Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 57 1 2019 02 13 1 4 Farzaneh Rahmani Universal Scientific Education and Research Network (USERN), Tehran, Iran. Mahsa Keshavarz-Fathi Universal Scientific Education and Research Network (USERN), Tehran, Iran. Sara Hanaei Universal Scientific Education and Research Network (USERN), Tehran, Iran. Arya Aminorroaya Universal Scientific Education and Research Network (USERN), Tehran, Iran. Farnaz Delavari Universal Scientific Education and Research Network (USERN), Tehran, Iran. Sasan Paryad-Zanjani Universal Scientific Education and Research Network (USERN), Tehran, Iran. Negar Sadat Ahmadi Universal Scientific Education and Research Network (USERN), Tehran, Iran. Parya Akbari Universal Scientific Education and Research Network (USERN), Tehran, Iran. Saboura Ashkevarian Universal Scientific Education and Research Network (USERN), Tehran, Iran. Farshad Barghi Universal Scientific Education and Research Network (USERN), Tehran, Iran. Saleheh Ebadirad Universal Scientific Education and Research Network (USERN), Tehran, Iran. Ali Jaberipour Universal Scientific Education and Research Network (USERN), Tehran, Iran. Mohammad Reza Kolahi Universal Scientific Education and Research Network (USERN), Tehran, Iran. Marjan Moallemian Universal Scientific Education and Research Network (USERN), Tehran, Iran. Ali Pourebrahimi Universal Scientific Education and Research Network (USERN), Tehran, Iran. Alireza Samimiat Universal Scientific Education and Research Network (USERN), Tehran, Iran. Zahra Vahedi Universal Scientific Education and Research Network (USERN), Tehran, Iran. Seyedeh-Sanam Ladi Seyedian Universal Scientific Education and Research Network (USERN), Tehran, Iran. Nima Rezaei Universal Scientific Education and Research Network (USERN), Children’s Medical Center, Tehran, Iran. 2019 01 16 No Abstract https://acta.tums.ac.ir/index.php/acta/article/view/7699 https://acta.tums.ac.ir/index.php/acta/article/download/7699/5203

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 57 1 2019 02 13 5 16 EN Alia Saberi Neuroscience Research Center, Department of Neurology, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran. Samaneh Kazemi Deputy of Research and Technology, Guilan University of Medical Sciences, Rasht, Iran. 2017 12 20 2018 11 05 Multiple sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system (CNS) and is characterized by a high degree of heterogeneity in progression and treatment response. Mitochondrial dysfunction is increasingly recognized as an important feature of MS pathology and may be relevant for clinical disease progression. This paper systematically reviews published evidence concerning the role of mitochondrial abnormalities with MS. Literature searched using the Web of Science, PMC/Medline via PubMed and Scopus databases up to May 2017 with no time and language limitation. After quality assessment, 9 articles were included in the study. All data extraction was conducted by two reviewers independently. Based on the results of the studies, it seems that mitochondrial DNA abnormality and mitochondrial dysfunction may be due to primary inflammation in MS or may be occurred itself before any inflammation, but definitely contributes to axonal degeneration and disease progression. Mitochondrial abnormality contributes to axonal degeneration in MS and disease progression. https://acta.tums.ac.ir/index.php/acta/article/view/6901 https://acta.tums.ac.ir/index.php/acta/article/download/6901/5204

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 57 1 2019 02 13 17 26 EN Akbar Ghorbani Alvanegh Human Genetics Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. Mahmood Tavallaei Human Genetics Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. Houri Edalat Human Genetics Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. 2018 02 06 2018 12 15 Chronic obstructive pulmonary disease (COPD) is going to be the third leading cause of death by 2020. Circulating miRNAs are among the most beneficial feasible non-aggressive biomarkers for diagnosis and treatment of many diseases. Among members of the significant miR-17-92 cluster, miR-20a and miR-92a are greatly involved in both inflammation and hypoxia (known as the main reasons for COPD comorbidities). Thus, the expression of these miRNAs was evaluated in the serum of 26 patients and 19 controls using the sensitive stem-loop RT-qPCR approach. The results revealed a significant reduction of these miRNAs in patients relative to controls (P<0.001). Decreased expression of miR-20a in a patient might reflect a progressive stage of the disease. MiR-92a might be used as an early-detection biomarker of COPD. These miRNAs can be used as therapeutic targets specifically in the context of the miR-17-92 cluster to address the various clinicopathological aspects of the disease. https://acta.tums.ac.ir/index.php/acta/article/view/7023 https://acta.tums.ac.ir/index.php/acta/article/download/7023/5205

