Radiotherapy for Ewing sarcoma: a 5 year experience from Iran cancer institute

Background: Ewing Sarcoma Family of Tumors [ESFTs] is the second most common primary tumors of bone in childhood. The decision regarding the optimal modality for achieving local tumor control remains uncertain. The aim of this study was to report the clinical features and outcome as well as reviewing risk factors in patients. Materials and Methods: This retrospective study included 75 ESFTs patients who were treated at cancer institute between 2004 and 2009. Files of all patients with ESFTs were reviewed retrospectively and we called them for follow up. Specific data were collected with regard to the age at diagnosis, gender, tumor site and size, clinical stage, surgical procedure, plan of radiotherapy and treatment outcome [5-year and median survival]. Results: The mean age at diagnosis was 21 that ranged from 1 to 52 years [SD = 9.6]. The mean tumor size at diagnosis was 4.8+/-4.48 cm. The percent of biopsy only, partial and complete resection was 54.7% [41 patients], 6.7% [5 patients] and 37.3% [28 patients] respectively. Radiotherapy was done as definitive treatment or postoperatively [adjuvant] in 46 [61.3%] and 16 [21.4%] patients respectively. Overall 5 year survival was 24% and median survival for patients with and without metastases was 21+/-17 and 75+/-10 months. Conclusion: Presence of metastases, age at diagnosis, positive surgical margin and tumor size were the prognostic factors that influenced outcome of patients. This study suggests that radiation therapy is an acceptable local treatment modality in patients with Ewing sarcoma family

[Effect of evening primrose, vitex agnus and vitamin E on premenstrual syndrome]

Herbal products consumption is increased worldwide. This study was done to compare the effect of Evening Primrose, Vitex agnus and vitamin E on premenstrual syndrome. In this clinical trials study, 210 women with premenstrual syndrome were randomly divided eqaly into Evening Primrose [500 mg, 3 times per day], Vitex agnus [40 mg/day] and vitamin E [400 Iu/day] groups. The subjects were received the thraputic regiment for 2 months. Severity of premenstrual syndrome was recorded for each subject using DSR Dickerson questinare, perior and at the end of intervention. After intervention, severity of premenstrual syndrome was reduced in Evening Primrose group [60.58 +/- 30.6 to 34.09 +/- 19.81], Vitex agnus [61.23 +/- 30.54 to 25.25 +/- 17.78] and the vitamin E group, [61.24 +/- 32.04 to 54.9 +/- 19.24]. Severity of premenstrual syndrome were reduced in the Evening Primrose and Vitex agnus groups in compared to vitamin E group [P<0.05]. Severity of premenstrual syndrome were reduced in Vitex agnus in comparision with Evening Primrose [P<0.05]. Vitex agnus, Evening Primrose and vitamin E can reduce severity of premenstrual syndrome, but therapeutic effect of Vitex agnus is more than Evening Primrose and vitamin E

[Assessment of the reliability and validity of the Farsi translation of the [orthognathic quality of life questionnaire] in 10-14 year-olds in Shiraz]

The Orthognathic Quality of Life Questionnaire [OQLQ] was designed by Cunningham in 2001 to assess the quality of life of patients in relation to orthodontic treatments. This study sought to evaluate the validity and reliability of the Farsi version of OQLQ in 10-14 year-olds in Shiraz This descriptive analytical study was conducted on 240 students in the age range of 10-14 years that were randomly selected from the 4 educational districts in shiraz. One elementary and one middle school were selected from each district. The OQLQ questionnaire contains two sections. The first section asks for demographic information of patients and the second part contains 22 questions regarding the quality of life in relation to dental status. This questionnaire was translated to Farsi using the standard forward-backward translation method. The standardized Cronbach's alpha, alpha if item deleted, item-total correlation and inter-item coefficients were used for the assessment of the reliability and validity of the questionnaire. For the calculation of test-retest validity, 30 students filled out the questionnaire again 2 weeks after the first session. Mann Whitney U and Chi square tests were used to assess the correlation between the different aspects of the quality of life in the questionnaire and willingness to take the treatment. Data were analyzed using SPSS version 18 software. The internal consistency analysis of the OQLQ indicated a good correlation between questions and domains of the questionnaire. Cronbach's alpha in this study was 0.86. For the calculation of test-retest reliability of the questionnaire, weighted kappa was found to be 0.91. Mann Whitney U and Chi square tests found significant differences between willingness for orthodontic treatment and dentofacial esthetics [part 2, P=0.008] and knowledge about dentofacial esthetics [part 4, P=0.018]. Farsi translation of OQLQ is a suitable tool for the assessment of the effect of dentofacial problems on thequality of life of orthognathic patients in an Iranian population

