مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و ششم شماره 1 (پیاپی 205، فروردین 1397)

Cancer/testis antigens (CTAs) are a kind of antigens that their expression mostly is restricted in testis and female’s genital organs. Tumor cells often express antigens whose expression is normally limited to germ cells. CTAs are composed of a vast gene family of closely related members and are commonly classified into two groups: the CT-X antigens that are encoded by the X chromosome and the non-X CTAs that are encoded by the autosomes. CTA are extensively and variably dispersed between tumors of diverse histotypes. CTA are broadly expressed in tumors, but not in normal tissue except for testis that is not available to the immune system, actually, the blood-testis barrier and the lack of HLA class I expression on the surface of germ cells avoid the immune system from the interaction with CTA proteins to be identified as non-self-structures. Consequently, CTA can be regarded as fundamentally tumor-specific targets. With extensive investigations on the function of this important biological molecules, their functions are somewhat revealed. Because of their high immunogenicity, tumor-limited, and biased expression, detection of these molecules provides unprecedented chances for further research and clinical development in the field of immunotherapy and cancer diagnosis. Also, growing evidence discloses that a number of CTAs stimulate epithelial mesenchymal transition (EMT) and generation of cancer stem-like cells, increasing metastasis, invasion and tumorigenesis. According to recent clinical attention, more features of CTA regulation are explored. CTA expression has been confirmed in a variety of human cancer tissues and some of them have been discovered to cause humoral and/or cellular immune responses in cancer patients, likewise, they displayed intertumor and intratumor heterogeneity in expression levels. CTAs are excellent targets for targeted tumor therapy, anticancer drug discovery, and diagnostic biomarkers, similarly, appreciated genes in the study of promoting tumorigenesis, immunotherapy, and malignant progression. This review summaries and classifies our current understanding of the complex and biased process of CTAs mRNA and protein expression in cancer, and provide the most current information on their function and regulation.

Immunotoxins such as pseudomonas exotoxin are Molecules with a unique structure like toxin-antibody part. These immunotoxins are two functional which crossing the cell membrane and enters the target cell and destroy the cell. Toxin-based treatments are a widespread research field and can have broad applications in the biology and public health. Immunotoxins act selectively against cancer cells and have a good potential for detecting and targeting cancer cells. Specific immunotoxins to target immune cells due to the selection type antibody and antibodies are responsible for the identification of the target cells. Cancer is becoming a major cause of death in most developed countries. In order to have a strong factor in cancer repression, that agent must target the cancer cells directly and specifically. Often, but not always, immunotoxins are produced for disabling and killing cancer cells, that this issue is one of new therapeutic approaches in recently. Clinical aims to designing and create new cancer therapies focused with this approach, a lot of information about the toxin and intracellular pathways have been obtained. So, toxins in medicine are useful for the treatment of human disease and study of professional cellular functions. So, immunotoxins have a high potential for cancer treatment. Other applications of immunotoxins, including immune system regulation and treatment of viral diseases and parasites diseases. More research is needed to improve the immunotoxin effects and to reduce their side effects. On the whole, with design creative, clever and experienced programs, many human diseases, particularly cancers can be in a short period of time and faster than other methods of treatment that the treatment of long, to be treated. Following the design and implementation of clinical trials, the effects of immunotoxins on animal tumorigenic models were performed. In fact, in this study, we focus on the use of protein-bound toxins with bacterial and herbal sources and more specifically Pseudomonas immunotoxins which attached to antibodies to target cancer cells.

