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Abstract Ganoderma lucidum polysaccharide is the most widely used complementary therapy in cancer. The present study aims to investigate the possible interaction between Ganoderma lucidum polysaccharide and Docetaxel (a chemotherapy drug) and the first-line medication for prostate cancer treatment (Flutamide) and sensitizing the cells to these treatments. The cytotoxic effects of Ganoderma lucidum polysaccharide in combination with Docetaxel and Flutamide on prostate cancer cells were investigated by the MTT test, Hoechst staining, and flow cytometry. In addition, the expression of genes related to apoptosis, angiogenesis, Epithelial-Mesenchymal Transition pathway (EMT), and prostate cancer biomarkers by Real-Time PCR was investigated. The results demonstrated that IC50 values for Ganoderma lucidum polysaccharide (30 μM and 20 μM), Docetaxel (10 μM and 5 μM), and Flutamide (20 μM and 12 μM) with MTT were confirmed by flow cytometry in a dose and time-dependent manner. Regarding the high efficacy of Ganoderma lucidum polysaccharide in combination with Flutamide and Docetaxel, 10 μM and 5 μM Flutamide were used instead of 20 μM and 12 μM and 5 μM and 2 μM Docetaxel was used instead of 10 μM and 5 μM in PC3 and LNCap, respectively. Moreover, for the first time, it was shown that Ganoderma lucidum polysaccharide alone and in combination with Docetaxel and Flutamide significantly augmented apoptosis, reduced cell migration and colonization, and downregulated expression of KLK2 and EMT pathway genes in both PC3 and LNCap cell line (P

Teratocarcinoma is one type of testis cancer that can be represented in the youth population and usually shows itself with swelling of the testis and edema and a rise of BHCG and alpha-fetoprotein, but spontaneous rupture is a rare manifestation. A 23-year-old man was referred to the Sina Hospital with complaints of testis pain and swelling. Laboratory findings were alpha f.p more than 2,000, BHCG titer 255.21, and LDH 504. Sonography findings showed the right testis had been detected with a heterogeneous mass with vascularity and cystic area with microcalcification, measuring 76*69 mm. During surgery, we faced rupture tumor that was unusual and rare. The radical orchidectomy was done successfully without any complications. After the surgery, pathology showed teratocarcinoma of the right testis, and a 6-month observation and follow-up were done without any complication.

The Thrombotic Microangiopathy Banff Working Group (TMA-BWG) was formed in 2015 to survey current practices and develop minimum diagnostic criteria (MDC) for renal transplant TMA (Tx-TMA). To generate consensus among pathologists and nephrologists, the TMA BWG designed a 3-Phase study. Phase I of the study is presented here. Using the Delphi methodology, 23 panelists with >3 years of diagnostic experience with Tx-TMA pathology listed their MDC suggesting light, immunofluorescence, and electron microscopy lesions, clinical and laboratory information, and differential diagnoses. Nine rounds (R) of consensus resulted in MDC validated during two Rs using online evaluation of whole slide digital images of 37 biopsies (28 TMA, 9 non-TMA). Starting with 338 criteria the process resulted in 24 criteria and 8 differential diagnoses including 18 pathologic, 2 clinical, and 4 laboratory criteria. Results show that 3/4 of the panelists agreed on the diagnosis of 3/4 of cases. The process also allowed definition refinement for 4 light and 4 electron microscopy lesions. For the first time in Banff classification, the Delphi methodology was used to generate consensus. The study shows that Delphi is a democratic and cost-effective method allowing rapid consensus generation among numerous physicians dealing with large number of criteria in transplantation.

The Banff community summoned the TMA Banff Working Group to develop minimum diagnostic criteria (MDC) and recommendations for renal transplant TMA (Tx-TMA) diagnosis, which currently lacks standardized criteria. Using the Delphi method for consensus generation, 23 nephropathologists (panelists) with >3 years of diagnostic experience with Tx-TMA were asked to list light, immunofluorescence, and electron microscopic, clinical and laboratory criteria and differential diagnoses for Tx-TMA. Delphi was modified to include 2 validations rounds with histological evaluation of whole slide images of 37 transplant biopsies (28 TMA and 9 non-TMA). Starting with 338 criteria in R1, MDC were narrowed down to 24 in R8 generating 18 pathological, 2 clinical, 4 laboratory criteria, and 8 differential diagnoses. The panelists reached a good level of agreement (70%) on 76% of the validated cases. For the first time in Banff classification, Delphi was used to reach consensus on MDC for Tx-TMA. Phase I of the study (pathology phase) will be used as a model for Phase II (nephrology phase) for consensus regarding clinical and laboratory criteria. Eventually in Phase III (consensus of the consensus groups) and the final MDC for Tx-TMA will be reported to the transplantation community.

Abstract The current study is important in informing clinicians about the possibility of concurrent oxalate nephropathy caused by Roux‐en‐Y gastric bypass, high oxalate materials, and high‐dose vitamin C intake for COVID‐19 prevention.

Introduction: Gastric cancer is one of the most common cancers capable of distant metastasis, but Scrotal and penile metastasis are very unusual, and occasionally, the initial manifestation of a latent primary tumor is even rarer. Mechanisms of gastric metastasis have been suggested through different pathways. Case presentation: In this study, we present a case in which a patient presented with painless swelling of the testicles and penis. The main was in the stomach. As far as we know, this is the first report of a scrotal and penile metastasis from gastric adenocarcinoma in Iran. At the time of diagnosis of these metastases had not yet been diagnosed with gastric cancer. Conclusions: Therefore, gastric tumors can metastasize to the genital area through lymphatic vessels in a reversible pathway. However, Proper imaging studies can identify early sites.