Effects of image enhancement on reliability of landmark identification in digital cephalometry.

Introduction: Although digital cephalometric radiography is gaining popularity in orthodontic practice, the most important source of error in its tracing is uncertainty in landmark identification. Therefore, efforts to improve accuracy in landmark identification were directed primarily toward the improvement in image quality. One of the more useful techniques of this process involves digital image enhancement which can increase overall visual quality of image, but this does not necessarily mean a better identification of landmarks. The purpose of this study was to evaluate the effectiveness of digital image enhancements on reliability of landmark identification. Materials and Methods: Fifteen common landmarks including 10 skeletal and 5 soft tissues were selected on the cephalograms of 20 randomly selected patients, prepared in Natural Head Position (NHP). Two observers (orthodontists) identified landmarks on the 20 original photostimulable phosphor (PSP) digital cephalogram images and 20 enhanced digital images twice with an intervening time interval of at least 4 weeks. The x and y coordinates were further analyzed to evaluate the pattern of recording differences in horizontal and vertical directions. Reliability of landmarks identification was analyzed by paired t test. Results: There was a significant difference between original and enhanced digital images in terms of reliability of points Ar and N in vertical and horizontal dimensions, and enhanced images were significantly more reliable than original images. Identification of A point, Pogonion and Pronasal points, in vertical dimension of enhanced images was significantly more reliable than original ones. Reliability of Menton point identification in horizontal dimension was significantly more in enhanced images than original ones. Conclusion: Direct digital image enhancement by altering brightness and contrast can increase reliability of some landmark identification and this may lead to more accurate cephalometric analysis.

[ relation of binocular symptoms with stereopsis]

To determine stereopsis with local [Titmus] and global [TNO] tests in symptomatic and asymptomatic subjects according to induced disparity [crossed or uncrossed]. In this cross sectional study, 80 students of Zahedan University of Medical Sciences who fulfilled the inclusion criteria were randomly selected. At first, refractive error was determined by retinoscopy and then based on the presence of binocular vision symptoms subjects were divided into symptomatic and asymptomatic. The ocular deviation was determined with use of the alternate prism cover test and stereopsis was determined with TNO and Titmus tests. Data was analyzed in software SPSS.15 using Mann-Withney U, Wilcoxon, Spearman correlation and Fisher's exact tests. Mean stereopsis with the TNO test in symptomatic and asymptomatic subjects with crossed disparity was 133.12 +/- 70.11 and 76.78 +/- 82.57 sec/arc and that with uncrossed disparity was 135.0 +/- 67.5 and 83.2 +/- 49.7 sec/arc, respectively. Using the Titmus test with crossed disparity the value was 44.3 +/- 7.27 and 40.7 +/- 3.4 sec/arc and with uncrossed disparity stereopsis was 50.0 +/- 12.1 and 40.0 +/- 0.0 sec/arc in symptomatic and asymptomatic subjects, respectively. The Mann-Withney U test showed significant difference between stereopsis [with crossed and uncrossed disparity] with symptoms [P<0.05]. Stereopsis is a useful factor in differential diagnosis of individuals with symptomatic and asymptomatic binocular vision that for these purpose the local and global tests can be used, the importance of the global tests is more than local tests. There is no difference between crossed and uncrossed disparity stereopsis in all subjects