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 57 1 2019 02 13 27 32 EN Alireza Khooei Department of Pathology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Fatemeh Atabaki Pasdar Department of Anatomical Sciences, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran. Alireza Fazel Department of Anatomy and Cell Biology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Mahmoud Mahmoudi Department of Immunology, Immunology Research Center, Bu-Ali Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran. Mohammad Reza Nikravesh Department of Anatomy and Cell Biology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Shahin Daneshmand Shahbazian School of Industrial Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran. 2018 01 29 2018 12 15 Morphologic examination still forms the main diagnostic tool in the differential diagnosis of molar placentas. However the criteria are subjective and show considerable inter-observer variability among pathologists. The aim of the present study was to investigate the role of Bcl-2 and Bax immunostaining in the differential diagnosis of molar placentas. Bax and Bcl-2 immunohistochemical staining were performed in 19 molars (8 partial and 11 complete hydatidiform mole) and 10 non-molar (hydropic abortion) formalin-fixed, paraffin-embedded tissue samples. Ploidy analysis using flow cytometry had confirmed diploidy in hydropic abortions and complete hydatidiform moles and triploidy in partial hydatidiform moles. Bcl-2 expression was observed only in syncytiotrophoblasts, No immunoreactivity was detected in Cytotrophoblasts, and stromal cells, the total score averages of Bcl-2 immunoexpression in partial hydatidiform moles and hydropic abortions were significantly higher than in complete hydatidiform moles, whereas no significant difference was observed between partial hydatidiform moles and hydropic abortions. Bax immunoreactivity was observed in cytotrophoblasts, stromal cells and occasionally in syncytiotrophoblasts. No statistically significant difference in Bax immunoexpression total score was observed among various groups. Based on the results of this study, Bcl-2 immunostaining offers a potential adjunctive diagnostic tool to distinguish complete hydatidiform mole from partial hydatidiform mole and hydropic abortion, but not partial hydatidiform mole from hydropic abortion, Bax immunostaining cannot be helpful in this regard. https://acta.tums.ac.ir/index.php/acta/article/view/7000 https://acta.tums.ac.ir/index.php/acta/article/download/7000/5206

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 57 1 2019 02 13 33 41 EN Asghar Aghamohammadi Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Majid Keivanfar Department of Pediatric Pulmonary and Sleep Medicine, Imam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. AND Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Imam Hossein Children’s Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. Safoura Navaei Pediatric Respiratory and Sleep Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Rohola Shirzadi Pediatric Respiratory and Sleep Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Farzad Masiha Department of Pediatrics, Mazandaran University of Medical Sciences, Sari, Iran. Zahra Allameh Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Imam Hossein Children’s Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. Amin Heydari Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Solat Eslami Dietary Supplements and Probiotic Research Center, Alborz University of Medical Sciences, Karaj, Iran. Gholamreza Azizi Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran. Mohsen Reisi Department of Pediatric Pulmonary and Sleep Medicine, Imam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. AND Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Imam Hossein Children’s Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. Mohammadreza Modaresi Pediatric Respiratory and Sleep Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. 2018 11 01 2018 11 14 Cystic fibrosis (CF), as a fatal genetic condition, is associated with high morbidity and mortality rates. In Iran, limited studies exist on this disease. This study aims to compare the demographic, clinical and paraclinical data of CF patients. This cross-sectional study was conducted in 2014-2015 on 174 CF patients referred to the Tehran Children Medical Center hospital, which is the main referral center for CF. For each patient, the forced  expiratory volume in one second (FEV1) was measured and the comparative demographic, clinical and laboratory data of patients were recorded. Overall, 59% of studied patients were boys (n=102) and 41% were girls (n=72). The mean patient age (and standard deviations) was 7.1 ±5.7 years, with a range of 10 days to 28 years. In 67% of cases, the disease was diagnosed before their first birthday. The patients in this study were classified based on the FEV1 into mild (62%), moderate (33%) and sever (5%), indicating the degree of pulmonary complications. Cultures of respiratory secretions were positive for Pseudomonas aeruginosa and Staphylococcus aureus, in 23% and 16% of cases, respectively. In total, 61% of patients (n=83) were assigned to receive oral azithromycin for prophylaxis. Gastroesophageal reflux (reflux) was the most common gastrointestinal complication (35%), Regarding the complex nature of CF and the necessity of constant monitoring of patients during the life-span, the comparative demographic, clinical and laboratory analysis of patients and registering and standardization of patients’ data, can be a major step in the better understanding of the disease, and thereby increasing the quality of life and life expectancy in the affected population. https://acta.tums.ac.ir/index.php/acta/article/view/7554 https://acta.tums.ac.ir/index.php/acta/article/download/7554/5207

