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Recently, extracellular vesicles (EVs) are generating considerable interest in terms of their ability. EVs defined themselves as a route for intercellular communication between the origin cells and the recipient ones by transferring information. This paper investigates the influence of peripheral blood mononuclear cells derived EVs on proliferation and apoptosis of the chronic myelogenous leukemia cell line k562. Trypan blue staining was used to detect cell viability subsequently, metabolic activity was assessed by the MTT assay. Cell apoptosis and cell cycle progression were evaluated using flowcytometric assay after treatment of k562 cell line with MNC derived EVs. Our results showed that MNC-EVs have no inhibitory effect on k562 cell growth and proliferation. Our data did not reveal any significant variations in the case of enhancing k562 cell line growth following treatment with MNC derived EVs. It seems tumour-derived extracellular vesicles support tumour cells growth by communicating with each other through their extracellular vesicles.

SARS-CoV-2 that causes Coronavirus disease 2019 (COVID-19) was first known in Wuhan, China, in December 2019. The aim of this study was to evaluate the level of common hepatic, renal, and cardiac diagnostic markers in hospitals in patients with severe COVID 19. In this study, 259 patients with symptoms of severe COVID-19 and a positive RT-PCR assay of nasopharyngeal samples were enrolled. Inclusion criteria are positive for COVID-19 patients at the diagnosis of an infectious disease physician. Diagnostic markers of liver, kidney, and heart were evaluated by age and gender. In this study, 48.3% of patients severe with COVID-19 were male, and 51.7% were female. The mean of markers such as LDH, Direct Bilirubin, SGOT, SGPT, D-dimer was higher than normal, which was observed in men more than women. The mean of CK-MB also was higher than normal, which was observed in women more than men. The highest mean of markers was seen in the older ages. The mean of BUN was observed in the age range of 55-64 years and above 65 years above normal. But the mean of CPK, creatinine, potassium and alkaline phosphatase were normal. The results of the present study showed an increase in the level of some of the most important diagnostic markers of hepatic, renal, and cardiac in patients with COVID 19. This increase was greater in some markers, including SGOT, SGPT, Direct bilirubin, LDH, D-dimer, in men than in women, and more in older patients.

Regarding the importance of non-alcoholic fatty liver disease (NAFLD) and the high prevalence of vitamin D3 deficiency in different societies. This study aimed to evaluate the distribution of Vit D3 deficiency in individuals with non-alcoholic fatty liver disease. In this cross-sectional study, 122 individuals with non-alcoholic fatty liver disease were selected by a simple sampling method. After collecting demographic data, serum Vit 25(OH) D3 level was measured by the ELFA method. Blood lipids level (TG, cholesterol, HDL, LDL), FBS, AST, ALT, alkaline phosphatase, total and direct bilirubin, albumin, and PT were measured by the enzymatic method. To analyze the data, descriptive and analytical methods and SPSS software version 16 were used. The study cases are comprised of 122 individuals (57.4% male). The average age of cases was 42.4±11.7 years, and the mean of serum Vit D3 level was 19.8±22 ng/dl (3-220 ng/dl). Regarding the serum 25(OH) D3 levels data showed 66.4% of cases were Vit D3 deficient (Vit D3 level< 20 ng/dl), 18% had insufficient level (Vit D3 level=20-30 ng/dl), and the remained 15.6% had sufficient level (Vit D3 level> 30 ng/dl). HDL level was higher in individuals with 25(OH) D3 sufficiency compared to those with 25(OH) D3 insufficiency and Vit D3 deficiency (P=0.019). There was no significant relationship between serum Vit D3 level and other investigated variables. The results of this study indicated that most individuals with non-alcoholic fatty liver disease had Vit D3 deficiency. Further studies are suggested.

Ethics is an essential element in the provision of healthcare services. Fundamental ethical values determine the manner in which the professional behavior is implemented in the healthcare area. These ethical principles find meaning in time and place and in the social context of ethical values and among children as vulnerable groups. So, this study examined the ethical principles of providing health care services for children and barriers to their application in Iran from key informants’ perspective. Therefore, qualitative content analysis method was used by means of semi-structured questionnaire to theoretical saturation scale with the participation of 20 key informants. Each interview underwent the process of implementation, evaluation, coding, and analysis, and then its findings were presented in two dimensions: desirable principles and barriers for its application, including 15 classes. Desirable principles include autonomy, beneficence, non-maleficence, justice, confidentiality, accent, consent, and participation. Obstacles to their compliance also included weakness of the policy landscape, weakness of the judicial system, cultural conservatism, socio-economic inequality, services commodification with unequal distribution, resource mismanagement (limitation), weakness of the professional education system, and the emergence of complex situations. From the key informants’ point of view, codes of ethics do not differ significantly from international principles, but their application is faced with difficulties, and they are likely to be improved through evidence-based policies according to the results of scientific studies.