[Relationship between central corneal thickness, intra ocular pressure and visual field in normal tension and primary open angle glaucoma]

Glaucoma is one of the most important cause of blindness wordwide. Exact determination of intra ocular pressure is important for the diagnosis and decision making about glaucoma treatment. Central corneal thickness is considered as effective factor on intra ocular pressure and visual field defect. This study was carried out to determine the relationship between central corneal thickness, intra ocular pressure and visual field in normal tension and primary open angle glaucoma. This descriptive study was carried out on 45 eyes with normal tension glaucoma and 45 eyes with primary open angle glaucoma in Al-Zahra ophthalmology hospital in Zahedan, Iran during 2010. Intra ocular pressure and central corneal thickness were measured by Goldman tonometer and pachymeter and visual field exanimated by Humphrey perimeter. Data were analyzed using SPSS-16, paired t-test, ANOVA, Mann-Whitney and Pearson correlation tests. There was significant correlation between central corneal thickness and intra ocular pressure [r=0.309, P<0.05]. A significant difference was detected in intra ocular pressure between two type of glaucoma [P<0.05]. Mean value of central corneal thickness in patient with mild visual field defect was higher than severe visual field defect but there was not significant statistical difference between central corneal thickness and visual field defect in subjects with glaucoma. This study indicated that increasing corneal thickness is accompanied with intra occular presure

[ cross dominancy and structural disorders of head and vertebral column]

Background and aim: The cross dominancy [CD] implicates as a condition that dominant eye and dominant hand are situated in opposite sides of a body. This condition can produce malformation and structural disorders in head posture and vertebral column. The aim of this study was to investigate the relationship between CD and structural disorders in vertebral column and head posture in students of Zahedan University of Medical Sciences

Methods: In this cross-sectional study, 300 students of Zahedan University of Medical Sciences were randomly selected and their dominant eye was determined by Miles test. Then subjects were divided into two groups [with cross dominancy and unilateral dominancy]. The presence of malformations of vertebral column and head posture were determined by checker board and plumb line. The data were analyzed using descriptive and analytical [Chi square] statistical tests

Results: The results of the present study demonstrated that 76 out of 300 students [25.3%] had cross dominancy [CD]. There were a significant difference between CD and scoliosis [P<0.001] or shoulder un-leveling [P=0.03] in two groups, but not between forward head posture [P=0.10] and chin deviation [P=0.22] with CD in two groups

Conclusion: The scoliosis and shoulder un-leveling had higher prevalence in CD subjects that is due to weak muscular support of vertebral column in coronal plane, but because of strong muscular support of vertebral column in sagittal plane, CD had not any considerable effect on chin deviation and forward head posture

[Effect of age on stereopsis]

To evaluate the effect of age on stereopsis. We evaluated stereoacuity using TNO and titmus test after full correction of refractive errors in 87 randomly selected subjects aged 5-80 years. There was a significant relashionship between stereopsis and age such that stereoacuity increased with aging [ANOVA, P<0.001]. Stereopsis decreases with aging and therefore age of the patient should be considered in this regard

[Comparison of gradient AC/A ratio with different deviation measurement techniques]

To compare the effect of different deviation measurement techniques and different lens powers on gradient accommodative convergence to accommodation [AC/A] ratio. We randomly selected 78 eligible students of different majors from Zahedan University of Medical Sciences. Following retinoscopy for refractive errors, alternate prism cover test, von Graefe and Maddox rod without additional lenses and with +/- 1, +/- 2 and +/- 3 D lenses were performed for measurement of deviation at near and determination of gradient AC/A Ratio. Data were analyzed using within subject factorial repeated measurement ANOVA and correlation tests. Mean AC/A ratio was 3.6, 3.7 and 4 prism diopter to diopter using alternate cover test, Maddox rod and von Graefe methods, respectively [P=0.2]. The highest and lowest AC/A ratios were related to von Graefe method with +3D and cover test with -1D lens power, respectively. Only differences between AC/A ratios with -1 and +2 lenses as well as with -1 and +3D were significant [P<0.05]. For all different deviation measurement methods, AC/A ratios with plus lenses were higher than minus lenses. The type of deviation measurement method had no effect on AC/A ratio but selected lens power affected the results. We recommend using 2 or 3 diopter instead of 1 diopter lenses to avoid possible effects of depth of focus