Prolonged mechanical ventilation and the need for tracheal intubation are the main indication of tracheostomy. This procedure can be done, in two ways: surgical tracheostomy or percutaneous tracheostomy. In this study, surgical tracheostomy was compared with percutaneous method in the intensive care unit.
This clinical trial study was performed on 61 patients admitted to the intensive care unit of Ayatollah Rohani Hospital of Babol University of Medical Sciences from April 14, 2013 to April 14, 2016. In the first group (44 cases), tracheostomy was performed in percutaneous (PDT) and in the second group (17 patients) surgically. The early complications and waiting time (intubation to tracheostomy) for tracheostomy were compared in two groups. All data were analyzed by SPSS software, ver. 22 (Armonk, NY, USA), Analysis of variance (ANOVA) and P values of less than 0.05 were considered significant.
The mean age of the patients was 59.87±8.15 years. The mean age of the male patients was 59.66±6.35 years and the female patients were 60.35±6.41 years. In this study, the average waiting time (time from intubation to tracheostomy) was 14.19 days in the PDT group and 20.69 days in the tracheostomy group, with a significant difference between the two groups (P= 0.001). The incidence of preoperative bleeding after surgery was five cases (8.2%). In the PDT group, two cases (3/3%) and the surgical group was three cases (4.9%) and the two groups did not have a significant difference (P= 0.46). The incidence of wound infection (during the period of admission and up to ten days later) in two groups was two patients (3.3%), one case (1.6%) In the PDT group, and one case (1.6%) in a surgical group and the two groups did not have a significant difference (P= 0.43). Other complications such a subcutaneous emphysema and posterior tracheal wall trauma and rupture was not shown in both groups.
The findings of this study showed that the complications (bleeding and wound infections) did not differ between the two groups. Due to the lower waiting time and the lack of need for patient transfer outside of the intensive care unit, percutaneous tracheostomy can be a safe alternative to the surgical tracheostomy.

One common symptom of diabetes is diabetic retinopathy, if not timely diagnosed and treated, leads to blindness. Retinal image analysis has been currently adopted to diagnose retinopathy. In this study, a model of hierarchical self-organized neural networks has been presented for the detection and classification of retina in diabetic patients.
This study is a retrospective cross-sectional, conducted from December to February 2015 at the AJA University of Medical Sciences, Tehran. The study has been conducted on the MESSIDOR base, which included 1200 images from the posterior pole of the eye. Retinal images are classified into 3 categories: mild, moderate and severe. A system consisting of a new hybrid classification of SOM has been presented for the detection of retina lesions. The proposed system includes rapid preprocessing, extraction of lesions features, and finally provision of a classification model. In the preprocessing, the system is composed of three processes of primary separation of target lesions, separation of the optical disk, and separation of blood vessels from the retina. The second step is a collection of features based on various descriptions, such as morphology, color, light intensity, and moments. The classification includes a model of hierarchical self-organized networks named HSOM which is proposed to accelerate and increase the accuracy of lesions classification considering the high volume of information in the feature extraction.
The sensitivity, specificity and accuracy of the proposed model for the classification of diabetic retinopathy lesions is 98.9%, 96.77%, 97.87%, respectively.
These days, the cases of diabetes with hypertension are constantly increasing, and one of the main adverse effects of this disease is related to eyes. In this respect, the diagnosis of retinopathy, which is the same as identification of exudates, microanurysm and bleeding, is of particular importance. The results show that the proposed model is able to detect lesions in diabetic retinopathy images and classify them with an acceptable accuracy. In addition, the results suggest that this method has an acceptable performance compared to other methods.

Renal artery stenosis (RAS) is a known cause of secondary hypertension and renal failure. The most patients with renal artery stenosis are asymptomatic. So, the exact prevalence of this disease is unknown. The gold standard of diagnosis of RAS is renal angiography that is an expensive somewhat hazardous procedure and may revealed nothing. The aim of this study was to develop a simple risk model score to predict significant RAS based on known risk factors. This may enable us to select patients with high probability of having RAS to perform angiography.
A total of 4177 patients whom underwent renal angiography from April 2001 to March 2016, were randomly assigned to a development and a validation dataset in ratio of 2:1 respectively. The clinical and laboratory data of patients were analyzed by multivariate regression analysis. The factors of female sex, history of hypertension and glomerular filtration rate were determined as predicting factors and they were assigned a weighted integer, the sum of the integers was a total risk score for each patient. This model was examined at validation set.
We retrospectively evaluated all patients undergoing renal artery angiography since 15 years ago. We extracted all risk factors of RAS including age, sex, height, weight, and history of diabetes, hypertension and hyperlipidemia. We also looked at coronary or peripheral vascular diseases and presence of heart failure. The age of patients was 63.5±11.2 years and 40% of the patients were female. The significant RAS was defined as 70% or more narrowing of renal artery. The prevalence of renal artery stenosis was 14.4% and 13.5% in development and validation dataset respectively. The area under curve and confidence interval for final mode in development dataset was 67.9% (65.0-70.8%). The rates of RAS increased with increasing risk score. In 1402 patients in validation dataset the model showed good discrimination power (cstatistic= 0.76)
This model simply assesses the risk of RAS using available information. This model can be used both in clinical and research purposes. The power of model for diagnosis of RAS is estimated to be 72.6% (68.8%-76.4%).

