فهرست مطالب seyed jalil hosseini

Downburst storms cause severe destruction by creating intense and unstable downdrafts. On the other hand, due to the difference in their structure from atmospheric boundary layer storms, it is essential to study and understand these flows under different conditions. Therefore, this study the effects of the impact angle of the downburst and the structure installation angle relative to the surface flow on a cube-shaped model investigates dynamically. The model is placed in front of the downburst in four angles of the storm colliding with the surface(θ), in two directions of the surface flow relative to the structure(α), and in the radial range of X/D=±1.5. Also, the ratio of horizontal displacement speed of this storm(VR) is considered to be 0.06 and 0.12. The results show that the increase of θ and VR caused the location of the maximum pressure coefficient to shift from the central point of the flow meeting the surface to the downstream. Also, increasing α has reduced the range of pressure and force changes by about 25% on the model. In addition, it was found that dynamic downburst caused stronger impacts on the structure and generally, these strong impacts occurred immediately after the downburst passed over the structure.

Due to the great importance of traditional structures and masonry materials and their high application, the effective parameters in the load-bearing capacity of these structural forms should be examined. In order to study the behaviour of building materials in traditional buildings and structures, due to the high cost and time-consuming laboratory studies, it is necessary to use software methods with accurate failure criteria. To achieve more acceptable and realistic results in the analysis of brick masonry structures, the Willam-Warnke fracture criterion, which is specific to brittle materials, is generally used. In this paper, the aim is to obtain the Willam-Warnke fracture criterion parameters for the combination of brick and mortar materials in macro modelling. For this purpose, with the help of laboratory studies on the combined materials of brick and mortar, the mechanical properties of these materials have been obtained. Finally, in order to validate the obtained parameters, these parameters were included in the numerical modelling of a semi-circular arch of building materials and compared with laboratory results. The results show that the developed parameters of Willam-Warnke fracture criterion predict the behaviour of building materials with a maximum error of about ten percent and a suitable and acceptable agreement is observed between the results of the analytical and laboratory model.

According to the mounting data, microRNAs (miRNAs) may play a key role in reprogramming. miR-106bis considered as an enhancer in reprogramming efficiency. Based on induced pluripotent stem cells (iPSCs), cell treatments have a huge amount of potential. One of the main concerns about using iPSCs in therapeutic settings is the possibility of tumor formation. It is hypothesized that a procedure that can reprogram cells with less genetic manipulation reduces the possibility of tumorigenicity. In this experimental study, miR-106b-5p transduced by pLV-miRNA vector into mice isolated spermatogonial stem cells (SSCs) to achieve iPS-like cells. Then the transduced cells were cultured in specific conditions to study the formation of three germ layers. The tumorigenicity of these iPS-like cells was investigated by transplantation into male BALB/C mice. We show that SSCs can be successfully reprogrammed into induced iPS-like cells by pLV-miRNA vector to transduce the hsa-mir-106b-5p into SSCs and generating osteogenic, neural and hepatoblast lineage cells in vitro as a result of pluripotency. Although these iPS-like cells are pluripotent, they cannot form palpable tumors in vivo. These results demonstrate that infection of hsa-mir-106b-5p into SSCs can reprogram them into iPSCsand advanced germ cell lineages without tumorigenicity. Also, a novel approach for studying the generation of iPSCsand the application of iPS or iPS-like cells in regenerative medicine is presented.

The Paris System for Reporting Urinary Cytology (TPS) is a new method for evaluating urinary cytology designed to reduce unreproducible reports. The aim of this study was to reclassify and compare urinary cytology reports with TPS criteria to determine the frequency of unreproducible reports compared to the previous system.

In this study, the laboratory electronic registration system analyzed patients' urine samples taken by voided or washing and brushing methods. The cytological evaluation was performed considering the previous system and TPS by a pathologist. The results of the two systems were compared, and the sensitivity and specificity of TPS were calculated.

