مجله دانشگاه علوم پزشکی گرگان
سال بیست و یکم شماره 3 (پیاپی 71، پاییز 1398)

Varicocele is a deficiency of the testicular veins which is recognized by elongation and tortuosity of the pampiniform or cremasteric venous plexus and can lead to impaired spermatogenesis. Varicocele intensity is associated with the reduction of male fertility potential. This review article discusses the effects of varicocele on spermatogenesis process and fertility potential, etiology of varicocele, therapeutic approaches, and the result of treatment. All the published papers from 1975 to 2018 from databases bank such as Science Direct, Google Scholar, Scopus, and PubMed with keywords; infertility, varicocele, varicocelectomy, spermatogenesis, clinical outcome were collected and within these papers, only 74 papers were included for this study. Increased of testicular temperature, backflow of toxic metabolites from the kidney or adrenal glands, hypoxia, hormonal disturbances and oxidative stress are the most prevalent pathogenic cause of varicocele that they can alter testis and sperm functions. Several studies show that varicocelectomy can improve sperm parameters, chromatin statue and fertility potential in infertile men with varicocele. Possibly, treatment of varicocele before assisted reproduction technologies could increase the chance of spontaneous pregnancy in these infertile men.

Atherosclerosis which is the result of cholesterol deposit in coronary arteries is the main cause of morbidity and mortality, worldwide. Reverse cholesterol transport (RCT) is a process that causes efflux of excess cholesterol in vessels layers and reduces the risk of atherosclerosis. Adenosine triphosphate (ATP) binding cassette transporters G5 and G8 (ABCG5 and ABCG8) are two membrane cholesterol transporters in hepatocytes and enterocytes that transport cholesterol into the bile and feces. Considering importance of ABCG5 and ABCG8 in RCT and prevention and treatment of coronary atherosclerosis, the aim of this review article was to study the ABCG5 and ABCG8 functions, the role of them in heart stroke prevention and the effects of exercise trainings on genes expression of these two substances. Atherosclerosis, exercise, physical activity, RCT, ABCG5 and ABCG8 were used keywords for searching of related articles between years 1990 to 2018 in google scholar, PubMed, Elsevier, Scopus, SID, science direct and ProQuest databases. 294 articles were found and after precise reading of them, 84 articles were selected for this review article. Overall, considering role of transcription factors LXR/RXR are responsible for regulation of genes involved in cholesterol efflux (ABCA1, ABCG1), cholesterol transport (lipoprotein lipase, CETP), cholesterol transformation to bile acids (CYP7A) and metabolism and excretion of cholesterol into bile or gut lumen, stimulation of them induces elevation of ABCG5 and ABCG8 genes expression. The effect of exercise on these factors is a novel subject that may increase our knowledge to prevention and treatment of atherosclerosis.

Type 2 diabetes is a chronic disease that associated with increased serum glucose and insulin function impairment. Exercise training and saffron supplement are known as two effective factors in the prevention of the complications of type 2 diabetes. The present study aimed to evaluate the impact of eight weeks of aerobic and resistance training with the consumption of saffron aqueous extract on malondialdehyde and glutathione peroxidase in men with type 2 diabetes. In this clinical trial study, 36 men suffering from type 2 diabetes were randomly assigned into six groups: placebo, aerobic training, aerobic training with supplement consumption, resistance training, and resistance training with supplement consumption. Aerobic training was performed at 50-70% of maximal heart rate, and the resistance training was performed at 65-70% of the maximum replication for eight weeks. The saffron supplement was consumed at the dosage of 3 mg day-1. The concentration of malondialdehyde and glutathione peroxidase was measured before and after the trial after the 12-hour fasting period. Level of malondialdehyde significantly reduced in placebo and aerobic training with supplement prior to intervention (P<0.05). Level of glutathione peroxidase were significantly increased in aerobic training with supplement (P<0.05), resistance training (P<0.05) and resistance training with supplement (P<0.05) groups after intervention. Aerobic and resistance training and their supplementation with saffron consumption can be regarded as an effective method to improve the peroxidase and antioxidant balance.

