Tehran University Medical Journal

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Background: Uterine contractions and an appropriate cervix are two important factors in labor contributing to good pregnancy outcomes. Oxytocin and prostaglandins, such as misoprostol, are used for the induction of labor. Misoprostol is used for cervical ripening and labor induction. The aim of this trial was to compare the efficacy and safety of titrated oral misoprostol solution with oxytocin for labor induction in pregnant women with an unfavorable cervix.

Methods: In this randomized double-blind clinical trial, 140 women with a gestational age of 34-42 weeks and an unfavorable cervix were recruited. The participants had an indication for labor induction and had been referred to the Women's Hospital in Tehran, Iran between January 2010 and January 2011. The participants were randomly assigned to receive 20 µg/hour titrated oral misoprostol plus intravenous placebo or 6 mU/min oxytocin plus oral placebo. In case contractions were inadequate, the drug doses were gradually increased. Pharmacological complications, the mean interval from the start of induction till vaginal delivery and delivery type were monitored and analyzed in both groups.

Results: The mean interval from the start of induction till vaginal delivery in misoprostol group was shorter than the oxytocin group (11.07±3.42 vs. 14.87±3.21 hours, P=0.001). The frequency of pharmacological complications and vaginal or cesarean deliveries were similar between the two groups (P>0.05).

Conclusion: Use of titrated oral misoprostol is a safe and effective method for labor induction in pregnant women with unfavorable cervix. Misoprostol is associated with a shorter interval from induction to vaginal delivery than oxytocin.

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Background: Creatine kinase is a cardiac biomarker that is used for the assessment of ischemic injuries and myocardial infarction. The present study was designed to evaluate effects of oxytocin administration during ischemia and reperfusion periods on CK-MB levels in the coronary effluent of isolated rat heart and the possible role of oxytocin receptor, nitric oxide (NO), prostacyclin and mitochondrial ATP-dependent potassium channels in this regard.

Methods: Male wistar rats (n=8) were anesthetized with sodium thiopental and their hearts were transferred to a Langendorff perfusion apparatus. All animals were randomly divided into nine groups as follow in the ischemia-reperfusion group, hearts underwent 30 min of regional ischemia followed by 120 min of reperfusion. In oxytocin group, hearts were perfused with oxytocin 5 min after ischemia induction for 25 min. In other groups, 35 min prior to oxytocin perfusion, atosiban (a non-specific oxytocin receptor blocker), L-NAME (an NO synthase inhibitor), indomethacin (a non-specific cyclooxygenase blocker) and 5-HD (a specific mKATP channel blocker) were perfused for 10 min. In all groups, we measured CK-MB levels in the coronary effluent at the end of reperfusion. Moreover, coronary flow (mL/min) was measured at baseline, during ischemia period and 60 and 120 min after reperfusion.

Results: Oxytocin administration significantly reduced CK-MB level in oxytocin group as compared to ischemia-reperfusion group. Administration of atosiban, L-NAME, indomethacin and 5-HD prior to oxytocin perfusion abolished the effects of oxytocin on CK-MB levels.

Conclusion: Administration of oxytocin during ischemia and reperfusion periods deceased CK-MB levels but infusion of atosiban, L-NAME, 5-HD and indomethacin inhibited oxytocin from exerting its effects.

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Background: The characteristic of stem cells in self renewal and differentiation to different types of cells has stimulated the interests for using stem cells as a starting material for generating insulin secreting cells. We've evaluated the differentiation potential of Programmable cells of monocytic origin (PCMOs) into insulin producing cells effected from the growth factors and fibroblasts conditioned media (FCM).

Methods: Peripheral blood monocytes of rat were cultured for 6 days in RPMI with 15% FBS, β- mercaptoethanol, MCSF and interleukin-3. Then, these cells were incubated in differentiation media with HGF, EGF, Nicotinamide, 15% fibroblasts conditioned media and glucose for 15days. Morphological differences of cells were studied by invert microscope. In several stages, the amounts of insulin in supernatant of cells were measured by radioimmunoassay kit. Also productions of insulin from differentiated cells were studied with DTZ special staining.

Results: In response to MCSF and IL-3, monocytes dedifferentiated. These programmable cells of monocytic origin (PCMOs) were capable of differentiating into insulin producing cells in differentiation media. The morphology of differentiated cells was similar to Beta cells and the amount of insulin in supernatant of differentiated cells was much higher than PCMOs (P<0.05).

