TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2009 | Volume:67 | Issue:8|Papers Count:14

Background: Human bone marrow mesenchymal stem cells (hMSCs) can differentiate into several types of mesenchymal cells, including osteocytes, chondrocytes, and adipocytes, but can also differentiate into non-mesenchymal cells, such as neural cells, under appropriate experimental conditions. Until now, many protocols for inducing neuro-differentiation in MSCs in vitro have been reported. In this study, we induced differentiation into neural phenotype in the hMSCs population by new protocol. In this treatment, hMSCs could express neural markers more than other reports, associating with remarkable morphological modifications.Methods: The Bone marrow specimens were aspirated from the iliac crest of normal men. hMSCs were isolated and cultured in DMEM containing 15% FBS.Between 4-8 passages conversion of hMSCs into neurosphere-like structures and induction this cells to nerve precursors in the low-attachment plastic bacterial dishes with bFGF, EGF & RA were initiated. After seven days terminal neural differentiation was initiated by plating the cells on poly-L-ornithin and Laminin coated dishes. Cells were differentiated for 7-14 days. We used flowcytometry and immunocytochemistry analysis for assessment of specific neural stem cell markers in induced cells.Results: Flowcytometery analysis showed that after induction, 90±2.52 percent of the cells will express neuronal marker Nestin and about 41±1 percent of the cells will express Tuj-1 and about 67±1.05 percent of the cells will express GFAP.Immunocytochemistry and morphologically modifications revealed the same results.Conclusion: Results showed that hMSCs treatment with bFGF, EGF& RA the number of Tuj1 neurons. These data confirmed that hMSCs can exhibit neuronal differentiation potential in vitro, depending on the protocols of inducement.

Background: Dopaminergic is the most important neurotransmitter is fear. The dopaminergic mesolimbic pathway has essential role in excitable behavior, and its role in Parkinson disease. The aim of this research in study, the effect of dopaminergic pathway in fear response.Methods: The elevated plus maze was used in combination with the percentage of time spent in the open arms of the maze (OAT%) and the percentage of entries into the open arms (OAE%) to measure fear. Increases in the OAT% and OAE% indicate an anxiolytic effect (reduction in anxiety), whereas decreases in the OAE% and OAT% indicate an anxiogenic effect. After five days, the rats were injected with saline and different doses of sulpiride and Bromocriptine.Results: Results showed that intracerebroventricular administration of sulpiride, in the doses of 5, 20mg/rat and bromocriptine, D2 agonist in doses 65, 95μg/rat produced a significant effect comparing to sham groups (p<0.05). While intracerebroventricular administration of sulpiride 15, 10mg/rat, and bromocriptine 70, 80mg/rat, did not show any significant effect comparing with sham group (p<0.05). In the current research intracerebroventricular administration of sulpiride, D2 antagonist at the doses of 5, 10, 15, 20mg/rat and Bromocriptine, D2 agonist in the doses of 65, 70, 80, 95mg/rat were used and theire effect on the fear behavior were studied.Conclusions: The possible effect of Dopaminergic system in the fear process, especially D2 receptor increase fear.

Background: Gastric adenocarsinoma is the first leading fatal malignancy in Iran. Despite advances in novel therapeutics approaches for gastric cancer (GC) patient, tumor dissemination via blood stream to distant organ is still the major cause of death. Therefore, there is urgent need to establish sensitive methods for early detection of disseminated tumor cells in peripheral blood (PB) and bone marrow (BM) specimens of gastric cancer patients.Methods: In the present study, we use Carcinoma Embryonic Antigen (CEA) as a tumor marker and Glyceraldehyde 3-Phosphate Dehydrogenase (GAPDH) as an internal control to detection and quantification of disseminated tumor cells in PB and BM specimens of affected individuals. Total RNA was extracted from AGS (gastric cancer) cell line and CEA and GAPDH fragments were generated by reverse transcription. The amplified fragments were cloned into pTZ57R/T vector separately. Double cloning of these genes has done into one pTZ57R/T vector.Serial dilution of this recombinant plasmid is used to construct standard curve, each containing a known amount of input copy number. Total RNA was extracted from BP and BM specimens of 35 GC patients. cDNA of the specimens were synthesized by reverse transcription and subjected to Quantitative Real-Time PCR (QRT-PCR).Results: We developed a highly sensitive and specific quantitative PCR for CEA and GAPDH using Real-Time PCR based on TaqMan technology. CEA mRNA was detected in 23% of PB and 20% of BM specimens. There was no CEA mRNA detecting in control group.Conclusions: The QRT-PCR for CEA can be a useful technique for detection of micro metastases in the PB and BM specimens of gastric cancer patients.