Introduction: Several factors are predisposing the urinary system for stone formation some are risk factors and some others are protective. There is not clear that radiofrequency electromagnetic wave (RF-EMW) of cell phones cell phone are risk factors or protective ones. This study is aiming at determining the role of RF-EMW on kidney stone formation. After one month the serological, histopathological, and radiological tests were done to evaluate the number and size of kidney stones. Methods: Forty Wistar rats weighting 200±10g were enrolled and sub-grouped into four groups:1- Control, 2- Cases with Ethylene glycol to form the kidney stones, 3- Cases with Ethylene glycol and RF-EMW exposure, 4- Cases with RF-EMW exposure (10 in each group 5 male and five female). The study was run over one month and at the end of the study, the serological, histopathological, and radiological tests were done to evaluate the number and size of kidney stones. Results: Our finding indicated that the serological changes and histopathological damage in all three case groups compare to the control group. The number and size of the kidney stones have changed in rats with both ethylene glycol and RF-EMW (p-value≤0.001). Change in serology and histopathology of kidney decreased in RF-EMW+ Ethylene glycol compare to Ethylene glycol alone (p-value≤0.001). Conclusions: With the short-term exposure of rats to waves emitted from mobile waves, we conclude that cell phone electromagnetic waves had a remarkable disintegrating effect on urolithiasis and the rate of detected stones and destructive pathological outcomes result from urinary tract calculi were notably diminished.

Introduction The current study examined the clinical impacts of phosphatase and tensin (PTEN) expression in prostate cancer (PCa) using immunohistochemistry. Methods 50 patients with mean age of 66.4±7.3 years who had undergone prostatectomy surgery with the diagnosis of PCa, were enrolled in the study. We collected 50 paraffin blocks from the malignant part and 50 paraffin blocks from the healthy part of each patient’s prostate. We considered malignant and healthy parts as the case and the control, respectively. Clinical and pathological information of the patients were gathered and their associations with PTEN status were assessed using odds ratios (ORs) analysis. Results The significant associations between tumor stage, perivascular invasion, perineural invasion, marginal involvement, extraprostatic extension, and biochemical recurrence (as assed by post-surgical prostate-specific antigen (PSA)) and PTEN expression were detected. For patients negative for PTEN, the odds ratio of the higher stage, perivascular invasion, perineural invasion, marginal involvement, and extraprostatic extension in comparison to patients positive for PTEN were estimated 7.5 (95%CI: 2.01,27.86), (95%CI: 1.65-25.57), 7.8 (95%CI:1.54-40.09), 9.78 (95%CI:2.33-41.08), and 4.84 (95%CI:1.07-21.84), respectively. Concerning biochemical recurrence, ORs was calculated 0.30 (95%CI:0.09-1.02) for PTEN positive patients compare to PTEN negative patients. Conclusions Since PTEN loss was associated with fe­atures of aggressive PCa, it can be concluded that loss of PTEN would lead to more aggressive PCa and thereby, lower clinical outcomes.

Increasing number of patients with kidney stones is a major worldwide concern that needs more attention for recognizing the disease in order to set up suitable prevention systems. In this study, we aimed to assess the prevalence and related risk factors of kidney stones in our local area (Isfahan, Iran). In 2011, we celebrated World Kidney Day (WKD) with several training programs for informing people about kidney diseases. A questionnaire containing demographic data, past medical history, and familial and self-history of kidney disease was fulfilled by each individual who participated in WKD. Blood pressure and body mass index (BMI) were also measured using standard methods. Statistical analysis with SPSS-20 software was done. 556 participants with a mean age of 44.69±15.32 were included in the study, of which 107 cases (19.2%) with a mean age of 50.24±12.33 had a kidney stone, and 449 cases (80.8%) with a mean age of 44.69±15.32 had no history of kidney stone. There were no significant differences between those with and without kidney stones regarding sex (P=0.176), type of daily work (P=0.91), diabetes mellitus (P=0.64), and place of living (urban versus rural) (P=0.92) and BMI (P=0.26). However, there were differences between groups regarding age (P˂0.001), Hypertension (HTN) (P=001), Cardiovascular disease (CVD) (P=0.02), and familial history of kidney stone (P˂0.001). Out of 107 patients with kidney stones, the mean number of urinary excretion of stones was 2.56±2.98. We found a greater prevalence of kidney stones in our local area compared with data from other research studies. Despite some previous studies, comparison of people with and without kidney stones did not reveal differences in the prevalence of DM, type of daily work (low activity versus high activity), and obesity but differences in the field of HTN and CVD were seen.

Introduction To compare the effectiveness of tamsulosin and Tolterodine in reducing stent-related symptoms with each other and with the control group we performed this randomized clinical trial. Methods 150 patients after successful first-time transurethral lithotripsy (TUL) for unilateral ureteral stones were elected for the study 17 patients were excluded in the first allocation. Other patients were randomized (With balanced blocked randomization) into three groups. In group 1, 41 patients received Tamsulosin (Omnic) 0.4mg once a day for a month and in group 2, 42 patients received tolterodine (Detrusitol) 2mg once a day for a month. In group 3, which was our control group, 50 patients received a placebo once a day for a month. Clinical stent-related symptoms questionnaires at the first visit (day 10) and before removing themes stent were completed. Two urine tests and an x-ray of the abdomen in the first visit have been performed. Results Despite the remarkable decrease in the severity of stent-related symptoms other than urine urgency in the control group (p-value0.05). Conclusion The results of our study show that administration of tolterodine and tamsulosin to reduce stent-related symptoms do not have superiority to each other and the control group.

Prostate cancer involves a considerable percentage of men worldwide and as be postulated; prostate cancer epidemiology is not restricted to a specific country. Despite tremendous efforts that have been made regarding prostate cancer diagnosis and treatment, this issue remains challenging for urologists and oncologists by far. The routine method for the diagnosis of prostate cancer is a prostate biopsy, which may accompany by several complications that may be detrimental to patients’ health. Consequently, an alternative method with lower rates of complications is necessitating. For almost two decades liquid biopsy, an alternative method for cancer diagnosis with obvious benefits in comparison with previous methods of cancer diagnosis, has been at the center of interest of many studies, in particular, studies with prostate cancer subjects. The applicability of liquid biopsy which primarily includes cell-free DNA, circulating tumor cells, RNAs, and exosomes in prostate cancer is the main area of research of recent research. However, using liquid biopsy in routine clinical practices yet has not occurred and further studies with more firm evidence are warranted. Herein, we provided a brief report of advancements that have occurred in prostate cancer.

