Koomesh
Year:2020 | Volume:22 | Issue:2 (78)|Papers Count:21

Introduction: A lot of research has been done on the effectiveness of mindfulness-based therapies in the treatment of addiction and the reduction of its long-term challenges. Correspondingly, this study was done with the aim of systematically reviewing and meta-analyzing the studies conducted in Iran on the effectiveness of mindfulness-based treatments on addiction relapse prevention. Materials and Methods: Accordingly, all articles performed in the country and published in creditable domestic or international journals were collected by searching the Sid, Magiran, Google scholar, Science direct, Web of Science and Pubmed databases. Search was conducted both in Farsi and English. After searching, screening, assessing the quality of research papers and applying inclusion and exclusion criteria, data was analyzed by utilizing Pooled RD extracted from results and Metan command. Results: Out of the 503 original articles, five articles had meta-analysis criteria. The meta-analysis performed on these studies indicated the significant effectiveness of this treatment on addiction relapse prevention. Conclusion: Regarding the effectiveness of mindfulness-based therapies, policy-makers and therapists need to pay more attention to the treatment of addiction using this therapeutic method.

Introduction: Inflammatory bowel disease(IBD) is caused by genetic, environmental, microbial and immune factors. IBD has two primary forms: Ulcerative colitis and Crohn´ s disease. The incidence of IBD has significantly increased over the last few decades. Given that patients have poor response to drug treatments or are resistant to drug therapies, new therapies are needed for gastrointestinal inflammatory disease treatments. Most types of cells including mesenchymal stem cells produce extracellular vesicles, which play a vital role in cell-to-cell communication. Extracellular vesicles, depending on their contents, can stimulate or suppress immune responses. In recent years, stem cells derived extracellular vesicles have been used as agents for autoimmune and inflammatory disease treatments. In these studies, stem cells-derived extracellular vesicles have been shown to improve inflammatory conditions. in this review, we summarize the therapeutic uses of extracellular vesicles in regulating immune responses in inflammatory bowel disease.

Epilepsy is the most common neurological disease with no definitive method in treatment. Notably, the main way to treat and control epileptic seizures is drug therapy. However, about 20-30% of patients with epilepsy are drug resistant and require other therapeutic manners. Deep brain stimulation is a new therapeutic strategy for these patients. Conspicuously, there are no clear answers for basic questions such as which brain area is a suitable target for stimulation, which pattern of stimulation exerts the best therapeutic effects and what is the probable mechanism of anticonvulsant effect of deep brain stimulation? Using laboratory models of epilepsy and seizure, it has been shown that low frequency electrical stimulation (LFS) is an effective pattern of deep brain stimulation to reduce the seizure severity. The mechanisms involved in LFS anticonvulsant effects are not completely determined. In this article, we reviewed the previous studies on the anticonvulsant effects of LFS and the possible mechanisms involved in it, as well as LFS-induced changes in the neuronal activities.

Introduction: Estimation of age has an important role in legal medicine, endocrine diseases and clinical dentistry. Correspondingly, evaluation of dental development stages is more valuable than tooth erosion. In this research, the modeling of calendar age has been done using new and rich statistical methods. Considerably, it can be considering as a practicable method in medical science that is a combination of some new statistical methods. Materials and Methods: Among the methods used to determine age, the most commonly used method in the world is the modern modified Demirjian’ s method based on the calcification of the permanent tooth in panoramic radiography. The study population is consisted of 87 patients who referred to Khatam-ol-Anbia Clinic of Yazd in a simple randomized method during the 12 months of the 2014-2015 year. Using the estimated age of third molar tooth and gender variables, we evaluated the calendar age. In the analysis of regression issues and especially the statistical modeling of many data such as economic data, psychology, social sciences, medical sciences, engineering, etc., we faced with the problem of collinearity among the predictor variables and the presence of remote areas in the data set. The least squares error method in estimation of the parameters of regression model was very sensitive to the outliers. Most of the existing methods for estimating the parameters of these models based on the least squares error approach, affected by the outliers, were yielded to inappropriate estimates, unexpected and high error rates. Robust methods were used to overcome the problem of the outlier observations. It is also recommended the ridge regression to fix the multicollinearity problem. Therefore, in this study, the robust ridge regression estimators will be introduced in the modeling of dependent variables that are less sensitive to the outliers. Results: The mean age of the subjects was 17. 21 years old, with a gender difference of 67% female and 33% male. Additionally, in the relationship between the estimated age of 4 teeth lower right (LR), lower left (LL), upper right (UR), upper left (UL) with a correlation coefficient were above 70%. Correlation between upper and lower jaw teeth was about 30% and between the left and right teeth was 60%. The reason of using robust ridge regression model in this study is the existence of outlier data and collinearity between independent variables. Conclusion: The necessity of using advanced statistical methods in medical sciences in the recent research is very important. In order to choose the best model, we need to study the data carefully. In this research, the fitted model for prediction of age based on the robust ridge regression method was more efficient with respect to the other methods.

