فهرست مطالب sanambar sadighi

In this study, these methods were used to estimate the treatment effect in patients with gastric cancer in the presence of noncompliance.

In medical sciences, simple and advanced methods are used to estimate treatment effects in the presence of noncompliance.

This historical cohort study surveyed 178 patients with gastric cancer underwent chemotherapy alone (chemotherapy alone group) and 193 patients underwent surgery and chemotherapy (surgery plus chemotherapy group) from 2003 to 2007 at the Cancer Institute of Imam Khomeini Hospital (Tehran). Demographic and clinical characteristics were extracted from patients' hospital records. The survival of patients was calculated as being from diagnosis to death or to the end of the study. The treatment effect was estimated using three

treatment as a time-dependent covariate, IPCW, and Structural Nested Models using STATA and R software.

Fifty-six patients (31.5%) who underwent chemotherapy and 69 patients (35.8%) who underwent surgery and chemotherapy died by the end of the study. The hazard ratio in group I compared to group II was estimated between 1.5 to 2.07 times based on the simple analysis method. The modified hazard ratio was estimated to be 1.21 (95% CI: 1.11-1.32) based on the SNM method. Surgery plus chemotherapy is superior to chemotherapy alone, and it improves the overall survival (OS) rate of gastric cancer patients.

Survival was improved in patients undergoing chemotherapy and surgery together compared to those undergoing chemotherapy alone. The results of the current study suggest that treatment effect can be estimated unbiasedly using the appropriate method.

Immune checkpoint expression on tumor-infiltrating lymphocytes (TILs) has a correlation with the outcome of neoadjuvant chemotherapy (NAC) in breast cancer. However, the reciprocal effect of these regimens on the quality and quantity of immune checkpoints has hitherto not been addressed. We aimed to evaluate the impact of three NAC regimens on TILs and immune checkpoints in a murine triple-negative breast cancer model. Syngeneic model of locally-advanced breast cancer was established in immunocompetent mice using a 4T1 cell line. Tumor-bearing animals were treated with human-equivalent dosages of doxorubicin, paclitaxel, paclitaxel and carboplatin combination, and placebo. Infiltration of CD3+, CD8+, and FoxP3+ cells into the tumor was assessed by immunohistochemistry. Expression of immune checkpoints, including PD-1, CTLA-4, and TIM-3, was evaluated by real-time PCR. Doxorubicin led to a significant (p <0.01) increase in the percentage of the stromal infiltrating CD3+ and CD8+ lymphocytes. Doxorubicin also suppressed significantly (p <0.05) the relative expression of PD-1 compared with the placebo. PD-1 expression was significantly (p <0.05) lower in the group treated with paclitaxel and carboplatin combination as compared with the placebo. The relative expression of TIM-3 was significantly (p <0.05) suppressed in doxorubicin-treated mice in comparison with other interventions. Our findings hypothesize that NAC with doxorubicin may potentiate antitumor immunity not merely by recruitment of TILs, but via down-regulation of PD-1 and TIM-3 checkpoints. Carboplatin-containing NAC may suppress PD-1 as well.

Because of the decreasing effect of metformin on insulin resistance, it has been suggested as an anti-obesity and anti-cancer drug. So, we aimed to study the effect of metformin therapy on tumor cell proliferation in non-diabetic breast cancer patients.

We conducted a prospective clinical trial and studied the effect of metformin therapy on the level of Ki67 as a measure of tumor cell proliferation. Our primary endpoint was to evaluate the changes in Ki67. The intervention group consisted of 25 non-diabetic breast cancer patients with no indication for neoadjuvant chemo- therapy. They were followed up from the time of biopsy to operation. Metformin (1500 mg/day) was prescribed in the intervention group from the date of diagnosis until the surgery (2.8 weeks). Controls were 20 early breast cancer patients who had been followed up with no prescription from biopsy until operation.

