conclusion: In this study we observed no significant change in Apaf-1 and Fas mRNA levels in systemic sclerosis fibroblasts compared to control group. Hence, Apaf-1 and Fas are not transcriptionally activated in SSc fibroblasts. Further studies need to take place on protein levels and function of these proteins to confirm the mRNA transcription results.

---

Background: Ankylosing spondylitis (AS) is an inflammatory disease that mainly affects axial skeleton of the body and ankylosing spondylitis ligaments around the spine at the junction of the spine are inflamed, because the disease is progressive and can lead to significantly cause of disability and the studies could provide a mechanism for the early detection of the disease or help determine when to start treatment, the difference in clinical presentations of AS in men and women is indicative of potential effect of gender on severity of the disease. This study was conducted with the aim to investigate the effect of gender on severity of AS.

Methods: In a cross-sectional study, one hundred and fifteen patients with ankylosing spondylitis who referred to Yazd Rheumatology Clinic between 2001 and 2013 were evaluated. Sampling was performed using non-random convenient method. The most important variables studied included demographic data, clinical presentation, radiographic stage of sacroiliac involvement, and laboratory data extracted from patients’ files and recorded in questionnaires.

Results: Both groups according to age at diagnosis, presence of enteritis, peripheral joint involvement and laboratory data such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and hemoglobin were matched. Inflammatory neck pain was more prevalent in men than in women (77.2% against 51.8%; P< 0.05). Sacroiliac radiographic study revealed stage 1 involvement in 11.3% of men and 37% of women (P= 0.009), and stage 4 in 27.2% of men and 3.7% of women (P< 0.001), with a significant difference.

Conclusion: According to the results of the study, the time between age of onset and age at diagnosis, inflammatory pain in the neck and advanced stage in men than in women was higher. Although these findings suggest that gender may have an impact on the pattern and severity of AS but the time delay in diagnosis as a disease affecting the intensity and pattern should not be overlooked.

---

Background: Autosomal recessive polycystic kidney disorder (ARPCKD) is one of the most prevalent hereditary disorders in neonates and children. Its frequency is between 1/6000 to 1/55000 births. In the most severe cases, it can be diagnosed prenatally by the presence of enlarged, echogenic kidneys and oligohydramnios. However, in the milder forms, clinical manifestations are usually detected in neonatal and childhood period. PKHD1 gene located on chromosome 6 is linked with this disorder. About half of detected mutations in this gene are missense ones. The largest protein product of this gene is called the FPC/polyductin complex (FPC). It is a single-membrane spanning protein whose absence leads to abnormal ciliogenesis in the kidneys.

Case presentation: Here we present a 5-year-old female patient affected with ARPCKD. She has been born to a non-consanguineous healthy Iranian parents. No similar disorder has been seen in the family. Prenatal history has been normal. In order to find the genetic background, DNA was extracted from patient's peripheral blood lymphocytes. PKHD1 gene exons and exon-intron boundaries were sequenced using next generation sequencing platform. Two novel variants have been detected in compound heterozygote state in the patient (c.6591C>A, c.8222C>A). Bioinformatics tools predicted these variants to be pathogenic.

Conclusion: In the present study, we detected two novel variants in PKHD1 gene in a patient with ARPCKD. The relatively mild phenotype of this patient is in accordance with the missense mutations found. Molecular genetic tools can help in accurate risk assessment as well as precise genotype-phenotype correlation establishment in families affected with such disorder to decrease the birth of affected individuals through preimplantation genetic diagnosis or better management of disorder.