Conclusion: HGF, EGF, Nicotinamide and fibroblasts conditioned media are differentiation factors of PCMOs into insulin producing cells. According to the results insulin producing cells can be differentiated from programmable cells of monocytic origin in presence of fibroblasts conditioned media.

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Background: Persistence of left ventricular hypertrophy (LVH) in renal transplant recipients is associated with unfavorable outcomes. Calcineurin-inhibitor (CNI) nephrotoxicity is a major cause of morbidity and mortality after kidney transplantation. In this study we compared sirolimus (SRL) with calcineurin-inhibitor as primary immunosuppressants for the attenuation of left ventricular hypertrophy in renal transplantation recipients.

Methods: In this prospective cohort study done in Shariati Hospital in 2010, we evaluated the effects of sirolimus and CNI on LVH of 55 renal transplant recipients. The cases (19) received sirolimus while the controls (36) received CNI while being matched for age and duration of transplantation. Data regarding blood pressure (BP), hemoglobin, serum creatinine, uric acid and lipid concentrations were assessed and changes in left ventricular (LV) mass were evaluated by echocardiography over a one-year follow-up.

Results: Left ventricular mass significantly decreased (P=0.0001) in the SRL group but blood pressure did not differ between the two groups. LV mass and LV mass index both decreased significantly (P≤0.05) but the difference was not associated with changes in BP. The difference in interventricular septal thickness at end diastole (IVSD) and posterior wall diameter (PWD) were significant (P≤0.05) in the SRL group but the difference in end diastolic diameter (EDD) was not significant.

Conclusion: Conversion from CNI to SRL-based immunosuppressive therapy in RTRs is safe and SRL may decrease LVH. SRL seems to be safe and improve renal function without cardiac compromise in kidney transplant recipients.

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Background: Fumonisins, a family of mycotoxins, are mainly found in wheat, corn and their products. Previous studies have shown that fumonisin B1 (FB1), the most abundant and toxic of known fumonisins, has been associated with many animal and human diseases including cancer. In the present study, the effects of FB1 were examined on the production of inflammatory cytokines in intestine and stomach cell lines.

Methods: This study was performed in the Cancer Research Center of Tehran University of Medical Sciences in 2010. The cell lines of colon adenocarcinoma (SW742) and gastric epithelium (AGS) were purchased from the Pasteur Institute of Iran. The cells were pretreated with different concentrations of FB1 (0 to 100 µM) for 3 days. The cells were later stimulated by lipopolysaccharides. Twenty-four hours after cell induction, the cytokines including tumor necrosis factor-alpha (TNF-α), interlukin-1 beta (IL-1β) and interlukin-8 (IL-8) were measured by ELISA.

Results: Treatment with FB1 induced a dose-dependent decrease in IL-8 production (P<0.05). This decrease was seen in both SW742 and AGS cell lines. Moreover, FB1 induced a dose-dependent increase in the production of TNF-α and IL-1β in both cell lines (P<0.05).

Conclusion: The results of this study indicated that FB1 could increase the inflammatory cytokines including TNF-α and IL-1β in gastric and intestinal celllines. These effects might result in the development of inflammatory responses and subsequent mucosal atrophy in in-vivo conditions.

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Background: Endometrial carcinoma (EC) is the most common gynecologic malignancy however, mechanisms underlying its pathogenesis remain obscure. Endometrial carcinoma has been classified into two major categories: type I (related to estrogen or endometrioid adenocarcinoma) and type II (unrelated to estrogen). Estrogen is the main trigger for the abnormal proliferation in the endometrial epithelium but progesterone can inhibit this process. The aim of this study was to analyze the expression of estrogen and progesterone receptors in all types of endometrial hyperplasia in comparison to endometrioid adenocarcinoma of endometrium.

Methods: Forty-seven specimens including 23 cases of histopathologically confirmed hyperplastic endometrium (12 simple hyperplasia, 5 complex hyperplasia without atypia, and 6 complex hyperplasia with atypia) and 24 cases of endometrial carcinoma were studied. Immunohistochemical staining of estrogen and progesterone receptors was performed in paraffin-embedded blocks and expression of estrogen and progesterone receptors were scored according to the proportion of positive staining cells.