With the rapid worldwide spread of a new coronavirus with the scientific name SARS-CoV-2 at the beginning of 2020, attempts to produce a vaccine started in different countries. This study aimed to review the mechanisms and functions of the coronavirus protein as a basis for vaccine production. A rapid review of available studies is conducted. Related information was extracted and summarized, compared, and discussed with regards to the coronavirus mechanisms and acts as a pathogen, including apoptosis and autophagy. An overview of available information on coronavirus functional mechanisms was performed to aid researchers in the development and production of vaccines against it.

Stone-free rate (SFR) after treatment can be estimated by plain radiography and ultrasonography, or computed tomography (CT) scanning. Based on the guidelines, CT is the primary method for SFR estimation after PCNL (percutaneous nephrolithotomy) due to its high sensitivity and wide availability. However, there is an extreme need to minimize unnecessary radiation exposure in patients. The CT scanning is more indispensable in the minimally invasive PCNL (MPCNL) technique to detect small residual stone fragments. Finally, we believe that using CT scan in follow up of MPCNL patients, rather than plain radiography and ultrasonography, is more accurate to detect residual fragments and estimate SFR as one of the important outcomes of this operations.

Nowadays coronavirus disease 2019 (COVID-19) is a major health problem all over the world. So, regarding the highly recommended homestay strategies for the prevention of COVID-19 the usual treatment platform for several diseases has changed. During self-quarantine, the urolithiasis treatment is completely different. However, we can suggest conservative treatment for three months during the COVID-19 outbreak and after that reevaluation of the patient will be done. Thus, the operation could be chosen carefully based on the patient's and urologist’s preferences and the rate of infection in that center.

Native kidney biopsy reports in previous studies that are mostly originated in Western countries show various results in different parts of the world. In this study, we aimed to determine the prevalence of renal biopsy disorders in Iran and compare it with that of other studies in the world. This cross-sectional study evaluated consecutive native kidney biopsies performed in four centers in Isfahan, Iran, from 2009 to 2014. We also reviewed other relevant studies in Iran and the world. Overall, 1547 renal biopsies were reviewed; 493 cases were excluded (transplant or re-biopsy cases) and 1054 cases (43.3% female) were included in our study with a mean (±standard deviation) age of 33.1 (±18.5) years. The first three most prevalent diagnoses were focal and segmental glomerulosclerosis (FSGS) (24.8%), minimal change disease (MCD) (14.2%), and membranous glomerulonephritis (MGN) (9.6%). IgA nephropathy (IgAN) was more prevalent among men, whereas lupus nephritis had a higher prevalence among women. In three out of six previous studies conducted in Iran, the most prevalent pathological diagnosis was MGN; in two others, MCD predominated; and in the third study, FSGS had the highest prevalence. In Europe and Western Pacific Region, IgAN was by far the most prevalent GN, while studies in other parts of the world show conflicting results. The most prevalent diagnosis in our study was FSGS, which was consistent with previous studies in Iran, which seems to have an increasing prevalence. It is recommended that having a national registry is crucial to determine the current status and for better planning and management of renal disorders.

Background: Considering the great variations in the reported prevalence of prostate cancer across the world possibly due to different genetic and environmental backgrounds, we aimed to determine the expression pattern and the diagnostic utility of α-methylacyl coenzyme A racemase (AMACR) among Iranian patients with prostate adenocarcinoma. Materials and Methods: In this cross-sectional study, formalin-fixed paraffin-embedded tissues of 58 patients with a definitive pathologic diagnosis of prostatic adenocarcinoma were evaluated. The expression of AMACR, intensity, and extensity of its staining was determined in selected samples by immunohistochemical technique. Results: AMACR expression was significantly higher in neoplastic compared to normal tissue (P < 0.05). The expression of AMACR was significantly associated with the age of the patients (P = 0.04). The intensity of the staining was associated with the grade of the prostate adenocarcinoma (P = 0.04). There was no significant relationship between AMACR expression and perineural invasion. The sensitivity, specificity, positive predictive value, and negative predictive value of AMACR were 90%, 96%, 96%, and 90%, respectively. Conclusion: Findings from our study indicate that AMACR could be used as a diagnostic tool for the diagnosis of prostate adenocarcinoma. However, due to false-positive staining in the mimicker of prostatic adenocarcinoma, it is recommended to use it in combination with basal cell markers.

Current non-invasive approaches for detection of urothelial cancers are suboptimal. We developed a test to detect urothelial neoplasms using DNA recovered from cells shed into urine. UroSEEK incorporates massive parallel sequencing assays for mutations in 11 genes and copy number changes on 39 chromosome arms. In 570 patients at risk for bladder cancer (BC), UroSEEK was positive in 83% of those who developed BC. Combined with cytology, UroSEEK detected 95% of patients who developed BC. Of 56 patients with upper tract urothelial cancer, 75% tested positive by UroSEEK, including 79% of those with non-invasive tumors. UroSEEK detected genetic abnormalities in 68% of urines obtained from BC patients under surveillance who demonstrated clinical evidence of recurrence. The advantages of UroSEEK over cytology were evident in low-grade BCs; UroSEEK detected 67% of cases whereas cytology detected none. These results establish the foundation for a new non-invasive approach for detection of urothelial cancer.