To assess the effectiveness of ondansetron pretreatment in alleviating propofol injection pain, 135 patients were randomly assigned to one of following three groups. Group 1 who received up to 2 mL pretreatment 50 mg tramadol in the saline, group 2 cases who received up to 2 mL pretreatment 4 mg ondansetron in saline, and group 3 who received up to 2 mL solution saline. A 20 gauge cannula was placed into the largest vein on the dorsum of the hand. Tourniquet was closed to the arm above the cannula and inflates to 70 mmHg, and then drug was injected. After 20 seconds, the tourniquet deflated, and propofol 2mg/kg injected over 10 seconds and pain assessment was made. Results: Tramadol and ondansetron significantly reduced the incidence and severity of propofol injection pain more than placebo (P=0.001). The efficacy of ondansetron in alleviating the pain on injection of propofol was no different from tramadol (P=0.330). Ondansetron pretreatment may be used to reduce the incidence of pain on injection of propofol, an advantage added to the useful prevention of postoperative nausea and vomiting.

There has been a highly significant increase in the number of patients with malignant mediastinal tumors in the last four decades. Since these lesions are infrequently encountered and there are very few reports in Iran concerning this issue, we performed this study to review our institutional experience of medias-tinal masses and to compare differences in the clinical spectrum between our study population and other patients studied by various reports. This was a retrospective, descriptive and cross sectional study conducted on 105 patients with mediastinal masses who underwent surgical resection over a 5-year period from 1999 to 2003 in three major hospitals in Tehran. A total of 105 patients with mediastinal masses including 65 males (62%) and 40 females (38%) with a mean age of 34 years (range,2-80 years) who had undergone surgery entered the study. Most mediastinal tumors (47%) were identified in the third and fifth decades of life and the most common malignancy during the first four decades of life was malignant lymphoma. Considering the location of mediastinal masses,the anterior mediastinum was the most common site (65%) followed by paravertebral sulci (21%) and visceral mediastinum (14%).The highest rate of malignancy was observed in visceral mediastinum (73% malignancy rate). Histopathologic evaluation of resected masses revealed twenty two types of tumors of which sixty percent were malignant. Nonspecific symptoms such as dyspnea (41%) and cough (40%) constituted the most presenting complaints. Twelve percent of patients were completely asymptomatic. The most common complication observed in this series of mediastinal masses was Superior Vena Cava (SVC) syndrome. There was no postoperative complication. Crude mortality rate of the whole series was 16%. The prevalence of tumors in our series varied from some previously published reports. We demonstrated definite differences in histologic distribution, age range, malignancy rate and diagnostic methods of mediastinal tumors between our study population and other reported cases which should be considered in the evaluation and planning of therapeutic modalities for mediastinal masses encountered in our current practice.

Pulmonary Langerhans Cell Histiocytosis (PLCH) is a rare idiopathic disorder that primarily affects young adult cigarette smokers. Affected patients often present with cough and dyspnea and about 20% of patients present with or later develop pneumothorax. It is striking that more than 90% of patients are smokers. We report a very unusual case of PLCH in a 20-year- old male patient with no smoking history in whom a life- threatening complication such as simultaneous bilateral pneumothorax was the presenting feature. The final diagnosis was made by open surgical biopsy and recurrent pneumothoraces necessitated surgical management with pleurodesis. We emphasize the early use of pleurodesis in managing patients with PLCH and spontaneous pneumothorax.

Pulmonary metastases occur in 30% of all oncology patients. Surgical resection of lung metastases is a widely accepted procedure but long-term results are disappointing with a 5-year survival rate of 20-40% and the results vary with the histologic type of the primary tumor. Due to unavailability of any study regarding pulmonary metastasectomy in Iran and emergence of new treatment modalities, reassessment of our current practices is essential. We performed a retrospective study of 60 cases of pulmonary metastasectomy during a 5-year period in one of the major thoracic surgery centers in Tehran (Imam Khomeini Hospital). Bilateral metastases were present in 23% of cases, number of metastases in each patient ranged from 1-12. Average disease-free interval was 12 months, pneumonectomy rate was 21.7% mostly as a second or third attempt and finally, recurrence or death following initial metastasectomy occurred in 12-18 months in most patients. These results confirm that surgery remains unsuccessful in obtaining long-term survival or cure in most patients with pulmonary metastases and treatment strategies other than surgery, such as radiofrequency ablation are needed to avoid performing multiple operations in these patients and improving their quality of life.