Urine samples were taken from 876 patients. The mean age of patients was 63.36 ± 12.62. Comparing the routine classification system and TPS, it was observed that the number of atypical reports in the TPS system decreased by 12%, and all of these cases were downgraded to the negative group in the new classification. The sensitivity and specificity of TPS were 29.4% and 95.1%, respectively, if suspected malignancy and positive reports for malignancy were considered. Finally, if positive reports for malignancy were selected, sensitivity and specificity changed to 11.8% and 100%, respectively.

Although the TPS system has low sensitivity for the diagnosis of urothelial malignancies, due to its high specificity, it is possible to consider and use this classification for screening patients.

Urothelial carcinoma is the seventh most common cancer in the world. The histological classification of papillary carcinoma is one of the most important determinants for its prognosis. Sometimes there is an overlap in the extent of the tumor, and the accurate microscopic diagnosis of the tumor is not always easy. The aim of this study was to evaluate P53 and CK20 immunohistochemical markers in comparison with morphologic findings in low- and high-grade urothelial carcinomas.

For this descriptive study, urinary bladder samples were collected from 50 cancer patients who had undergone biopsy and surgery in Shohaday-e Tajrish Hospital of Tehran, Iran, during the years 2015-2016. P53 and CK20 were studied, and the demographic and histopathological characteristics of the tumor were also analysed.

The mean age of patients enrolled in this study (48 males and 2 females) was 65.8±11.9. Twenty-five cases presented with low-grade and 25 cases presented with high-grade papillary urothelial carcinomas. Sensitivity, specificity, and positive and negative predictive values for P53 were 48%, 80%, 70.5%, and 60.6%, respectively, while the same values for CK20 were 44%, 92%, 84.6%, and 62.2%, respectively. Immunohistochemical results were also positively correlated with the extent of the tumor.

Based on the results, P53 and CK20 may serve as specific markers for diagnosis of low- and high-grade papillary urothelial carcinoma but not sensitive. P53 and ck20 staining have also a high specificity as 80% and 92% and low sensitivity compared to the low and high morphology of papillary carcinoma, thus their positive and their staining intensity are valuable for diagnosis, but their negative results are not determinant.

Bladder cancer is the fourth most common cancer in men and the most common cancer in women, comprising 8% of all males and 3% of female tumors. The present study aimed to estimate the five-year survival rates of bladder cancer in Iran.

Information on3,337 registered cases of bladder cancer was obtained from the Office of National Cancer Registry in the Ministry of Health and Medical Education (MOH & ME). A telephone survey was conducted to gather additional information, such as survival status, demographic, and clinical profile. Kaplan–Meier estimates of five-year survival rates were calculated according to the age of diagnosis, gender, pathological type, and provincial pole. Results and

Overall five-year survival rate was 77%. According to the pathologic type, five-year survival rates were 81%, 66%, 81%, 42%, 77%, and 82% in low-grade urothelial carcinoma, high-grade urothelial carcinoma, adenocarcinoma, undifferentiated carcinomas, Squamous Cell Carcinomas (SCCs), and other tumors, respectively. Additionally, those tumors  were 93%, 88%, 81%, 64%, and 44% among patients whose average ages at diagnosis were < 50, 50–59, 60–59, 70–79, and > 80 years old, respectively. Our study revealed that age and histological type were the major prognostic factors for survival in patients with bladder cancer. Therefore, given the histologic features of the tumor and patients with advanced age, a continuous screening would be highly warranted.

The Academy of Medical Sciences is obligated to promote scientific associations and exploit their potentials. Developing a plan to enhance their participation in policy making and planning in healthcare is the road towards achieving this goal by 2025.