Over the years, there has been a steady increase in the number of patients requiring dialysis. However, no consensus exists between choosing either hemodialysis (HD) or peritoneal dialysis (PD) as the preferred method of dialysis for patients. In this study, we have compared the quality of life of the patients undergoing either HD or PD. This cross-sectional study was performed in the dialysis center of the Noor and Saint Ali Asghar University Hospital in Isfahan, Iran in 2012. Forty-six patients who underwent PD (28 males and 18 females) and 46 similar patients undergoing HD (26 males and 20 females) were compared. A standardized Persian version of the short form-36 (SF-36) tool was used to assess the quality of life and to assess the quality of dialysis weekly Kt/V in patients undergoing PD and single random Kt/V sampling in HD patients were assessed. Patients undergoing PD reported higher scores in physical functioning. The lowest scores in both groups were reported in mental health section. In physical functioning section, physical role functioning section and overall score of the SF-36 tool, PD patients reported significantly higher scores compared to the HD patients (P

Focal Xanthogranulomatous pyelonephritis is a rare chronic inflammatory condition of kidneys which usually is associated with postrenal obstruction or renal stone leading to chronic bacterial infection and eventually chronic glomerular inflammation. About 90% of cases are of the diffuse type and associated with staghorn renal calculi. The case presented in this paper is of the focal type in a 58-year-old diabetic female. Interestingly she did not have symptoms or laboratory presentation of chronic renal bacterial infection except for elevated ESR. She sought medical attention due to severe pulmonary infection of the background of morbid obesity. Imaging studies revealed several pulmonary lesions and a large mass of the right kidney which was indistinguishable from renal malignancy. After surgical resection of the right kidney, the lesion is pathologically diagnosed to be a focal Xanthogranulomatous pyelonephritis. The pulmonary lesions were spontaneously resolved about three months following right nephrectomy.

There is an increasing need for renal replacement therapy due to the growing number of cases with chronic kidney disease leading to end-stage renal disease. Two modalities of dialysis available are hemodialysis (HD) and peritoneal dialysis (PD). In this study, we aimed to compare the financial aspects of HD with PD. A total of 53 patients on HD and 43 patients on PD were included in the study and were assessed for several financial aspects of dialysis. The data collected were analyzed using SPSS-18. A statistically significant difference was noted between the HD and PD groups in the need for diagnostic tests, drugs, hospitalization, etc, with PD being less expensive. We strongly suggest physicians in our area to use PD on a larger number of patients for better financial outcome.

Calcium oxalate (CaOx) crystal deposition is a common finding immediately after kidney transplantation. However, small depositions of CaOx could be benign while extensive depositions lead to poor graft outcome. Here we report three cases with end-stage renal disease (ESRD), bilateral nephrolithiasis, and unknown diagnosis of primary hyperoxaluria (PH) who underwent a renal transplant and experienced an early-onset graft failure. Although an acute rejection was suspected, renal allograft biopsies and subsequent allograft nephrectomies showed extensive CaOx deposition, which raised a suspicion of PH. Even though increased urinary excretion of CaOx was found in all patients, this diagnosis could be confirmed with further tests including genetic study and metabolic assay. In conclusion, massive CaOx deposition in kidney allograft is an important cause of poor allograft survival and needs special management. Furthermore, our cases suggest patients with ESRD and a history of nephrolithiasis should be screened for elevated urinary oxalate excretion and rule out of PH.

Background The aim of this survey was to explore the baseline knowledge of the Iranian community about Chronic Kidney Disease (CKD) definition and its two main risk factors, i.e. diabetes and hypertension. This study also introduced a model of public education program with the purpose of reducing the incidence of CKD in high-risk groups and thereby decreasing the economic burden of CKD in Iran. Methods This cross-sectional study was conducted on world kidney day 2013 in Isfahan, Iran. Self-administered anonymous questionnaires evaluating the knowledge of CKD and its risk factors were distributed among subjects who participated in a kidney disease awareness campaign. Chi-square test and logistic regression analysis were used to examine the differences in the level of knowledge across different socio-demographic groups. Results The questionnaires were completed by 748 respondents. The majority of these respondents believed that “pain in the flanks” and “difficulty in urination” was the early symptoms of CKD. Roughly, 10.4% knew that CKD could be asymptomatic in the initial stages. Only 12.7% knew diabetes and 14.4% knew hypertension was a CKD risk factor. The respondents who had a CKD risk factor (i.e. diabetes and/or hypertension) were significantly more likely than respondents without CKD risk factor to select “unmanaged diabetes” [Odds Ratio (OR)= 2.2, Confidence Interval (CI) (95%): 1.4–3.6] and “unmanaged hypertension” [OR= 1.9, CI(95%): 1.2–3.0] as “very likely to result in CKD”. No more than 34.6% of all respondents with diabetes and/or hypertension reported that their physician has ever spoken with them about their increased risk for developing CKD. Conclusion The knowledge of Iranian population about CKD and its risk factors is low. Future public health education programs should put efforts in educating Iranian community about the asymptomatic nature of CKD in its initial stages and highlighting the importance of regular renal care counseling. The high-risk individuals should receive tailored education and be encouraged to adopt lifestyle modifications to prevent or slow the progression of CKD.

Objective: Anti-inflammatory, immuno-modulatory, and antioxidant properties of Moringa oleifera Lam. suggest that it might have beneficial effects on colitis. The present study was performed to investigate the anticolitis effect of Moringa oleifera seeds hydro-alcoholic extract (MSHE) and its chloroform fraction (MCF) on acetic acid-induced colitis in rats. Materials and Methods: Both MSHE and MCF with three increasing doses (50, 100, and 200 mg/kg) were administered orally to separate groups of male Wistar rats, 2 h before ulcer induction (using acetic acid 4%) and continued for 5 days. Prednisolone (4 mg/kg) and normal saline (1 ml/kg) were used in reference and control groups, respectively. All rats were sacrificed 24 h after the last dose (at day 6) and tissue injuries were assessed macroscopically and pathologically. Results: Extracts with three doses mentioned before were effective to reduce weight of distal colon (8 cm) as a marker for inflammation and tissue edema. Three doses of MSHE and two greater doses of MCF (100 and 200 mg/kg) were effective to reduce ulcer severity, area, and index as well as mucosal inflammation severity and extent, crypt damage, invasion involvement, total colitis index, and MPO activity compared with controls. MCF (50 mg/kg) was not significantly effective in reducing evaluated parameters of colitis compared with controls. Conclusion: It is concluded that MSHE and MCF were both effective to treat experimental colitis and this might be attributed to their similar major components, biophenols and flavonoids. Since the efficacy was evident even in low doses of MSHE, presence of active constituents with high potency in seeds is persuasive.