Background: Hairy cell leukemia (HCL) is a rare B-cell neoplasm that comprise approximately 2% of all lymphoid leukemias. Over the past 20 years splenectomy was the only effective therapy but with the advent of purine analogues such as cladribine, splenectomy has been limited to certain situations. After cladribine therapy most patients achieve complete and durable remission. The aim of this study was to compare effectiveness of splenectomy and cladribine in Iranian patients with HCL and also to evaluate the clinical and laboratory features of patients at diagnosis.Methods: 50 patients with the diagnosis of HCL enrolled to our study.The male to female ratio was 3:1, and the median age at diagnosis was 50 years.After diagnosis 20 (40%) and 12 (24%) of patients had splenectomy and cladribine therapy respectively. The reminder of patients were treated with both splenectomy and cladribine.Results: The most common clinical findings were splenomegaly (98%) and fatigue (80%) respectively. Leucopenia and anemia was present in 96% and 80% patients in order.88.6% and 55.5% of patients achieved complete remission after cladribine therapy and splenectomy respectively. After cladribine therapy and splenectomy relapse occurred in 10% and 74% of the patients.Conclusions: Our finding are comparable with previous studies and show that Cladribine induces complete and durable remission in most hairy cell leukemia patients and should be considered as first line therapy. Splenectomy should be performed in certain cases such as spleen rupture.

Background: Postpartum hemorrhage is a major cause of maternal mortality and morbidity. It has been identified that active management of third stage of labor is an effective way in preventing postpartum hemorrhage. This randomized controlled trial was conducted to compare sublingual misoprostol versus intravenous oxytocin in the management of postpartum hemorrhage in nulliparous women.Methods: In this randomized controlled trial conducted in Arash hospital from 2006 to 2009, Five hundred forty two nulliparous pregnant women were enrolled. They were randomized to receive either 400 microgram sublingual misoprostol or 20 IU oxytocin intravenously, immediately after the birth of newborn.Results: Postpartum Hemorrhage was significantly lower in women who received sublingual misoprostol (p<0.0001). Patients who received misoprostol had shorter length of third stage of labor (6.45 minute in misoprostol Vs 6.9 minute in oxytocin group, p=0.003). Comparison of hemoglobin levels in two groups before and after delivery showed that there is a significant lesser hemoglobin drop in misoprostol group p=0.046. Side effects were more common in misoprostol group (p<0.0001). However, they were not serious; shivering (35.66%) in misoprostol group and headache (9.63%) in oxytocin group were the most common adverse effects.Conclusions: Sublingual misoprostol is more effective than intravenous oxytocin in preventing postpartum hemorrhage and is recommended for prevention of postpartum hemorrhage.