[Effect of metformin on the Pdx-1 gene expression during development of mouse pancreas]

Metformin, an oral medicine used to treat type 2 diabetes, is a Glucagon-Like Peptide-1 [GLP-1] analogue, which has been demonstrated to stimulate the expression of Pancreatic duodenal homeobox-1 [Pdx-1], Insulin and Glucose transporter 2 [Glut-2] genes. In this study, the regulatory effect of metformin on beta cells function through the expression of Pdx-1, Insulin and Glut-2 genes was investigated. Pregnant C57BL/6 mice were randomly divided into 2 groups. Normal saline was given to the control group and the experimental group received 75, 150 and 250 mg/kg metformin daily by intraperitoneal injection from day 8.5 of pregnancy. Half the pregnant animals were then sacrificed by cervical dislocation or day 19.5 of pregnancy and the pancreases of embryos were dissected. The other half of pregnant animals were allowed to deliver their pups and the pancreases of one day old mice were dissected. The dissected pancreases were then used for assessment of Pdx-1, Insulin and Glut-2 genes expression by semi-quantitative RT-PCR method. Results showed that the administration of various doses of metformin caused no changes in the expression of Pdx-1, Insulin and Glut-2 genes compared to the control group [P>0.05]. The regulatory effect of metformin on beta cells function might not be related to the expression of Pdx-1, Insulin and Glut-2 genes and may be related to the expression of gloconeogenesis pathway genes

[ investigation of relationship between binocular vision status and migraine headaches]

According to controversial results between migraine headaches and binocular vision anomalies, this study was designed to investigate the relationship between some parameters of binocular vision refractive errors and migraine headache. In this case-control study, 30 patients with neurologically diagnosed migraine who had inclusion criteria were selected as case group and 30 persons with no migraine headache were selected as control group. First, patients were screened by standard headache questionnaire and diagnosis refined by neurologist. The Refractive errors were determined by retinoscopy and were corrected. Then near point of convergence, jump convergence, stereopsis, fusional reserves and far and near deviation were determined. Data were analyzed by SPSS.15 software, using Man-Withney U test and multiple logistic regressions. The mean of near phoria, stereopsis, far positive fusional reserve, far negative fusional reserve, near positive fusional reserve, near negative fusional reserve in case and control groups were 6.5 +/- 2.85, 8.3 +/- 6.72 pd, 49.0 +/- 26.11, 154.17 +/- 333.82 sec/arc, 10.7 +/- 2.76, 6.07 +/- 5.07, 18.2 +/- 4.7, 11.0 +/- 7.37, 16.5 +/- 4.49, 13.97 +/- 8.72, 22.7 +/- 5.22 and 14.67 +/- 9.25 pd, respectively. The means of above parameters and jump convergence was significantly different between two groups [P<0.05]. However; no significant difference was observed between two groups for other variables [P>0.05]. In multiple logistic regression only jump convergence, far positive fusional reserve and near positive fusional reserve stayed in model [P<0.05]. This study showed higher rates of binocular vision anomalies [abnormal jump convergence, higher amounts of near deviation, abnormal positive and negative fusional convergence and reduced stereopsis] in migraine group than control. Hence, people who experience migraine headaches should be referred to their optometrist regularly to evaluate their binocular vision statuses

In vitro evaluation of force-expansion characteristics in a newly designed orthodontic expansion screw compared to conventional screws.

