Tehran University Medical Journal

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Background: In this study were focused on corneal cells changes in keratoconus disease, as there are differences between results of other studies that were done on keratokonic eyes. And the chief purpose was a comparison between keratoconus and normal population based corneal endothelium (in cell density, pleomorphism and polymegethism of cells). Methods: This study is an observational study and is a case-control type. This study was done in Farabi Ophthalmology Hospital, Tehran, from September 2013 to February 2014. In this study, 26 mild (corneal power is lower than 48 diopter) and moderate (corneal power is between 48 to 54 diopter) keratoconic eyes (case group) with no history of contact lenses wear or eye surgeries were compared with 25 normal eyes (control group) that corneal power based topographic images is lower than 47.2 diopter. This comparison were done based specular microscopy images which were taken by Noncontact (Topcan Sp-2000 P) specular microscope in 5 corneal regions (central, superior, inferior, nasal, temporal). Then the information related to the cell density, Coefficient of Variation (CV) of polymegethism and pleomorphism of cells were analyzed by SPSS software, version 21 (SPSS, Inc., Chicago, IL, USA). Results: Superior corneal region has the largest amount of endothelial cell density in case and control groups (P<0.001). But the effects of keratoconus on the cell density was not significant (P=0.96). And also CV of polymegethism in two groups (case and control groups), was similar (P=0.828). Pleomorphism was seen in 7 eyes of 26 eyes in case group (26.9%) and 6 eyes of 25 eyes in control group (24%). Conclusion: Keratoconus does not have any considerable effect on cell density, polymegethism and pleomorphism, in mild and moderate stages and corneal opacity risk caused by intraocular surgeries (such as: Cataract or Glaucoma surgeries) and some diseases (such as diabetes and uveitis) is similar in keratoconic and normal eyes.

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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.

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Background: Polycystic ovary syndrome (PCOS) that occurs with chronic lack of ovulation, systemic inflammation and hyperandrogenism is manifested most common endocrine disorder in women of reproductive age. Ziziphora tenuior L. due to possess its Pulegone, flavenoid and anthocyanin has anti-inflammatory and anti-oxidant activity. This study investigates the modulating effects of Ziziphora tenuior L. extract by its anti-inflammatory properties on hormonal profile and the improvement of tissue symptoms of estradiol valerate- induced PCOS. Methods: In this experimental study that established in Laboratory,s Animal Center and Cellular And Molecular Research Laboratory, Kharazmi University, Karaj, from October 2012 to November 2013, 144 female adult Wistar rats divided into three groups of control (without injection), estradiol valerate- induced polycystic ovarian syndrome (2 mg/rat estradiol valerate, subcutaneously) and Ziziphora tenuior L. extract-treated groups. After induction of the syndrome within 60 days, experimental groups were injected 100, 150 and 200 mg/kg bw Ziziphora tenuior L. extract for 10 consecutive days intraperitoneally. The animals were anesthetized by chloroform. Their ovaries and blood serum was harvested to hormonal analysis and histomorphometric studies. Data using of one-way ANOVA test and P< 0.05 was considered significant level. Results: The ovarian sections in PCOS group exhibited a significant reduction in thickness granulosa layer (82%), number of corpus luteums (54%), appearance of some cysts (79%) and increased CRP serum level (68%) compared with the control group, while the histological changes in Ziziphora tenuior L. extract-treated ovaries did not have significant difference compared with control (P= 142). The decrease of LH, estradiol, and testosteron was significant in Ziziphora tenuior L. extract-treated groups compared with the estradiol valerate- induced PCOS. Conclusion: It seems that Ziziphora tenuior L. extract may improve functional and endocrine disturbances of estradiol valerate- induced PCOS and modulate the hormone level by anti-inflammatory effects. Ziziphora tenuior L. extract also starts the ovulation process again in polycystic ovary syndrome group.

