Tehran University Medical Journal
Year:2021 | Volume:79 | Issue:3|Papers Count:11

The presence of the antibodies against the main thyroid antigens, which include thyroid peroxidase (TPO) or microsomal antigen, thyroglobulin (Tg) as well as thyrotropin receptor or Thyroid Stimulating Hormone Receptor (TSH-R), is a hallmark and symbol of the autoimmune thyroid diseases (AITDs) as one of the most common autoimmune diseases (AD) around the world. The prevalence of the thyroid peroxidase antibodies (anti-TPO antibody) and the thyroglobulin antibodies (anti-Tg antibody) is considerably higher in patients suffering from Graves’ disease (GD) and Hashimotochr('39')s thyroiditis (HT, chronic autoimmune thyroiditis, autoimmune hypothyroidism). While the TSH receptor antibodies (TRAbs) are common in the patients suffering from GD, they are relatively rare and infrequent in HT patients. This fact may indicate that TRAbs are more specific than other antibodies. In fact, TRAbs as one of the most important autoantibodies against the different thyroid antigens, are a set of the heterogeneous group of antibodies that based on the function, fall into three categories, including TSHR-stimulating antibodies (TSAbs), TSHR-blocking antibodies (TBAbs), and the neutral antibodies (no effect on receptor). TSAbs and TBAbs result in overproduction and reduction of intracellular cAMP respectively. Therefore the induction of the relevant signaling pathways can be the cause of different clinical symptoms in the form of hyperthyroidism or hypothyroidism consecutively. The extra-thyroidal effects of TRAbs as the extra-thyroid GD manifestations, such as ophthalmopathy and dermopathy, often have an effect on the eyes as well as the skin with the relatively well-known immunological mechanisms of the antibodies functions. Hashimoto encephalopathy is an extra-thyroidal effects of anti-TPO that provokes the central nervous system. On the other hand, anti-TPO like anti-Tg can affect the reproductive organs of women and lead to infertility by an unknown mechanism. Moreover, the circulating antibodies against the thyroid antigens can also be detected in other autoimmune diseases such as rheumatoid arthritis (RA), type I diabetes (T1DM) and celiac disease (CD). In this review article, the most important types of thyroid autoantibodies, their essential immunological processes in AITD as well as the main and important clinical extra-thyroidal manifestations of them have been discussed and reviewed.

This review was conducted between December 2018 and March 2019 at Isfahan University of Medical Sciences. A review of various studies revealed what data mining techniques to predict the probability of survival, what risk factors for these predictions, what criteria for evaluating data mining techniques, and finally what data sources for it have been used to predict the survival of breast cancer patients. This review is based on the Prism statement consisting of published studies in the field of predicting the survival of breast cancer patients using data mining techniques from 2005 to 2018 in databases such as Medline, Science Direct, Web of Science, Embase data and Scopus. After searching in these databases, 527 articles were retrieved. After removing duplicates and evaluating the articles, 21 articles were used. The three techniques of logistic regression, decision tree, and support vector machine have been most used in articles. Age, tumor grade, tumor stage, and tumor size are used more than other risk factors. Among the criteria, the accuracy criterion was used in more studies. Most of the studies used the Surveillance, Epidemiology, and End Results Program (SEER) dataset. Typically, in the field of survival probability prediction, data mining techniques in the field of classification are given more attention due to their adaptation to this field. Accordingly, data mining techniques such as decision tree techniques, logistic regression, and support vector machine were used in more studies than other techniques. The use of these techniques can provide a good basis for clinicians to evaluate the effectiveness of different treatments and the impact of each of these methods on patientschr('39') longevity and survival. If the output of these techniques is used to provide the data input required by a decision support system, clinicians can provide risk factors related to the patient, the patientchr('39')s age, and the patientchr('39')s physical condition when providing services to breast cancer patients. Through the outputs provided by the decision support system, they provided the most optimal decision to choose the best treatment method and consequently increase patient survival.