Introduction: Weight is the most important growth factor in newborns and perceived self-efficacy is known as an effective factor weigh gaining. The aim of this study was to determine the effect of mother's infant massage on neonatal weight and perceived self-efficacy of mothers with low birth weight infants. Materials and Methods: 80 infants were divided into intervention and control groups in this qusiexperimental study in neonatal intensive care unit. 40 low-birth weight infants received massage by their mother for 60 days, 15 minutes a day, and only normal care was taken in the control group. At the end of the study, weight gain and selfefficacy scores were analyzed standard statisctical methods. Results: The results showed that there was a significant difference between the mean weight changes in the intervention group (2120. 88± 385. 26) and control (1760. 88 ± 220. 31) at the tenth day of birth and two months (P = 0. 001). The results of independent t-test showed a significant increase in self-efficacy scores and its dimensions in the two intervention groups compared to the control group (P<0. 001). Conclusion: Low-birth-weight infant massage improves weight gain and promotes perceived self-efficacy in mothers. Due to the low cost of this method, it is suggested to teach massage techniques as one of the essential training during discharge in newborns.

Introduction: Children with cancer need psychological treatment to increase their quality of life along with medical treatments. Accordingly, the aim of this study was to determine the comparing the effectiveness of cognitivebehavioral art-play therapy group and the cognitive-behavioral story therapy on health related quality of life among children with cancer. Materials and Methods: The research method was semi-experimental, and research design was three groups with two stages (pre-test and post-test design). From statistical population of 8-12 years old children with cancer in Amir Hospital (Shiraz city, Iran) in the Summer of 2018, 36 children were selected and then randomly assigned in two therapeutic groups (each group with 12 cases) and a control group (with 12 cases). Children Health related Quality of Life Scale (KiD-KINDL-Bullinger & Ravens-Sieberer, 1998) was used to measure the dependent variable in the pretest and post-test. The group of cognitive-behavioral art-play therapy and cognitive-behavioral story therapy received 12 sessions of treatment. The data were analyzed using multivariate analysis of covariance. Results: The results showed that there was a significant difference between cognitive-behavioral art-play therapy and cognitive-behavioral story therapy with the control group in health related quality of life (P<0. 001) and their components. However, there was no significant difference between cognitive-behavioral art-play therapy and cognitive-behavioral story therapy in increasing the health related quality of life in children with cancer (P>0. 05). Conclusion: It is suggested that cognitive-behavioral story therapy and cognitive-behavioral art-play therapy should be used in educational and therapeutic environments to promote the level of health related quality of life for children with cancer.