Results: Overexpression of progesterone receptors was seen in 18 (75%) out of 24 cases of endometrial carcinoma and 23 (100%) of all types of endometrial hyperplasia. The aforesaid differences were statistically significant (P=0.023). 70.8% of cases with endometrial carcinoma were 3+ for immunohistochemical staining of progesterone receptors as were 85.7% of the cases with endometrial hyperplasia the difference being also statistically significant (P=0.02).

Conclusion: Considering the increased proportion of progesterone receptor expression in all types of hyperplastic endometrium in comparison to endometrial carcinoma, hormonal therapy by progestinal agents is recommended as a treatment of choice.

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Background: Transitional Cell Carcinoma (TCC) is the most common type of urinary bladder cancer. Cyclooxygenase-2 (COX-2), a key enzyme in prostaglandins biosynthesis, has been introduced as a new candidate for targeted therapy in this cancer. In this study, we investigated the expression of COX-2 in urinary bladder TCCs and its relationship with clinicopathological parameters such as tumor grade and stage.

Methods: This cross-sectional study was performed in the Pathology department of Sina Hospital in Tehran, Iran during 2006-2011. Pathology reports of patients with definite diagnosis of urinary bladder TCCs who had undergone Transurethral Resection (TUR) were reviewed and 40 cases were selected. Subsequently, COX-2 expression was assessed immunohistochemically by the examination of paraffin embedded tissue blocks. Staining in more than 5% of tumor cells was considered as positive expression.

Results: COX-2 was expressed in 52.5% of the patients. High-grade tumors revealed a higher (87.5%) COX-2 expression versus other grades of the lesions and there was a statistically significant difference in COX-2 expression between them (P<0.001). Patients' age was also related to the expression of this marker (P=0.03). In contrast, this marker did not correlate with other characteristics including gender, lymphatic invasion or tumor stage. In addition, perineurial or vascular invasions were not detected in any of the patients.

Conclusion: COX-2 expression was seen in more than half of our patients and it had a marked relation to tumor differentiation. Accordingly, this molecule may be a useful tumor marker in the assessment of urinary bladder cancers.

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Background: Although the conventional vaccines have been instrumented in the incidence of many infectious diseases, the advances in genetic engineering and bioinformatics have provided the opportunity for developing improved and new vaccines.
Methods: Reverse vaccinology was pioneered by a group of researchers investigating development of a vaccine against serogroup B Neisseria meningitidis. Reverse vaccinology analyzes the entire genome of a pathogen with the aid of computational programs to identify potentially antigenic extracellular proteins.
Results: Using this method for Neisseria meningitidis genome analysis, 600 secretory or surface-exposed proteins were identified and, subsequently, 350 proteins were expressed and purified. Finally, seven proteins capable of activating the immune system against a range of strains were identified.
Conclusion: Improved computational techniques are now able to provide researchers with high-confidence predictions for complex biological characteristics. This will herald a move to computer-aided biotechnology in which time-consuming and expensive large-scale experimental approaches are progressively replaced by functional bioinformatic investigations.

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Background: Staphylococcus aureus is the most common pathogen responsible for skin and soft tissue infections worldwide. Methicillin-resistant S. aureus is a major cause of both nosocomial and community acquired infections. The emergence of antimicrobial-resistant S. aureus is of global concern. Fluoroquinolone antimicrobials including ciprofloxacin, levofloxacin, and moxifloxacin are used to treat skin and soft tissue infections due to S. aureus. Emergence of ciprofloxacin resistance has increased in community acquired methicillin-resistant S. aureus strains. The aim of this study was to evaluate the minimum inhibitory concentration of ciprofloxacin and hexahydroquino-line derivatives against methicillin- and ciprofloxacin-resistant S. aureus.
Methods: Identification of S. aureus was performed by routine microbiological tests in the Department of Pathobiology in Winter 2012. The susceptibility of S. aureus strains to both methicillin and ciprofloxacin was examined by the Kirby-Bauer disk-diffusion method. The minimum inhibitory concentration of ciprofloxacin, hexahydroquinoline derivatives and their combination were separately determined by broth microdilution method against methicillin- and ciprofloxacin-resistant S. aureus.
Results: The minimum inhibitory concentration of ciprofloxacin decreased in the presence of hexahydroquinolinein derivatives in comparison with ciprofloxacin alone.
Conclusion: This study showed that hexahydroquinoline derivatives enhance the antibacterial effect of ciprofloxacin against methicillin- and ciprofloxacin-resistant S. aureus. Therefore, these derivatives could be used as inhibitors of antibiotic resistance in combination therapies. This enhancement may be related to the inhibitory effect of hexahydroquinoline derivatives on the expression of antibiotic efflux pump in the bacteria. However, the structural features of a fluoroquinolone that determine whether it is affected by efflux transporters are not fully defined.