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 57 1 2019 02 13 42 50 EN Majid Jawad AL-Ghazali Department of Chemistry, College of Sciences, Kufa University, Kufa, Iraq. Hanaa Addai Ali Department of Chemistry, College of Sciences, Kufa University, Kufa, Iraq. Mohauman Mohammad AL-Rufaie Department of Chemistry, College of Sciences, Kufa University, Kufa, Iraq. Rawaa Adday Ali Department of Microbiology, Collage of Veterinary Medicine AL-Qasim, Green University, Kufa, Iraq. 2018 09 07 2018 11 14 The objective of this project was investigating and comparing changes of serum irisin, and trace levels of the elements (Zn, Cu, Mg) in pregnant women with gestational diabetes mellitus GDM in addition to wholesome pregnant group, examining the correlation among (Zn, Cu, Mg) levels and irisin insulin impedance in GDM pregnant women. Sixty GDM pregnant women and thirty wholesome pregnant women were examined. The pair groups were matched for age, and maternal serum irisin. Insulin levels and gestational age were calculated by the assay for enzyme-linked immune sorbent kit at gestation at 24-28 weeks. The confederation between clinical and biochemical parameters and maternal serum irisin levels were predestined. Serum levels of glucose, body mass index, insulin, OGTT, HOMA IR, HOMAβ, HbA1c, Hb%, irisin, Zn, Cu and Mg were investigated and analyzed for the examined collection as well as control samples. Pregnant women with GDM disease had noteworthy rising fast blood glucose FBG (P=0.004), first-hour OGTT glucose (P=0.001), second-hour OGTT glucose (P=0.001), fasting insulin FI (P=0.001) levels, HOMA IR (P=0.001), HOMAβ (P=0.001), HbA1C (P=0.001), Hb% (P=0.017), as contrasted to healthy women. Levels of irisin serum were significantly minimizing (P=0.001) in women, and sequentially more advanced GDM (mean±SD=71.65±8.03) than healthy pregnant controls (mean±SD 136.54±22.56). Analyses among irisin levels of anthropometric and biochemical values in gestational diabetes patients disclosed that none of the scrupulousness values were remediated with serum irisin level. His present outcomes indicate that the levels of serum irisin might be presented as an incoming GDM marker with decreased irisin levels being GDM symptomatic. https://acta.tums.ac.ir/index.php/acta/article/view/7467 https://acta.tums.ac.ir/index.php/acta/article/download/7467/5208

