مجله دانشکده پزشکی اصفهان
پیاپی 441 (هفته اول مهر 1396)

Postsurgical pain is one of the complications that can affect patient's life negatively. The aim of this study was to evaluate the effect of intravenous lidocaine in comparison to intraperitoneal lidocaine on postsurgical pain in laparoscopic cholecystectomy.
This was a randomized, double-blind clinical trial study on96 patients who underwent laparoscopic cholecystectomy in Alzahra hospital, Isfahan, Iran in 2013-2014. Patients with American Society of Anesthesiologists (ASA) physical status of I and II considered to undergo laparoscopic cholecystectomy were divided into 3 groups of control, intravenous lidocaine, and intraperitoneal lidocaine. Collected data were analyzed using Kruskal-Wallis, ANOVA, and chi-square tests via SPSS software. P value of less than 0.050 was considered significant.
Findings: Mean pain intensity based on visual analogue scale (VAS) was considerably higher in control group in comparison to two others (P This study showed that intravenous and intraperitoneal lidocaine can reduce postsurgical pain intensity, and pethidine administration in laparoscopic cholecystectomy.

Breast cancer is a multifactorial potentially lethal disease that is triggered by genetic factors as well as numerous environmental factors. The present research aimed to examine the expression of Vascular endothelial growth factor messenger RNA (VEGF mRNA), cytokeratin-19 mRNA (CK19 mRNA), and vascular endothelial growth factor (VEGF) protein biomarker in the peripheral blood of patients with breast cancer.
40 patients with breast cancer were compared to 40 healthy individuals. The real-time reverse transcriptase polymerase chain reaction (real-time RT-PCR) method was used to determine the expressions of the CK19 mRNA and VEGF mRNA biomarkers in the peripheral blood samples of the healthy participants and the patients. The VEGF protein was also compared using the (ELISA) method.
Findings: The positive VEGF mRNA biomarker was observed in 30 of the 40 patients with breast cancer; thus the sensitivity of this marker was 75%. In the healthy participants group, 6 of the 40 participants showed a positive VEGF mRNA biomarker expression. The CK19 mRNA marker was positive in 25 of the 40 patients, which indicated a sensitivity of 62.5%. In the healthy participants group, the positive expression of the CK19 mRNA biomarker was observed in 7 of the 40 participants. VEGF was positive in 27 of the 40 patients. In the control group, 5 of the 40 participants showed the positive expression of this biomarker.
In sum, based on the results of this research, the assessed breast cancer tumor markers can be used as screening tests for the early diagnosis of patients. To further prove the findings of this study, more extensive studies with larger sample sizes are recommended.

Valvular heart disease as a public health problem in developing countries. Studies reported a lower incidence of coronary artery disease (CAD) among patients with valvular heart disease. The relationship of valvular heart disease and coronary artery disease is still unknown. The aim of this study was to evaluate the association between valvular heart disease and coronary artery disease in patients with stable angina.
This was a case-control study on 1062 patients with stable angina undergone angiography for certain elective indication in Shahid Chamran hospital, Isfahan University of Medical Sciences (IUMS), Iran, from September 2011 to September 2016. Besides, the echocardiography was evaluated within 6 months before and 6 months after the coronary angiography. Then relationship between coronary artery disease and having valvular heart disease was assessed.
Findings: In this study, 1062 patients with mean age of 61.67 ± 11.38 years were evaluated that 64% of them were men. About 61.3% had coronary artery disease and 33.9% had valvular heart disease. Patients with coronary artery disease were at lower risk for experiencing valvular heart disease. Patients with mitral stenosis or mitral regurgitation, aortic stenosis or regurgitation, and those with tricuspid valve regurgitation were less likely to have coronary artery disease. 22.0% of patients with coronary artery disease had one vessel involvement. In addition, patients with two vessels involvement had less valvular heart disease than patients with one or three vessels involvement.
Patients with coronary artery disease were less likely to develop heart valve disease. Patients with coronary artery disease showed milder valvular heart disease.