Control of postoperative pain is one of the most important stages in the recovery of patients after surgery. This study was done to compare the effectiveness of combined Ondansetron and Apotel on the post-operative pain after surgery of upper limb fractures. This double blind clinical trial study was done on 50 individual (41 male and 9 female) with upper limb fractures referring to 5 Azar hospital in Gorgan northern Iran during 2017. Patients were assigned (block randomization) into control and intervention groups. After the end of operation in the recovery phase, both groups received pain PCA (Patient Controlled Analgesia). In control group, the pain pump consisted of 2 grams of Apotel and in the intervention group; the pain pump consisted of 2 grams Apotel and 8 mg of ondansetron. Visual Analogue Score (VAS) was evaluated in both groups after surgery for 24 hours. Pain score of patients compared in the 2 groups during the 3 time intervals after surgery. 4 hours after upper limb fracture surgery, the mean pain was significantly decreased in the intervention group (3.20±0.707) compared to control group (3.64±0.569) (P<0.05). 12 hours after upper limb fracture surgery The Mean pain, in the intervention group (1.88±0.927) was significantly reduced in compare to control group (2.64±1.186) (P<0.05). 24 hours after upper limb fracture surgery, The Mean pain was significantly reduced in the intervention group (1.40±0.645) in compare to control group (2.08±0.997) (P<0.05). This study showed that administration of compination of Apotele and Ondansetron in post-operative pain of upper limb fractures is effective than apotele alone.

Cardiovascular diseases and heart failure are major diseases in developed countries. Stem cells showed specific features to play an important role in heart disease treatment. One of the most common compounds has been used to induce differentiation of stem cells into cardiomyocyte is 5-Azacytidine. Medium contents of cell culture such as different glucose concentrations also influence on morphology and function of final differentiated cells. This study was done to evaluate the effect of glucose on improvement of BM-MSC differentiation into cardiomyocyte - like cells. In this experimental study, effect of two different glucose concentrations (5 and 25mM) on the mesenchymal stem cells differentiation (MSCs) to cardiomyocytes during 21 days was evaluated. Bone marrow MSCs (BM MSCs) seeded in differentiation medium which treated with 5-aza and 5 & 25mM glucose concentrations. In next step, total RNA was extracted and cDNA synthesis was carried out. Finally, quantitative polymerase chain reaction (Q-PCR) was done to determine level of cardiac-specific markers during differentiation process including Connexin43, α-cardiac actin, TroponinT and TroponinI. Level of cardiac-specific markers during differentiation of mesenchymal stem cells to cardiomyocyte including Connexin43, α-cardiac actin, TroponinT and TroponinI in 5 and 25 mM of glucose concentration was diferent, but this diference was not significant. Our results showed that two concentrations of glucose (5, 25mM) have no remarkable effect on the expression of cardiac markers during differentiation of bone marrow mesenchymal stem cells to cardiomyocyte.