This descriptive-analytical study was performed by the qualitative method. Secondary data were obtained from the analysis of upstream documents and documentation of the collective activities of the associations. Primary data were collected from the views of policy-making stakeholders through interviewing, focus group discussion and a written questionnaire from 138 academic societies. The analyzed data were classified into three sections: cognition, orientation and implementation. The assignments of this 5-year program were formulated in four departments and were reviewed by all scientific associations.

Associations were the reference point for experts in the field and had close relations to the community, and ability to legislate and to plan is one of their strengths. Lack of their role in policy making at the Ministry of Health (MOH) and lack of health system trust regarding the associations, cultural individualism in the scientific community, and weakness of team working and weakness of the associations in relation to policy makers are the top priorities of the associations to tackle.

The collective movement of the scientific community and the MOH is mandatory if we wish to achieve the first position in the region by 2025.

Infertility refers to the failure in achieving pregnancy of a couple after one year of regular sexual intercourse without using a protection method. The purpose of this research work was to evaluate the current status of the test and quality control performance in semen analysis in selected laboratories. The semen analysis was performed in the Laboratory of Andrology in terms of macroscopic examination which include volume, color, viscosity, pH and acidity, and in terms of microscopy: the rate of sperm movement, the exact number of sperms per ml of semen, the percentage of sperm viability and movement, the presence of germ cells and white blood cells. Several questions for each part of the test were selected and answered by the director of the laboratories or andrology section supervisor.   There was a wide range in the performance of selected medical laboratories in Tehran regarding the standards of semen analysis according to the World Health Organization (WHO) Laboratory Manual for the examination and processing of human semen, fifth edition in 2010. They followed the instructions related to the sample collection in about 70% of the evaluated parameters, initial macroscopic examination in about 87% of the selected subjects, and the microscopic evaluation of sperm in about 65% of the test parameters. some laboratories do not follow the instructions of the WHO in performing semen analysis, and most of them do not follow the suggested methods in all parts of the test.

Prostate cancer (PCa) is the third most diagnosed cancer among men in Iran with approximately 4200 new cases in 2015. Considering the rapid growth of cancer diagnosis, this study aims to investigate the economic burden of PCa patients and their health-related quality of life (HRQoL) A retrospective survey was conducted on 500 registered patients to discover the pattern of care and distribution of patients in the main treatment categories. In the next step, a multi-center survey of the patients under treatment was conducted. The objective of this survey was to estimate direct medical costs (DMC), non-medical costs, and productivity losses for patients and family members. HRQoL was measured by the Functional Assessment of Cancer Therapy–Prostate questionnaire. Despite high age of patients (72±9.25 years), only 53.3% of them were retired or disabled. The largest proportion of patients (54.3%) received medicinal or surgical hormone therapy. Radical prostatectomy was the main treatment for 31.7% of patients, 10.2% received radiation therapy, and 3.8% underwent chemotherapy. DMC for incident population was approximately 12.5 million US dollars/year, and the highest average cost per capita belonged to chemotherapy patients. Unpredictably, productivity loss was nearly as much as direct cost. The mean score for HRQoL was 0.62±0.16 for all patients. Orchiectomy group had the lowest HRQoL score (0.55±0.16). Chemotherapy patients suffered the worst scores in the physical well-being subscale (0.47±0.24). Hormone therapy patients had the least scores in the prostate-specific subscale (0.50±0.18). The economic burden of PCa is estimated approximately 25.8 million US dollars per year for incident population. When we refer to the high proportion of patients diagnosed in advanced state of the disease and higher per capita cost for these patients, policy makers should promote screening strategies to control health care costs and to increase both life expectancy and HRQoL.

Scientific associations are known as the ` base of civil society ' and it is a bridge between the government and the people. The use of NGOs and nongovernmental associations’ potentials is one of the most important specify of modern societies. Scientific associations are unique because of overcoming the weaknesses of non - scientific entities and make synergy. One of the most important goals and functions of these associations is development scientific educational and research collaboration. This is proper platform to recognize, encourage, guide and exchange experiences between scientists.
Medical science associations in Iran have efforts in realization health system goals. These associations collaborate with ministry of health, universities and research centers and their activities related to planning, implementing, evaluating and revising educational programs and research projects for the health system promotion. In this article, forty years experiences of medical sciences education system of Iran in development medical science associations presented could be benefit for other countries.