Background: Dietary antioxidant vitamins, in particular vitamin C, can play a role in preventing the onset or progression of age-related visual impairment. The aim of this study was to determine the plasma ascorbic acid levels in normal individuals and in senile cataract patients.Methods: The test group included fifty cataract patients, while the control group members were selected among medical staff and patients' companions after age matching with test group. The use questionnaire contained age, sex and location of residency (Urban or Rural). Five milliliter of drawn blood centrifuged and plasma ascorbic acid level was measured by spectrophotometry. Statistical analysis of plasma ascorbic acid concentrations were done using paired t-test.Results: The mean plasma ascorbic acid level intest group and incotral group was 0.96±0.08 and 1.12±0.15mg/dl respectively. Plasma ascorbic acid level in test group was significantly lower than control group (p<0.0001). Aging was associated with a reduction in plasma ascorbic acid level in male while it showed no significant alteration in females. Rural and the female gender showed higher plasma ascorbic acid level.Conclusions: This study revealed plasma ascorbic acid level in patients with senile cataract was lower than normal individuals. Antioxidant vitamins, in particular vitamin C, found in Mediterranean fruits and vegetables could be probably used in the prevention of cataracts, which is a major health service burden in many countries.

Background: In kidney transplantation decision about the proper kidney donation is different between surgeons, but simple vasculature anatomy and a kidney without abnormalities are the most important reasons of choosing a kidney. Therefore complete assessment of renal vessels of a live donor with noninvasive techniques is a necessity for nephrectomy. For delineation of the kidney vasculature anomalies and urinary system abnormalities, Multi-Detector CT seems to be excellent method for evaluation.Methods: In this study 59 live donors were assessed with Multi-Detector CT Angiography. After injection of contrast media, we acquired images with 0.6 mm slice thickness. Processing and three dimentional reconstructions were done and the accessory arteries, early branching of main renal artery, the number of main renal vessels and the ureters were assessed.Findings were compared with the nephrectomy results.Results: In Multi-Detector CT Angiography the prevalence of accessory renal artery was 3/4% with 98% accuracy, early branching of main renal artery was 8/4% with 100% accuracy. Multiplicity of renal veins was seen in 8/4% of donors with 98% accuracy. Duplicated ureter was not seen in any of the donors.Conclusions: The accuracy of CT Angiography is 95% for depicting accessory renal artery and multiple renal artery and 100% for early branching.These results were comparable with findings in conventional angiography.Studies showed this method more valuable than M.R. Angiography and digital subtraction angiography. It is less invasive and can be named as the gold standard method in the diagnosis of anomalies of vessels & collecting system in live donors.

Background: Kienbock disease is characterized by avascular necrosis of the lunate bone. Without treatment, it is usually progressive. While many factors may predispose to Kienbock's disease, it is likely caused by a combination of repetitive loading, vascular risk and mechanical predisposition. Treatments therefore have been designed to decrease compressive loading of the lunate, to prevent lunate collapse, and to allow lunate revascularization. There has been a suggested different treatment, no treatment has ever been proved successful and the rate of surgical complication is relatively high. In this study we performed a new surgical method in the treatment of Kienbock disease. In this method we performed lunate decompression which is a very simple procedure and has no potential complication.Methods: in this study, 11 patients with Kienbock disease in the stage of I to IIIb were surgically treated by a new method of lunate core decompression. The pain, range of motion, functional disability and radiographic indices of the patients were evaluated after two years.Results: the average age of patients were 29 years, 8 (72%) were men. The mean pre-operative pain score (VAS) diminished from 87.5 to 13.5 postoperatively (p<0.001) and DASH score from 84 to 14 (p<0.001) and range of motion was also significantly improved.7 (63%) persons were very satisfied, 2 (18%) were satisfied and 2 (18%) were not much changed.Conclusions: Our findings suggest that the new surgical treatment of lunate core decompression could probably be a simple and effective treatment of Kienbock disease without any potential complication.