We could not find any statistically significant difference between the two groups regarding baseline clinical or tumor characteristics such as age, stage, grade, estrogen receptor, HER2 status or time, and type of surgery. However, the immuno- histochemistry (IHS) study showed a decrease in median Ki67 from 35.14 to 29.6 in the intervention group (P-value= 0.02). While an increase from 24.5 to 30.6 was detected in the control group (P-value= 0.02). Both of these changes were statistically significant. Although mild gastrointestinal symptoms were seen in approximately 50% of cases, generally, patients tolerated metformin well. There was a correlation between the score of HOMA, a metabolic factor, and the changes in KI67.

Metformin prescription in a short period of time between biopsy and definitive surgery leads to the inhibition of breast cancer cell growth. We found a relationship between metformin anti-proliferative effect and glucose and insulin metabolism.

According to the studies the rate of emergency departments use among cancer patients exceed among those of the general population; however there are differences in study populations by cancer type, initial treatments, socioeconomic status, disease stages, and health insurance status and so on. Patients' symptoms and severity of complications are varied as well. The emergency departments are actively involved in different stages of cancer management such as primary diagnosis, ongoing treatments and end-of-life period. Cancer patients in their end of life period usually have more serious complications and need more specialized cares, as well as those received chemotherapy and surgical treatments. Understanding the reasons of such visits could be useful in the development of dedicated interventions for preventing un-necessary emergency department visits by cancer patients which is discussed in this mini review

Breast cancer is the most common diagnosed female cancer. Breast cancer is also the leading cause of cancer death in females accounting for 13.7% of female cancer‑related mortality globally. Variable known prognostic factors such as histological tumor type, tumor size, nodal status, grade, age, and estrogen receptor (ER) status and the proliferation marker – Ki‑67 influence the type of treatment decision. The purpose of this present study is to investigate the association between Ki‑67 expression with several clinicopathological variables and patients’ outcome. This is a retrospective cohort study from September 2008 to March 2017; 165 newly diagnosed breast cancer patients were enrolled in the study. Ki67 levels were measured using immunohistochemistry and compared with clinicopathological variables. The relation of Ki67 expression with disease‑free survival (DFS) and overall survival (OS) was also analyzed. The result of this study revealed that age, tumor size, menopausal status, and human epidermal growth factor receptor 2 (HER2) status had no effect on the patients’ outcome. Patients with ER‑positive, progesterone receptor (PR)‑positive, and HER2‑negative tumors expressed a higher rate of Ki‑67 (>10%) than patients with ER‑negative, PR‑negative, and HER2‑positive tumors, respectively. However, we found that Ki‑67 levels were not significantly increased statistically with ER, PR, and HER2 statuses. There was a statistically significant correlation between Ki‑67 expression and with higher stages of the disease. Multivariate analysis showed that Ki‑67 expression could not to be an independent prognostic factor for 5‑year OS and DFS. Furthermore, p53 status was only prognostic factor for 5‑year OS whereas higher stages of disease and p53 status were prognostic factors for 5‑year DFS. Ki67 could not be an independent variable for prediction of breast cancer outcome.

Physicians’ beliefs about disclosure manner and their ethical attitude for telling the truth is an important issue in patient-physician interaction. The aim of this study was to examine clinicians’ practice and perception of disclosure models for giving bad news to breast cancer patients.
Participants (n = 207, age 21–61 years, mean work experience = 4.03 ± 6 years) working in different medical centers in Tehran, Iran, were recruited by purposive sampling method. They completed clinicians’ attitude and practice of Breaking Bad News (BBN) scales. Psychometric properties (reliability and validity) of these scales were approved.
Clinicians’ practice differed significantly by their perception of disclosure model for giving bad news. Furthermore, difference in clinicians’ practice and perception of disclosure model for BBN was observed for age, gender, medical work experience in oncology setting, and receiving special training. Finally, clinicians’ perception of disclosure model for BBN (Adj. R2 = 0.32), age (Adj. R2 = 0.17), gender (Adj. R2 = 0.11), and receiving special training for giving bad news (Adj. R2 = 0.09) positively predicted their practice of BBN.
Findings of the study point to the importance of the clinicians’ perception of disclosure model for giving bad news and transcultural variables as factors affecting their practice. Therefore, it seems necessary to incorporate special BBN trainings and protocols culturally adapted to the Iranian society in educational curricula of medical specialties in breast cancer setting.