The main purpose of this study is to evaluate the effects of varicocelectomy on serum testoster- one levels and semen quality in infertile men who suffer from varicocele.
This prospective study enrolled 115 subjects with clinical varicocele grades II and III and 240 fertile men as the control group. Total volume of testosterone serum level (ng/dl) and semen quality were com- pared before and after microscopic varicocelectomy. We normalized testosterone serum levels for age, grade, and testis size basis. SPSS 20 software was used to analyze the data. All results of continuous variables were reported as mean ± SD. Statistical significance was set at a P The mean ages of individuals who participated in the treatment (32.2 ± 5.23) and control (32.8 ± 5.27) groups were similar. There were similar mean values for adjusted testosterone levels between the varicocele (567 ± 222 ng/ml) and control (583 ± 263 ng/ml) groups. In the varicocele group, the adjusted testosterone levels insig- nificantly increased to 594 ± 243 ng/ml. Among semen parameters, only mean sperm concentration significantly increased after varicocelectomy.
Despite increases in sperm concentration, adjusted testosterone levels did not significantly improve after varicocelectomy.

Infertility is clinically defined as failure of a couple to conceive after one year of regular sexual intercourse and occurs in both males and females for various reasons. About half of the infertility causes is due to male factors such as azoospermia and the lack of sperm in the ejaculate. Azoosperima is divided into two types: Non-obstructive azoospermia (NOA) and obstructive azoospermia (OA). NOA is a type of male infertility caused by spermatogenesis defects. Therefore, investigating the factors involved in spermatogenesis, including hormones and genes, is one of the important aspects in understanding the mechanism of infertility in men. To this end, we aimed to investigate the expression of the clusterin gene expression and LH, FSH and testosterone hormone levels in the testicular tissue and blood of NOA patients, respectively.
The study population included 42 NOA infertile men referred to Royan Institute, Tehran, Iran in June 2016 to February 2017. Their blood samples were collected and testosterone, LH and FSH hormones were measured by ELISA. Afterwards, based on the biopsy results the patients were categorized into TESE (positive sperm retrieval) and TESE- groups. The genomic RNA was extracted from testicular tissue samples obtained from TESE surgery. After converting to cDNA, the clusterin gene expression was investigated by Real-time PCR technique. The achieved data was analyzed using SPSS software, version 18 (Armonk, NY, USA).
According to Real-time PCR results, the expression level of clusterin gene in TESE group was significantly higher than TESE- group (P= 0.035). The mean of FSH and LH hormone levels in the TESE group was relatively lower than the TESE- group (P= 0.07 and P= 0.08), but there was no significant difference in the mean of testosterone hormone levels between the two groups (P= 0.66).
Based on the results of this study, the clusterin gene can have a role in spermatogenesis and by evaluating FSH and LH hormones in a larger non-obstructive azoospermic patient’s population significant statistical results can be achieved.

Traditional approaches in Continuing Medical Education (CME) appear to be ineffective in any improvement of the patients’ care, reducing the medical errors, and/or altering physician's behaviors. However, they are still executed by the CME providers, and are popular among the majority of the physicians. In the present study, we have done our best to explore the parameters involved in the degree of CME programs’ effectiveness in Iran.
In this study, 31 participants, consisting of general practitionares, CME experts and providers, were recruited to participate in in-depth interviews and field observations concerning experiences with CME. Application was made of the qualitative paradigm along with the qualitative content analysis, using grounded theory data analysis methodology (constant comparative analysis).
Our analysis demonstrated that: based on participant experiences, the insufficient consistency of the training program contents with the demands of GPs, besides non-beneficiary programs for physicians in addition to non-comprehensive educational designs, created a negative attitude to the continuing education among physicians. This could be defined by unrealistic continuing education, which is the main theme here.
Impracticable continuing education has created a negative attitude toward the CME programs among physicians so much so that they consider these programs less important, resulting in attending the said programs without any specific aim: they dodge absenteeism just to get the credit points. Evidently, promoting CME programs to improve the performance of physicians requires factual needs assessment over and above adaptation of the contents to the physicians’ performance.