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Background: Protozoa are unicellular eukaryotes. A type of intestinal protozoan pathogens is the cause of infection and serious injuries in human with or without clinical symptoms. It seems that parasitic infections as a stressor factor can affect on stress system activity and immune system function and sensitivity. The major purpose of this paper was to evaluate serum cortisol level and the general inflammation by measuring neutrophil to lymphocyte ratio in patients with intestinal protozoa. Methods: A total of 40 men were entered in a case-control study in Besat and Baqyiatallah (a.s.) Hospitals in Tehran from April to September 2014. Men were equally divided into 2 groups based on infection with the intestinal protozoa (control and patient groups). This study was conducted on blood samples of these people. Serum cortisol level and neutrophil to lymphocyte ratio were determined in control and patient with the intestinal protozoa groups. Cortisol was measured using cortisol kit (Diagnostic Biochem, Canada) and by ELISA method. In addition, the samples were treated with Wright stain method, and neutrophil to lymphocyte ratio was calculated using WBC diffraction method. Results: According to the results of this study, mean age between control and patient groups was not statistically significant (P= 0.91). Serum cortisol concentration in patients with the intestinal protozoa was significantly higher than the control group (P= 0.043). In addition, a significant increase was observed in neutrophil to lymphocyte ratio in patients with parasitic infections compared to the control group (P= 0.026). Conclusion: Based on the results of this study, parasitic infection (intestinal protozoa) as a stressor factor can increase serum cortisol concentration. In addition, intestinal protozoa was reduced immune system sensitivity and function. It seems that the neutrophil to lymphocyte ratio can be a potential useful parameters for evaluating the stress system activity and function in patients infected with the intestinal protozoa.

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Background: Multiple Sclerosis (MS) is a neurodegenerative disease of the central nervous system (CNS). The hippocampus is a vital center for learning and memory it is extremely vulnerable to neurodegenerative diseases. The male hormones could be neuroprotective for the CNS. The current study is an attempt to investigate the effect of testosterone on learning and spatial memory following the demyelination of CA1 area by the injection of ethidium bromide in the rats' hippocampus. Methods: This experimental study has been conducted on healthy rats in the faculty of science of the Urmia University from September 2013 to February 2015. For demyelination in all previously gonadectomized healthy rats, 3µl ethidium bromide was injected into the CA1 area of rats by stereotaxic surgery. In addition, the treatment groups received 1µl testosterone (6µg/µl) during a 20-day timeframe on a daily basis after demyelination by the ethidium bromide. The control groups had no drug injection. The process of the learning and spatial memory of the rats were closely monitored by the radial Maze. The demyelination and remyelination in the hippocampus were checked by the myelin-specific coloring (Luxol fast blue and Cresyl violet). Results: The histological results suggest that the testosterone is capable of minimizing the destructive impacts of ethidium bromide in the treatment group as well as enhancing the remyelination process. In the group treated by testosterone, the percentage of the pyknotic cells 20 days after demyelination induction, represented a significant reduction compared to that of ethidium bromide group (P=0.008). The behavioral studies analyses show that the amount of the food finding time in those groups received ethidium bromide was significantly longer than those of the control groups (P=0.001). Furthermore, the application of the testosterone in the treatment groups reduced the extent of demyelination while the memory impairment induced by the ethidium bromide was significantly improved (P=0.001). Conclusion: Testosterone can act as a neuroprotective factor that reduces the extent of demyelination and the number of pyknotic cells. It also may improve the learning and memory impairment induced by ethidium bromide.

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Background: There is a concern by some doctors that not interrupting the patients' initial statements of concerns can lead to too long medical visits. Therefore, in this study, the duration of the patients' initial statements of concerns was studied. Methods: This descriptive cross sectional study was conducted from August to October, 2011 in the Emergency Department of Imam Khomeini Hospital in Tehran. 100 patients entered the study through convenience sampling. Based on a 5 level triage system Emergency Severity Index (ESI), patients who were not life-threatening conditions (level 5) entered the study and critically ill patients and foreign patients were excluded from the study. Demographic data of the patients and durations the patients' initial statements of concerns were recorded and measured. Results: Fifty-six percent of patients were men. 79 percent of them had academic degree less than diploma and most of them have Persian ethnicity (60 percent). The mean age of the participants was 37.09 (SD, 1.68). The mean durations of patients' initial statements was 71.60±2.37 seconds. The minimum time was 22.51 seconds and the maximum time was 206.51 seconds. There was significant difference between age (P=0.001, r=0.382) and gender (P=0.032, df=98, t= -2.17) with the durations of patients' initial statements. But education level (P=0.996, F (2, 97)=0.004) and ethnicity (P=0.266, F (6, 93)=1.3) did not have a significant effect on the durations of patients' initial statements. Conclusion: According to the findings of this study, duration of patients' initial statements of concerns is less than what which leads to an increase the time of medical visits.