Introduction: Anxiety and aggression among working children during childhood can be considered a predictor of risky behaviors for the rest of the life. One of the educational skills for working children is the ability to cope with the emotions and control anger. This study was aimed to study the effect of anger management training on working children’ s anxiety and aggression in Isfahan, Iran. Materials and Methods: A quasi-experimental pretest/post-test design with the control group was conducted on the 60 working children recruited from two centers by convenience sampling method in Isfahan (Iran). The Aggression Questionnaire (Buss & Perry, 1992) and Spence Children’ s Anxiety Scale (Spence, 2003) were completed by the participants in pre-test and post-test. The experimental group attended in eight sessions of 60-minute classes. Results: The results revealed that, as far as the group was concerned, there was a significant difference between anxiety and aggression of the participants according to group membership (experimental and control groups) after adjusting the effect of pretest variables (P˂ 0. 001). Conclusion: As a whole, teaching anger control is one of the important factors influencing the aggression and anxiety of working children. As such, it is suggested that various types of educational techniques for control anger can be considered in order to reduce aggression and anxiety in working children.

Introduction: Assessing the quality of life of patients with chronic complications of diabetes and blood pressure leads to planning and measures to prevent or control complications and improve the quality of life of patients. The aim of this study was to evaluate the quality of life of patients with hypertension and diabetes types Materials and Methods: This descriptive cross-sectional study was performed on 150 subjects of 100 patients (50 type 2 diabetes and 50 hypertension) and 50 healthy individuals from attending patients (lack of diabetes, hypertension and other chronic diseases according to a clinical expert) who had been referred to the clinic at Kosar Hospital (Semnan, Iran) during the first six months of 2017. The data collection tool was a personal characteristics and disease list and a quality of life questionnaire (SF-36). Results: There were no significant differences in age group, marital status, education and place of residence. The groups were significantly different in terms of overall quality of life score (p=0. 013) and in physical dimensions (p=0. 001) and psychological symptoms (p=0. 013). So that the overall quality of life score of diabetic patients was less likely to have hypertensive patients (p=0. 009). Remarkably, the quality of life of patients with type 2 diabetes was lower in the subscales of physical and psychological symptoms in patients with high blood pressure (P<0. 001). Conclusion: Findings showed that the quality of life score of patients with diabetes was lower than the patients with hypertension, especially in physical and psychological symptoms. Therefore, planning to improve the quality of life of patients with diabetes is necessary.

Introduction: Early dental caries in childhood is one of the most prevalent health problems. This survey was conducted to determine the prevalence of early childhood caries and its contributing socio-economic factors among kindergarten children of Semnen, Iran. Materials and Methods: In this cross-sectional study, 1332 children under 6 years from Semnan kindergartens were selected by census and examined for dental caries using WHO criteria. Variables including age, gender, educational level and occupation of parents and the level of kindergarten were recorded in a checklist. Additionally, the number of decayed, filled or extracted teeth was also calculated to represent the dmft score. Results: From 1332 studied children, 61. 1% had early childhood caries (ECC). Variables including age (OR= 2. 21 and 95%CI: 1. 90-2. 56, p<0. 001)) and maternal career (p= 0. 002) showed significant relationship with ECC. Moreover, the incidence of ECC was 2. 33 and 2. 95 times greater among children with housewife mothers and mothers having non-medical jobs, respectively than that of children with mothers having medical jobs. Conclusion: The results indicated a high prevalence of early childhood caries among Semnan children. Therefore, particular emphasis should be placed on educational and interventional programs, especially for mothers of children specifically at preschool age regarding their health care procedures and diet.

Introduction: Patients with heart disease suffer from sleep disorders due to the disease process. Aromatherapy is one of the ways to treat sleep disorders. The aim of this study was to compare the effect of aromatherapy with orange and citrus aurantium on sleep quality in patients with acute coronary syndrome. Materials and Methods: This clinical trial study was performed on 120 patients admitted to selected hospitals of Shahid Beheshti University of Medical Sciences (Tehran, Iran) in 2019. The samples were randomly divided into four groups of aromatherapy with Orange extract, Citrus aurantium extract, Orange-Citrus aurantium extract and the control. The control group received only routine care. Data collection tools included St. Mary's Hospital Sleep Quality Questionnaire and demographic profile form. Results: The mean sleep time in the Citrus aurantium group (6. 5 ± 0. 3 hours), the orange group (8 ± 0. 7 hours) and the Orange-Citrus aurantium group (8 ± 0. 8 hours) was significantly higher than the control group (5. 4 ± 0. 4 hours) (p=0. 000). The mean score of sleep quality in the orange, Citrus aurantium and Orange-Citrus aurantium groups was significantly better than the control group (p=0. 0008). The sleep quality score in the combined aromatherapy group was significantly higher than each group alone (P<0. 05). No significant differences were found in the sleep quality between Orange and Citrus aurantium groups. Conclusion: Aromatherapy with the combined Orange and Citrus aurantium extracts and each extract alone has a positive effect on sleep quality and can be used as a complementary measure in nursing care.