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Background: Ventilator associated pneumonia (VAP) is one of the serious complications of ventilatory support, occurring in ICUs. The aim of this study was to determine various risk factors associated with the acquisition of Acinetobacter infection and its antimicrobial susceptibility pattern.
Methods: This cross-sectional study was performed in the ICUs of Rasoul-e-Akram Hospital in Tehran, Iran during the year 2011. A total of 51 endobronchial aspirates from intubated patients who had been clinically diagnosed to have VAP were studied bacteriologically. The in vitro susceptibility was determined by disk-diffusion and broth microdilution MIC methods.
Results: Out of 51 patients with VAP, 35 (66.66%) had positive cultures for Acineto-bacter species. In vitro susceptibility test revealed that a high percentage of isolates were resistant to imipenem, piperacillin-tazobactam, third generation cephalosporines, and aminoglycosides.
Conclusion: The antimicrobial resistance of gram negative bacteria, particularly Acine-tobacter species, is increasing and preventive measures need to be taken as a matter of urgency.

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Background: Warthin tumor- like papillary carcinoma of thyroid is a rare variant of papillary thyroid carcinoma. It is characterized by distinct papillary structures lined by oncocytic tumor cells with nuclear features of papillary carcinoma and marked lymphoplasmocytic infiltrate in the papillary stalks. This tumor derives its name from its resemblance to Warthin tumor of major salivary glands.
Case presentation: We report a 54- year- old man presented with bilateral thyroid masses. Histopathological study showed papillary structures lined by cells with eosinophilic granular cytoplasm and ground- glass nuclei with lymphoplasmacytic infiltration of the stalks.
Conclusion: Warthin tumor-like papillary thyroid carcinoma could be mistaken for benign lymphoepithelial lesions such as Hashimoto thyroiditis, Hurthle cell tumors and tall cell variant of papillary carcinoma. Follow- up information on the previously reported cases has suggested that these tumors behave similarly to usual papillary carcinoma.

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Background: Amphotericin B Deoxycholate (ABD) has been the best therapeutic agent for treatment of most systemic fungal infections. However, untoward adverse effects like nephrotoxicity may limit its appropriate therapeutic use. We studied administration of fat emulsion early after infusion of ABD to evaluate its effects on ABD-associated nephrotoxicity.
Methods: This study was a randomized clinical trial. Patients with fungal infections admitted in Amir-Alam and Imam-Khomeini University Hospitals, Tehran, Iran, entered the study during 1390- 1391. The patients were randomized to intervention and control groups. In both groups, patients received 1mg/kg/day ABD in dextrose 5%. In intervention arm, the patients additionally received intralipid 10% daily that was started as soon as possible within one hour after infusion of ABD. ABD-associated nephrotoxicity (a minimum 50% increase in baseline serum creatinine to a minimum of 2mg/dl), daily serum creatinine changes during first two weeks of treatment and some other relevant indices of renal function were compared between groups. ABD-related hypokalemia was also compared as an additional target.
Results: Thirty one patients entered the study. ABD-associated nephrotoxicity and values of other relevant indices of renal function were not different between intervention and control groups (P>0.05). Daily changes in serum creatinine level within first two weeks of treatment in both groups were not also statistically different (P=0.62). Furthermore, ABD-related hypokalemia was not significantly different between groups (P=0.47).
Conclusion: Administration of intralipid 10% early after infusion of ABD in dextrose 5% does not have any effect in decreasing ABD-associated nephrotoxicity. Moreover, it does not have any significant effect on ABD-related hypokalemia.