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 57 1 2019 02 13 51 56 EN Nadhum L. Tahir Department of Family Medicine, Al-Rusafa Health Director, Baghdad, Iraq. Qays A. Hassan Department of Surgery, Al-kindy College of Medicine, University of Baghdad, Baghdad, Iraq. Harth M. Kamber Department of Surgery, Al-kindy College of Medicine, University of Baghdad, Baghdad, Iraq. 2018 08 27 2018 11 14 Asymptomatic or clinically silent kidney stones are possibly serious because, in their expected passage, they may cause infection, obstruction and renal impairment. The purpose of this study was to determine the prevalence of silent kidney stones in a sample of Baghdad population and consider how this value could affect the justification for a screening system. To our best knowledge, this is the first study of its kind conducted in Iraq. We investigated 714 consecutive patients who sustained an abdominal ultrasound at our hospital with further kidney screening. All these patients did not have clinical signs and symptoms of nephrolithiasis. Age, sex, the indication for ultrasound, the size, side, and the number of the discovered stones were recorded. We observed silent kidney stones in 3.4% of patients. Males were stone carriers mostly. Stones were detected more in the left kidney than the right. Distinctly, multiple stones and stones of a large size were minimally seen. We conclude that the prevalence of clinically silent nephrolithiasis of 3.4% does not support a global screening. Yet, this screening may be justified in a limited pattern for those male subjects higher than 50 years, having a positive family history of renal stones, and their socioeconomic status is granted. https://acta.tums.ac.ir/index.php/acta/article/view/7458 https://acta.tums.ac.ir/index.php/acta/article/download/7458/5209

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 57 1 2019 02 13 57 62 EN Rozina Abasi Larki Department of Nephrology, Yasuj University of Medical Sciences, Yasuj, Iran. Alireza Panahi Department of Internal Medicine, Yasuj University of Medical Sciences, Yasuj, Iran. Leila Manzouri Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran. Moslem Sedaghattalab Department of Internal Medicine, Yasuj University of Medical Sciences, Yasuj, Iran. 2018 02 09 2018 12 15 The oxidative stress results in atherosclerosis and cardiovascular diseases in patients receiving hemodialysis. N-acetylcysteine is a well-known antioxidant agent. There are little studies about the effect of N-acetylcysteine on patients receiving hemodialysis, and, if any, their results are inconsistent. This study, as a double-blind, randomized clinical trial, was conducted on 44 hemodialysis patients in Shahid Beheshti Hospital, Yasuj, Iran in 2015. Patients were randomly allocated into two groups, in the intervention group, N-acetylcysteine 600 mg every 12 hours for eight weeks was administered and the second group received placebo during this period every 12 hours. Blood samples were taken to measure C-reactive protein, interleukin-6 and other biochemical markers such as ferritin, albumin, and creatinine at baseline and at the end of treatment. 40 patients completed the study (21 on N-acetylcysteine, 19 on placebo), with a mean age of 60.72±17.60. There was not any significant difference between intervention and control groups in interleukin-6 (8.85±6.9 vs. 10.32±8.68, 95% CI, -3.52 to 6.46; P=0.55) and C - reactive protein (0.85±0.29 vs. 0.9±0.31, 95% CI, -.14 to .24; P=0.60). In addition, there was no significant relationship between the two groups in other biochemical markers. In this study, administering N-acetylcysteine was safe and caused a reduction in some inflammatory markers, but these changes were not significant in comparison with placebo. https://acta.tums.ac.ir/index.php/acta/article/view/7035 https://acta.tums.ac.ir/index.php/acta/article/download/7035/5210

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 57 1 2019 02 13 63 67 EN Özgün Akgül Department of Genral Surgery, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey. Erdinç Kamer Department of Genral Surgery, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey. Turan Acar Department of Genral Surgery, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey. Nihan Acar Department of Genral Surgery, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey. Erdem Sarı Department of Genral Surgery, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey. Yelda Dere Department of Genral Surgery, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey. Özcan Dere Department of Genral Surgery, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey. Ercüment Tarcan Department of Genral Surgery, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey. Hüdai Genç Department of Genral Surgery, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey. Mehmet Haciyanli Department of Genral Surgery, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey. 2018 02 03 2018 12 15 The incidence of papillary microcarcinoma (PMC) keeps raising due to fine needle aspiration (FNA) biopsies and the pathologic evaluation of thyroid specimens of cases operated for benign thyroid disorders. The files of 78 patients who underwent surgery between January 2006 and May 2013 in our department and were diagnosed with PMC were analyzed, retrospectively.Cases were grouped as incidental and non-incidental depending on the preoperative diagnosis. The diameter of the nodules in the preoperativeultrasonographic examination, pathological parameters such as tumor size, bilaterality, multifocality,and capsular invasion were found significantly high in non-incidental group(P<0.05). No significant difference was detected between the two groups’ age, sex, and vascular invasion.Preoperative radiologic examination by experienced radiologists and FNA performed for suspicious nodules may increase the rate of early and correct diagnosis. In our opinion, determining the most useful criteria for malignancy will help to detect incidental PMC in cases followed up for multinodular goiter. https://acta.tums.ac.ir/index.php/acta/article/view/7016 https://acta.tums.ac.ir/index.php/acta/article/download/7016/5211