Introduction: The available data indicate that there is a relationship between proprioception deficit and low back pain. For this reason, proprioception exercises are usually part of the rehabilitation protocols for these patients. Previous studies revealed that whole body vibration (WBV) can improve muscle performance and proprioception. The aim of this study was to investigate effect of WBV on trunk proprioception in non-specific chronic low back pain (NSCLBP). Materials and Methods: In this randomized clinical trial study, 50 patients with NSCLBP were enrolled. They were randomly assigned to the WBV and control groups. Correspondingly, patients in the experimental group received WBV with frequency 20Hz and acceleration 3-17 g for 360 second in 6 repetitions, and patients in the control group were placed on device at the same position and time, with no vibration. Trunk repositioning error in 30%, 60% maximal flexion of lumbar region and in neutral position was measured with Dual Digital inclinometer, before intervention and immediately after 20 minutes. Results: By matching the original effect of measurement conditions (p<0. 001) and its interactive effect with group (p = 0. 008), there was a significant difference between two groups immediately after the intervention (p=0. 027). Conclusion: WBV with low frequency can improve trunk proprioception in individual with non-specific chronic low back pain. So, it can be introduced as a novel physical therapy intervention for these patients.

Introduction: Pregnancy and childbirth is one of the most important events in women's life, which can have significant effects on women's lives. Among these complications, gestational diabetes can be associated with physical and psychological consequences. Understanding the understanding of the disease has a predictive value in improving the health behaviors of patients. The purpose of this study was to investigate the effect of self-regulation theory based educational intervention on perceived stress in women with gestational diabetes. Materials and Methods: This study was a randomized controlled clinical trial. Samples were selected from women with gestational diabetes in the prenatal ward of Alzahra hospital in Rasht (March 2018 to September 2018). Demographic characteristics and perceived stress questionnaires were completed in both groups. In the intervention group, the educational intervention was based on perception of the disease individually in 3 sessions daily. After the intervention and 4 weeks after the intervention, the perceived stress questionnaire was completed in both groups again. Results: Before intervention, there was no significant difference between demographic characteristics and perceived stress in the two groups (p=0. 65). Immediately after the intervention (p<0. 001) and one month after the intervention, the perceived stress scores of the experimental group (18. 5± 3. 24) compared to the control group (23. 20± 7. 87) were significantly decreased (p<0. 002). Conclusion: The results of the present study showed that self-regulation model based educational intervention can decrease the perceived stress of women with gestational diabetes. Therefore, this intervention is recommended as a useful, easy and low cost method for women with gestational diabetes to reduce stress in them.

Introduction: Decision making about surgery in patients with submucous cleft palate (SMCP) is usually postponed until speech assessment is applicable. Therefore, these patients spend more years with disorders associated with cleft. This study was aimed to investigate and compare the prevalence of different communication disorders in patients with unrepaired SMCP at different ages, since this information can help to provide therapeutic services in multidisciplinary teams. Materials and Methods: Clinical records of patients over3 years of age with unrepaired SMCP who were visited in the Isfahan Cleft care team between the years 2005-2015, were reviewed. Percentage of patients demonstrating language disorder, compensatory misarticulation and hypernasality was calculated in three age groups (3-7, 7-16, and over than16 years). Results: The majority of the 61 studied patients were preschool children and 37. 8% of them suffered from obvious language deficits. 73. 8% of the patients required speech therapy services due to compensatory misarticulation. The prevalence of compensatory misarticulation was significantly different between the group one and two (p=0. 008). 37. 7% of patients demonstrated moderate/severe hypernasality and so required instrumental assessments. Conclusion: Considering the high prevalence of language deficits in the studied preschool children, there is an essential need for proper management of probable ear problems and more accurate evaluations of language in this group. The high prevalence of compensatory misarticulation in all studied age groups indicated these patients’ need for coherent speech therapy and psychological services because of the effects on the psychosocial development, also assessments of educational abilities and providing educational support. At least one third of these patients required instrumental assessments and probably surgeries.