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Background: Ovarian mucinous borderline tumors are divided into two morphologic groups: endocervical-like and intestinal type. Most endocervical adenocarcinomas exhibit mucinous and/or endometrioid differentiation, they infrequently metastasize to the ovaries but may simulate primary ovarian tumors (both atypical proliferative or borderline and carcinoma). In patients with mucinous adenocarcinoma in the abdominal cavity, caution should be exercised in interpreting the possible primary site of the tumor on the basis of the immunohistochemical profiles. The presence of human papillomavirus (HPV) DNA is assessed to determine whether the ovarian neoplasms were metastases or primary independent neoplasm. Approximately 90% of endocervical adenocarcinomas are related to high-risk human papillomavirus (hr-HPV) with the remainder being unrelated to HPV. Both types metastasize to the ovaries very infrequently. Ovarian endocervical-type (mullerian) mucinous tumors and tumors composed of a mixture of endocervical-type mucinous, serous endometrioid, squamous, and indifferent cells with abundant eosinophilic cytoplasm reported to date have been primarily limited to borderline and micro invasive types. We report a-36-yr old woman with adenocarcinomas of uterine cervix who also had ovarian mucinous borderline tumor.
Case presentation: The patient presented with abnormal uterine bleeding and lower abdominal pain. She had a history of uterine cervix polyps. Pelvic ultrasound showed a right adnexal mass and a large cervical size. Histological diagnosis in uterine cervix biopsy revealed adenocarcinoma of cervix. Radical hysterectomy type III with bilateral salpingo-oophorectomy was performed. Histological finding in adnexal mass revealed borderline mucinous tissue of ovarian tumor. Testing for HPV DNA in the tumoral tissue was negative. This confirms that the ovarian tumor is not metastatic from endocervical adenocarcinoma.
Conclusion: We conclude that in a patient with tumors that involve two organs, complete diagnostic investigation should be done to distinguish the primary origin. The factors that affect cell proliferation, can probably have synchronous effects on the two similar cells.

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Background: The role of gram-positive cocci especially Staphylococci species in causing urinary tract infection are well known. Among the Staphylococci species Methicillin Resistance Staphylococcus aureus (MRSA) is the most important. The rate of MRSA is increasing worldwide. This is alarming because the danger of these organism in public health. Therefore the aim of this study was to determine the sensitivity of gram-positive cocci, as well as MRSA to vancomycin and other antibiotics.
Methods: This was a descriptive study, and were carried out on 300 patients with urinary tract infections (UTI) caused by gram-positive cocci, referred to Imam Khomeini hospital during eight months. Prior to the antibiotic sensitivity testing all the isolates were identified according to the standard conventional biochemical procedure, and then the antibiotic susceptibility test were carried out according to Bauer-Kirby method.
Results: Among the gram positive cocci causing UTI, the most abundant were Staphylococcus saprophyticus (37.7%), followed by Staphylococcus epidermidis (22.3%) and Staphylococcus aureus (18%) respectivley. The sex distribution of patients were 163 female (54.3%) and 137 male (45.7%) respectively, and the prevalence rate of urinary tract infections in female was (8.6%) higher than male. The rate of sensitivity of isolated Staphylococci were as followed, sensitive to vancomycine (100%), Ciprofloxacin (89.2%), rifampin (87.6%), and amikacin (71.8%) respectivley, but were resistant to penicillin and amoxicillin (100%). The antibiotic sensitivity rate of isolated  Streptococci was to vancomycine (85.1%), ciprofloxacin (50.7%) and penicillin (79.1%) respectively.
Conclusion: Vancomycin is still a suitable antibiotic for the treatment of Staphyloco-ccus infections. Although 6% rate of enterococci resistance to vancomycin is alarming, and use of this antibiotic in the treatment of other gram-positive bacteria should be done with precaution.