Copper oxide nanoparticles with unique properties have numerous biological applications with probably toxicity. This study was conducted to determine the toxicity of copper oxide nanoparticles on the pituitary-gonadal axis and spermatogenesis in male rats. In this experimental study, 40 male Wistar rats were randomly allocated into 4 groups including control group and three intervention  groups which receiving the cancentration of 10, 20 and 30 mg/kg of copper oxide nanoparticles 5 times intra-peritoneally, respectively. Blood sampling was collected first day and 15 days after the last injection. Level of testosterone, FSH and LH were measured by ELISA method. After anesthesia and dissection of mice in each group, tissue sections of testis were prepared and stained with hematoxylin-eosin. Morphological status of spermatogenesis process and counting of types of cells (spermatogonium, spermatocyte and spermatid) were studied by optical microscope. In the first day of blood collection, a significant increase in LH and FSH level was observed at concentrations of 10 and 30 mg/kg, respectively. Also, Testosterone and FSH level decreased significantly reduced at 10 mg/kg/bw concentration compared to control (P<0.05). In 15 days after of the last injection, level of testosterone (P<0.05) and LH (P<0. 05) significantly increased in concentrations of 10 and 30 mg/kg/bw respectively. Also, there was a significant reduction in level of FSH in the concentration of 10 mg/kg/bw (P<0.05). The examination of testis tissue sections showed a significant decrease (P<0.05) in density and number of cell types (spermatogonium, spermatocyte and spermatid) and anomalies in the spermatogenesis process, in a dose-dependent manner. The most disturbances was seen at a concentration of 30 mg/kg/bw of copper oxide nanoparticles. Copper oxide nanoparticles may interfere with the secretion of gonadotropins and testosterone and ultimately lead to a disruption of the spermatogenesis process.

Multiple Sclerosis (MS) is a neurologic necrotic and chronic illness that causes by demyelination in CNS. One of the common clinical symptoms in MS is cognitive disorders. The most common cognitive defects in patients with MS are reduction of memory and information processing rate hippocampus functions in brain are memory and learning. This study was done to determine the function mechanism of memory discover by study on hippocampus. Nowadays tendency of herbal therapy is increased because of drug's side effects. This study's purpose that is from experimental typ effect of compaind extract of Portulaca olerace, Urtica dioica and Boswellia serrata on memory and number of neurons in CA1 area of hippocampus in induced multiple sclerosis rats. In this experimental study 30 male adult rats were randomly allocated into control group, sham group (salin injection), (MS + salin) group, (MS + mixture extract, dose of 200 mg/kg), (MS + mixture extract, dose of 400 mg/kg). MS model was induced by intra hippocampal injection a single dose of ethidium bromide (0.01% ethidium bromide sulotion in 0.9% salin) and in 3 microlitre volume with 1 microlitre in minute rate intraperitoneally. Compaind extract of Portulaca olerace, Urtica dioica and Boswellia serrata were injected as the treatment for 21 days. The shuttle box test was used for evaluation of memory. Dissector method was used for neural density in CA1 of hippocampus. Histopathology method was used for evaluation of the alteration of cells. Neural density in MS induced group was singnificantly reduced in comparison with control and sham groups (P<0.05). Neural density was singnificantly increased in treatment groups in comparison with MS induced group (P<0.05). Histological results showed that induction of MS caused the disrution of neuron cells in compare to controls, but intraperitonal injection of compaind extract cause neurogenesis in tertment groups. Memory in MS induced group was singnificantly reduced in comparison with control and sham groups (P<0.05), but memory was singnificantly increased in treatment groups in comparison with MS induced group (P<0.05). Compaind extract of Portulaca olerace, Urtica dioica and Boswellia serrata with dosages of 200 and 400 mg/kg/bw due to neurogenesis and amilioration can effective in memory recovery and neural necrosis in MS disease.

Multiple sclerosis (MS) is the most common disabling neurological disease which leads to nerve conduction velocity (NCV) reduction and finally reduction of functional abilities. This study was executed to determine the effect of six weeks resistance training on NCV, strength, balance and walking speed in Multiple Sclerosis patients. In this quasi-experimental study, 23 MS patients were nonrandomly divided to control (n=10) and resistance training (n=13) groups. Two days before and after training program, NCV, strength, balance and 25 foot walking tests was executed. Resistance training protocol was included tree sessions per week for six weeks and intensity of training was 55% of 1RM. Six weeks of lower body resistance training significantly increased nerve conduction velocity (NCV) (P<0.05), strength (P<0.05), balance (P<0.05) and walking speed (P<0.05) in MS patients. Controlled resistance training can improve Multiple Sclerosis patient’s nerve conduction velocity which finally can lead to improve functional abilities, such as strength, balance and walking speed.