The authors selected European Organization for Research and Treatment (EORTC) C30 and EORTC QLQ CR29 to specify bowel, bladder, and sexual dysfunction of Iranian colorectal cancer patients.
A sample of 100 patients with colorectal cancer attending Iran Cancer Institute from March 2012 to March 2013 at first-line chemotherapy in the adjuvant or palliative settings participated in the study. Patients responded to the study questionnaires at the beginning and after 3-4 cycles of chemotherapies. Responses to the core questionnaire (QLQ-C30) and the QLQ-CR29 were linearly converted into 0-100 scores, using the EORTC guidelines. Correlations between the QLQ-C30 and QLQ-CR29 were examined, using Pearson’s product moment correlation in order to assess construct validity. Known groups’ comparon examined the ability of EORCT-CR29 to dtinguh between subgroups of patients with and without a stoma. Sensitivity to changes over time was examined by the response to chemotherapy in palliative or neoadjuvant settings. Internal constency was measured using Cronbach’s alpha coefficient with estimates of a magnitude of 0.7.
The mean age of patients was 53.6. Based on clinical and pathologic staging, 60% of the patients had presented while their cancer was in stage IV with dtant metastas at the time of referring to the clinic. Thirty-three percent of patients, almost all from rectal tumor group, had a permanent ostomy. In general, the correlation between the EORTC QLQ-C30 and QLQ-CR29 was in the expected directions, demonstrating that functional scales of both questionnaires had a positive correlation with each other while negative correlation was observed between functional and symptom subscales. In addition, the QLQ-CR29 differed considerably between patients with and without a stoma.The QLQ-CR29 results showed improved functioning scores after treatment and at the same time symptoms decreased. The Cronbach’s alpha for the scales ranged from 0.48-0.77.
In general, the Iranian version of the EORTC QLQ-CR29 worked well and now could be used in outcome studies in colorectal cancer.

Anti-cancer potential of silymarin have been shown in cell culture. However, regarding this matter no prospective clinical study has been done. In a randomized double blind pilot study, we compared effects of addition of standard chemotherapy along with silymarin (420mg/day) versus placebo on clinical response of advanced tumors after three cycles of cisplatin-based chemotherapy. There was no significant difference in tumor size after three consecutive chemotherapy courses but a trend toward lower metastasis rate in chemotherapy silymarin group. Concomitant use of silymarin along with chemotherapy was very well tolerated but didn’t significantly increase clinical response. Due to trend toward significant lower metastasis in silymarin group, further study with larger sample size is needed to better clarify probable role of adjunctive therapy with silymarin in patients with solid tumors.

Desmoids tumors, characterized by monoclonal proliferation of myofibroblasts, could occur in 5-10% of patients with familial adenomatous polyposis (FAP) as an extra-colonic manifestation of the disease. FAP can develop when there is a germ-line mutation in the adenomatous polyposis coli gene. Although mild or attenuated FAP may follow mutations in 5΄ extreme of the gene, it is more likely that 3΄ extreme mutations haveamore severe manifestation of thedisease. A 28-year-old woman was admitted to the Cancer Institute of Iran with an abdominal painful mass. She had strong family history of FAP and underwent prophylactic total colectomy. Pre-operative CT scans revealed a large mass. Microscopic observation showed diffuse fibroblast cell infiltration of the adjacent tissue structures. Peripheral blood DNA extraction followed by adenomatous polyposis coli gene exon by exon sequencing was performed to investigate the mutation in adenomatous polyposis coli gene. Analysis of DNA sequencing demonstrated a mutation of 4 bpdeletions at codon 1309-1310 of the exon 16 of adenomatous polyposis coli gene sequence which was repeated in 3 members of the family. Some of them had desmoid tumor without classical FAP history. Even when there is no familial history of adenomatous polyposis, the adenomatous polyposis coli gene mutation should be investigated in cases of familial desmoids tumors for a suitable prevention. The 3΄ extreme of the adenomatous polyposis coli gene is still the best likely location in such families.