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Background: Gestational trophoblastic disease (GTD) is a heterogenous group of neoplastic lesions that is derived from placental trophoblastic epithelium. According to World Health Organization (WHO) classification they include: Hydatidiform mole (complete and partial), invasive mole, choriocarcinoma and placental site trophoblastic tumor. Hydatidiform mole is the most common and the diagnosis is achieved by pre-evacuation ultrasonographic evaluation, laboratory tests and finally histological assessment as gold standard. Since these disorders show varying potential for local invasion and metastasis, the accurate diagnosis, follow up and recommendations given to patients may differ.
Methods: Consecutive cases with diagnosis of GTD from archive of pathology department of women (Mirza Kochak Khan) hospital were reviewed in whom results of clinical presentation and pre-evacuation ultrasound examination were documented. There were overall 220 cases for which the following clinical features were determined: gravidity, parity, history of previous abortion and gestational trophoblastic disease, the clinical symptoms such as vaginal bleeding and hypertension. Finally concordance between pre-evacuation ultrasonographic and histological diagnosis by kappa test is calculated.
Results: Out of 220 cases with clinically gestational trophoblastic disease diagnosis, 197 cases were confirmed by histological diagnosis. The concluding histological diagnosis includes: 98 cases of complete mole (CM), 84 partial mole (PM), 4 invasive mole and 11 cases of choriocarcinoma. Outside 98 cases with histological diagnosis CM only in 4 cases misdiagnosed by ultrasonoghraphy (4.1%) and high degree of concordance between ultrasonography and histological diagnosis is seen.
Conclusion: Ultrasonographic examination accompanied with clinical examination, beside histological assessment as gold standard have high efficacy in diagnosing  complete mole. This study did not show this finding for partial mole.

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Background: Colorectal carcinoma is a common malignancy, in treatment of which pelvic radiotherapy plays an important role. But this may lead to azospermia. We designed a study to determine the delivered dose to the testis with thermoluminescence dosimetry (TLD) and compare it to the dose calculated by the Three-dimensional planning software. Methods: We measured the testicular doses by TLD the TLDs were fixed to the scrotum in six points anteriorly and posteriorly in two random fractions of the radiation course. All patients received a 50-50.4 Gy radiation dose to the pelvis in a prone position with standard fractionation and 3-dimensional planning, through three or four fields. The average dose of the TLD measurements was compared to the average of 6 relevant point doses calculated by the planning software. Results: In 33 patients with a mean age of 56 years, the mean testis dose of radiation measured by TLD was 3.77 Gy, equal to 7.5% of the total prescribed dose. The mean of point doses calculated by the 3-dimensional planning software was 4.11 Gy, equal to 8.1% of the total prescribed dose. A significant relationship was seen between the position of the inferior edge of the fields and the mean testis dose (P= 0.04). Also body mass index (BMI) was inversely related with the testicular dose (P= 0.049). Conclusion: In this study, the mean testis dose of radiation was 3.77 Gy, similar to the dose calculated by the planning software (4.11 Gy). This dose could be significantly harmful for spermatogenesis, though low doses of scattered radiation to the testis in fractionated radiotherapy might be followed with better recovery. Based on above findings, careful attention to testicular dose in radiotherapy of rectal cancer for the males desiring continued fertility seems to be required.

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Background: Thyroid carcinoma is the most frequent malignant tumor of the endocrine system in human body and accounts for nearly 1% of all cancers. Medullary thyroid carcinoma is the third frequent of thyroid cancer and accounts about 5-8% of thyroid cancer. Osteocalcin, known as a Bone Gamma-carboxyglutamic Acid-containing Protein (BGLAP), is the most non collagenous protein. Retinol binding proteins are the family of proteins that have diverse actions but mainly transport retinol in human body. In this study to evaluate effect of existence medullary thyroid carcinoma on metabolism of bone and adipose tissue, plasma level of two mentioned proteins had analyzed. Methods: Population in this study consists of 46 individuals with medullary thyroid carcinoma and 44 healthy subjects referred individuals to Research Institute for Endo-crine Sciences, Shahid Beheshti University of Medical Sciences. People with the disease after diagnosis of medullary thyroid carcinoma and pathologically confirmed by biopsy in the initial stages of the study were called. After informed consent, 10 ml of blood from the antecubital vein of left hand in sitting position obtained and after cen-trifugation, plasma was isolated from all samples until analyzed kept in the freezer. Plasma levels of hormones were measured by sandwich type ELISA method. Obtained results were analyzed by SPSS version 16 with independent t-test method. Results: Mean plasma level of osteocalcin in patients was 33.1±3.5 and in healthy sub-jects was 12.5±1.2 ng/ml (Mean±SD) and Odds Ratio (OR) value was 1.04. In patients, mean plasma level of retinol binding protein was 82.5±2.7 and in healthy subjects was 22.8±1.6 μg/ml and OR value was 2.1. The confidence level considered at 95%. These differences of plasma levels were statistically significant (P= 0.001). Conclusion: According to difference between plasma levels of osteocalcin and retinol binding protein-4 in patients suffered of medullary thyroid carcinoma comparison with normal subjects, it can be said that, probably medullary thyroid carcinoma has effect on bone and adipose tissue metabolism, so osteocalcin and retinol binding protein-4 hormones have potential to be used for confirmation of diagnosis or following treatment of medullary thyroid carcinoma.

