Structure-activity relationship of pyrazol-4-yl-pyridine derivatives and identification of a radiofluorinated probe for imaging the muscarinic acetylcholine receptor M4

There is an accumulating body of evidence implicating the muscarinic acetylcholine receptor 4 (M4) in schizophrenia and dementia with Lewy bodies, however, a clinically validated M4 positron emission tomography (PET) radioligand is currently lacking. As such, the aim of this study was to develop a suitable M4 PET ligand that allows the non-invasive visualization of M4 in the brain. Structure-activity relationship studies of pyrazol-4-yl-pyridine derivates led to the discovery of target compound 12 - a subtype-selective positive allosteric modulator (PAM). The radiofluorinated analogue, [18F] 12, was synthesized in 28 ± 10% radiochemical yield, >37 GBq/μmol and an excellent radiochemical purity >99%. Initial in vitro autoradiograms on rodent brain sections were performed in the absence of carbachol and showed moderate specificity as well as a low selectivity of [18F] 12 for the M4-rich striatum. However, in the presence of carbachol, a significant increase in tracer binding was observed in the rat striatum, which was reduced by >60% under blocking conditions, thus indicating that orthosteric ligand interaction is required for efficient binding of [18F] 12 to the allosteric site. Remarkably, however, the presence of carbachol was not required for high specific binding in the non-human primate (NHP) and human striatum, and did not further improve the specificity and selectivity of [18F] 12 in higher species. These results pointed towards significant species-differences and paved the way for a preliminary PET study in NHP, where peak brain uptake of [18F] 12 was found in the putamen and temporal cortex. In conclusion, we report on the identification and preclinical development of the first radiofluorinated M4 PET radioligand with promising attributes. The availability of a clinically validated M4 PET radioligand harbors potential to facilitate drug development and provide a useful diagnostic tool for non-invasive imaging.

Evaluation of the additive effect of domperidone on patients with refractory gastroesophageal reflux disease; a randomized double blind clinical trial

Background: Gastroesophageal reflux disease [GERD] is a common problem with annoying symptoms. It is associated with negative impact on quality of life. Prokinetic agents may be used in combination with acid suppression agents as an adjunctive in patients with GERD refractory to proton pump inhibitors [PPI] therapy, rather than as sole treatment. This study aimed to evaluate the efficacy of combination of PPI with domperidone [a prokinetic agent] compared with PPI alone in the treatment of patients with refractory GERD

Methods: This study was a double blind clinical trial on 29 patients with GERD refractory to PPI during the period of one month. By randomization, the patients were divided into two groups. Group A was treated by pantoprazole 40 mg twice daily and domperidone three times a day for a month, while group B was treated by pantoprazole 40 mg twice daily and placebo three times a day. In this study endoscopy was performed to evaluate the prevalence of erosive esophagitis, non-erosive reflux, and hiatal hernia. Manometry was conducted to study the prevalence of dysmotility. GERD symptom questionnaires including the Gastrointestinal Symptom Rating Scale [GSRS], Carlson Dennett, and the Medical Outcomes Study Short Form-36 health survey [SF36] were used before and after treatment for screening GERD and assessing treatment response

Results: There were 17 [58.62%] women and 12 [41.37%] men. The prevalence of erosive esophagitis and non-erosive reflux, was 10.34% and 89.66%, respectively. There was a significant difference comparing reflux symptoms before and after treatment between the two groups according to reflux and Carlson Dennett questionnaires. At the end of the study, symptoms of reflux significantly improved by treatment. Although, the quality of life questionnaire scores improved by treatment, there was no statistically significant difference in response to treatment between the two groups

Conclusion: In this research, we showed that adding domperidone to PPI could not make any improvement in patients with refractory reflux regarding the quality of life and improving the symptoms

efficacy of levofloxacin-based triple therapy for helicobacter pylori eradication after failure with clarithromycin-containing regimens

Background: Clinical trials and meta-analyses have reported about 20% failure rates in first-line Helicobacter pylori [H. pylori] eradication. This reflects the need for effective second-line eradication regimens

Materials and Methods: 61 patients with H. pylori infection who had failed previous non-bismuth clarithromycin-containing first line therapies entered the study. They were given a 14-day levofloxacin-containing triple regimen consisted of pantoprazole 40 mg, amoxicillin 1gr, and levofloxacin 500mg, each given twice daily. Eight weeks after the treatment, H. pylori eradication was assessed by 14C-urea breath test