Aortic coarctation is a common disease which has serious consequences such as death. The definite treatment is surgery, and recognizing the complications of this surgery will reduce the consequences. Therefore, we decided to study the outcomes of this surgery over four years.
The study includes 132 patients who underwent reconstructive surgery in Shahid Chamran Hospital, Isfahan, Iran, during 2011-2015. The needed information including the type of the surgery and the complications was collected through the patients’ records and calling them. Chi-square, Student's t, and ANOVA tests were used to compare the data.
Findings: Relapse was observed in 17 patients (12.9%), hemorrhage in 3 patients (2.3%), chylothorax in 2 patients (1.5%), endocarditis in one patient (0.8%), blood pressure contradictory in 20 patients (15.2%), and death in 4 patients (3.0%). Only relapse rate was higher in patients older than 20 years, as compared to patients younger than 20 years (20.0% vs. 4.8%, P = 0.009). As well as, relapse rate was higher in patients under artificial patch (19.2%) as compared to the other groups and lowest relapse rate was observed in patients under the subclavian artery flap (0.0%) (P = 0.028); but on the other side, no significant correlation was not found between other complications with age, sex, and type of surgical repair.
According to the result of this study, complications in patients undergoing reconstructive surgery were high and also that was higher in older age patients. We also discovered that the complications were the least when using subclavian artery flap method in the reconstructive surgery.

Now a day, antibiotic resistance is a global problem. A way to solve this problem is production of alternative drugs. In this regard, today so many researches on antimicrobial peptides against pathogens are being done. LL-37 peptide is one of these peptides that is cationic and has antibacterial, antiviral, and anticancer activity. This project aimed to study the antimicrobial effectiveness of peptide LL-37 on multiple-drug-resistant (MDR) Acinetobacter baumannii.
First, the LL-37 gene was linked to the pET-32a vector; then, recombinant DNA was transformed into the host bacteria and inducted to produce proteins. After the production and purification of recombinant proteins, to activate the protein, dialysis was performed in phosphate buffered saline (PBS). Then, the efficiency of peptide LL-37 on multiple-drug-resistant Acinetobacter baumannii was tested using common laboratory tests such as minimum inhibitory concentration (MIC).
Findings: The minimum inhibitory concentration of LL-37 on Acinetobacter baumannii ATCC19606 was 1.5 µg/ml. In addition, the activity test showed that the recombinant proteins could inhibit the growth and decay the bacteria.
The results of this study show that LL-37 protein, in comparison to other peptides and drugs in other studies, is more efficient and in low concentration can cause destruction of bacteria. This can herald a bright future for the treatment of infections caused by multiple-drug-resistant Acinetobacter baumannii.

Memory problems were reported to be among the most common cognitive disorders affecting patients with stroke. The aim of this study was to investigate the effectiveness of mindfulness training and memory specificity training on the aspects of memory in patients with ischemic stroke.
A quasi-experimental design with pre/posttest and two experimental groups was used in this study. 16 patients with ischemic stroke were selected via available sampling among patients referred to Alzahra hospital, Isfahan, Iran, in 2014, and were randomly assigned into two equal groups. The groups were trained with either mindfulness training, or memory specificity training. Then, the patients were evaluated using Prospective and Retrospective Memory Questionnaire (PRMQ).
Findings: The effect size was calculated as 4.5 and 2.3 for mindfulness training and memory specificity training, respectively, indicating marvelous effectiveness of treatment for both groups. There was significant difference between the two groups in total score of PRMQ according to ANCOVA test (P According to the findings, mindfulness training and memory specificity training had increasing effect on memory in patients with ischemic stroke. Mindfulness training was more effective on the prospective memory.

Colorectal cancer is the fourth common cancer and third cause of death due to cancer in the world. Chemotherapy plus surgery are the routine methods in treatment of colorectal cancer. Cytotoxic drugs such as 5-fluorouracil, ograliplatin, and leukoverin in treating colorectal cancer have several side effects for patients. On the other hand, finding new components to improve drug responsiveness, reduce drug dosage and therefore, reduce side effects of chemotherapy are important. Curcumin is a substance of plant origin with antioxidative, anti-inflammatory, and antibacterial properties. In addition, it has antitumor effects in preclinical, and phases I and II clinical studies in various cancers such as prostate, breast, colon, and pancreas. The results of these studies indicated the efficacy, more tolerance among patients, and improving the quality of life. In this article, we reviewed the role of curcumin in colorectal cancer and the involved mechanisms.