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Background: One of the most important issues in medical sciences is wound healing and repair. Application of natural ingredients and herbs for treating ulcers has been in the history of human life. Nowadays, due to the lack of side effects of medicinal plants and a variety of effective compounds in plants, as well as numerous disadvantages of synthetic drugs there has been tendency to use medicinal plants in clinic. Aloe vera is an herbal drug used for treatment of dermal diseases. In this study we evaluated, effects of aloe vera on the wound healing through the microscopic techniques and cell counting.

Methods: In this experimental study, sixty Wistar rats weighing 200-250 g were placed under general anesthesia and sterile conditions. Then a square shape wound with 1.5´1.5 mm dimension was made on the back of the neck. Rats were randomly divided to control and experimental group’s. Each group was divided to three subgroups with 4, 7, and 14 study days. In 1st experimental group aloe vera was used twice on the wound surface and in 2nd experimental group was used once daily and the positive control group were applied phenytoin cream 1% from the zero days of surgery. The control group did not get any treatment on the wound surface. For histological studies, during the fourth, seventh and fourteenth day’s rats were sacrificed and samples were taken from the wound area and adjacent skin. After histological staining with hematoxylin and eosin (H&E) and Masson's trichrome stains, the cells were counted, wound surface and wound healing were investigated.

Results: The macroscopic and microscopic evaluation showed that wound healing increased because the fibroblast numbers in two experimental groups improved compared with control group. The percentage of wound healing on different days in the experimental and control groups were significant. Data were analyzed by using one-way ANOVA test and P< 0.05 was significant.

Conclusion: Present study showed that the twice application of topical aloe vera mucilage can result in rapid wound healing in rats.

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Background: Chickenpox is a very contagious viral disease that caused by varicella-zoster virus, which appears in the first week of life secondary to transplacental transmission of infection from the affected mother. When mother catches the disease five days before and up to two days after the delivery, the chance of varicella in neonate in first week of life is 17%. A generalized papulovesicular lesion is the most common clinical feature. Respiratory involvement may lead to giant cell pneumonia and respiratory failure. The mortality rate is up to 30% in the case of no treatment, often due to pneumonia. Treatment includes hospitalization, isolation and administration of intravenous acyclovir. The aim of this case report is to introduce the exogenous surfactant replacement therapy after intubation and mechanical ventilation for respiratory failure in neonatal chickenpox pneumonia and respiratory distress.

Case Presentation: A seven-day-old neonate boy was admitted to the Neonatal Intensive Care Unit at Amirkola Children’s Hospital, Babol, north of Iran, with generalized papulovesicular lesions and respiratory distress. His mother has had a history of Varicella 4 days before delivery. He was isolated and given supportive care, intravenous acyclovir and antibiotics. On the second day, he was intubated and connected to mechanical ventilator due to severe pneumonia and respiratory failure. Because of sever pulmonary involvement evidenced by Chest X-Ray and high ventilators set-up requirement, intratracheal surfactant was administered in two doses separated by 12 hours. He was discharged after 14 days without any complication with good general condition.

Conclusion: Exogenous surfactant replacement therapy can be useful as an adjunctive therapy for the treatment of respiratory failure due to neonatal chickenpox.

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Background: Peripheral nerve injury is one of the most challenging of modern surgical problem. Recent advances in understanding the physiological and molecular pathways demonstrated the important role of growth factors in peripheral nerve regeneration. Platelet-rich plasma (PRP) is a biological product that has many growth factors. The aim of this study was to investigate the effect of PRP in the regeneration of sciatic nerve crush in the rat model.

Methods: In this experimental study that established in the animal lab of the Hazrat Fatemeh Hospital in Tehran from September to October 2013, Twenty-four healthy male Sprague-Dawley rats (200-250 g) were randomly divided into two groups. In all rats the sciatic nerve was cut and then carefully repaired by the tension free method under a light microscope. In group 1, after the repair, 0.05 µL of PRP was injected below the epineurium to the proximal and distal parts of the repaired area. In group 2 the same amount of normal saline was injected to the proximal and distal of the repaired area. After six weeks footprint analysis, neurophysiologic and histopathology evaluations were performed.