Endotracheal tube cuff pressure must be maintained in safe range. Many factors could be affecting on endotracheal tube cuff pressure in patients on mechanical ventilation. Patients undergoing mechanical ventilation (MV) in critical care settings require changing position for different reasons. The aim of this study was to determine the effect of changes in body position and head of bed on the endotracheal tube cuff pressure in patients with mechanical ventilation.
This quasi-experimental study (pre-post design) was performed from April to October 2016 on 70 patients with positive pressure mechanical ventilation in critical care settings in two university hospitals in the cities of Semnan and Shahroud, Semnan Province, Iran. At first, the endotracheal tube cuff pressure of patients was regulated on 25 cmH2O in the bed position of 30 degree. Then the patients were randomly positioned on zero degree bed position, 45 degree bed position, lateral position of patients toward mechanical ventilation apparatus and lateral position opposite the MV apparatus. In each position cuff pressure was measured after 5 minutes pause and head and neck of the patients was not flexed or extended. Tube cuff pressure was measured and recorded in the end expiratory with aneroid manometer after each position change. Data analysis was performed with software of SPSS software, version 18 (Armonk, NY, USA) in the significant level of 0.05.
Most of study patients (58.6%) were male and no smokers (81.4%). Age mean of patients were 63.37±20.9 years. Most of patients connected to MV because of respiratory failure. In each change positions and head of bed regulation, the mean of endotracheal tube cuff pressures were significantly increased (P Findings of this study showed that changing position of bed and patients undergoing mechanical ventilation, especially in lateral position opposite to the apparatus could increase endotracheal tube cuff pressure. This increase may reach to abnormal range and cause tracheal injury.

Sports injuries of the knee joint are very common. There are both contact injuries and non-contact injuries. Contractile injuries may be due to an impairment of the knee joint position sense or a decrease of the quadriceps muscle strength. Using a Kinesio taping method may decrease this impairment. The aim of the current study was to assess the effect of direction and tension of Kinesio taping of the quadriceps muscle on repositioning sense of the knee joint and maximum concentric and eccentric torque of the knee extensors.
Twenty-one recreationally active healthy males, determined by convenient non-probability sampling method, participated in this quazi-experimental study. The tests were performed in biomechanics laboratory of School of Rehabilitation of Tehran University of Medical Sciences, Iran, between July to November 2017. They visited biomechanics laboratory 5 sessions. The first session was for familiarization with the main tests and signing an informed consent form. For 2 through 5 sessions, one of each Kinesio tape tension approaches of 100, 115 and 140 percent (origin to insertion direction) and 100 percent (insertion to origin direction) was randomly applied on the quadriceps muscle. Active and passive repositioning sense of the knee joint at 60-degree flexion and maximum concentric and eccentric torque of the knee extensors of the dominant extremity before and after Kinesio taping were measured using a Biodex System 3 isokinetic dynamometer (Biodex Medical Systems, Shirley, NY, USA). Order of measuring active and passive repositioning sense and maximum concentric and eccentric torque of the knee extensors were randomly selected.
Origin to insertion Kinesio taping method with tension of 100, 115 and 140 percent significantly decreased means of active and passive repositioning sense errors (P 0.05).
According to the results, Kinesio taping could influence on repositioning sense of the knee joint at 60-degree knee flexion. Maximum concentric and eccentric extensor torques was also increased.