Background: Acute pancreatitis (AP) refers to afflicted inflammation of pancreas with unfavorable adverse effects and developed multiple organ failures. Unfortunately, there is not a certain therapeutic method for this disease. Oxidative stress has a serious role in the pathogenesis of AP. Thus, decreasing of oxidative stress may prevent induction and progression of AP. Punica granatum L. has been extensively used in traditional medicine and possesses various active biological elements. Due to antioxidant and anti-inflammatory properties of pomegranate, it could be considered as a good candidate alternative medicine with beneficial effects on AP. In this study, we decided to study the protective effect of three fractions of pomegranate seeds on cerulein-induced AP. Methods: AP was induced in male Syrian mice by five intraperitoneal (i.p.) injection of cerulein (50 μg/kg) with 1 h intervals. Treatments with pomegranate freeze-dried powder (PFDP) and hydroalcoholic pomegranate seeds extract (PSE) at doses of 125, 250, 500 mg/kg (i.p.) were started 30 min before pancreatitis induction. Pomegranate seed oil fraction (PSOF) was orally administered (50, 100, 200 μL/kg) and continued for 10 days. Pancreatic tissue was evaluated for histopathological parameters and pancreatic myeloperoxidase (MPO) activity as well as lipase and amylase levels were measured in plasma. Results: The higher doses of three fractions (250 and 500 mg/kg for PFDP and PSE and doses of 100, 200 μL/kg for PSOF) significantly reduced amylase and lipase activity in serum (at least P < 0.01), pancreatic MPO activity (P < 0.001), edema, leukocyte infiltration and vacuolization in comparison to the control group (P < 0.05). Conclusions: These results propose that pomegranate seeds fractions can prevent and/or treat the AP.

Background: At this study, we aimed to compare the urinary value of N-acetyl-β-D-glucosaminidase (NAG) with β2-microglobulinuria (β2M) to find the best marker for early diagnosis of acute kidney damage in children. These markers were used instead of routine evaluations of renal function tests such as creatinine (Cr). Methods: This study was conducted on 80 pediatric patients with the age range of 3 to 16 years old. They were categorized into patients with glomerular disease, tubular disease, and finally patients who had urological problems. Urinary NAG, β2M and Cr were measured. The ratio of NAG/Cr and β2M/Cr was compared between the groups. For analysis, one way ANOVA, chi-square, post-hoc least significant difference (LSD) and receiver operating characteristic (ROC) curve were used. Findings: The mean of NAG/Cr in glomerular disease group was significantly more than the other groups (P < 0.05). There was no significant difference of NAG/Cr between two groups of tubular disease and urological disease patients’ group (P > 0.05). The mean of NAG/Cr in two groups of patients with tubular and urological disease was more than control group (P > 0.05). In patients with glomerular disease group, the mean of β2M/Cr ration was more than other groups. Besides, the mean of β2M/Cr in two groups of patients with tubular and urological disease was more than control group (P > 0.05). In all groups, the diagnostic value of NAG/Cr was more than β2M/Cr. Conclusion: Urinary measurement of NAG/Cr is a simple, cost benefit and non-invasive method which can be used to detect early stages of renal injury such as glomerular, tubular or urological problems.

Background: The Immense cost of cancer treatment is one of the main challenges of health care systems all over the world including Iran. The aim of this study was to analyze the direct treatment costs of colorectal cancer patients in Isfahan, Iran. Methods: In this cross sectional study, the medical records of colorectal cancer (CRC) patients admitted to the Seyyed-al-Shohada Hospital "SSH" from 2005-2010 were reviewed. The profiles of 452 patients were examined. However based on inclusion, exclusion criteria a total number of 432 profiles were analyzed. All records including age, sex, treatment processes and treatment costs were extracted from the patients′ profiles and analyzed using Kruskal-Wallis test. Findings: The results showed that 56.1% of CRC patients were male. The mean age of patients suffering from CRC was 56 ΁ 13.4. More than Thirty-six percent of the patients were in stages 1-3 of CRC and more than half of them (64.4%) were in the 4 th stage. The higher the stage of the cancer the higher the percentage of treatments used. 5-Fluorouracil and Leucovorin (5FU/LV) was the most common used chemical treatment protocol. The mean treatment cost for stage one was 10715 (΁4927), for stage two 15920 (΁3440), stage three 16452 (΁2828) and for stage four was 16723 (΁2555) US Dollars. The cost of drug treatment was the first cost driven between the medical services. Conclusion: CRC in Iranian population starts in younger age than people in western countries. This imposed considerable direct and indirect economic cost to the society. The direct medical cost of colorectal cancer in Iran is very higher than 38 million $. Screening programs could reduce the economic cost of CRC significantly.

Background: Renal biopsy has an important role in the evaluation of renal disease. A sufficient amount of renal tissue in biopsy sample is required for pathologic diagnosis. The common method of renal biopsy (Blind method) is used for years. Today, new techniques for renal biopsy have been considered from which the most important biopsy techniques are CT scan-guided biopsy and real time ultrasounography. The purpose of this study was to determine the adequacy of renal biopsy samples of adults prepared by mentioned different methods. Methods: In this descriptive cross-sectional study, data of 788 patients undergoing renal biopsy in Al-Zahra and Noor hospitalsin Isfahan, Iran during 3 years were analyzed. Findings: Adequacy of biopsy specimens was appropriate in 74% of cases. Adequacy of biopsy specimens was higher in non transplanted kidnies. The trend to using new methods of renal biopsy has been increased among specialists during the study. The Adequacy of biopsy specimens in blind method, CT scan-guided biopsy, and real time ultrasounography was 75.2%, 66.4%, and 77.6% respectively (P > 0.05). Conclusion: According to the findings of current study, the advantages of new biopsy methods than traditional blind method have not been demonstrated but the growing experience in this area was considerable. In addition, sufficient experience was derived regarding the blind method of renal biopsy.