Pain adversely affects cancer patients quality of life . Knowing different sources of pain helps physicians and patients to manage it. The aim of this study was investigating physical factors affecting pain in Iranian cancer patients.
This cross-sectional study randomly enrolled cancer patients who were newly admitted to the Medical Oncology Department of Cancer Institute of Iran in 2013 . Patients divided in to two groups by questioning whether they have pain or not. Patient's demographic characteristics were collected from medical records. Multivariate Logistic Regression method was used to analyze results.
A total 269 subjects were included. 52.78% patients suffered pain. 69.72% of pain group and 54.33% of no-pain group were female and average age for the pain group was 49.59±13.57. There was significant difference at pain control of patients who “capable to work but with misery” and “able to conduct personal affairs” (OR: 9.60, 95% CI: 2.38-38.71 Р=0.00). Cancer treatment was a protective factor from pain experience (OR: 0.87, 95% CI: 0.37-2.05 Р=0.76). 62.70% of pain group was in advanced stage; had 2.18-fold higher risk of pain compared to the patients who was in limited stage (CI: 1.02-4.65). Patients who took more pain-killer drugs had less control of pain (54.41%) (OR analgesic: 3.07, OR opium: 12.11 and OR multi drugs: 8.97).
Although pain could be relieved in most cancer cases, more than 50% of our patients showed under-controlled pain. Understanding patients’ desires and past experiences of disease and collaboration of medical, radiation and surgical oncologists with palliative care nursing, psychological specialties in multidisciplinary teams is urgent to solve miss-treatment of cancer pain.

Primary cardiac sarcomas are very rare and there is no consensus on management. Clinical presentation is usually late. Despite newer diagnostic technology, prognosis remains dismal. We report a case of right atrial sarcoma in a 28-year-old man who presented with acute cardiac tamponade. Emergency subxiphoid pericardial drainage stabilized the patient's critical condition. The lesion was advanced. Therefore, we only performed a suboptimal surgical resection. Despite planning for radiation, the patient's status deteriorated. Only palliative measures continued during the next four months before his death due to disseminated metastasis and progressive cardiopulmonary failure.

Metformin has been suggested as anti-cancer in retrospective studies. We design a prospective controlled study about metformin efficacy in the window time between biopsy and definite surgery with changes of Ki-67 as the primary endpoint.
The primary cohort had composed of 50 pathologically diagnosed invasive breast cancers, accrued in Medical Oncology Department of Iran Cancer Institute from February to November 2014. Patients neither had indication of neoadjuvant chemotherapy, nor involved with diabetes mellitus. They followed during the time period of biopsy and definitive surgery with taking tests on pathology specimens for ER, PgR, HER-2/neu and Ki-67 index. We checked fasting insulin and glucose level as well as quality of life and adverse effects in both times in the intervention group. Metformin (1500 mg/day) was prescribed to intervention group from pathology report to the night before surgery.
From 45 patients, 25 had been received metformin for median time of 2.8 weeks. Controlled group included 20 patients who followed in the window time. There were no statistically significant differences between two groups regarding baseline clinical and tumor characteristics such as age, stage, grade, ER, PgR, HER2 status, time and type of surgery. However, immunohistochemistry study showed decrease of median Ki-67 from 35.14 to 29.6% in the intervention group and increase from 24.5 to 30.6 in the control group. Both of these results were statistically significant. Patients tolerated metformin very well, but mild gastrointestinal symptoms were seen in 30% of cases. There was a correlation between metabolic factor of HOMA score (fasting insulin level fasting blood sugar/405) and changes in Ki-67.
In the present study metformin prescription in the short period of time between Biopsy and definite surgery had shown inhibition of breast cancer cell growth. We found relationship between metformin anti-proliferative effect and glucose and insulin metabolism. To find direct apoptotic stimulation of metformin and long-term results of this drug further studies in the adjuvant settings with cooperation of pharmacokinetic groups are recommended.