Background: spacecrafts rotate around the Earth every 90 minutes, so the 24-hour cycle turns to 90 minutes. Retinoic acid, an active metabolite of vitamin A, plays a role in regulating the circadian rhythm and its deficiency can impair the biological clock function and consequently impair the circadian rhythm of locomotor activity. The goal of the study was to assay the effects of simulated spaceship conditions on serum and hippocampal retinoic acid levels in rats. Methods: The tail-hanging, hindleg-weightlessness rat model was applied to mimic the microgravity conditions from June to September 2017 in the zoo of the Aja University of Medical Sciences. Thirty-two male Wistar rats weighing 200-250 gr/in an experimental study were randomly assigned into 4 groups (n=8): 1) control animals with 12/12 h day-night rotation, 2) animals with 12/12 h day-night rotation under 14 days unloading, 3) control animals with 45/45 min day-night cycle, and 4) animals with 45/45 min day-night cycle under 14 days unloading. At the termination of the simulation step, rats were anesthetized, and blood samples were collected and the entire brain was removed and each brain was segmented into Hippocampus. ELISA assays were used to detect retinoic acid in the serum and homogenized hippocampus. Data were statistically assayed using two-way ANOVA and Bonferroni as a post hoc test. P<0. 05 was considered significant. Results: The circadian cycle of 45/45 min compared to the 12/12 h dark cycle increased the levels of retinoic acid in serum (F=4. 901, P=0. 037) and hippocampus (F=5. 793, P=0. 029) in rats. But simulated weightlessness had no effect on retinoic acid content in serum (F=0. 149, P=0. 703) and hippocampus (F=0. 004, P=0. 952). Conclusion: It seems that retinoic acid content in serum and hippocampus is affected by circadian cycle change, and weightlessness has not affect.

Background: Ovarian cancer is the fifth leading cancer-related cause of death in women worldwide and is often diagnosed at advanced stages. Regarding the low sensitivity and specificity of the currently available diagnostic techniques, in the present study, we aimed to evaluate the accuracy of RMI and ROMA indexes and comparing these two indexes with CA-125 and HE4 parameters for the diagnosis and differentiation between benign and malignant ovarian tumors. Also, we determined the optimal cut-off level of these markers in patients who attended Arash Women’ s Hospital. Methods: In this cross-sectional study, we included 137 women with ovarian mass who were attended the gynecology clinic of Arash Womenchr('39')s Hospital, Tehran, Iran (April 2017-April 2019), and were eligible according to the inclusion criteria. We included patients with an adnexal mass over 3 cm. Our exclusion criteria were as the following: pregnancy, age under 18 and over 90 years, taking hormonal agents, renal failure, suspected ovarian torsion, ovarian cancer and taking antibiotics, nitric oxide compounds, and heavy metals. Based on serum CA125, HE4, and ultrasound findings, ROMA and RMI indexes were determined for each patient, and the sensitivity and specificity of HE4, RMI, ROMA, and CA125 were compared with the result of the operative histopathologic assessment. Results: According to the area under the ROC curve, regardless of the patientschr('39') menopausal status, the highest diagnostic value was dedicated to RMI with 89% under the curve area and 95% confidence interval (81. 6-96. 4%). Diagnostic values of other markers were as the following: 87. 7%(95%CI=80. 3-95%) for HE4, 87. 3(95%CI=79. 1-95. 4%) for CA125, and 86. 2%(95%CI=78. 7-93. 6%) for ROMA. In terms of menopausal status, HE4 had the highest diagnostic value in premenopausal patients, while in the menopausal group CA125 had the highest diagnostic value. Conclusion: Measurement of HE4 before menopause and CA125 during menopause seems to be helpful in the early detection of ovarian cancers in women with ovarian masses.

Background: Acute coronary syndrome (ACS) is one of the causes of disability and death. Levels of Uric acid, blood glucose, and dyslipidemia are the risk factors for the disease, but their role in electrocardiographic changes has not been studied. Based on this, this study aimed to investigate the relationship between some demographic and clinical characteristics with electrocardiographic changes. Methods: This cross-sectional study was performed on 484 patients with Acute Coronary Syndrome admitted to Shahroud Imam Hossein Hospital from the beginning of January to the end of June 2018. In this study, the relationship between demographic, clinical and laboratory variables in patients with the acute coronary syndrome with STE, STD, Dynamic changes and inverted T waves were investigated. The required information was extracted from the Patientschr('39') records using the researcher-made checklist. Statistical analysis of data was conducted by using descriptive tests for estimating mean and frequency and statistical-analytical tests including chi-square and ANOVA were performed by SPSS software version 22. Results: The results show that the proportion of STD deviations in women with ACS was 12. 6% higher than in men, but the proportion of STE and Dynamic changes in men was 10. 4% and 12. 2% higher than women, respectively. The proportion of STD, STE, inverted T and Dynamic changes in people with hyperlipidemia was 67. 8%, 77. 6%, 64. 7% and 75. 8%, respectively. The proportion of STD, STE, inverted T and Dynamic changes in patients with hypertension were 0. 12%, 5. 1%, 11. 2%, and 19. 1%, respectively that there was a difference with patients without high blood pressure. Between addiction, fasting blood sugar and LDL with STD; Between History of heart disease, history of angiography, hypertension, creatinine and WBC with STE; and between creatinine and fasting blood sugar statistically significant differences were observed. Conclusion: There were significant correlations between electrocardiogram changes, gender, addiction, hypertension, creatinine, LDL level, fasting glucose and white blood cell count.