Results: All patients completed the study. The eradication rate was 91.8% [95% confidence interval = 84.9% - 98.6%] by both intention to treat and per-protocol analyses. Side effects of therapy were reported by eight patients [13.1%], but they were severe in only two patients [3.2%]

Conclusion: According to the high H. pylori eradication rate and the very low rate of severe adverse effects, levofloxacin-containing triple therapy seems to be a suitable second-line option in case of previous failure by clarithromycin-containing therapies. We suggest further studies with shorter duration of treatment or lower dose of levofloxacin

A randomized trial study on the effect of amniotic membrane graft on wound healing process after anal fistulotomy / Ensaio clínico randomizado sobre o efeito do enxerto de membrana amniótica sobre o processo de cicatrização após fistulotomia anal

Abstract Objective Human amniotic membrane (HAM) used as a wound coverage for more than a century. The aim of this study is to evaluate the efficacy of amniotic membrane on wound healing and reduce post-operative complication. Study design Randomized clinical trial study. Place and duration of study Surgery Department, Shahid Faghihi Hospital, Shiraz, in the period of between Sep. 2014 and Nov. 2015. Methodology 73 patients with anal fistula were divided into two groups. The patients suffered from simple perianal fistula (low type) without any past medical history. Fistulotomy were performed for all of them and in interventional group HAM were applied as biologic dressing. Their wound healing improvement was evaluated post-operative in two groups. Results From 73 patients participated in the study, 36 patients were in control group and 37 patients were in intervention group. According to the analysis of images taken from the wound, the rate of wound healing was 67.39% in intervention group and 54.51% in control group (p < 0.001). Discharge, pain, itching and stool incontinency was lower in intervention group. Analysis of pathology samples taken from the wound showed no differences between two groups. Conclusion HAM application could lead to improvement of wound healing and reduced post-operative complications. In conclusion, HAM may act as a biologic dressing in the patients with anal fistula.

Resumo Objetivo Membrana amniótica humana (MAH) tem sido usada para cobrir feridas por mais de um século. O objetivo deste estudo é avaliar a eficácia da membrana amniótica na cicatrização de feridas e reduzir complicações pós-operatórias. Desenho do estudo Ensaio clínico randomizado. Local e duração do estudo Departamento de Cirurgia, Shahid Faghihi Hospital, Shiraz, Irã, entre setembro de 2014 a novembro de 2015. Método 73 pacientes com fístula anal foram divididos em dois grupos. Os pacientes sofriam de fístula perianal simples (tipo baixo) sem histórico médico prévio. A fistulotomia foi realizada em todos eles e no grupo intervenção, MAH foi aplicada como curativo biológico. A melhora da cicatrização foi avaliada no período pós-operatório em dois grupos. Resultados De 73 pacientes que participaram do estudo, 36 pacientes eram do grupo controle e 37 pacientes do grupo intervenção. De acordo com a análise das imagens da ferida, a taxa de cicatrização foi 67,39% no grupo intervenção e 54,51% no grupo controle (p < 0,001). Secreção, dor, prurido e incontinência fecal foi menor no grupo intervenção. A análise das amostras patológicas retiradas da ferida não mostrou diferenças entre os dois grupos. Conclusão A aplicação de MAH pode levar à melhoria da cicatrização de feridas e reduzir as complicações pós-operatórias. Em conclusão, a MAH pode atuar como um curativo biológico nos pacientes com fístula anal.

Efficacy of biofeedback therapy before and after sphincteroplasty for fecal incontinence because of obstetric injury: a randomized controlled trial