Polycystic ovary syndrome (PCOS) is one of the most common neuroendocrine-metabolic disorders at the infertile age. Patients with PCO often at risk for secondary complications including metabolic difficulties (impaired glucose tolerance, insulin resistance, type 2 diabetes mellitus), reproductive (hirsutism, hypeandrogenism, infertility) and psychological features (worsened quality of life, anxiety, depression). Studies of the past decade suggest that the quality of life is important in the improvement of this syndrome. The purpose of this study was to provide an accurate pattern in the lifestyle of these women.
This case-control study was conducted to assess the lifestyle of patients with polycystic ovary syndrome who referred to Vali-e-Asr Infertile Clinic of Imam Khomeini Hospital, Tehran, from March to February 2015. After filling the consent form, 168 women participated in this study with the age range of 20-40 years and the body mass index (BMI) less than 28 m2/kg. The dimensions of lifestyle in this study were evaluated by the following questionnaires: general qualities of life (GHQ-28), Pittsburgh sleep quality, depression-anxiety-stress (DASS-42) and researcher-made demographic questionnaire.
The mean of BMI and weight in study group were higher than control group (P= 0.002) (P These results indicate that environmental factors can easily effect on the quality of life in PCO women. The pattern of sleep is not desirable. Menstrual disorder effects on the mood and the impact of the low income generates negative emotions and affects their quality of life, since the cost of treatment for infertility is high for the low-income families. Therefore, this study indicates that having proper weight and proper sleep can help to plan a correct pattern of lifestyle in these patients.

Impaired balance is one of the most common symptoms that occur after stroke. There are several tests for evaluating balance in neurological disorders. Brief-balance evaluation systems test (Brief-BESTest) is the short version of BESTest that assess the systems contributing to postural control. The purpose of this study was to investigate the inter- and intra-rater reliability of the Persian version of Brief-BESTest for balance evaluation in patients with stroke.
Patients with stroke recruited from the Tehran University of Medical Sciences Physiotherapy Clinics in Tehran participated in this cross-sectional study. Patients were included in the study with first ever stroke, able to follow instructions, able to walk without aid, and willingness to participate in the study. The study was conducted from August to December 2016. Two physiotherapists independently scored the videotaped performance of patients on Persian Brief-BESTest in one session for inter-rater reliability. The first physiotherapist recorded the patients’ performance on Persian Brief-BESTest after 1 week for intra-rater reliability. The physiotherapists were blinded to each other’s scores. Intraclass correlation coefficient (ICC) was used to assess the reliability. SPSS statistical software, version 18 (IBM, Armonk, NY, USA) was used for all analyses.
Thirty patients with stroke (10 males, 20 females, mean age 57.3±13.5 years, duration 40.7±47.3 months) participated in this study. The ICC values for inter-rater reliability and intra-rater reliability of total scores were 0.98 (95% CI: (0.95-0.99)) and 0.99 (95% CI: (0.98-0.99)), respectively. The ICC values for inter- and intra-rater reliability of each item score were 0.72-1.0, and 0.87-1.0 respectively.
The Persian version of Brief-BESTest has high inter- and intra-rater reliability for evaluation of balance in patients with stroke. Therefore, it is recommended for use by clinicians in the clinic and for research purposes in the clinical trials.

Complete molar twin pregnancy with coexisting fetus is a rare and important diagnosis in obstetrics. Preeclampsia, preterm labor and life-threatening vaginal bleeding are the serious complications of this type of pregnancy. Gestational trophoblastic neoplasia should be ruled out after termination of pregnancy. In this study we reviewed a molar twin pregnancy with a live coexisting triple x fetus which has not been reported till now.
Our case was a 22-year-old primigravida woman and 17-18th week of pregnancy, who referred to an University Hospital in Mashhad, Iran with complaint of vaginal bleeding On October 2016. Her first trimester ultrasonography in 13th week of gestational age, reported a live single fetus with an anterior great placenta and cystic formation regarding molar pregnancy. According to above-report, Amniocentesis was done in 15th weeks of pregnancy and its result was triple X. After severe and life-threatening vaginal bleeding, she underwent an emergent hysterotomy. A fetus with no obvious anomaly and a great hydropic and vesicular placenta delivered. Episodic crisis of her blood pressure was best controlled with anti-hypertensive drugs. In our case, chemotherapy with methotrexate was started after poor decline of βHCG titration and definite diagnosis of gestational trophoblastic neoplasia. Remission was completely achieved after four courses of chemotherapy.
Differentiation between complete molar pregnancy with live fetus and partial mole is always challenging in obstetrics. Serious complications as preeclampsia and severe vaginal bleeding may become life-threatening. Coexisting molar pregnancy should be ruled out in a pregnancy associated with frequent and unexpectant vaginal bleeding. Amniocentesis and an expert radiologist can help to differentiate them. Following these patients is very important to reveal any trophoblastic neoplasia.