محمدتقی قربانیان

Discharge against medical advice indicates the dissatisfaction of patients with the care services of the health system. Additionally, it threatens patient's life and causes negative financial outcomes for hospitals. 

This study identifies the causes of self-discharge decisions from the emergency department at Kowsar Hospital, Semnan City, Iran.

This was a descriptive-analytical study conducted between August 2021 to March 2022. The data were collected by a researcher-made questionnaire containing demographic characteristics and reasons for self-discharge, including the following three main concepts: Personal, staff-related factors, and environmental factors with sub-concepts. Meanwhile, the data were analyzed using the SPSS software, version 22.

A total of 140 patients with a mean age of 33.52±16.17 years were included, of which 58.6% were men and 41.4% were women. Moreover, 63.6% of patients were married, 42.1% had a diploma education, and 11.4% had a history of taking neuropsychiatric drugs. Also, 42.9% of patients were covered by social security insurance. The highest rate of self-discharge was in the evening (42.1%) and night (37.9%) shifts. The most important reasons for self-discharge decision were problems related to insurance (30%), COVID-19 infection (26.4%), poor communication (17.1%), dissatisfaction with care (15.7 %), disrespectful behavior of staff (12.9%), and inappropriate emergency ward facilities (12.1%).

Make appropriate decisions to improve the quality of medical services and increase cooperation in health insurance, separating the departments of infectious diseases away from other departments, holding briefing sessions for physicians and medical staff, increasing awareness of patients about possible complications of self-discharge, and improving the amenities of emergency ward can reduce the rate of self-discharge decision.

Neurogenesis is the process through which neurons are generated from neural stem cells. This process has been shown to occur in special zones of the adult brain including the subventricular zone (SVZ) of the lateral ventricles and the dentate gyrus of the hippocampus. Gonadal steroids affect different steps of neurogenesis, and cell proliferation seems to be increased by estrogens. This study aimed to investigate the neurogenic changes in the SVZ at different phases of the estrous cycle.

In this experimental study, 26 NMRI mice were used. The mice were identified by vaginal smear and then divided into 4 groups including proestrus (n=5), estrous (n=7), metestrus (n=7) and diestrous (n=7). Different stages of the estrous cycle were determined by staining vaginal smears. Also, the qualitative assessment of cell proliferation in the SVZ was performed by cresyl fast violet staining and glial fibrillary acidic protein (GFAP) immunohistochemistry at different stages of the estrous cycle.

In microscopic sections stained with cresyl violet, it was observed that cell density in the proestrus stage of the estrous cycle was greater than in any other stages of the estrous cycle. A comparison of sections stained with anti-GFAP showed that the density of astrocytes in proestrus was significantly higher than in other groups.

Proestrus stage of the estrous cycle is associated with increased cell proliferation and density of astrocytes in the SVZ of mice. Neurogenesis is correlated to changes in sex hormonal levels at different phases of the estrus cycle.

In recent years using of Bone marrow mesenchymal stem cells (BMSC) in regenerative medicine, tissue engineering and gene therapy is highly regarded. Convenient access, ability to expand and MSC differentiation capacity along with the ability of adhesion to plastic surfaces and in-vitro growth and development are considered as the characteristic feature of these cells. Bone marrow mesenchymal stem cells possess the ability to differentiate into mesodermal lineage, among other adult cells, can be used in tissue engineering and are good candidates for transplantation. Lovastatin as a lowering cholesterol agent and reducing inflammation, as well as antioxidant and, in particular, neuroprotective effects can be effective in the treatment of neurogenic diseases. The aim of this study was to evaluate the effect of lovastatin on survival, proliferation and expression of GDNF and oct4 genes of Bone marrow mesenchymal stem cells. Lovastatin is presumed to exert their neuroprotective effects by inducing neurotrophic factor gene expression and cell proliferation.

In this experimental study, we used 4-6 week adult Wistar rats. The BMSCs were isolated from rat femurs and tibias and cultured in α-MEM. The cell pellet was resuspended in α-MEM supplemented with 10% fetal bovine serum (FBS), 1% penicillin and streptomycin and cultured in 25-cm2 culture flasks at a density of 2 × 104 cells and incubated at 37°C and 5% CO2.  For lovastatin treatment, we exposed MSCs to 1 μM, 5 μm, 10 μm and 15 μm of lovastatin for 24 h. The survival rate of cells was measured by MTT assay. The growth rate and proliferation of cells at 24 hours after culture were assessed by staining with DAPI. The expression of Oct4 and GDNF factors was also evaluated by RT-PCR. 

MSCs were attached to culture plate and were quickly proliferated. In the culture plate, these cells were usually appeared in three forms: small spherical, fusiform and fibroblast-like and flattened. The results of this study indicate that the proliferation rate at 5, 10 and 15 µM lovastatin showed a significant increase compared to control groups (P<0.5). Gene expression density of gelial derived neurotrophic factors (GDNF) and oct4 genes showed that, there were significant differences between MSCs treatment groups and control group (P<0.5). Cell viability and proliferation rate indicate that experimental groups has a higher proliferation rate than control group. Moreover, results showed an increase in mRNA expression for GDNF and Oct4 compared to the control group (P <0.05). 

Therefore, lovastatin can be used to improve the culture of mesenchymal stem cells, which is used for transplantation and cell therapy. BMSCs may be a useful therapeutic agent for the treatment of neurodegenerative disorders.