Continuing Medical Education (CME) has been considered as a lifelong commitment for doctors to provide the optimal care for patients. Despite a long history of creating CME programs, outcomes are far from ideal. The present qualitative study aims to clarify the barriers affecting effectiveness of the CME programs in Iran based on the experiences of general practitioners.
Sixteen general practitioners were recruited to participate in in-depth interviews and field observations concerning experiences with CME. The study was performed using a qualitative content analysis method. The codes, categories and themes were explored through an inductive process in which the researchers moved from specific to general.
The participants’ experiences identified a number of barriers, particularly insufficient interaction with the instructors; additional problems included the teachers’ use of an undifferentiated approach; unreal and abstract CME; and ignorance of the diverse reasons to participate in CME.
Based on the study results, there are multiple barriers to effective implementation of CME in Iran. The key barriers include insufficient interaction between the trainees and providers, which must be considered by other stakeholders and program designers. Such interactions would facilitate improved program design, invite more specific tailoring of the education to the participants, allow for more effective educational methods and set the stage for outcome evaluation from the learners actually applying their new knowledge in practice. Replication of these findings with another sample would improve confidence in these recommendations, but these findings are broadly consistent with findings in the educational literature on improving the efficacy of CME.

Varicocele is recognized as the most common cause of male factor infertility and is found in 15% of the general population. This prevalence increases to 35% in men presenting with primary infertility and between 70 to 80% in men presenting with secondary infertility. The effect of varicocele on Leydig cell function and testosterone production has been always a question. In this study we examined the effect of varicocelectomy on serum testosterone. This research protocol was approved by the institutional review board at Royan Institute in infertility department and also this study has been done in Royan Institute (Tehran، Iran) during one year since September 2012 till October 2013. In this cross-sectional study، Serum levels of total testosterone in 79 men with clinical varicocele and in 70 fertile men who served as a control group were compared. Men aged 23–46 years with clinically palpable varicoceles as determined by physical examination were studied. Three to 6 months، testosterone levels were measured again after varicocelectomy، then testosterone levels were compared before and after varicocelectomy. The mean of serum testosterone levels before surgery in infertile men with varicocele and fertile men were 590 (230) vs. 583 (237) ng/dl respectively. No statistically significant changes were noted in serum testosterone levels for any groups. Three month after varicocelectomy mean serum testosterone levels were significantly increased in infertile men with varicocele compared with preoperative levels from 590 (230) to 663 (242) ng/dl (P=0. 009). Also the testis volume of patients were examined، which were divided into two groups included the men with testis volume less than 16 ml (<16) and more than 16 ml (≥16). In infertile men affected with clinical varicocele، varicocelectomy seems to have caused positive impact on the level of serum testosterone increase. It is thought that positive effect is probably caused by improvement of the Leydig cell functions which induce the increase of serum testosterone level.