Results: Significant differences existed between the two groups footprint analysis (P= 0.001). Also the nerve conduction latency test was significantly shorter in PRP group. (1.0233 ms in PRP group and 1.7375 ms in control) (P< 0.001). The average amplitude in the first group and the second group was 7.6250 mv (control) 6.3667 mv that does not show a statistically significant difference (P= 0.093). Significant differences between the two groups in the number of axons of the proximal portion of the study was not seen (P= 0.29). The parameters included number of axons of the proximal and the distal part of axons, the diameter of the distal and proximal axons in the two groups were compared. In the two groups there was statistically significant difference between the above parameters. (P= 0.298).

Conclusion: It seems that PRP may have an important role in peripheral nerve regeneration and functional recovery after nerve laceration and repair. Further clinical evaluation recommended.

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Background: Recent studies have indicated the relation of vertebral endplate lesions (Modic changes) to low back pain (LBP). The aim of this study was to investigate the Modic changes in magnetic resonance imaging (MRI) of patients with low back pain, and its correlation with age, sex, type of changes, number of involved segments and location of changes. Additionally, association of degenerative disc changes and disc herniation was assessed.

Methods: In this retrospective study, MRI records of 229 patients with LBP referring to Medical Center of Hazrat-e-Rasoul Hospital, Tehran, Iran, from August to February 2014, were assessed and Modic changes and degenerative and herniated disc changes were recorded.

Results: Based on our observations, a significant association between Modic type and age (P= 0.003) existed in patients with LBP. The highest prevalence in Modic location were observed in anterior part of vertebral endplate (48.8%, P= 0.001). Although, observation of the Modic changes in superior vertebral endplate was higher than inferior parts, but this differences was not statistically significant. The highest prevalence in degenerative disc disease was disc dehydration which was observed in 18.1% of patients (P= 0.04). The relationship between the degenerative changes and Modic type was significant (P= 0.04), while the most prevalent change of disc contour was disc bulging which occurred in 23.7% of patients (P= 0.01). The highest frequency of abnormal disc contour were observed in Modic type 2 which was statistically significant (P= 0.01). Modic surface involvement above 25% was significantly associated with disc herniation (P= 0.04). There was no significant association between Modic height involvement above 25% and disc herniation.

Conclusion: Considering significant association between Modic changes and degenerative and herniated disc changes, reporting of Modic changes is necessary.

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Background: Acute respiratory distress syndrome (ARDS) is one of the most important complications associated with traumatic brain injury (TBI). ARDS is caused by inflammation of the lungs and hypoxic damage with lung physiology abnormalities associated with acute respiratory distress syndrome. Aim of this study is to determine the epidemiology of ARDS and the prevalence of risk factors.

Methods: This prospective study performed on patients with acute traumatic head injury hospitalization in the intensive care unit of the Shohaday-e Haftom-e-Tir Hospital (September 2012 to September 2013) done. About 12 months, the data were evaluated. Information including age, sex, education, employment, drug and alcohol addiction, were collected and analyzed. The inclusion criteria were head traumatic patients and exclusion was the patients with chest trauma. Questionnaire was designed with doctors supervision of neurosurgery. Then the collected data were analysis.

Results: In this study, the incidence of ARDS was 23.8% and prevalence of metabolic acidosis was 31.4%. Most injury with metabolic acidosis was Subarachnoid hemorrhage (SAH) 48 (60%) and Subdural hemorrhage (SDH) was Next Level with 39 (48%) Correlation between Glasgow Coma Scale (GCS) and Respiratory Distress Syndrome (ARDS) were significantly decreased (P< 0.0001). The level of consciousness in patients with skull fractures significantly lower than those without fractures (P= 0.009) [(2.3±4.6) vs (4.02±7.07)]. Prevalence of metabolic acidosis during hospitalization was 80 patients (31.4%).

Conclusion: Acute respiratory distress syndrome is a common complication of traumatic brain injury. Management and treatment is essential to reduce the mortality. In this study it was found the age of patients with ARDS was higher than patients without complications. ARDS risk factor for high blood pressure was higher in men. Most victims were pedestrians. The most common injury associated with ARDS was SDH. Our analysis demonstrates that Acute respiratory distress syndrome is common after traumatic brain injury. Management of traumatic brain injury is necessary to manage and reduce the mortality.