Objective : Expansion screws like Hyrax, Haas and other types, produce heavy interrupted forces which are unfavorable for dental movement and could be harmful to the tooth and periodontium. The other disadvantage of these screws is the need for patient cooperation for their regular activation. The purpose of this study was to design a screw and compare its force- expansion curve with other types. Materials and Methods : A new screw was designed and fabricated in the same dimension, with conventional types, with the ability of 8 mm expansion (Free wire length: 12 mm, initial compression: 4.5 mm, spring wire diameter: 0.4 mm, spring diameter: 3 mm, number of the coils: n0 ine, material: s0 tainless steel). In this in vitro study, the new screw was placed in an acrylic orthodontic appliance, and after mounting on a stone cast, the force-expansion curve was evaluated by a compression test machine and compared to other screws. Results : Force-expansion curve of designed screw had a flatter inclination compared to other screws. Generally it produced a light continuous force (two to 3.5 pounds) for every 4 mm of expansion. Conclusion : In comparison with heavy and interrupted forces of other screws, the newly designed screw created light and continuous forces.

[ effectiveness of pencil pushup training and office-based vision therapy for treatment of convergence insufficiency]

To compare the effectiveness of pencil pushup training [PPT] versus office-based vision therapy in patients with convergence insufficiency. Sixty students of Zahedan Medical University with convergence insufficiency were randomly selected. After determining refractive error [by retinoscopy using cyclopentolate 1%, if needed], near point of convergence [by millimeter ruler], near heterophoria [by alternate prism cover test] and positive relative convergence [by prism bar]; subjects were divided into two groups to receive PPT [3 times daily for 10 min], or office prism training [2 times each week for 30 min]. Subjects were re-examined 4 and 8 weeks after initiation of treatment. Independent samples t-test showed that near point of convergence, phoria and positive relative convergence were not statistically different between the two groups before treatment. After 4 and 8 weeks of treatment only positive relative convergence was different between the two groups. Repeated measurement ANOVA showed considerable difference between the two groups in general but the Bonferroni test showed that the observed difference was related only to positive relative convergence. PPT and office-based vision therapy are comparable for treatment of convergence insufficiency

[Evaluation of orthodontic treatment needs in 14-18 year- old students in Shiraz]

Iran has one of the highest numbers of young people in the world; therefore, epidemiologic studies of dento-skeletal malformations in adolescents and young adults are important from population health viewpoints. The purpose of the study was to assess the needs for orthodontic treatment according to Index of Orthodontic Treatment Needs [IOTN] in 14-18 year old students in the city of Shiraz. 1818 students were selected from four districts of education in Shiraz using random cluster sampling. The dental health [DHC] and aesthetic [AC] components of the IOTN were used as an assessment measure of for orthodontic treatment needs. Also, demographic characteristics of the participants were recorded using a questionnaire. The data were analyzed using the student and Chi-squared tests. 60% of the students had no need for orthodontic treatment, 28.4% were in borderline category, and 11.7% showed definite needs for treatment. Also, there was a statistically significant association between malocclusion severity and sex or fathers job or education. 14-18 year old students in Shiraz had better dental appearances and did need less orthodontic treatment than in other populations

[ effect of anisometropia on stereopsis]