Background: The number of patients suffering from diabetic ulcers has been increased in recent years and the current therapies have faced failure. This study aimed to investigate the effects of Wharton’ s jelly stem cells (WJMSCs) on the diabetic wound in an animal mode. Methods: During this laboratory experimental study carried out in Skin and Stem Cells Research Center from March 2021 to November 2021, WJMSCs were isolated and their differentiation capability to osteocytes and adipose cells was assessed using the colorimetric method, and the expression of specific markers was evaluated using flow cytometry. 12 male Wistar rats weighing 200 to 250 grams were purchased from the Pasteur Institute and kept in the animal room in standard condition. Streptozotocin was used to induce diabetes in male Wistar rats. Animals were divided to control (normal saline injection: n=6) and WJMSCs injection (n=6) groups. Wounds with 0. 8 cm in diameter were made on the back of rats. After subdermal injection of normal saline and WJMSCs, wound healing was evaluated 7, 14 and 21 days using the photography method. Data were analyzed using a t-test and analysis of variance. Results: The results showed that the isolation process should be performed no later than a few hours after the cesarean section. Storing the sample for one day or more caused sample contamination leading to significant failure in cell proliferation and differentiation. WJMSCs were positive for specific mesenchymal stem cell markers (CD44, D73, CD90 and CD 105, and negative for CD45 and CD 34. They were capabale to differentiate into osteocytes and adipose cells and had a high viability rate (83. 1%). Subdermal injection of WJMSCs in diabetic rats resulted in acceleration of diabetic wound healing compared with the control group. Conclusion: Subdermal injection of WJMSCs can effectively accelerate diabetic wound healing. According to which, applying Wharton’ s jelly stem cells can be considered in cell therapy particularly in the field of diabetic wound healing.

Background: Control of bleeding during dacryocystorhinostomy (DCR) surgery is of particular importance and controlling the bodychr('39')s hemodynamic responses to stress effectively reduces the amount of bleeding during surgery and improves the surgical area. Therefore, in this study, we aimed to investigate the effect of two-drug combinations Labetalol-Hydralazine and Labetalol-Trinitroglycerin on hemodynamic factors during dacryocystorhinostomy surgery. Methods: The present study is a double-blind randomized clinical trial that was performed on 71 patients who were candidates for dacryocystorhinostomy (DCR) surgery. Patients enrolled in the study using computerized randomization software (Random allocation software). they were divided into two groups. The study was conducted from September 2016 to September 2017 in Isfahan. The amount of bleeding, the cardiovascular response of patients during and after surgery, the degree of satisfaction of the surgeon and the patient, the severity of pain, and the occurrence of nausea and vomiting were assessed, collected and analyzed. Results: Between the two groups in terms of demographic characteristics there was no significant difference. There was no significant difference between the two groups in terms of mean arterial blood pressure (MAP), heart rate (HR) during surgery and the time of staying in the recovery room (P>0. 05). There was no significant difference between the two groups in terms of bleeding volume, surgeon and patient satisfaction (P=0. 73), frequency of vomiting, length of stay in recovery (P=0. 57), the severity of nausea (P=0. 38), pain (P=0. 33) and rebleeding in recovery (P=0/75). Conclusion: The results of the present study show that the use of labetalol with hydralazine in comparison with labetalol with trinitroglycerin has similar results in terms of hemodynamic factors as well as bleeding volume and surgeon and patient satisfaction criteria. Therefore, both of these compounds can be used to reduce bleeding and control vital signs during and after dacryocystorhinostomy surgery.