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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.

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Background: It is reported that high frequency of chromosomal aberrations in peripheral blood lymphocytes of individuals is a marker of cancer predisposition. The aim of this study was to investigate the in vitro frequency of chromosomal damage in lymphocytes of patients with head and neck cancer against gamma irradiation compared with those in healthy individuals.

Methods: In a case and control study, peripheral blood lymphocytes of 101 patients with head and neck cancer were collected before the onset of radiotherapy. Lymphocytes of 40 healthy individuals were also collected as controls. Head and neck cancer patients and the control group were consecutively recruited between April 2012 and February 2015 from Clinics of Cancer Institute, Imam Khomeini Hospital, Tehran, Iran. Lymphocytes of patients or control group were cultured and exposed to gamma radiation in G2- and G0- phase of the cell cycle. The induced chromosomal aberrations such as chromosome and chromatid breakages, chromosome and chromatid gaps, chromatid exchanges and micronuclei were scored in one-hundred metaphase cells of each individual. The mean of each chromosomal aberration was compared in patient and control groups. Early and late tissue reactions were scored during radiotherapy treatment or thereafter.

Results: There was no significant difference in demographic characterization between the two study groups. The frequency of radiation- induced G2 aberrations in lymphocytes of patients was significantly higher than in those of healthy donors (P= 0.001 for chromosomal breaks). The frequency of radiation-induced micronuclei in G0 assay was also higher in patients than in those in controls (P= 0.05). The results also indicate that there is no correlation between the two assays. No significant correlation was also observed between aberration frequencies in lymphocytes and the degree of both early and late normal tissue reactions.

Conclusion: The results indicate that the in vitro chromosomal radiosensitivity of peripheral blood lymphocytes of patients with head and neck cancer against gamma irradiation was significantly higher than that in healthy individuals.

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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.

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Background: Coronary artery disease is considered as main factor for patients’ hospitalization. Chest pain is the most common symptoms of patients and its assessment is an important factor in coronary artery disease. So, this study aimed to determine the relationship between the severity of chest pain with physiological indexes in patients with coronary artery disease.

Methods: This study was a descriptive-analytical design that performed on 80 patients with that were hospitalized in coronary care unit of Shahid Mofatteh Hospital in Varamin city, Iran, from March to September, 2014. In this study, the relationship between the chest pain severity and blood pressure, pulse rate, respiratory rate, O₂ saturation and ST segment alterations were assessed. Finally, the gathered data were analyzed by descriptive and inferential statistics.

Results: The mean of chest pain severity was 6.51±2.14 in patients. Patients’ age was between 26 to 85 years old and the mean of age was 60.79±13.79 and there was no significant correlation between age and chest pain severity (P=0.985). Also male and female patients were equal. There was no significant difference between chest pain severity of men and women (P=0.471). The findings of study showed no correlation between chest pain severity and heart rate (r=-0.174 and P=0.122), respiratory rate (r=-0.013 and P=0.909), O₂ saturation (r=0.051 and P=0.651), ST segment alterations (r=0.07 and P=0.539). Also, there was no significant difference between chest pain severity and systolic pressure (P=0.353), diastolic blood pressure (P=0.312) and body mass index (P=0.256) among patients.

Conclusion: In this study, there were not enough evidences for relation between chest pain and physiological indexes in patients with coronary artery disease. So performing more studies in another settings and conditions recommended.

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Background: Operation theatre in a hospital requires considerable human and physical resources to deliver surgery services on an agreed schedule. However, operation theatres are sometimes underutilized due to avoidable last minute cancellations of operations. Cancellation of operations on the day of intended surgery results in operation theatre planning difficulties, hospital inefficiency and resource wastage. In addition, it causes stress for patients and their relatives and results in unnecessary hospital staying. Cancellation of planned operations could be avoided by applying appropriate management strategies and techniques. Quality management as an organizational strategy helps enhance hospital departments’ productivity.

Methods: This study aimed to reduce cancelled surgeries in Shahid Rajaei Hospital in Tehran using a quality management model. A participatory action research was used for the intervention between April 2013 and March 2014. Information on operations cancelled on the day of surgery obtained each day from the operating theatre list. Using a checklist, the reasons for operations cancellation were identified, investigated and an action plan was developed for its reduction. The plan was implemented using the action research cycle.