For good stereopsis, the two retinal images should have similar clarity, shape, and size. Anisometropia is one of the factors which has affect on stereopsis. The purpose of this study was investigation of induced anisometropia effect on binocular function and stereopsis. In this semi experimental study, a total of 135 students from Zahedan University of Medical Sciences who had inclusion criteria were selected randomly. At the beginning of the work, the refractive errors of the subjects were determined and corrected with retinoscop and their stereopsis measured using T.N.O test. Subsequently, this hyperopic and myopic anisometropia induced by use of negative and positive spherical lenses [power 1, 2, 3 diopter] in trial frame in front of one eye and in each state stereopsis measured again. In agreement and against the rule astigmatic anisometropia induced by positive cylindrical lenses in 180 and 90 degree axes and stereopsis measured again. Data were analyzed by SPPS. 14 software using within subjects factorial and repeated measurement ANOVA test. This study showed that both type and amount of anisometropia had significant effect on stereopsis [P<0.001]. The mean of stereopsis before intervention was [36.42 +/- 12.65]. The most and least reduction of stereopsis were related to 3D hyperopic anisometropia [339.42 +/- 125.1] and 1D with the rule astigmatic anisometropia [36.57 +/- 12.6], respectively. The mean of stereopsis before and after different type and amount of induced anisometropia were significantly different [P<0.001]. The result of this study showed that with increasing of anisometropia, stereoacuity decreases. Therefore, low degree of anisometropia, even 1D, can decrease both stereopsis and binocular function and thus, the amendment of stereopsis is necessary

effect of Cyclosporine A on the orthodontic tooth movement in rats

Immunosuppressive drugs have special effects on bone remodeling during orthodontic tooth movement. This study aimed at investigating the effect of oral Cyclosporin A, an immunosuppressive drug, on the orthodontic tooth movement in rats. Eighty male Sprague-Dawley rats, weighting 220-280 gm, were used. The animals were randomly assigned into control and experimental groups, each one containing 40 rats. Each group included four subgroups, each of 10 rats. Four groups of rats were selected for the assessment of the effect of olive oil and stripping stress of the lower incisors for a period of 15 and 30 days. The two experimental sub-groups received 10 mg/kg Cyclosporine A by gastric gavages every 24 hours for 15 and 30 days. The other two experimental sub-groups received 30 mg/kg cyclosporine-A by gastric gavages every 24 hours for 15 and 30 days. A fixed orthodontic appliance consisting of nickel - titanium closed coil spring, was ligated between the maxillary right incisor and the first molar. The initial activating force was 60 gm. One way Analysis of Variance and Tukey were used for comparing tooth movement between the two groups and eight sub-groups. The results showed that oral Cyclosporine A [30 mg/kg/30 day] could accelerate the rate of orthodontic tooth movement in rat [0.635 +/- 0.22 mm] [P<0.05]. Also, its administration period was more effective than the dose itself. Olive oil and stripping stress could not increase the rate of tooth movement. Due to the findings of this study and predominant effect of Cyclosporine A on orthodontic tooth movement in rats, the patients using Cyclosporine A may have the chance of more tooth movement. Further studies are requested for evaluating the effect of Cyclosporine A on increasing tooth movement in accordance with its dose and duration

Correction of crowding by Soft Elastic Foils: a case-report study

Everyday because of developing new materials and techniques,more adults become interested in orthodontic treatments. Soft positioner and its new generation in the name of Invisalign System is an example. The present case report was designed to study the effects of soft elastic foils as serial aligners on treating the mild to moderate crowding. Three teenage patients with crowding not more than 6 millimeters were selected. After the preparation of orthodontic diagnostic records and filling the periodontal chart, manual teeth setup was carried out on working casts with a maximum 0.5 millimeter displacement. Aligners were made up of bioplast foils. The appliance was worn by patient full time for at least 2 weeks. Then the new one was made and this procedure was continued until complete tooth alignment. The last aligner was used as retainer for three months later These variables were evaluated after treatment: dental alignment, over jet, overbite, inclination of upper and lower incisors, lips relation to E line, mandibular plan angle, clicking in TMJ, periodontal status and tooth pain. Active treatment period lasted between 3-5 months. Anterior crowding was completely corrected in all patients. Protrusion of upper and lower incisors were seen in lateral cephalograms. Overbite, mandibular plan angle and lips relation to E line did not change. Improvement of periodontal status were recorded in all patients.Low to moderate toothache was reported during the first 2 days. Mild to moderate crowding could be corrected successfully with soft elastic foils [Serial Aligners] without deleterious effects on TMJ and periodontium however manual tooth setup was time consuming