Chronic lymphocytic leukemia (CLL) is a common blood cancer in people aged over 40. In addition to clinical and pathologic staging and blood tests, immunoglobulin variable heavy chain (IgVH) mutation analysis is a relevant prognostic factor for CLL. Finding the most prevalent mutation type and conducting a molecular analysis of immunoglobulin in the majority of the patients can contribute to identifying the disease pattern.

In the present study, we used molecular detection methods to find the relationship between clinical and pathologic findings with immunoglobulin heavy chain mutations in CLL patients in Iran.

Patients with CLL were randomly selected from patients referred to Imam Khomeini hospital, Tehran, Iran. All patients underwent a clinical staging of the disease and had flow cytometric analysis performed on their blood samples. The panels of cell surface markers used for the diagnosis of chronic lymphoid leukemia include CD19, CD3, CD23, CD10, and CD5. The diagnosis confirmed a minimum of 20% positive expression of dual CD5 and CD19 markers. Genomic DNA was then extracted from the patients’ blood and IgVH mutation analysis was conducted with pGEM-T (easy vector) cloning kit followed by IgVH sequencing.

Study patients were 42 to 80 years old, with their mean age of 62 (SE = 1.87) years. About 73% of them were male. The mean white blood cell (WBC) count, lymphocytes percentage, average hemoglobin level, and platelet count were 56,000/µL, 85%, 12 g/dL, and 150,000/µL, respectively. According to their molecular analysis, 38.9% of patients were unmutated and 61.1% showed mutation in the variable heavy chain locus. The most common mutation had occurred in IgVH3 allele (66.66%). The mean overall survival rate of patients, mutated and unmutated, was, respectively, 39 (95% CI, 32 to 46) and 31 (95% CI, 26 to 36) months (P = 0.4). Binet stage had statistically significant relationship with patients’ survival (P = 0.02).

According to this study, IgVH3 mutation was found to be prevalent (Although a correlation was found to exist between the patients’ survival and IgVH mutation, it was not statistically significant). We can conclude that clinical methods are still valuable to predict the prognosis of patients with CLL. Given the high cost and need for specialized laboratory, determining the cost and value of examining immunoglobulin heavy chain mutations and types of mutation such as IgVH3 are necessary in further studies.

Breast cancer is the most common cancer in women around the world. It has been known for over a century that androgens and androgen receptor (AR) play a role in normal and neoplastic breast cells. The aim of this study was to determined the AR expression on tumor cells and its correlation with other prognostic and predictive factors as well as contribution of AR in patients overall survival (OS) and disease- free survival (DFS). This retrospective cross-sectional study performed on 189 patients who referred to Medical Oncology Ward of Cancer Institute, Tehran University of Medical Sciences, from April 2007 to February 2010. We performed an immunohistochemistry study for AR (AR441 clone, Dako, Germany) (10% cut-off point) and Ki-67 MIB-1 clone, Dako, Germany) on paraffin embedded blocks. Other data were extracted from patients’ documents. Overall, AR expression was 49.1%. Mean age of the patients with and without AR was 47.86 and 48.49 years, respectively. AR positive tumors presented more in stage I/II than III/IV (P=0.02) and AR were more positive for estrogen receptor positive, lower grade of tumor (grade I/II versus III) and lower Ki-67 (P=0.01). AR positivity had neither correlation with progesterone receptor, HER2/neu, P53 expression or menopausal status. OS and DFS were higher in AR positive patients but did not reach statistical significance. In triple-negative breast cancer (TNBC) group, 25% of tumors showed AR expression. AR had non-significant positive correlation with OS in TNBC cancer patients. OS and DFS had significant statistic positive correlation with ER, PR and stage regardless of AR status. Based on this study, although androgen receptor expression showed correlation with other prognostic factors for survival in patients, we didn’t find statistically significant independent relationship between AR and overall survival in patients. As far as there isn’t any targeted therapy for triple-negative breast cancer (TNBC), prospective basic and clinical studies regarding AR inhibitors in the treatment of TNBC seems to be logical and valuable.