Results: The number of surgeries increased by 4.06 percent and operations cancellation was reduced by 32.4 percent using the quality management strategy. Surgeon and anesthetist related factors, over-running of previous surgery, changes in patient clinical status and lack of intensive care unit beds were the main reasons for cancelling surgeries. Standardization of processes, proper planning and using anesthetics clinic helped reduce the operations cancellation.

Conclusion: Last minute surgeries cancellation is potentially avoidable. Implementing an appropriate quality management model helps enhance hospital departments’ productivity and reduce surgical cancellation.

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Background: Hypertension is one of the major risk factors for cardiovascular disease. The studies show that factors such as vitamin D, parathyroid hormone, calcium and phosphorus are involved in the regulation of blood pressure. The purpose of this study was to investigate the relationship between blood pressure with vitamin D, parathyroid hormone, calcium, and phosphorus in sedentary postmenopausal women.

Methods: This investigation is in the form of a descriptive correlational study that was performed in September 2015. The statistical population was all healthy and sedentary postmenopausal women 50-70 years old in Urmia city, Iran. Fifty-four sedentary postmenopausal women were selected as subjects and voluntarily and bona fide participated in this study. General and anthropometric characteristics of height, weight, and body mass index (BMI) in subjects were measured by wall-meter with an accuracy of one millimeter, digital scale with precision of 100 g (Beurer, Germany), and dual emission X-ray absorptiometry (DXA) (Hologic, USA) machines, respectively. Diastolic and systolic blood pressure was measured by indicator machine. Serum levels of vitamin D, parathyroid hormone, calcium, and phosphorus were measured by ELISA and Auto-analyzer (BT 1500, Biotecnica, Italy machines, respectively. Results: The mean general, anthropometric, and physiological/laboratory variables of subjects were: age 54 yr, height 156 cm; weight 72 kg; BMI 29 kg/m2; systolic and diastolic blood pressure 76.20 and 110.70, respectively; vitamin D 25.22 ng/ml, parathyroid hormone 33.29 ng/ml, calcium 9.44 ng/ml, and phosphorus 3.26 ng/ml. Moreover, results showed that there was no significant relationship between systolic and diastolic blood pressure and vitamin D (P>0.581 and P>0.619, respectively). There was no significant relationship between systolic and diastolic blood pressure and parathyroid hormone (P>0.623 and P>0.341, respectively). There was no significant relationship between systolic and diastolic blood pressure and calcium (P>0.704 and P>0.141, respectively). There was no significant relationship between systolic and diastolic blood pressure and phosphorous (P>0.058 and P>0.357, respectively). Conclusion: The results suggest that there is no relationship between systolic and diastolic blood pressure with serum levels of vitamin D, parathyroid hormone, calcium, and phosphorous in sedentary postmenopausal women 50-70 years old.

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Background: Members of the tumor necrosis factor (TNF) superfamily of ligands and their receptors (TNFR) are critical regulators of the adaptive immune system. A proliferation inducing ligand (APRIL) is a member of tumor necrosis factor superfamily. APRIL was identified via database mining in 1998 by Hahne, et al. APRIL allows tumor cells to proliferate at a reasonable rate even in low serum. APRIL is abundantly expressed in many tumor cells and tumor tissues. Increasing level of APRIL expression related to replacement of -Arg-Lys-Arg-Arg- motif by -Ala-Lys-Arg-Ala- between amino acids 101-104 and thus abrogated APRIL processing. Previous studies have shown a correlation between APRIL expression with some autoimmune disease, breast cancer, stomach cancer, esophagus cancer and colorectal cancer. Herein, we explore correlation between serum APRIL with pancreatic cancer. Methods: Our study is performed in digestive disease research institute (DDRI) of the Shariati Hospital in Tehran City and affiliated Hospital of Tehran University of Medical Sciences. In this study, concentrations of serum APRIL in sera (30 pancreatic cancer patients and 30 healthy controls) from November 2011 to November 2013 collected and level of a proliferation inducing ligand measured by ELISA technique. In this study used from SPSS software, version 22 (IBM SPSS, Armonk, NY, USA) to perform statistical data analysis. Results: The case group measurement results compared with control groups results according to some characteristics such as age, smoking and, diabetes. ELISA analysis of APRIL measurements show that mean serum APRIL level of pancreatic cancer patients (7 ng/ml) was significantly higher than control group (5 ng/ml). The p-value of this study was 0.003. Conclusion: Our results indicate that serum APRIL, as a potential biomarker, has a positive diagnosis and prognosis value for pancreatic cancer.