• Background: Renal transplantation is the treatment of choice for patients with end stage renal disease (ESRD). In cases of ant graft dysfunction at any time after transplantation, kidney biopsy is the golden standard for diagnosis. Kidney biopsies are categorized according to the Banff classification. This study aimed to evaluate the frequency of different allograft biopsies. • Methods: In this cross-sectional study, the renal allograft biopsies obtained in both Alzahra and Noor in Isfahan, centers during the years 2006 to 2008 were studied based on Banff classification. The information and data were obtained from the department of pathology. When the data were completely gathered, they were analyzed via SPSS software. • Finding: From 161 specimens, 68% were men and 32% were women. 85% of the grafts were from living unrelated donors, 9.9% from cadaver and 5% from living related donors. The relative frequencies of pathology diagnosis of biopsies were as 13.7% Tubular atrophy and interstitial fibrosis (TA &IF) grade II, 9.9% TA &IF III, 6.8% Acute rejection (AR) IA, 5.6% AR IB, 5% infarction, 5% borderline, 4.3% AR IIA, 4.3% TA&IF I, 3.7% antibody rejection and 1.9% AR IIB; also 44.7% had unrelated pathology to rejection. The greatest mean age for the patients under biopsy was for TA&IF I (45.5 years) and the smallest was for acute tubular necrosis (ATN) (24 years). The greatest mean time for biopsy was for TA&IF III (2666.2 days after biopsy) and the smallest was for ATN (72.8 days after biopsy). • Conclusion: A great number of studies on renal allograft pathologies have been done in different transplant centers around the world. No studies have been done on pathologies in Alzahra and Khorshid hospitals in Isfahan which are referral centers for transplantation. This study can give us a picture of the major causes of graft dysfunction in our country according to race, environment and...

Background: Renal transplantation is the treatment of choice for most patients with end stage renal disease. In addition, renal biopsy is the gold standard to assess the causes of renal allograft dysfunction. This study was designed to evaluate and designate renal lesions according to Banff schema. Methods: In this cross-sectional study, all renal allograft biopsies obtained from renal transplant patients at Alzahra and Noor referral hospitals in Isfahan during 2006-2008 were studied. Evaluations were made according to the Banff classification 2009. Clinical data was collected from the pathology database and analyzed using SPSS. Results: A total number of 161 specimens were studied from 68% male and 32% female subjects. The donor source was living unrelated in 85%, living related 9.9% and cadaveric in 5% of cases. Pathologic results showed 22.4% acute tubular necrosis (ATN), 13.7% interstitial fibrosis and tubular atrophy (IF/TA) grade II, 9.9% IF/TA (Grade III), 6.8% acute T-cell mediated rejection (TCMR-IA), 5.6% TCMR-IB, 5% borderline change, 5% infarction, 4.3% TCMR-IIA, 4.3% TA/IF (Grade I), 3.7% acute antibody-mediated rejection (ABMR), 1.9% TCMR-IIB and 17.4% other lesions. Conclusions: The commonest causes of graft dysfunction after kidney transplant were IF/TA, no evidence of any specific etiology (NOS) and ATN. Living donors were found to be important sources for kidney transplantation in Iran.

Objectives: to identify the histopathological findings that may act as possible predictors of complete remission or progression to chronic kidney disease in Iranian adults with primary focal segmental glomerulosclerosis (FSGS). Methods: In this historical cohort study, pathological findings of 50 patients with primary FSGS were reviewed by single renal pathologist without knowing about patient’s identities or outcomes. We divided the patients based on their histopathological findings, and compared the outcomes (renal insufficiency and complete remission) among these groups. Results: There were significant differences in the complete remission in subject with and without mesangial hypercellularity (p

Background: Primary focal segmental glomerulosclerosis (FSGS) is defined by the presence of proteinuria, often in nephrotic range and pathologically by segmental scars (SS). The aim of this study is to identify the possible predictors of complete remission or progression to chronic kidney disease in Iranian adults with primary focal segmental glomerulosclerosis. Methods: In this historical cohort study, pathological findings of 50 patients with primary FSGS were reviewed by single renal pathologist without knowing about patients′ identities or outcomes. Patients were divided based on their histopathological findings and outcomes were compared among these groups. Results: There were significant differences in the complete remission rate in subjects with and without mesangial hypercellularity (p < 0.05), and in patients with and without hyalinosis (p < 0.05). According to the cut off points based on ROC curve analysis for the quantitative data, there was significant difference in renal insufficiency between the patients with and without global scars more than 12% (p < 0.05). Also multiple logistic regression analysis strongly suggests the association of mesangial hypercellularity and global scar with no complete remission and progression to renal insuffi-ciency, respectively. Conclusions: In the studied patients, presence of mesangial hypercellularity and hyalinosis has been suggested as prognostic factors for lower remission rate. According to multivariate analysis, only mesangial hypercellularity and global scar were found to act as independent prognostic predictors of lower complete remission rate and progression to renal insufficiency in patients with FSGS, respectively.