It has been shown in some investigations that cardiovascular events are the main causes of death in hemodialysis patients. The exact etiology is unknown but some of the articles have reported a relation between aluminium ions in the dialysis solution and cardiovascular disorders. To determine the probable effect of aluminium on vasculature function, in vitro effects of aluminium ion on vasoconstriction induced by KCl (30 mM) or phenylephrine (10 µM) were investigated using isolated rat aorta. AlCl3 (1-4 mM) decreased both KCl and phenylephrine induced contractions in a dose dependent manner (P

Hemorrhoidectomy is the treatment of choice for patients with third or fourth-degree hemorrhoids. Although the majority of surgeons believe that surgical hemorrhoidectomy is the most effective approach with excellent results in the management of hemorrhoid disease, but hemorrhoidectomy is not a simple procedure. One of the complications of this surgery is an injury to anal sphincters that can lead to incontinency in some patients. In this study, we aimed to reveal the percentage of external and internal anal sphincter injuries in surgical hemorrhoidectomy. We prospectively enrolled 128 patients from April 2006 to February 2007. They underwent hemorrhoidectomy in three general hospitals in Tehran. All patients were in grade III or IV and underwent open hemorrhoidectomy (Milligan-Morgan). After surgery, all resected material was histopathologically examined by two expert pathologists and the results confirmed by other one if there is any discrepancy. From all specimens which sent to the pathology department 15.8% (21 Pts.) had muscle fibers that Smooth muscle fibers were seen in 80.5% (17 Pts.) of them and striated muscle fibers were found in 19.5% (4 Pts.). Although hemorrhoidectomy is a safe and effective method for treatment of hemorrhoid, but the inadvertent removal of smooth and striated muscle during open hemorrhoidectomy had raised concerns about its effects on postoperative anorectal function.

Hemorrhoidectomy is the treatment of choice for patients with third or fourth-degree hemorrhoids. Although the majority of surgeons believe that surgical hemorrhoidectomy is the most effective approach with excellent results in the management of hemorrhoid disease, but hemorrhoidectomy is not a simple procedure. One of the complications of this surgery is an injury to anal sphincters that can lead to incontinency in some patients. In this study, we aimed to reveal the percentage of external and internal anal sphincter injuries in surgical hemorrhoidectomy. We prospectively enrolled 128 patients from April 2006 to February 2007. They underwent hemorrhoidectomy in three general hospitals in Tehran. All patients were in grade III or IV and underwent open hemorrhoidectomy (Milligan-Morgan). After surgery, all resected material was histopathologically examined by two expert pathologists and the results confirmed by other one if there is any discrepancy. From all specimens which sent to the pathology department 15.8% (21 Pts.) had muscle fibers that Smooth muscle fibers were seen in 80.5% (17 Pts.) of them and striated muscle fibers were found in 19.5% (4 Pts.). Although hemorrhoidectomy is a safe and effective method for treatment of hemorrhoid, but the inadvertent removal of smooth and striated muscle during open hemorrhoidectomy had raised concerns about its effects on postoperative anorectal function.

To assess the effectiveness of ondansetron pretreatment in alleviating propofol injection pain, 135 patients were randomly assigned to one of following three groups. Group 1 who received up to 2 mL pretreatment 50 mg tramadol in the saline, group 2 cases who received up to 2 mL pretreatment 4 mg ondansetron in saline, and group 3 who received up to 2 mL solution saline. A 20 gauge cannula was placed into the largest vein on the dorsum of the hand. Tourniquet was closed to the arm above the cannula and inflates to 70 mmHg, and then drug was injected. After 20 seconds, the tourniquet deflated, and propofol 2mg/kg injected over 10 seconds and pain assessment was made. Results: Tramadol and ondansetron significantly reduced the incidence and severity of propofol injection pain more than placebo (P=0.001). The efficacy of ondansetron in alleviating the pain on injection of propofol was no different from tramadol (P=0.330). Ondansetron pretreatment may be used to reduce the incidence of pain on injection of propofol, an advantage added to the useful prevention of postoperative nausea and vomiting.