Background: Degenerative scoliosis most commonly affects the lumbar spine in the elderly, resulting in facet and disc degeneration, leading to increased pain and progressive deformity. Due to the importance of the results of long fusion and the rate of coronary and sagittal correction of imbalance in patients with degenerative scoliosis, the present study was performed to evaluate the results of long fusion surgery in patients with degenerative lumbar scoliosis. Methods: The present study was performed as a prospective cohort study in patients with degenerative scoliosis who were candidates for surgery at Al-Zahra Hospital in Isfahan. Basic patient information including age, sex, anatomical location of vertebral deviation and slip, degree of severity of deviation based on cobb angle and number of previous surgeries were reviewed and recorded. The surgical characteristics of the patient were extracted from the medical record including the approach used, the anatomical location of the fusion, whether or not to perform decompression, the number of decompression and fusion levels, the amount of bleeding during surgery, and the duration of surgery. Results: Eleven female patients participated in this study. The mean age of patients was 55. 64 years with a standard deviation of 7. 67 years. The minimum age was 40 years and the maximum age was 66 years. Patientschr('39') symptoms included low back pain-leg pain (3 cases), back pain-lameness (2 cases) and back pain-leg pain-lameness (6 cases). All patients underwent two stages of surgery. Mean amount of bleeding and time of surgery in the second surgery were significantly reduced compared to the first surgery (p <0. 05). Complications of surgery included proximal junctional vertebral fracture (PGK) in two patients. Conclusion: Degenerative scoliosis is a complex clinical condition in which the patientchr('39')s main problems are pain and disability. Long fusion surgery in patients with degenerative scoliosis significantly reduced the mean deviation, Patient’ s pain and severity of disability 6 months after surgery.

Background: Several scoring systems are available to evaluate the cardiac surgery risk. Frailty increases the risk of adverse outcomes after surgery. The Frailty evaluation system is a relatively new method, and in this study, we compared the frailty scoring method with the conventional Euroscore method. Methods: This cross-sectional study was performed on 88 elderly patients (over 65 years of age) undergoing coronary artery bypass graft surgery in Seyed al Shohada Heart Center, Urmia, Iran, from October 2019 to March 2020. Patients undergoing other cardiac surgeries, patients with left main coronary artery involvement, patients with low-threshold chest pain, and life-threatening emergencies were excluded. At the preoperative period and based on the CAF (the Comprehensive Assessment of Frailty) Scoring System and the EuroScore system, the total score was calculated for each patient. Patients were followed up until one month after surgery in terms of morbidity and mortality. Patients' data were analyzed and the correlation between the total score of both systems and the postoperative consequences were statistically analyzed. Results: In this study, the mean age of patients was 70. 84± 5. 07 (65-91) years and most of the patients were male, 65(73 9%). The mean ejection fraction of patients was 44. 13± 5%. Twelve patients (13. 6%) had mild frailty (CAF score of 1 to 8), 74 patients (84. 1%) had moderate frailty (CAF score of 9 to 18) and 2 patients (2. 3%) had severe frailty (CAF score of 19 to 28). In the postoperative period, there were two cases of mortality (2. 3%) and four cases of complications (4. 55%). The mean serum creatinine level in dead patients was significantly higher than in discharged patients. We did not find any significant relationship between frailty CAF score and EuroSocre with postoperative complications. In a comparison of two methods for predicting surgery outcomes: the mean EuroScore in the two dead patients was significantly higher than discharged patients (8. 11 vs 2. 89 with p value=0. 001). Conclusion: EuroSocre evaluation was a better predictor of postoperative mortality and its measurement is easy.

Background: The goal of the study was to investigate the effect of 5 weeks of high-intensity interval training (HIIT) on the levels of resistin and adiponectin and liver enzymes in Wistar rats with non-alcoholic fatty liver. Methods: To do this basic research, 24 Wistar male rats were purchased and transferred to Baqiyatallah University then, they were allocated randomly into three groups: Control group (CG, n=8), induced fatty liver diseases group (FG, n=8), and induced fatty liver diseases+exercise group (FEG, n=10). The present study was conducted in July and August of 2019. To induce fatty liver disease, 140 mg per kg of bodyweight oral tetracycline drug was administered to rats by gavage for seven days. Fatty liver (steatosis) was confirmed by measuring liver enzymes. The training group performed HIIT for five weeks and five days per week. First, the maximum aerobic test (MAT) was performed, and based on data of this test; the HIIT protocol was conducted as 5×2 min-intervals with (50-120% Mat) and with 1 min recovery (30-50% MAT). Blood and tissue sampling were taken 48 hours after the last training session. Blood samples were centrifuged at 4000 rpm for 10 minutes, and serum samples were frozen at-20 degrees. One-way ANOVA and Tukey post hoc test were used to analyze data. Results: Following performing HIIT, serum levels of adiponectin and resistin in the FEG compared to FG increased and decreased significantly, respectively (P=0. 001). In addition, the FEG experienced a significant decrease in serum levels of AST and ALT enzymes. The aerobic capacity of the rats in the HIIT group increased significantly compared to the other two groups. Conclusion: By modulating body fat levels and the secretion of adipokines such as adiponectin and resistin, HIIT was involved in improving the condition of rats with non-alcoholic fatty liver disease.