Surgery is the most important treatment in gastric cancer (GC) patients and also chemotherapy and radiotherapy are used as adjuvant and/or neo-adjuvant therapies for reducing locally relapse and metastasis. This study aimed to compare patient's survival and affected factors in this two treatment groups. This historical cohort study was conducted on 181 patients underwent chemotherapy (group 1) and 201 patients underwent surgery (group 2). The effect of demographic, clinical and pathological risk factors on patient's survival was assessed by log-rank test and Cox Proportional Hazard (CPH) model. Data were analyzed using SPSS16. Fifty and six patients (30.6%) in surgery group and 69 patients (34.3%) in chemotherapy group passed atoay death by the end of the study. The median survival time in two groups was 19 and 28 months, respectively. Age at diagnosis and tumor grade in surgery group, and gender and pathologic stage in chemotherapy group were significant (p<0.05). Demographic and pathological characteristics of patients are the significant determinant of treatment success and increasing survival, however, assessing the causal effect of treatments on survival will be well achieved via controlled clinical trials through which the effects of confounders can be controlled.

Cisplatin is a widely used chemotherapeutic agent with a major side effect of nephrotoxicity. Delayed increase in serum creatinine after cisplatin injection makes serum creatinine not to be an ideal marker for early detection of cisplatin nephrotoxicity. Recently several new biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) have been proposed for early detection of acute kidney injury (AKI). This study assessed kinetic of urine NGAL-creatinine ratio in patients who received cisplatin-containing chemotherapy. Patients with a glomerular filtration rates greater than 45 mL/min who received cisplatin-containing chemotherapy were included. Urine creatinine and NGAL concentrations were measured before cisplatin infusion and 6, 24, 48, and 72 hours after cisplatin administration. To minimize hydration effects, urine NGAL levels were adjusted according to urine creatinine. Twenty-four patients were assessed. According to the Acute Kidney Injury Network criteria, 2 patients (8%) experienced cisplatin-associated AKI. The median increases in urine NGAL-creatinine ratio were 335% (interquartile range, 320% to 350%) in the patients with AKI and 100% (interquartile range, 73% to 190%) in those without AKI (P =. 02) during the first 24 hours after cisplatin administration. A urine NGAL-creatinine ratio greater than 26.9 ng/mg 24 hours after cisplatin infusion had a sensitivity of 86% and a specificity of 50% to detect cisplatin-associated nephrotoxicity. Urine NGAL-creatinine ratio significantly increased in patients with cisplatin-associated AKI. Urine NGAL-creatinine ratio within the first 24 hours after cisplatin infusion may better predict cisplatin-associated nephrotoxicity than serum creatinine level.

To evaluate the effect of adding neoadjuvant chemotherapy to surgery and radiation therapy for locally advanced resectable oral cavity squamous cell carcinoma, 24 patients with T3 or T4a oral cavity squamous cell carcinoma were randomly assigned to surgery alone or Docetaxel, Cisplatin, and 5-FU (TPF) induction chemotherapy followed by surgery. All patients were planned to receive chemoradiotherapy after surgery. The primary end-points were organ preservation and progression-free-survival. SPSS version 17 was used for data analysis. Median follow-up was 16 months. The median age of the patients was 62 years old (23-75 years). Man/woman ratio was 1.13. The primary site of the tumor was the tongue in most patients (48%). No significant difference was observed between pathologic characteristics of the two groups. Chemotherapy group showed 16% complete pathologic response to TPF. No significant difference in organ preservation surgery or overall survival was detected. However, the patients in the chemotherapy group had longer progression-free-survival (P=0.014). Surgery followed by chemoradiotherapy with or without TPF induction results in similar survival time. However, progression-free-survival improves with the TPF induction chemotherapy. Studies with more patents and new strategies are recommended to evaluate organ preservation improvement and long-term outcomes.