Fecal incontinence is a challenging condition in that it exerts various psychosocial impacts on daily life. Different treatment modalities have been suggested for fecal incontinence. The present study aimed to evaluate the efficacy of biofeedback therapy in combination with surgery in the management of fecal incontinence. The present randomized controlled trial was performed on 27 women with a complaint of fecal incontinence because of delivery trauma. The patients underwent sphincteroplasty and levatorplasty via the same method by 2 colorectal surgeons. In Group I, biofeedback therapy was performed 3 months before and 6 months after the surgery; in Group II, biofeedback therapy was applied only 6 months after the surgery; and in Group III, only surgical management was performed. The results revealed a significant difference between the preoperative and postoperative Wexner scores of incontinence in all the 3 groups. Additionally, the difference between the preoperative and postoperative scores was significant only in Group I and Group III, but not in Group II. The reduction in the Wexner score was significantly less in Group III. However, no significant difference was observed between the 3 groups concerning the mean difference of preoperative and postoperative manometry. The present study revealed no significant role for biofeedback therapy alone in the improvement of manometric evaluation. However, the Wexner score, which is an indicator of patient satisfaction, increased with biofeedback therapy following sphincteroplasty. In general, surgical treatment is now reserved for selected patients with fecal incontinence and has recently been developed with biofeedback therapy

comparison between hybrid therapy and standard triple therapy for helicobacter pylori eradication in patients with uremia: a randomized clinical trial

Background: The prevalence of peptic ulcer disease in hemodialysis patients is more than the general population. They are also more prone to complications including upper gastrointestinal bleeding. The aim of this study was to compare the efficacy of 14 days hybrid regimen with 14 days triple therapy for Helicobacter pylori [H. pylori] eradication in hemodialysis patients

Methods: Forty hemodialysis patients with naïve H.pylori infection were randomized to receive either hybrid regimen [pantoprazole 40 mg + amoxicillin 500 mg, both twice a day during the first 7 days, followed by pantoprazole 40 mg + amoxicillin 500 mg + clarithromycin 500 mg + tinidazole 500 mg, all twice a day, for the second 7 days, or standard triple therapy including pantoprazole 40 mg, clarithromycin 500 mg, and amoxicillin 500 mg, all twice a day for 14 days. H.pylori eradication was assessed by fecal H.pylori antigen test 8 weeks after the treatment

Results: All the patients completed the study. According to both intention to treat and per-protocol analyses, H.pylori eradication rates were 100% [95% confidence interval [CI]: 100] in those who received hybrid therapy and 70% [95% CI: 69.4 - 70.8] in those who were treated by standard triple therapy [p=0.02]. Severe adverse effects were not reported by any patient; however, mild adverse effects were more frequent in those who received standard triple therapy [p<0.05]

Conclusion: Hybrid regimen could achieve ideal H.pylori eradication rates with low rates of adverse effects

comparison between hybrid and concomitant regimens for helicobacter pylori eradication: a randomized clinical trial

Background: Helicobacter pylori [H. pylori] is one of the most common bacterial infections worldwide. We designed a study to compare the efficacy of 14-day hybrid regimen with 10-day concomitant therapy for H. pylori eradication in Iran

Methods: 252 patients with naive H. pylori infection were randomly divided to receive either hybrid regimen [pantoprazole 40 mg, and amoxicillin 1 gr twice daily for 14 days, accompanied by clarithromycin 500 mg, and metronidazole 500 mg, twice daily just during the last 7 days] or concomitant regimen [pantoprazole 40 mg, amoxicillin 1 gr, clarithromycin 500 mg, and metronidazole 500 mg, all twice daily for 10 days]. 8 weeks after therapy, 14C- urease breath test was performed to confirm eradication

Results: According to intention to treat analysis, the eradication rates were 87.3% [95% CI: 81.4-93.1] and 80.9% [95% CI: 74-87.8] in hybrid and concomitant groups, respectively [p=0.38]. Per-protocol eradication rates were 89.3% [95% CI: 83.8-94.7] and 83.1% [95% CI: 76.3-89.8], respectively [p=0.19]. The rates of severe side effects were not statistically different between the two groups [4% vs. 8.7%]

Conclusion: 14-day hybrid therapy can be considered as a nearly acceptable regimen with few severe side effects in Iran. However, it seems that the efficacy of this therapy is decreasing as the resistance rates to antibiotics are increasing. We suggest further studies to assess the efficacy of a more prolonged concomitant therapy for H. pylori eradication in Iran

Efficacy of clarithromycin containing bismuth-based regimen as a second-line therapy in helicobacter pylori eradication