Introduction: Electroconvulsive therapy (ECT) is used to treat generalized seizures in psychiatric diseases. The aim of this study was to evaluate the effect of adding dexmedetomidine to ketamine on heart rate and blood pressure changes in in psychiatric patients undergoing electroconvulsive therapy (ECT) Materials and Methods: In this randomized, double-blind randomized clinical trial, taken place at the Alzahra Subspecialty Medical Center (Isfahan, Iran) between 2018-2019. Fifty patients who were candidate for undergoing ECT entered the study and were divided into two groups namely A and B. The group A received a package containing 0. 5 mg/kg succinylcholine and 1. 5 mg/kg ketamine plus 0. 1 mg/kg dexmedetomidine, and the group B received a medicine package containing 0. 5 mg/kg succinylcholine and 1. 5 mg/kg ketamine plus normal saline. The hemodynamic variables and side effects of the two drug classes were evaluated and compared to each other. Results: The durations of spontaneous respiratory recovery from seizure termination, end seizure to complete consciousness and recovery in the group A was significantly lower than the group B (P<0. 001). However, the mean of systolic blood pressure and mean arterial blood pressure after the end of seizure was significantly less in the group A than the group B, but the mean of SPO2 in the fifth minute in the group B was significantly lower than the group A. However, the frequency of nausea and muscle pain in the group B was significantly higher than the group A. Conclusion: The addition of dexmedetomidine to ketamine in the candidate patients for ECT can shorten the duration of seizure, recovery time, respiratory depression, and also reduce complications such as nausea, muscle pain and oxygen depletion.

Introduction: Phenylketonuria is a disorder due to deficiency of the phenylalanine hydroxylase enzyme. Delay or untreatement would cause impacts on motor-cognitive and individual-social skills. This study aimed to investigate the effect of a controlled diet program on behavioral-emotional disorders in patients with phenylketonuria. Materials and Methods: In a quasi-experimental study, 60 patients with phenylketonuria referred to Hazrate Masoumeh Hospital in Qom (the seventh largest city in Iran) were studied. The data were collected using parents' strengths and difficulties questionnaire (SDQ) to assess the status of behavioral-emotional disorders in patients by one of parents. Data were collected before and after-a three-months controlled diet-intervention. Results: The mean of phenylalanine in the patients was 12. 81 ± 5. 89 mg/dl before intervention and was decreased to 11. 88 ± 6. 8 mg/dl after intervention and this difference was statistically significant (p=0. 018). The most significant effect of intervention was on increase of prosocial behaviors equal to 45%, reduction of conduct problems 38. 3%, reduction of hyperactivity-attention deficit problems by 35%, decrease of emotional symptoms by 35% (p<0. 001). The mean score of the questionnaire and its sub-scales including emotional symptoms, conduct and hyperactivity problems decreased significantly after intervention (p<0. 001), and prosocial behaviors showed a significant increase (p<0. 001). Conclusion: A three-months regular and controlled nutritional intervention showed a positive effect on behavioralemotional disorders in patients with phenylketonuria. The diet intervention reduces patients' problems in sub-scales of emotional symptoms, behavioral, and hyperactivity problems and promote the prosocial behaviors.