The Wnt/β- The Wnt/β-catenin signaling pathway is involved in many developmental processes in both fetal and adult life; its abnormalities can lead to disorders including several types of cancers and malfunction of specific cells and tissues in both animals and humans. Its role in reproductive processes has been proven. This study was designed to evaluate the expression of the key regulator of this signaling pathway GSK3-β and its presumed role in azoospermia. WNT3a protein concentration and GSK3-β gene expression levels were measured and compared between two groups of infertile men. The test groups consisted of 10 patients with obstructive and 10 non-obstructive azoospermia. The control group was selected among healthy men after vasectomies that were willing to conceive a child using a testicular biopsy technique. Samples were obtained by testicular biopsy and screened for the most common mutations (84, 86 and 255) in the SRY region before analyzing. GSK3-β gene expression was assessed quantitatively by real time-PCR. The WNT3a protein concentration had no significant difference between the two test groups and controls. Expression of GSK3-β was down-regulated in non-obstructive azoospermia (3.10±0.19) compared with normal (7.12±0.39) and obstructive azoospermia (6.32±0.42) groups (p=0.001). Down-regulation of GSK-3β may cause to non-obstructive azoospermia. Regulation and modification of GSK-3β gene expression by drugs could be used as a therapeutic solution.

To determine the optimal number of biopsies in patients with non-obstructive azoospermia (NOA) who undergo testicular sperm extraction (TESE), and assess the impact of testicular histology on outcome. Seven hundred and forty-one patients with NOA who underwent TESE in our institution were enrolled in the study. Testicular sperm extraction was performed applying an open surgical technique on the larger testis. The number of biopsies varied according to the presence or absence of spermatozoa. No further biopsies were obtained once spermatozoa were detected. If no spermatozoa were seen, the procedure was continued to a maximum number of 5 biopsies, including a single biopsy of the contralateral testis. Spermatozoa were obtained in 330 (44.5%) patients after a single biopsy. The success rate increased to 381 (51.4%), 416 (56.1%), 433 (58.4%), and 441 (59.5%) after the second, third, fourth, and contralateral sampling, respectively. Multiple sampling increased the success rate; however, success rate did not increase considerably after the third sampling. Performing contralateral testicular biopsy was advantageous in patients with uniform or mixed pattern hypospermatogenesis. We recommend performing at least 3 biopsies in patients with NOA who undergo TESE. Further biopsies may also be advantageous when the NOA is a consequence of either uniform or mixed pattern hypospermatogenesis.

Hairball in a urethral diverticulum has rarely been reported. These hairballs are usually formed in the diverticulum coated with a hair bearing epithelium and can lead to urinary obstruction or infection. Using laser is a safe way to ablate such stones.

Sexually transmitted infections (STIs) remain a public health problem of major significance in most parts of the world. This study aimed to detect the most prevalent pathogens in patients with signs and symptoms of STI referring to a group of university clinics in Tehran. In this cross-sectional study using randomized cluster sampling, 507 consecutive male and female patients presenting with signs and symptoms of STI referring to selected health care centers of Shahid Beheshti University were evaluated between May 2005 and May 2007. Diagnosis was made according to WHO criteria for signs and symptoms of STI in addition to microscopic study of genital discharges. The most prevalent STI pathogens were Candida, Trichomona, Neisseria gonorrhoeae and Chlamydia with respective frequencies of 53.96%, 18.87%, 4.91% and 22.26% in women and 47.10%, 8.67%, 9.50% and 34.71% in men. Candida was detected in majority of cases. Chlamydia was the most prevalent STI in both sexes. Simple preventive care has crucial role in decreasing the frequency of STIs in society.

The objective of this study was to evaluate the value of serum prostate-specific antigen (PSA) and prostate-specific antigen density (PSAD) in the diagnosis of prostate cancer. A total of 330 consecutive patients suspected of having prostate cancer due to either abnormal digital rectal examination or elevated serum PSA levels underwent transrectal ultrasonography-guided sextant biopsy of the prostate. The PSA and PSAD values were assessed based on the biopsy results. One hundred and twenty-one patients (36.7%) had prostate cancer. In this group, the mean PSA was 31.60 ± 30.85 ng/mL (range, 1.9 ng/mL to 166.0 ng/mL) and the mean PSAD was 0.83 ± 1.01 (range, 0.04 ng/mL/cm3 to 6.38 ng/mL/cm3). In those without prostate cancer the mean PSA and PSAD levels were 13.80 ± 18.72 ng/mL (range, 0.4 ng/mL to 130.0 ng/mL; P <. 001) and 0.24 ± 0.32 (range of 0.01 ng/mL/cm3 to 2.29 ng/mL/cm3; P <. 001). The receiver operating characteristic curve analysis revealed that the discriminating power of serum PSA for detecting prostate cancer, as estimated by the area under the curve, was 0.74 while that for PSAD was 0.81 (P <. 001). For the PSA range of 3.5 ng/mL to 41 ng/mL (gray zone) the areas under the curve was 0.68 for PSA, while it was 0.78 for PSAD (P <. 001). The use of PSAD instead of PSA in the diagnosis of prostatic cancer improves the diagnostic accuracy