Rosemary leaf extract, as a medicinal plant, can stimulate stem cells proliferation. The aim of this study was to determine the effect of rosemary extract on the proliferation and survival of human adipose stem cells (hASCs).

In this experimental study, fat tissue was isolated from Caesarean women at Damgan Hospital. Extracted cells were cultured in α–MEM (Alpha-Dulbecco’s modified minimal essential medium) containing 10% FBS. Stemness of cells was confirmed by flow cytometry and expression of CD44, CD105, CD73, CD90, CD34, CD45 markers of 106 cells and their differentiation potential. The survival rate, proliferation of cells treated with 30, 40, 50, 60 and 70 µg/ml concentrations of Rosemary extract containing 40% of carnosic acid for 24 and 48h were evaluated using hoemocytometry, MTT and PCR assays.MTT: [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide] PCR: Polymerase chain reaction.The data were analyzed using Spss software (version 16), with Tukey test and the level of significance was considered 0.05.

Cultured hASCs showed spindle and fibroblastic shapes under microscopic study. They expressed positive response to CD44, CD73, CD90, CD105 and negative response to CD34 and CD45markers and differentiated into adipocytes and osteocytes. The proliferation rate and survival of cells treated with Rosemary at a concentration of 50 μg/ml for 48 h were increased significantly (P≤0.05), as compared to cultured cells in medium without Rosemary, containing serum.

Rosemary extract as a supplement to the serum can increase the rate of proliferation and survival of hASCs, making the cells more suitable for transplantation.

The uterus is a dynamic tissue responding to hormonal changes during reproductive cycles. As such, uterine stem cells have been studied in recent years. Transcription factors oct4 and sox2 are critical for effective maintenance of pluripotent cell identity.

The present research evaluated the mRNA expression of oct4 and sox2 in the uterine tissues of ovariectomized mice treated with steroid hormones.

In this experimental study, adult virgin female mice were ovariectomized and treated with estradiol 17β (E2), progesterone (P4), and a combination of E2 and P4 (E2 & P4) for 5 days. Uterine tissues were removed, and immunofluorescent (IF) staining and quantitative real-time PCR of oct4 and sox2 markers were performed.

IF showed oct4 and sox2 expression in the uterine endometrium and myometrium among all groups. The mRNA expression of oct4 (p=0.022) and sox2 (p=0.042) in the E2-treated group significantly were decreased compared to that in the control group. By contrast, the mRNA expression of oct4 and sox2 in the P4 (p=0.641 and 0.489 respectively) and E2 & P4-treated groups (p=0.267 and 0.264 respectively) did not show significant differences compared to the control group.

The results indicate ovarian steroid hormones change the expression of oct4 and sox2 in the mice uterine tissues, which suggest the involvement of steroid hormonal regulation in uterine stem cells.

One of the most major obstacles of ovarian tissue vitrification is suboptimal developmental competence of follicles. Matrix metalloproteinases 2 (MMP-2) and 9 (MMP-9) and their tissue inhibitors TIMP-1 and TIMP-2 are involved in the remodeling of the extracellular matrix in the ovaries.

This study aimed to evaluate the expression of MMP-2, MMP-9, TIMP-1, and TIMP-2 genes in the preantral follicles derived from vitrified mouse ovaries.

In this experimental study, the gene expression of MMP-2, MMP-9, TIMP-1, and TIMP-2 in the isolated preantral follicles derived from fresh and vitrified ovaries of 14-16 days old female mice through real time qRT-PCR was evaluated. Developmental parameters, including survival rate, growth, antrum formation and metaphase II oocytes were also analyzed.

The developmental parameters of fresh preantral follicles were significantly higher than vitrified preantral follicles. The TIMP-1 and MMP-9 expression levels showed no differences between fresh and vitrified preantral follicles (p=0.22, p=0.11 respectively). By contrast, TIMP-2 expression significantly decreased (p=0.00) and MMP-2 expression increased significantly (p=0.00) in vitrified preantral follicles compared with to fresh ones.

Changes in expression of MMP-2 and TIMP-2 after ovarian tissues vitrification is partially correlated with decrease in follicle development.

Long ago, only the movement disorder of Parkinson's disease (PD) was considered by researchers, but non-motor symptoms such as cognitive and memory disorder precedes the clinical symptoms. In the present study, a 6-hydroxydopamine (6-OHDA) rat memory impairment model of PD was used to investigate in vivo production of oxidative stress and memory disorder.

6-OHDA (6μg/2μl of saline) was bilaterally injected in the substantia nigra pars compacta (SNC). The sham-operated rats were injected with saline. Spatial memory was evaluated in morris water maze (MWM). 6 days after neurosurgery the rats were killed and hippocampal tissues were separated on an ice-cold surface. Analysis of superoxid dismutase (SOD), glutathione peroxidase (GPX) and catalase (CAT) activity were performed.

There was no significant difference in total traveled distance between groups therefore, injured animals had no problem in movement. There was also a significant increase in the escape latency in lesioned group as compared to the sham (P<0.000). The time spent in quadrant target zone of injured rats was significantly shorter than sham rats (P<0.002). One way ANOVA analyses showed a significant reduction in SOD antioxidant activity in the hippocampus of injured rats as compared to sham (P<0.05). Moreover this reduction was not significant in GPX and CAT enzymes.

Bilaterl substantia nigra pars compacta-lesioned as a model in early phase of Parkinson's disease would allow us to test new neuroprotective agents and treatment strategies.