Introduction: Preconditioning of mesenchymal stem cells (MSCs) is a promising strategy to enhance the therapeutic properties of transplanted MSCs. In this study, we investigated the synergistic effects of treadmill exercise and dimethyloxalylglycine (DMOG)-preconditioned stem cells in an Alzheimer’ s disease (AD) model. Materials and Methods: DMOG-treated MSCs were intravenously transplanted in the AD model and the rats went on treadmill exercise for one month. Thusly, expression of bax, bcl-2, Nrf2, and NQO1 genes were assessed using real-time PCR. Results: Transplantation of DMOG-treated cells had greater effects on increasing Nrf-2 and NQ1 expression and reducing apoptosis compared to non-treated cells. Ultimately, treadmill exercises for one month along with the transplantation of DMOG-treated cells showed the highest neuroprotective effect. Conclusion: It seems that the transplantation of DMOG-treated cells beside exercise may have protective effects in the AD model via an increase in antioxidant capacity and a decrease in apoptosis.

Introduction: Damage to the central and peripheral nervous system causes neuropathic pain. Caffeine is a plant alkaloid and non-selective antagonist of A1, A2a and A2b adenosine receptors. It is reported that caffeine increases the threshold of pain. In this study, the effect of acute caffeine on behavioral responses of neuropathic pain was investigated. Materials and Methods: The present study was conducted on 56 adult male Wistar rats in the weight range of 220-250 g. Neuropathic pain was induced by chronic constriction injury (CCI(. Animals were randomly divided into 7 groups (n = 8): Control, Sham, CCI, CCI + Saline, and CCI + Caffeine (10, 50 and 100 mg/kg). Thermal hyperalgesia, mechanical and thermal allodynia has been done on days 4, 7, 14, 21, 28 after CCI. Results: Neuropathic rats desmostrated increased pain thresholds. Notably, caffeine at a dose of 10 mg/kg significantly increased the thermal allodynia., but at doses of 50 and 100 mg/kg, it significantly decreased the thermal hyperalgesia and mechanical allodynia. Conclusion: Our findings indicated that the effects of caffeine on pain responses are dose-dependent. Probably the inhibition of adenosine A1 receptors by caffeine increases pain responses, while the inhibition of A2a and A2b adenosine receptors is associated with protective effect of caffeine against pain responses.

Introduction: ELISA is a sensitive, specific, reproducible and fast method to quantify the biological activity of antibodies. Trastuzumab is a humanized monoclonal antibody against HER2 receptors which prevents the initiation of downstream signaling pathway. Trastuzumab can be used as a positive control in the ELISA experiments for antiHER2 antibodies. Additionaly, insufficient washing and blocking can be the cause of background in the ELISA experiment that is necessary to be optimized. As we do not want to waste antigen, it is also important to determine the last dilution of antigen that can give good titration curve for trastuzumab. The aim of this study was to optimize ELISA method for trastuzumab biosimilar (AryoTrust™ , Aryogen pharmed). Materials and Methods: In this study, different variables including the number of washing cycle, the blocking agent and antigen concentration in HER2-based ELISA and the type of HER2 negative cell line and the blocking agent in cell-based ELISA were studied. Results: It was demonstrated that 5 times washing between different steps of HER2-based ELISA causes significant lower non-specific background as compared to 3 times washing. Moreover, the nonspecific binding was significantly lower in the presence of % 5 skim milk as blocking agent as compared to BSA %1 or BSA %3. In addition, the lowest HER2 concentration which gives good titration curve for trastuzumab was 0. 1 μ g/ml. In cellbased ELISA experiment, it was demonstrated that the use of MDA-MB-231 as negative HER2 cell line caused significant lower background than MCF-7. Furthermore, BSA 3% was chosen as proper blocking agent. Conclusion: The results of this study can be used for development of HER2 and cell-based ELISA for anti HER2 antibodies and its fragments.