McGill pain questionnaire (MPQ) is the most useful standard tools for pain assessment. Due to cultural differences, the questionnaire has been translated into several languages. We aimed to translate and adapt MPQ into Persian language and assess its reliability in Iranian cancer patients. The MPQ was translated by translation-base method with preserving the original structure. Subsequently we used Persian McGill Pain Questionnaire (P-MPQ) and interviewed 84 patients and repeated the interview after 24 hours in 30 patients. Alpha coefficient of questionnaire (n=84) was 0.85 and the stability coefficient (n=30) in all areas (sensory, emotional, and other assessment) were more than 0.8. Stability coefficient was significant and reliable for all the MPQ subclasses. Adaptation and reliability of Persian-McGill Pain Questionnaire (P-MPQ) are enough for epidemiologic studies of chronic pain in cancer patients in Iran.

With the aim of regenerating healthy tissues, different tissue engineering strategies pointed to extracellular matrix (ECM)-based scaffolds in tissue engineering and regenerative medicine and wound healing. It is a multidisciplinary science works to create biocompatible scaffolds with perfect physical parameters, mechanical integrity and high porosity to promote cell growth, migration and angiogenesis. With the increased incidence of obesity, subcutaneous adipose tissue is abundant and readily accessible. Liposuction surgeries yield from 100 mL to 3 L of lipoaspirate tissue. We present our prepared acellular ECM powders derived from human adipose tissue obtained from lipoaspirate, which contains large amounts of collagen suitable for induction of adipogenesis. The study had been carried out from December 2012 to March 2013 in Tissue Bank and Research Center in Imam Khomeini Hospital Tehran, Iran. Fresh human adipose tissue was obtained by liposuction of abdominal fat pad in a private Day Clinic. By using wasted material of liposuction, we obtained 100 to 200 cc fat tissue from each patient. After physical (freeze-thaw-slicing-manual massage) and chemical (enzymatic-detergent-acid digestion) treatment, an acellularized matrix was created from fat tissue. The final material lyophilized and ground to powder. We analyzed ultra structure and biochemical properties of obtained ECM powder by using electron microscopy, immunohistochemistry (IHC) examination and proteomic studies. After mechanical and chemical process of decellularization, scanning electron micrographs of the samples showed smooth and contiguous collagenous components throughout the scaffold. IHC showed strong positive labeling for collagen IV and no evidence of nuclear material in the specimen. Separation of protein complex by Blue Native Polyacrylamide gel electrophoresis (BN-PAGE) has proven type I collagen triple helices associate to form banded fibrils. RNA preparation and Gene Expression Analysis (RT-PCR) by using specific primers for laminin, fibronectin, collagen type I and IV, desmin, and actin showed strong staining of our fat tissue scaffold with collagen type I, fibronectin, collagen IV and laminin. The results show that our decellularization method produced an adipose ECM scaffold rich of collagen fibers, suitable and effective substrate for use in soft tissue engineering and regenerative medicine.

Chronic Lymphocytic Leukemia (CLL) is among the most prevalent blood cancers in people over the age of 40. In addition to clinical-pathologic staging and blood tests, another crucial prognostic factor of CLL is the immunoglobulin variable heavy chain mutation analysis. Finding the most prevalent mutation type and conducting a molecular analysis of it in the majority of the patients can contribute to identifying the disease pattern in a specific region or country. In the present study, we have used molecular detection methods in order to find the relationship between clinical pathologic findings and immunoglobulin heavy chain mutations in CLL patients in Iran. From 2009-2011, 26 patients with a suspected diagnosis of CLL were randomly selected from patients referred to Imam Khomeini Hospital. All patients underwent a clinical staging of the disease and had flow cytometric analysis performed on blood samples. The panels of cell surface markers used for the diagnosis of Chronic Lymphoid Leukemia include CD19, CD3, CD23, CD10 and CD5. The diagnosis confirmed a minimum of 20% positive expression of dual CD5 and CD19 markers. Genomic DNA was then extracted from the patients’ blood and IGVH mutation analysis was conducted with pGEM-T kit. Patients were in an age range of 42 to 80, with their mean age being 62 (SE=1.87) and 73% of them being male. Their mean WBC count, lymphocytes percentage, average hemoglobin level and platelet count were, respectively, 56000/microliter, 85%, 12 gr/dl and 150000/microliter. According to their molecular analysis, 38.9% of patients were unmutated and 61.1% showed mutation in the variable heavy chain locus. The most common mutation had occurred in the IGVH3 allele (66.66%). The mean overall survival rate of patients, mutated and unmutated, was, respectively, 39 (95%CI 32, 46) and 31 (95%CI 26, 36) months (P=0.407).Benet stage had statistically meaningful relation to patients survival (p=0.02) Similar to the findings of other studies, IGVH3 mutations were found to be prevalent by this study too. Although a correlation was found to exist between the patients’ survival and IGVH mutation, it was not statistically significant due to the limited number of the patients. We can conclude that clinical methods are still valuable in determining the prognosis of patients with CLL today.