Reducion of efficiency of the muscles after long duration training increases the probability of injury after the occurrence of fatigue. Sprain lateral ankle is one of the most common injuries occurs during sport activities. This study was done to compare the effect of two types of hopping and combined balance - strength training on the balance of static and dynamic balance and strength of selected muscles in soccer men with unilateral chronic ankle instability. In this quasi-experimental study 36 soccer men with unilateral chronic ankle instability non-randomly divided into the three groups including: control, hopping and combined balance - strength training groups. Check list was used to collect demographic information, for the measurement the balance of the static, dynamic balance and strength respectively of the tests bass stick and Y balance and manual muscle test were used. There was significant increasd of the balance of the static and the total result of dynamic balance in the two training groups in compare to controls (P<0.05). The subjects of the group trianing balance - strength in the all directions of the test Y performance were better than training hopping group (P<0.05). After training, the strength of abduction, adduction and inversion of ankle significantly increased in the two training groups in compare to controls (P<0.05). According to invertion test the ankle of subjects in balance - strength training group had beter function in compare to training hopping group (P<0.05). However, other factors such as strength, extension and flexion of the knee and dorsi and plantar flexion of the ankle were not significant between the two intervention groups. Both the balance - strength and hopping training can be effective in improving the balance and strength soccer men with chronic ankle instability unilateral. However, it seems the training selected balance - strength training due to the comprehensive nature of it and the reason as to strengthen each of these factors for conduit and have a greater effect on athletes with chronic ankle instability to have faster recovery.

There is a corolation between meta-cognitive beliefs and psychological adaptability. The subjects with adaptability beliefs have more soci-psyclogical adaptability. Diabetes has a negative impact on the quality of life. Therefore, this study was done to determine the relationship between meta-cognitive beliefs and adaptability with quality of life in type 2 of diabetic patients. This descriptive correlation study was done on 100 type 2 diabetic patients (60 males, 40 females) whom refered to association of diabetes center in Tehran, Iran during 2016. They were selected by network sampling method. Data collection was done by Wales and Cartwright Hatton (2004) Meta-cognitive beliefs, Bell's (1961) adjustment and ware and quality of life (1996) questionnaires. There was a positive and significant relationship between metacognitive beliefs (r=0.756) with quality of life (P<0.05). In addition, there was a significant relationship between adaptability (r=-0.917) with quality of life (P<0.05). The results of sub-scales of metacognitive beliefs showed that the strongest predictor of adjustment and quality of life is the component of positive beliefs about worry, and then the components beliefs about superstition, punishment and responsibility associated with worry and beliefs about uncontrollability of worrying and about the dangers of failing to control worrying, respectively, had a good predictor role.the severity of diabetes significantly reduced the qulity of life (P<0.05). Metacognitive beliefs and compatibility can affect the quality of life in diabetic patients.

Rheumatoid arthritis (RA) is the most common systemic inflammatory disease. The FOXP3 gene is an agent that activates during the course of the disease and accumulates in the sinus arthritis of the inflamed joints, resulting in persistent inflammation and ultimately tissue damage. Regarding the role of polymorphism in promoter regions in gene expression, this study was conducted to determine the association of rs2232365 polymorphism in promoter of FOXP3 gene with the incidence of rheumatoid arthritis in Iranian population. In this case-control study, in order to investigate the relationship between FOXP3 gene rs2232365 polymorphism and rheumatoid arthritis, 77 patients and 67 healthy subjects were evaluated. The genotype of individuals for polymorphism rs2232365 was determined by PCR-RFLP method. The highest genotypic frequency was related to CC genotype with 89% frequency in two healthy and diseased populations and no difference was observed in genotypic and allelic abundance in healthy and patient populations. Different genotypes of this polymorphism did not have a significant relation with the risk of RA, while it had a significant correlation with the level of CCP factor and CC genotype was associated with the progression of RA disease by increasing the level of CCP (P<0.05). This study showed that there is no correlation between polymorphism rs2232365 in promoter of FOXP3 gene with Rheumatoid arthritis in Iranian population.