Introduction: The intensity of the strength training at the start for preventing muscle damage, inflammation and intrinsic antioxidant is not well defined. Intrestingly, the purpose of this study was to evaluate the effect of maximal and sub-maximal resistance exercise on muscle damage, inflammation and intrinsic antioxidant in non-athlete men. Materials and Methods: Nineteen young untrained men [(age (years): 20. 16 ± 1. 21 years, height (cm): 178. 21 ± 1. 75, weight(kg): 65. 74 ± 1. 37] completed 3sets, 15 repetitions, resistance exercise with two maximal and submaximal intensities with 3 minutes' intervals. Blood samples were obtained at pre-exercise, immediately, 2h, 24h, 48h and 72h after exercise. Correspondingly, blood samples were analyzed for creatin kinase (CK), total leucocytes and uric acid (UA). Results: CK increased significantly 48h and 72h after both resistance training intensities compared to base values. The increase of this enzyme was significantly higher 72h after maximal intensity resistance training compared to submaximal intensity. Considerably, leuckocyte increased significantly 24h, 48h and 72h after both resistance training intensitis compared to base values, but it was significantly decreased 2h after both intensity resistance training compared to before and immediately after exercise. Uric acid increased significantly 2h, 24h and 72h after high resistance training intensity and 2h, 48h and 72h after submaximal resistance training intensity compared to base values. Whereas it was significantly decreased 48h after maximal intensity compare to submaximal intensity (P<0. 05). Conclusion: It is recommended that untrained individuals and trainer start resistance training with submaximal intensity for preventing muscular damage and maintaining health.

Introduction: Breast cancer is one of the most common recurrence cancers among women. There are several factors that can affect multiple recurrence of this disease. On the other hand, simultaneous examination of the types of relapses will make the results more accurate. The purpose of this study was to use a joint frailty model to model multiple recurrences of breast cancer patients. Materials and Methods: In this retrospective survival study, 342 breast cancer patients whose records were registered at the Shohada Tajrish Hospital Cancer Research Center (Tehran, Iran) were investigated in 2005-2015. Patients were monitored for at least 6 months after diagnosis and their last condition was recorded in this study, the joint frailty survival model was used and data analysis was done in R software version 3. 4. 1. Results: The 3-year and 5-year survival rates were 0. 79 and 0. 68 respectively. According to the results of the fitted joint frailty model, it can be said that the risk of multiple recurrence is increased for patients with tumor grade greater than I. Also, tumor size (>20 mm) has a significant effect on the risk of recurrence and the risk of local and metastatic recurrence is more for HER2+ patients. Conclusion: According to the results of this study, the relationship between metastasis and local relapses was high in breast cancer patients, which has great importance in the process of recognizing and treating of this disease. Although in this study, in a large sample of patients, there was a positive correlation between multiple recurrences, but these results should be considered with caution with small number of recurrences.

Introduction: Vaspin is a new adipokine which is a member of serine protease inhibitor family and might improve insulin sensitivity. The aim of this study was to investigate the effect of concurrent training (aerobic and resistance) on vaspin, and C-reactive protein levels in middle-aged sedentary obese men. Materials and Methods: 20 sedentary obese men (age: 50. 7 ± 2. 1 years, the percent of body fat (BF): 31. 10 ± 1. 80, weight: 93. 53 ± 5. 22 kg, BMI: 30. 88 ± 1. 22 kg/m2) were selected and randomly divided into two groups. Training consisted of a combination of endurance training (10-34 minutes and intensity 50-75% of maximum heart rate) and resistance training (1-2 set with 10-12 repetitions and intensity of 50-75 percent one repetition maximum) for 12 weeks and three sessions per week with 48 hours' rest between sessions. Blood samples were gathered after 12 hours of fasting and 48 hours after the last training program. Results: Vaspin levels decreased significantly in the experimental group. The weight, BMI, and BF decreased 4. 2%, 4. 7, 7. 6%, respectively, and also insulin resistance decreased 7. 1% in the exercise group than the control group. There was no significant relationship between vaspin changes and anthropometric indices, insulin resistance and C-reactive protein. Conclusion: In conclusion, vaspin serum concentration is decreased in parallel with the decline in the weight, and insulin sensitivity following the combined aerobic and resistance exercise.