Solid tumors are characterized by a plethora of epigenetic changes. In particular, patterns methylation of cytosines at the 5-position (5mC) in the context of CpGs are frequently altered in tumors. Recent evidence suggests that 5mC can get converted to 5-hydroxylmethylcytosine (5hmC) in an enzymatic process involving ten eleven translocation (TET) protein family members, and this process appears to be important in facilitating plasticity of cytosine methylation. Here we evaluated the global levels of 5hmC using a validated immunohistochemical staining method in a large series of clear cell renal cell carcinoma (n = 111), urothelial cell carcinoma (n = 55) and testicular germ cell tumors (n = 84) and matched adjacent benign tissues. Whereas tumor-adjacent benign tissues were mostly characterized by high levels of 5hmC, renal cell carcinoma and urothelial cell carcinoma showed dramatically reduced staining for 5hmC. 5hmC levels were low in both primary tumors and metastases of clear cell renal cell carcinoma and showed no association with disease outcomes. In normal testis, robust 5hmC staining was only observed in stroma and Sertoli cells. Seminoma showed greatly reduced 5hmC immunolabeling, whereas differentiated teratoma, embryonal and yolk sack tumors exhibited high 5hmC levels. The substantial tumor specific loss of 5hmC, particularly in clear cell renal cell carcinoma and urothelial cell carcinoma, suggests that alterations in pathways involved in establishing and maintaining 5hmC levels might be very common in cancer and could potentially be exploited for diagnosis and treatment.

Caroli’s disease (CD) is a rare congenital abnormality characterized by dilatation of intra hepatic bile ducts, which causes stone formation, recurrent cholangitis and higher risk for biliary malignancy. Association of this anomaly with congenital hepatic fibrosis is named Caroli’s syndrome (CS). The monolobar involvement of CS is a very rare condition, curable by partial hepatectomy. We report a 40-year-old woman with recurrent epigastric pain without icterus with normal AST, ALT and alkaline phosphates for 5 years due to left lobe Caroli syndrome which was diagnosed by CT scan and MRCP. Then, the patient underwent successful operation (left hepatic resection). After 8 months follow up, she was symptom free. Because the presentation of unilobar CS may be as late as middle age, this congenital anomaly should be considered in differential diagnosis of patients with recurrent epigastric pain without icterus in this age group and MRCP is a useful diagnostic tool. KEY WORDS: Caroli’s disease, Caroli’s syndrome, congenital hepatic fibrosis, magnetic resonance cholangiopancreatography.

BACKGROUND: CD44 is a transmembrane glycoprotein involved in cell-cell and cell-matrix interactions. De novo expression of CD44 and its variant isoforms has been associated with aggressive behavior in various tumors. Since little data is available on the role of CD44 expression in renal cell carcinoma, we evaluated CD44 expression to determine its prognostic value. METHODS: Forty-six patients with renal cell carcinoma were studied. CD44 expression was evaluated semiquantitively on paraffin-embedded tumor tissue by immunohistochemistry. The prognostic value of CD44 was tested using Kaplan Meier plots by the log rank test and Cox regression analysis. RESULTS: Fifteen out of 46 specimens (32.6%) were CD44-positive. According to bivariate analysis, tumor stage, tumor size, nuclear grade and CD44 expression were significant prognostic factors. CONCLUSIONS: CD44 expression can be considered as a useful prognostic parameter in renal cell carcinoma. KEY WORDS: CD44 expression, renal cell carcinoma, immunohistochemistry.

Background: The aim of this study was to determine the pathologic causes of renal allograft failure in transplant nephrectomy specimens. Materials and Methods: In this cross-sectional study performed in the referral transplant center of Isfahan, Iran, medical files of all patients who underwent nephrectomy in 2008–2013 were studied. Age at transplantation, sex, donor's characteristics, causes of primary renal failure, duration of allograft function, and pathologic reasons of nephrectomy were extracted. Slides of nephrectomy biopsies were evaluated. Data were analyzed using SPSS. Results: Medical files of 39 individuals (male: 56.4%; mean age: 35.1 ± 16.0 years) were evaluated. The main disease of patients was hypertension (17.9%), and most cases (64.1%) were nephrectomized < 6 months posttransplantation. Renal vein thrombosis (RVT) (51.3%) and T-cell-mediated rejection (TCMR) (41.0%) were the most prevalent causes of transplanted nephrectomy. Cause of primary renal failure was correlated to nephrectomy result (P = 0.04). TCMR was the only pathologic finding in all of patients nephrectomized >2 years posttransplantation. There were 14 cases in which biopsy results showed a relationship between primary disease of patients and pathologic assessment of allograft (P = 0.04). A significant relationship between transplantation-nephrectomy interval and both the nephrectomy result and histopathologic result existed (P < 0.0001). A relationship between primary allograft biopsy appearance and further assessment of nephrectomized specimen (P < 0.001) existed as well. Conclusion: The most pathologic diagnoses of nephrectomy in a period of less than and more than 6 months posttransplantation were RVT and TCMR, respectively. Early obtained allograft protocol biopsy is suggested, which leads to better diagnosis of allograft failure.

Background. Restless leg syndrome (RLS) is one of the prevalent complaints of patients with end stage renal diseases suffering chronic hemodialysis. Although there are some known pharmacological managements for this syndrome, the adverse effect of drugs causes a limitation for using them. In this randomized clinical trial we aimed to find a nonpharmacological way to improve signs of restless leg syndrome and patients’ quality of life. Material and Methods. Twenty-six patients were included in the study and divided into 2 groups of control and exercise. The exercise group used aerobic exercise during their hemodialysis for 16 weeks. The quality of life and severity of restless leg syndrome were assessed at the first week of study and final week. Data were analyzed using SPSS software. Results. The difference of means of RLS signs at the first week of study and final week was in exercise group and in control group. There was not any statistical difference between control group and exercise group in quality of life at the first week of study and final week. Conclusions. We suggest using aerobic exercise for improving signs of restless leg syndrome, but no evidence was found for its efficacy on patient’s quality of life.