Gingival recession is a common disease leads to esthetic problems, increased sensitivity of teeth and root caries. This study was done to determine the prevalence of gingival recession in dental students with high level of oral hygiene. This descriptive-analytic study was performed on 214 dental students of Golestan University of Medical Sciences, Gorgan, Iran during 2017-2018. After collecting demographic information, clinical examination including Oral Hygiene Index (OHI) and Gingival Index (GI), Severity of gingival recession, width of keratinized gingival, attachment of frenulum, toothbrush trauma, tooth malpositions, periodontal diseases and other iatrogenic factors was measured. Prevalence of gingival recession was 23.8% .Class 1 and 2 of gingival recession was 84.62 % and 15.38%, respectively. Class 3 and 4 of gingival recession did not observe in any subjects. Toothbrush trauma was the most etiologic factor in 35.4% of dental students suffering of gingival recession (P<0.05). Also, dental malposition with 20.83%, loss of keratinized gingival with 14.58%, orthodontics procedures with 12.5%, periodontal diseases with 10.4% were the other factors in gingival recession. Toothbrush trauma and dental malposition are the most important etiologic factors in dentistry students suffering from gingival recession.

For many reasons, having children with the desired gender has long been a concern for human societies. Some studies have shown the effect of a maternal diet pregnancy on gender ratios. Considering that during the holy month of Ramadan, women's diet is undergoing a major change, and studies about the association of such diet change, especially the mother's fasting, on the gender of the fetus are rare and the results have contradictory; the present study, was conducted, to investigate the relationship of mother's fasting in the follicular phase of the last menstrual cycle and gender of newborn. This descriptive - analytical study was conducted on 139 pregnant women who had started their last menstrual period before their pregnancy during Ramadan and referred to midwifery clinic of Sayyad Shirazi hospital or health centers in Gorgan city for prenatal care in 2016 and 2017. The data collection tool was a checklist containing the demographic characteristics of the pregnant mother, date of the last menstruation, gestational age, number of pregnancy and days of mother fasting. 86 pregnant women (62 %) were fasting and 53 non-fasting (38%). Frequency of newborn's gender in pregnant women who were fasting was 43 boys and 43 girls and in non-fasting women were 35 and 18, respectively. The frequency of boys in non-fasting mothers was higher than girls but this difference was not significant. In analysis of simultaneous effects of variables on baby's gender, none of the variables were statistically significant with the newborn's gender. Variables such as the number of pregnancies (P=0.051) and maternal fasting (P=0.083) non significantly reduced the ratio of boy born to 30%. There is no relationship between gender of babies and mother's fasting in the follicular phase of the last menstrual cycle.

Nosocomial infection is a major challenge in health care system. In fact, it is regarded as one of the risk factors in hospitalized patients. The aim of this study was to determine the antibacterial effect of silver nanoparticles (AgNPs) nursing gowns on geram – positive bacterial. This descriptive and analytical study was done on 200 nurses gowns were surveyed in two hospitals of Sirjan city in Kerman Province cenral area of Iran. At first, the antimicrobial activity of silver nano fabrics on Staphylococcus aureus bacteria was confirmed by examining the optical density OD (0.325) medium. Sampling was gathered into the two modes, before using nano gowns and after using nano gowns by using wet sterile swabs. The samples collected were cultured and the formations of colonies were examined and biochemical tests were used to identify isolated bacterial. The most commonly isolated gram- positive bacterial from normal gowns were Staphylococcus epidermidis (43%) and the lowest pathogen was Streptococcus (1%). In these hospitals, after using nano silver gowns, the amount of microbial load on the clothes were determind zero. This study showed that gram- positive bacterials of nursing gowns after contact with silver nanoparticles were eliminated.