There has been a highly significant increase in the number of patients with malignant mediastinal tumors in the last four decades. Since these lesions are infrequently encountered and there are very few reports in Iran concerning this issue, we performed this study to review our institutional experience of medias-tinal masses and to compare differences in the clinical spectrum between our study population and other patients studied by various reports. This was a retrospective, descriptive and cross sectional study conducted on 105 patients with mediastinal masses who underwent surgical resection over a 5-year period from 1999 to 2003 in three major hospitals in Tehran. A total of 105 patients with mediastinal masses including 65 males (62%) and 40 females (38%) with a mean age of 34 years (range,2-80 years) who had undergone surgery entered the study. Most mediastinal tumors (47%) were identified in the third and fifth decades of life and the most common malignancy during the first four decades of life was malignant lymphoma. Considering the location of mediastinal masses,the anterior mediastinum was the most common site (65%) followed by paravertebral sulci (21%) and visceral mediastinum (14%).The highest rate of malignancy was observed in visceral mediastinum (73% malignancy rate). Histopathologic evaluation of resected masses revealed twenty two types of tumors of which sixty percent were malignant. Nonspecific symptoms such as dyspnea (41%) and cough (40%) constituted the most presenting complaints. Twelve percent of patients were completely asymptomatic. The most common complication observed in this series of mediastinal masses was Superior Vena Cava (SVC) syndrome. There was no postoperative complication. Crude mortality rate of the whole series was 16%. The prevalence of tumors in our series varied from some previously published reports. We demonstrated definite differences in histologic distribution, age range, malignancy rate and diagnostic methods of mediastinal tumors between our study population and other reported cases which should be considered in the evaluation and planning of therapeutic modalities for mediastinal masses encountered in our current practice.

Laparoscopy has made a revolution in surgical procedures and treatment of various diseases but its complications are still under investigation. Intra-abdominal visceral and vessel injuries, trocar site hernia, and leaving foreign bodies into the peritoneal cavity are among some laparoscopic surgery complications. This is a rare report of Penrose drain migration following incomplete laparoscopic Fundoplication surgery. The patient was a 47- year- old woman, who was a candidate for Touplet Fundoplication via laparoscopic approach due to refractory gastro-esophageal reflux disease (GERD). While wrapping a Penrose drain around the esophagus, the patient had a cardiorespiratory arrest. Attempts to remove the Penrose drain were unsuccessful and the surgical procedure was terminated due to patient's condition. Four months later, after a long period of dysphagia and abdominal pain, the Penrose drain was defecated via rectum.

Pulmonary Langerhans Cell Histiocytosis (PLCH) is a rare idiopathic disorder that primarily affects young adult cigarette smokers. Affected patients often present with cough and dyspnea and about 20% of patients present with or later develop pneumothorax. It is striking that more than 90% of patients are smokers. We report a very unusual case of PLCH in a 20-year- old male patient with no smoking history in whom a life- threatening complication such as simultaneous bilateral pneumothorax was the presenting feature. The final diagnosis was made by open surgical biopsy and recurrent pneumothoraces necessitated surgical management with pleurodesis. We emphasize the early use of pleurodesis in managing patients with PLCH and spontaneous pneumothorax.

Pulmonary metastases occur in 30% of all oncology patients. Surgical resection of lung metastases is a widely accepted procedure but long-term results are disappointing with a 5-year survival rate of 20-40% and the results vary with the histologic type of the primary tumor. Due to unavailability of any study regarding pulmonary metastasectomy in Iran and emergence of new treatment modalities, reassessment of our current practices is essential. We performed a retrospective study of 60 cases of pulmonary metastasectomy during a 5-year period in one of the major thoracic surgery centers in Tehran (Imam Khomeini Hospital). Bilateral metastases were present in 23% of cases, number of metastases in each patient ranged from 1-12. Average disease-free interval was 12 months, pneumonectomy rate was 21.7% mostly as a second or third attempt and finally, recurrence or death following initial metastasectomy occurred in 12-18 months in most patients. These results confirm that surgery remains unsuccessful in obtaining long-term survival or cure in most patients with pulmonary metastases and treatment strategies other than surgery, such as radiofrequency ablation are needed to avoid performing multiple operations in these patients and improving their quality of life.

It has been shown in some investigations that cardiovascular events are the main causes of death in hemodialysis patients. The exact etiology is unknown but some of the articles have reported a relation between aluminium ions in the dialysis solution and cardiovascular disorders. To determine the probable effect of aluminium on vasculature function, in vitro effects of aluminium ion on vasoconstriction induced by KCl (30 mM) or phenylephrine (10 µM) were investigated using isolated rat aorta. AlCl3 (1-4 mM) decreased both KCl and phenylephrine induced contractions in a dose dependent manner (P

Laparoscopy has made a revolution in surgical procedures and treatment of various diseases but its complications are still under investigation. Intra-abdominal visceral and vessel injuries, trocar site hernia, and leaving foreign bodies into the peritoneal cavity are among some laparoscopic surgery complications. This is a rare report of Penrose drain migration following incomplete laparoscopic Fundoplication surgery. The patient was a 47- year- old woman, who was a candidate for Touplet Fundoplication via laparoscopic approach due to refractory gastro-esophageal reflux disease (GERD). While wrapping a Penrose drain around the esophagus, the patient had a cardiorespiratory arrest. Attempts to remove the Penrose drain were unsuccessful and the surgical procedure was terminated due to patient's condition. Four months later, after a long period of dysphagia and abdominal pain, the Penrose drain was defecated via rectum.