Abstract Increasing the Antiphospholipid-nephropathy (APS-N) alterations on lupus renal lesions cause renal disease progression and detoriation of prognosis. The aim of this study was to find some indicators in lupus patients that can predict the occurring of APS-N in them and can be construct the preventive treatments for prevention of more complications. Background: In this descriptive study, the renal biopsy specimens of 66 patients with lupus nephritis, were reviewed according to new classification of lupus nephritis ISN/RPS 2003 by a nephropathologist and synchronous alterations due to APS, were studied. Results were analyzed by SPSS-12 and statistical methods, independent sample test, chi-square. Methods: The APS-N alterations were seen in 31.8% of patients. The most common class of lupus nephritis was IV. There was no significant difference between any one of the lupus nephritis class and the existence of synchronous APS-N alterations (P > 0.05), between lupus nephritis and APS-N with serum Cr level at the time of renal biopsy (P = 0.434) and also between the presence of anti phospholipid antibodies and the existence of synchronous APS-N alterations (P= 0.904). The difference between clinical signs (thrombosis, ischemia) and existence of the synchronous APS-N alterations, was strongly significant (P = 0.001). Findings: This study recommend that pathologists should be careful to diagnose and report the existence of synchronous APS-N alterations in renal biopsy specimens related to lupus nephritis patients, because these alterations help the physician to carry out proper treatment and prevent of future vascular thrombotic events in lupus nephritis patients. Conclusion: Anti phospholipid syndrome, lupus nephritis, normal pathology. Key words:

Peutz-Jeghers syndrome is a rare autosomal dominantly inherited condition, characterized by the presence of hamartomatous gastrointestinal polyps and mucocutaneous pigmentation. Patients with this syndrome can be associated with other neoplasms such as ovarian neoplasms known as sex-cord tumor with annular tubules that are associated in one third of the cases with this syndrome and other types of malignancies. We report a 42-year-old woman with a history of Peutz-Jeghers Syndrome and bilateral breast cancer that presented with abnormal uterine bleeding. Total abdominal hysterectomy with bilateral salpino-oophorectomy was done and an ovarian sex cord tumor with annular tubules was incidentally diagnosed. By reviewing literatures and in agreement with previous studies we suggest routine screening for malignancies in patients with Peutz-Jeghers syndrome.

Background: C4d as a part of complement activation process is a marker for detecting antibody-mediated rejection (ABMR) and its positivity accompanied by positive donor specific antibody (DSA), and morphologic view of humoral rejection has been suggested to detect ABMR since 2003. Materials and Methods: 41 specimens of transplanted kidney biopsies gathered from 2006 to 2008 were evaluated for morphological changes on light microscopy, and nephro-pathologist made distinct diagnosis for all of specimens then c4d staining was done for all of them. The association between primary diagnosis without c4d staining and c4d scoring on peritubular capillaries and glomerular capillaries were evaluated to determine whether morphological changes were enough for distinct diagnosis or not. Results: Acute tubular necrosis (ATN) 27%, interstitial fibrosis and tubular atrophy (IF&TA) 17%, and T cell mediated rejection (TCMR) 22% were the commonest diagnosis on light microscopy, and 17% of all biopsies had diffuse positive c4d staining. There was not any report of ABMR in morphological evaluation while c4d positive staining was seen in some specimens (17%). It may result from masking of ABMR by other morphological changes such as TCMR and no specific histologic changes for ABMR on light microscopy. Conclusion: We would like to emphasize that c4d staining should be done for all of renal allograft biopsies, and pathologists all over the world should consider the probability of ABMR masked by other morphological changes on light microscopic evaluation.

Background: The cytological diagnoses of serous effusions are usually made by routine cytomorphology with certainty. However, overlapping cases sometimes exist between reactive mesothelial and adenocarcinoma cells. We tried to evaluate the diagnostic utility of proliferative index using a Ki-67 monoclonal antibody in distinguishing between reactive mesothelial cells and adenocarcinoma in serous effusions. Materials and Methods: Paraffin blocks and H and E stained slides of peritoneal and pleural fluid cell blocks were retrieved from cytology archive of Alzahra Hospital, Medical University of Isfahan, between 2006 and 2010, from among 1025 slides which were screened to ascertain their appropriate diagnoses. Among of these 80 paraffin-embedded cell blocks, 40 cases for each reactive and adenocarcinoma groups were selected. The proliferative index was calculated by using the Ki 67 monoclonal antibody against nuclear proteins. Results: The mean ages of the patients in the reactive mesothelial and adenocarcinoma groups were 60.58 and 58.45 years, respectively. The gender distribution for the malignant group included 23 cases (%57.5) of females and 17 cases (42.5%) of males. This ratio for reactive group included 14 cases (35%) and 26 cases (65%). The mean of Ki-67 index in adenocarcinomatous cells was 17.15 (SD=15.11) and in reactive mesothelial cells was 3.58 (SD= 3.59) (P=0.001). We consider to using the proliferative marker of Ki-67 on benign and malignant lesions revealed 12% as cut off level. The means of Ki-67 index according to serousal spaces were included: Pleura: 10.56 (SD= 13.06) and peritoneum: 10.03 (SD= 12.78), (P=0.9). Conclusion: Ki-67 index is useful immunostaining panel for differentiation of mesothelial and adenocarcinoma cells in malignancy like ovarian carcinoma that sometimes mimics mesothelial morphology.

BACKGROUND: Inguinal hernia is a common disease specially in men. Hernias have major complications such as incarceration, bowel obstruction, strangulation and even life-threatening problems. Here, all hernias should be treted by surgical operation. Reparation of hernias has two methods: open hernioplasty and laparoscopic hernioplasty. The purpose of this study was to compare the complications and recurrence of hernias after operation by two methods of laparoscopic hernioplasty and open surgery. METHODS: In this clinical trial conducted during one year, 80 patients were operated by two surgeons by two methods of laparoscopic and open surgery. Before the operation, the patient’s data were documented in a questionnaire. Patients were visited by their surgeon 6 weeks and at mean 15±6 months after operation in clinic in order to assess the complications and recurrence after surgery. Data were analyzed by SPSS software ver 14 at P