Child Sexual Abuse (CSA) is a very serious problem all over the world with widespread and often unrecoverable negative consequences for victim, family and the society. Significant proportion of victims reported abused sexually when they were younger than 7 years. This study was done to evaluate the knowledge and attitude of pre-school girls about sexual abuse prevention in Gorgan during 2016. In this descriptive study, 56 pre-school girls with mean age of 76.13±3.87 months (6.34 years), who were chosen through systematic random sampling, among the files of the households with
a pre-school age girl from two health centers in Gorgan, north of Iran during 2016. The Personal Safety Questionnaire- Persian version (PSQ-P) including 12 questions was used to test children’s sexual abuse prevention knowledge and attitude by interview method. Out of  the 56 children studied, only 9 children (16%) knew all three private parts and of these, only 2 children (3.5%) knew the correct name for all three parts. 80% of children believed that if the perpetrator would ask them to keep touching the private parts as a secret, they should not inform another person. 48% of them did not choose appropriate avoidance responses during inappropriate touching of private parts. 43% of them reported that they do not like their private parts and the appropriate touch of the private parts was not allowed by most children too. Most pre-school girl children had no proper knowledge and attitude about the sexual abuse prevention, indicating highlights shortcomings in prevention educations at different levels of society.

Various infections and the formation of stones could be the cause for bile duct obstruction of that sterile organ. Determination of pathogenesis factors and the bacteria involved in infections are important in the prevention of disease, and cares needed following surgery. This study was done to determine the bacteria in the gallbladder of patients with cholelithiasis and evaluation of pathogenic factors of the prevalent isolated bacteria. In this descriptive laboratory study, 35 samples of gallbladder tissues which contained gallstones were collected under sterile conditions in “Department of General Surgery of Imam Khomeini Hospital”, Tehran, Iran during 2016. The stone types were analyzed and decomposed by chemical procedures, and the bacteria existed in the tissues were also identified using biochemical experiments. The tissues with negative results in microbiological studies were looked for any contaminating bacteria, applying the DNA extracted from gallbladder tissue as a template using F27 and R1492 as the primers for PCR (Polymerase Chain Reaction) amplification of 16SrRNA gene. Those with the positive results of microbiological tests were subjected to the DNA sequencing following gel purification and blasted against the NCBI gene database. The most frequently isolated bacteria were studied according to the intensity of biofilm formation, using the microtitre plate method. CsgF and Ag43 (Flu), the genes involved in the induction of such phenotype were also analyzed in this study. The antibiotic resistance assay of the isolates was performed using disc diffusion procedure. Thirteen out of thirty five samples of post-surgery gallbladder tissues were found to be infected by different bacteria, including: Klebsiella (3 cases), Escherichia coli (4 cases), Enterobacter (1 case), Staphylococcus aureus (2 cases), Enterococci (2 cases), and Streptococcus (1 case). In 23 out of 35 samples (65.7%), no bacteria could be isolated using microbiological methods. However, in seven out of 23 samples, the amplified 16SrRNA had an indication of Klebsiella (6 cases) and Enterococcus (1 case) isolates. Therefore, the most prevalent genus in gallbladder infections was Klebsiella (47.36%). Chemical analysis showed that the highly frequent compound of gallstones (98%) were of cholesterol and bilirubin. Escherichia coli with fourcases were the highest culture growing isolated bacteria, in all of which, the biofilm formation genes were present. In the two out of four Escherichia coli isolates the intensity of biofilm formation was high. Although, in the remaining two isolates was medium. While, they were found to be sensitive to the most of the antibiotics, they showed resistance to Tetracycline, Ciprofloxacin and Ceftazidime in different ranges. The present study provided evidence that non-cultural bacteria are hihly present in gallbladder infections. The high potential of the commonly isolated bacteria in biofilm formation should be taken as a warning to follow the precise protocol of antibiotic prescription for treatment of gallbladder infections.