The eradication of Helicobacter pylori infection, commonly prevailing in the stomach, has been important since its introduction. Adequate preparations should be made in finding alternatives when faced with first-line treatment failures. Currently, ideal second-line treatments are indistinct and varied among countries as result of different antibiotic resistance patterns. We aimed to evaluate the safety and efficacy of a clarithromycin-containing bismuth-based quadruple regimen as a second-line treatment. Forty-eight H.pylori-positive patients with proven gastric or duodenal ulcers and/or erosions who had previously failed to respond to furazolidone-containing regimens were enrolled. They received pantoprazole [40 mg-bid], amoxicillin [1gr-bid], bismuth subcitrate [240 mg-bid], and clarithromycin [500mg-bid] for 10 days. Eight weeks after treatment, a 14C-urea breath test was performed for the re-evaluation of H. pylori eradication. Forty-three patients completed the study. H.pylori eradication rates were 79.2% [95% CI=65.00-89.53] and 88.4% [95% CI=74.91-96.11] according to intention-to-treat and per-protocol analyses, respectively. All patients had excellent compliance to treatment and one did not continue therapy because of adverse effects. In developing countries such as Iran, a ten-day clarithromycin-containing bismuth-based quadruple regimen is encouraged as a second-line treatment because of the acceptable rate of eradication and low adverse effects

Developing a novel risk-scoring system for predicting relapse in patients with ulcerative colitis: a prospective cohort study

Objectives: Ulcerative Colitis [UC] follows a natural clinical course of relapses and remissions. The aim of this study was to construct a risk-scoring formula in order to enable predicting relapses in patients with UC

Methods: From October 2012 to October 2013, 157 patients from Shiraz, southern Iran who were diagnosed with UC and in remission were enrolled. At 3-month intervals, multiple risk factors of hemoglobin, complete blood counts, serum iron and albumin, erythrocyte sedimentation rate, and faecal calprotectin levels, sex, age, cigarette smoking, positive family history of inflammatory bowel diseases, past history of appendectomy, extra-intestinal accompanying diseases, extent of disease at the beginning of study, number of previous relapses, duration of disease and duration of remission before the study were assessed. Univariate and multivariate logistic regression were applied to fit the final model. The new risk-scoring system accuracy was assessed using receiver-operating-characteristics [ROC] curve analysis

Results: Seventy four patients [48.1%] experienced a relapse. Multivariate analysis revealed that relapses could significantly be predicted by the level of fecal calprotectin [OR=8.1], age [OR=9.2], the Seo activity index [OR=52.7], and the number of previous relapses [OR=4.2]. The risk scoring formula was developed using the regression coefficient values of the aforementioned variables

Conclusion: Four predictor variables were significant in the final model and were used in our risk-scoring formula. It is recommended that patients who achieve high scores are diligently observed, treated, and followed up

Inflammation, a key factor in cancer ambush

Inflammatory condition is the consequence of defensive mechanism of immune system against viral and bacterial infection, tissue injury, UV radiation, stress and etc. Persistently acute inflammation leads to chronic phase which is characterized by production of pro-inflammatory mediators from T cells. These molecules [e.g. IL-6, TNF-alpha, IL-1beta and IL-17] are mostly pleiotropic cytokines involved in multiple signaling cascades. NF-kappaB, STAT3, and HIF-1alpha are the major engaged pathways directing to several downstream targets associating with tumorigenesis and inflammation. Carcinogenesis processes such as DNA mutation/damage, proliferation, angiogenesis, apoptosis, and invasion are implicated to inflammation. Clearly there is a closely association between cancer and inflammation reported as "Seven Hallmark of Cancer". The elucidation of relationship between inflammation and cancer and their interaction may result in effective therapy and prevention. Gastric cancer is one of the main cancer involved in complex correlation of inflammation and cancer. Inflammation in gastric epithelium could trigger cellular transformation and promote invasion by inducing immune responses and utilizing signaling cascades. Gastric tumor microenvironment has inverse association by providing cytokines and inflammatory mediators. This closely relationship facilitates gastric tumor development and the induction of chronic inflammation in tumor microenvironment. The current review will focus on describing the possible and critical ways in which inflammation and cancer are linked together with specific view to gastric cancer and inflammation. Finally, it introduces some putative treatment generally used in this way in order to direct more attention for further exploration

comparison between moderate- and high-dose furazolidone in triple regimens for Helicobacter pylori eradication in Iran