Background: Diffuse large B Cell lymphoma (DLBCL) is the most common subtype of non-Hogkin lymphoma (NHL). We performed a retrospective study of patients with de novo DLBCL treated in the Medical Oncology department of Cancer Institute of Iran, Tehran to assess the clinicopathologic and immunohistochemistry correlation and prognosis of the patients.Methods: World Health Organization (WHO) classification was used to reexamine 1470 biopsy specimens related to the years 1985-2006. After excluding five cases of T Cell large cell lymphoma, 50 Patients diagnosed as DLBCL.Results: Median age of the patients was 45.5 (20-85) years: 60% were male and 30% had primary extra nodal disease. The most common extra nodal sites were bone, gastrointestinal tract and Head and neck areas. The most common stages were stage II (32%), stage III (32%), stage IV (20%) and stage I (16%) retrospectively and 33% had B-symptoms. All of The Patients received chemotherapy (83% CHOP regimen) and 46% treated by radiotherapy after chemotherapy.With a mean follow up time of 32 months, median survival time was 34 (95% CI 24-40) months. Prognostic factors for survival were tumor stage, B-symptoms and early relapse (less than 6 months).Conclusions: Our data showed the importance of Immunohistochemistry method in diagnosis of DLBCL. Although DLBCL is potentially curable with CHOP chemotherapy protocol, addition of monoclonal antibody (Anti CD 20) and finding new prognostic factors to predict early relapse are clearly needed in Iran.

Background: Although the short-term results of kidney transplantation have improved greatly during the past decades, the long-term results have not improved according. Graft loss due to chronic allograft dysfunction (CAD) is a major concern in renal transplant recipients (RTRs). There is little data about disease progression in this patient population. In this paper, we investigated history of kidney function as the pattern, waiting time and rate of pass from intermediate stages in RTR with CAD.Methods: In a single-center retrospective study, 214 RTRs with CAD investigated at the Urmia University Hospital urmia, Iran from 1997 to 2005.Kidney function at each visit assessed with GFR. We apply NKF and K/DOQI classification of chronic kidney disease (CKD) staging system to determine pattern of disease progression per stage in this group of patients.Results: The pure death-censored graft loss was 26% with mean waiting time 81.7 months.100% of RTRs passed from stage I to II in mean waiting time 26.3 months. The probability of prognostic factors transition from stage II to III was 88.9% with mean waiting time 25.5 months, transition from III to IV was 55.7% with mean waiting time of 24.9 months and transition for stage 4 to IV was 53.5% with mean waiting time of 18.2 months. In overall rate of transition from stage i to j in patients with stage III at the beginning of the study (time of start CAD's process) was faster than others.Conclusions: This study revealed, that kidney function in first years after transplantation is one of the most important II to III of survival probability per stage and death-censored graft loss. Therefore care of RTRs in first year could potentially increase long-term kidney survival.

Background: One of the clinical manifestations of Human Immunodeficiency Virus (HIV) infected patients is cardiovascular disorder. The aim of this study was to evaluate the prevalence of cardiovascular disorders in HIV infected patients for the beginning treatment of these patients and reducing mortality and morbidity in these patients.Methods: This cross-sectional study was performed on 134 HIV infected patients who referred to Imam Khomeini hospital, Tehran University of Medical sciences, Tehran Iran during years 2007-2008. Demographic characteristics, history of smoking and opium addiction, antiretroviral therapy, class of drugs and duration of consumption were recorded. After completion of physical examination, electrocardiography and echocardiography studies were done.Results: In this study 98 (73.1%) patients were male. The mean age of the patients was 36.5±10.3 years. The mean of the CD4 number were 296±181.Injection drug users were 54.4% of the study patients. Cardiovascular disorders were found in 84 (62.7%) patients. Among patients with heart diseases, 75% were male. The most Electrocardiographic change was the axis deviation of the heart found in 32 (23.7%) patients. Pericardial effusion and LVEF<50% were noted in 7 (5.2%) and 23 (17.2%) patients respectively. The involvement of the mitral valve in 59 (44%), tricuspid valve in 21 (15.7%) and aortic valve in 6 (4.5%) patients were noted. Myocardial dysfunctions existed in 10 (7.4%) patients.Conclusions: Our results showed a high prevalence of cardiovascular disorder in HIV infected patients. We recommend the evaluation of the cardiovascular system in all HIV infected patients even if they are symptom free.