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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.

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Background: Rabies is an acute encephalitis that causes more than 60,000 deaths worldwide. The only way to save individuals bitten by a rabies-infected animal is the timely use of effective vaccines. Treatment with new generation vaccines is expensive. Therefore, there is a global movement towards the production of less expensive vaccines which retain and improve upon the quality and effectiveness of the vaccine. Production and evaluation of non-classical vaccines is one of the approaches taken in this regard. In this study, we describe a new eukaryotic expression system to express the nucleoprotein N gene of rabies virus which, if suitable, may be evaluated for anti-rabies vaccine production. Methods: The complete sequence of the N gene of rabies virus PV subtype was amplified by real-time polymerase chain reaction and cloned into the pCDNA3.1(+) vector. The cloned gene was excised from the vector by restriction enzyme digestion and sequenced. Due to mutations detected in the N gene, the gene coding sequence was purchased as a recombinant pGH/N vector. Vector pGH/N was amplified and following enzymatic digestion, the excised N gene was once again cloned into vector pCDNA3.1(+). Successful cloning was confirmed using restriction digests and quick check. The recombinant vector pCDNA3.1(+)/N was transformed into cultured BSR cells and protein N expression was analyzed using fluorescent antibody test (FAT). Results: Electrophoresis confirmed amplification of the nucleoprotein N gene and subsequent restriction enzyme digestion showed that the N gene had been successfully cloned into the recombinant pCDNA3.1(+)/N vector. However, DNA sequencing revealed the presence of mutations within the N gene. Restriction digest of the commercial pGH/N vector showed that the N gene had been excised from the vector. Successful cloning of the N gene into the pCDNA3.1(+) expression vector was confirmed using restriction digests and quick check. Protein expression in BSR cells was assayed by immunostaining with anti-ribonucleocapsid FITC-conjugated antibody and visually confirmed by fluorescence microscopy. Conclusion: This study showed that the protein N of rabies virus subtype PV can be expressed in a eukaryotic expression system using the pCDNA3.1(+) expression vector.

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cBackground: Choriocarcinoma is a highly malignant form of gestational trophoblastic disease. It is characterized by metastatic potential, rapid growth and deeply invasion into blood vessel and then widespread dissemination metastasis. However, the most common sites of metastatic choriocarcinoma are lung, vagina, liver, and brain. But, metastatic choriocarcinomas rarely is extended to gastrointestinal system. It is im-portant to keep in mind that despite extensive metastasis, choriocarcinoma is very curable disease. Due to high responsibility of this disease, early diagnosis of choriocarcinoma and treatment with chemotherapy can prevent mortality and morbidity of these patients. In this case report, we present a rare case of metastatic choriocarcinoma in the small bowel after normal term pregnancy. Case Presentation: A 34-years-old woman G4, P4, L4 presented with abnormal postpar-tum vaginal bleeding (45 days) and unresponsive to usual medical and surgical therapy (oxytocine, metergene, antibiotic, and double curettage). The patient was admitted in the Ghaem Hospital, Mashhad University of Medical Sciences in April 2013. She suf-fered from rectal hemorrhage and severe weakness. Because of unsuitable condition (shock), laparotomy was performed and small bowel involvement was observed. Seg-mental resection of small bowel detected metastatic choriocarcinoma of the lesion. We couldn’t rescue our patient due to unresponsive to combination chemotherapy (actino-mycine, methotrexate, cyclophosfamide, vincrystine, etopuside). Conclusion: In abnormal postpartum hemorrhage, we should consider the possibility of choriocarcinoma. Although, it is important to note rare manifestations of metastatic choriocarcinoma of small bowel in massive gastrointestinal hemorrhage.