Selection of an acceptable method for the treatment of posterior urethral disruption defects would be highly desirable. We determined the efficacy and success rate of some techniques including supracrural rerouting for removing of these defects among our patients. Records of 200 consecutive men treated with anastomotic urethroplasty for traumatic posterior urethral strictures were reviewed at our teaching hospital. Prior treatment, surgical approach, and ancillary techniques required during reconstruction were evaluated. Success rate due to posterior urethral reconstruction was achieved in 78.0% of cases. Supracrural urethral rerouting was performed in 11 patients (5.5%), of whom 7 sustained recurrent stricture requiring intervention. The highest success rate of defect resolving was reported by urethral mobilization (92.4%). Supracrural rerouting is not an acceptable technique and can result in postoperative complications such as recurrent stricture in most of the patients with posterior urethral disruption defects

Infertility is one of the most common and important subjects in today’s obstetrics and gynecology. Immunological factors such as the presence of antisperm antibodies (ASA) are challenging etiologies for infertility. This study was performed to determine the correlation between the type of sexual practices (oral‚ anal and vaginal during menstruation) and the ASA levels in semen and in the sexual partners’ serum.

In this analytic cross sectional study which was performed in Royan Institute between 2005-2007‚ the type of sexual behaviours was determined in 51 couples with primary or secondary infertility. The ASA level was determined in both sexual partners’ blood serum and in the semen‚ using the Sperm Mar Test kit.

Using statistical analyses‚ there was no significant difference between the types of sexual practices (anal‚ oral‚ vaginal during menstruation) and the prevalence and level of ASA.

Based on the results of this study, the prevalence and level of ASA has no significant correlation with the types of sexual behaviours (anal‚ oral‚ vaginal during menstruation).

Considering the significance of continuous medical education and its role in the quality of the presented health and treatment services, and the holding of more than 3000 of such programs, this study was carried out to determine the effect of continuous medical educational program regarding renal stones during the years 1997-1998. In this study, the educational trial strategy was carried out on 100 physicians having their offices in Tehran. In this respect, the effect of training was evaluated on the knowledge, perspective, and way of management of physicians before and after stone ejection, renal colic pain, and its diagnosis. For this purpose, the trained medical students as false patients ( one week before and two months after the program) referred to the offices. The level of knowledge was measured using a 29-item and four-choice questionnaire. For perspective, a 10-item questionnaire was used according to Likert score. The influence of programs was assessed by McNemars, Sign, and Chi-square tests. Out of I 00 studied patients, the data was complete only for 80 ones. In this respect, 19 (24%) were female and 61 (76%) were male at an age range of 43.2 ± 12.5 years and a period of 14.5 ± 11.9 years has passed from their graduation. It was shown that the training program was successful in improvement of knowledge and perspective, even for the total period of the study (P<0.001). In addition, only the way of management showed a significant and successful improvement. In this regard, the serum administration had been reduced significantly (P<0.01) in patients with colic pain. It is concluded that the contents of training programs in proportion to the requirements can upgrade the knowledge and perspective and in this way can affect the efficiency of physicians and other methods should be applied for alteration of behavior.