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Background: Cardiopulmonary resuscitation, commonly well-known as CPR, is an emergency technique that includes chest compression often with artificial ventilation in an exertion to manually preserve complete brain task until additional measures are taken to return spontaneous blood circulation and breathing in a person who is in cardiac arrest. According to the International Liaison Committee on Resuscitation Guidelines, CPR includes chest compressions for adults between 5 cm (2.0 in) and 6 cm (2.4 in) deep and at a rate of at least 100 to 120 per minute. Cardiopulmonary resuscitation is aimed to reverse vital organs as like as heart, lungs and for subsistence of patients. Several researches showed that different factors affect the resuscitation results. The current study was designed to assess the results of resuscitation and its association factors.

Methods: This retrospective, descriptive and analytic study was carried out in Baharloo Hospital, Tehran, Iran during March 2014 and February 2015. In current work, all resuscitated patients were imported and patients with uncompleted files and died before entrance to hospital were excluded. The data was obtained from medical records units, office files unit and the unit of quality improvement. Data were analyzed by use of SPSS version 22 (Armonk, NY, USA) software and Chi-square test and Student’s t-test.

Results: From 891 patients, 813 cases were entered the study that 498 (61.3%) were male and 315 (38.7%) were female. 41.1% of resuscitation were successful and 58/9% were unsuccessful. The mean and standard deviation time of resuscitation was 28.80 and 12.6 minutes; the most frequent primary diagnosis was cardiovascular disease. In this study there was a significant difference between age and duration of the resuscitation with successful resuscitation (P= 0.02) but, in the variables of ward and resuscitation team were not significant (P> 0.05). Conclusion: The results of this study showed that resuscitation in younger group, short duration of resuscitation and patients without heart diseases are more successful.

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Background: Studies show that aerobic exercise prevents osteoporosis in menopause by stimulating osteoblastic cells. Therefore, the purpose of this study was to investigate the effect of 12 weeks of moderate-intensity aerobic exercise on alkaline phosphatase gene expression, serum levels of alkaline phosphatase, parathyroid hormone, and calcium in sedentary women.

Methods: This investigation is a semi-experimental study that was performed in September 2015 at Urmia University, Iran. The statistical population was all healthy and sedentary postmenopausal women 50 to 65 years old in Urmia city. Twenty sedentary postmenopausal women with an average age 60.12±2.12 yr, weight 72.35±10.50 kg, and body mass index 29.46±3.24 kg/m2 voluntarily and bona fide participated in this study, and then subjects were randomly divided to the Exercise/E (10 women) and Control/C (10 women) groups by random sampling method. E group performed of 12 weeks walking and jogging moderate-intensity aerobic exercise at 65-70% maximal heart rate of training, three sessions per week and per session 50-60 (min), but the C group participated in no intervention. Twenty-four hours before and after the 12-week training program were taken blood samples in order to measure of alkaline phosphatase gene expression and serum markers of bone in the E and C Groups. Evaluation of gene expression and serum markers of bone were measured by real-time reverse transcription PCR (RT-PCR) and Auto-analyzer (Biotechnica, Italy)/ ELISA reader (Awareness Inc., USA) machines, respectively. Data analysis included descriptive and inferential (ANCOVA test) statistics using SPSS version 23 (Chicago, IL, USA) and a significance level of P≥0.05 was considered. Results: The results showed that alkaline phosphatase gene expression and parathyroid hormone after 12 weeks of moderate-intensity aerobic exercise in between-groups were significantly increased (P=0.027 and P=0.006, respectively), while serum levels of calcium and alkaline phosphatase were not significantly different (P=0.941 and P=0.990, respectively).

Conclusion: The results suggest that 12 weeks of aerobic exercise of walking and jogging at 65-70% maximal heart rate of training increases alkaline phosphatase gene expression and parathyroid hormone in sedentary postmenopausal women.