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 57 1 2019 02 13 68 71 EN Aghigh Heidari Department of Anesthesiology, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Fereidoun Sabzi Department of Cardiac Surgery, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. 2017 09 09 2017 12 19 Metastatic involvement of cardiac valve and pericardium mimicking a cardiac valve pathology accompanied with cardiac tamponade is a rare phenomenon. These metastases commonly arise from the lymphoreticular system, the pulmonary system, and breast. Metastatic spread of breast carcinoma to the cardiac valve is exceedingly rare, and only two case reports have been detected in English literature so far. We report a rare case of a patient with adenocarcinoma of the breast, which presented with severe mitral valve regurgitation and pericardial effusion which was managed urgently with mitral valve replacement. Our case shows the probability of combined metastatic pericardial and valve involvement in patients with breast adenocarcinoma. The patient was treated with mitral valve replacement and intrapericardial infusion of cisplatinum drug to control possible recurrent effusion. https://acta.tums.ac.ir/index.php/acta/article/view/6699 https://acta.tums.ac.ir/index.php/acta/article/download/6699/5212

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 57 1 2019 02 13 72 74 EN Mohsen Ayati Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Reza Shahrokhi Damavand Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Reza Nowroozi Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Hasan Inanloo Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Erfan Amini Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Elnaz Ayati Departemnt of Obstretrics and Gynecology, Tehran University of Medical Sciences, Tehran, Iran. 2017 11 06 2018 05 06 Renal cell carcinoma (RCC) is uncommon during pregnancy. Accurate and timely diagnosis and careful preoperative planning are essential to optimize the patient outcomes. A 27-year-old pregnant woman presented with a large mass in left kidney and inferior vena cava (IVC) tumor thrombus, diagnosed at 33 weeks gestation. She was evaluated with an initial impression of pyelonephritis at other institutions and referred to our center after a delay of more than 3 weeks. RCC with IVC tumor thrombus has the potential to increase the likelihood of thromboembolic events including pulmonary embolism during pregnancy. Furthermore, simultaneous radical nephrectomy with IVC thrombectomy and Cesarean section (CS) is challenging and might be associated with significant intraoperative blood loss. After consultation with an obstetrician and cardiac surgery team, our patient underwent CS and simultaneous left radical nephrectomy with IVC thrombectomy at 34 weeks gestation. The postoperative course was uneventful and histologic analysis revealed pT3bN0M0 papillary RCC. https://acta.tums.ac.ir/index.php/acta/article/view/6821 https://acta.tums.ac.ir/index.php/acta/article/download/6821/5213

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 57 1 2019 02 13 75 77 EN Parvaneh Dehghan Department of Oncology, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran. Samaneh Kakhki Department of Pharmacology, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran. 2018 02 06 2018 11 05 Krukenberg tumors are rare metastatic ovarian tumors with its primary site being the gastrointestinal tract as a most common site and poor prognosis. We hereby, present a 25-year-old pregnant female suffering from abdominal pain and iterative vomiting episodes. She was diagnosed with a terminal stage of the malignant disease. She underwent total ovariectomy without any radiotherapy. Histological examination of the specimen yielded diagnosis of Krukenberg tumor. Ten days later, the patient underwent a natural vaginal delivery in the 25th gestational week because of labor pain, and we extracted a dead male newborn of 31 cm, 510 g, AP score 0. Three weeks later, the patient died because of pulmonary failure. https://acta.tums.ac.ir/index.php/acta/article/view/7024 https://acta.tums.ac.ir/index.php/acta/article/download/7024/5214