Currently, autologous and allogeneic adipose tissues represent a ubiqui-tous source of material for fat reconstructive therapies. However, these approaches are limited, and often accompanied by a 40-60% reduction in graft volume following transplantation, limited proliferative capacity of mature adipocytes for ex vivo expansion, and extensive adipocyte damage encountered when harvested with conventional liposuction techniques. Recently, cell-based approaches utilizing adipogenic progenitor cells for fat tissue engineering have been developed and were reported to promote both short-term in vivo adipogenesis and to repair defect sites. The aim of this study was to isolate stem cells from fat tissue than examine the growth of stem cells by invitro tests. For human adipose stem cell isolation (hASC), subcutaneous adipose tissue sites were obtained from female subjects undergoing elective procedures. Tissues were washed 3-4 times in phosphate buffered saline (PBS) and suspended in an equal volume of PBS supplemented with 1% FCS and 0.1% collagenase type I. The tissue was placed in an agitated water bath at 37 1C. The supernatant containing mature adipocytes, was aspirated. Portions of the SVF were suspended in DMEM medium. hASCs were selected based on their ability to adhere to tissue culture plastic and subsequently expanded to 75-90% confluence. Adipose stem cells were isolated and cultured on DMEM. To assess mesenchymal origin of stem cells we used flow-cytomery technique as well as differentiation to osteocyte and chondrocyte lines. The nature of the mesenchymal cells was confirmed by flow -cytometry tech-niques, based on the expression of CD90, CD105, CD166, and lack of expression of hematopoietic markers of CD34, CD31, and CD45. The successful differentiation of our stem cells to osteocyte, chondrocyte had been showed by specific Alizarin-Red and Toluidine-blue staining of cells. Although we have not the results of in vivo tests to support in vivo adipo-genesis either alone or in combination with natural or synthetic matrix, the results showed that stem cells isolation from adipose tissue was successful, and we provided an environment for differentiation of stem cells.

In survival studies when the event times are dependent, performing of the analysis by using of methods based on independent assumption, leads to biased. In this paper, using copula function and considering the dependence structure between the event times, a parametric joint distribution has made fitting to the events, and the effective factors on each of these events would be determined. This retrospective cohort study was conducted from March 2003 to March 2007. The data collected from 256 patients with gastric cancer who underwent surgery and that the event time of the two outcomes of death and recurrence for them was recorded. Akaike Information Criterion (AIC) was used to determine of suitable parametric models. Moreover, applying copula function with regard to the relationships between the events, the effect of the risk factors of each of the two outcomes was determined. The data analysis was done using R2.12.1 software. According to the AIC criterion, the Weibull distribution had the best fitting in both of the event times. The median times for recurrence and survival of the patients were estimated 20.2 and 28.1 months respectively. Furthermore, with a fitting of Weibull distribution to the two event times using Clayton copula function, the variables of gender, tumor size and tumor pathological stage on survival, and tumor size and tumor pathological stage on recurrence were significant (P<0.001). Applying copula function for determining specific risk factors of the semi-competing events produces suitable results opposite the common methods which are based on independent assumption of the events.