Furazolidone has been used as an alternative for clarithromycin or metronidazole in Helicobacterpylori [H. pylori] eradication regimens. In Iran, 14-day Furazolidone-containing quadruple regimens have shown promising eradication rates, but short-course, low dose therapies are always attractive. Therefore, we designed a study to compare the efficacy of two 10-day triple regimens containing moderate and high dose furazolidone for H. pylori eradication. Two hundred and ten patients with peptic ulcer disease who were naive to H. pylori treatment were included. They were randomized into 2 groups: 105 patients received omeprazole 20mg, amoxicillin 1000mg, and furazolidone 200mg [OAF-400], all twice a day for ten days. And the remaining 105 patients received omeprazole 20mg twice a day, amoxicillin 1000mg twice a day and furazolidone 200mg three times a day for ten days [OAF-600]. Urease breath test was performed 8 weeks after the treatment to confirm H. pylori eradication. The intention-to-treat eradication rate was 76.19% in group OAF-400 and 80.95% in group OAF-600 [p=0.38]. Per protocol eradication rates were 81.63% and 89.47%, respectively [p= 0.11]. Severe adverse effects were reported by 8.6% of the patients in group OAF-400 and 5.7% of the patient in group OAF-600 [p=0.1]. However, the total side effects [including mild, moderate, and severe ones] were significantly more prevalent in the OAF-600 group [p=0.001]. None of our triple furazolidone-based regimens [moderate- and high-dose] could achieve the standard eradication rate, and therefore, cannot be considered as a suitable option for first-line treatment

late-onset psoas abscess formation associated with previous appendectomy: a case report

Psoas abscesses could originate from an adjacent source of infection in the abdominopelvic cavity known as a secondary complication of acute appendicitis. However, it is considered as a very rare event when occurring late after the presentation of appendicitis. Whether it is the source or complication of acute appendicitis following appendectomy remains unclear. A 25-year-old man was admitted to our center with fever and abdominal pain. His past medical history was unremarkable except for having an acute appendicitis and complicated appendectomy 4 years before presenting illness. On admission, the patient was febrile with right lower quadrant abdominal tenderness and moderate leukocytosis. The Abdominopelvic CT-scan revealed a large right psoas muscle than the opposite site, that contained a hypodense mass measuring 6 cm in diameter with extension into right iliacus and internal oblique muscles..The patient underwent subsequent percutaneous abscess drainage under image guide and concurrent broad-spectrum antibiotic therapy

Interposition of ileal J-pouch for rectum reconstruction in dog

Background: The gold standard of the management of rectal cancer in the middle and lower parts is low anterior resection with coloanal anastomosis. About 50% of the patients undergoing this procedure might experience some complications because of the low capacity of the neorectum. The aim of this study was to evaluate ileal J-pouch interposition as a neorectum between the anal canal and the remaining colon in comparison to coloanal anastomosis and transverse coloplasty

Methods: Twelve dogs, weighing 23-27 kg, were divided into three groups. After laparotomy, the volume of the primary rectum was measured so that it could be compared with that of the neorectum at the end of the study. After rectal resection in Group A, the colon was directly anastomosed to the anus. In Group B, a 5-cm longitudinal incision was made 2 cm proximal to the anastomosis and was sutured transversely [coloplasty]. In Group C, a 5-cm ileal J-pouch was interposed between the colon and anus. After 8 weeks, the neorectum was evaluated for volume, radiology, and pathology

Results: All the samples were alive until the end of the study. The healing of the anastomotic lines was acceptable [pathologically] in all. The mean volume expansion was 20.9% in Group A, 21.7% in Group B, and 118.2% in Group C, with the latter being significantly higher than that of the other groups [P=0.03]. Colon J-pouch and coloplasty after proctectomy in some situations have not been performable. This study evaluated the performance of ileal J-pouch interposition

Conclusion: This study showed that ileal J-pouch interposition might produce an acceptable reservoir function and that it seems feasible and safe in selected cases

Expression status of UBE2Q2 in colorectal primary tumors and cell lines

Background: Activation of the ubiquitin-proteasome pathway in various malignancies, including colorectal cancer, is established. This pathway mediates the degradation of damaged proteins and regulates growth and stress response. The novel human gene, UBE2Q2, with a putative ubiquitin-conjugating enzyme activity, is reported to be overexpressed in some malignancies. We sought to investigate the expression levels of the UBE2Q2 gene in colorectal cell lines as well as in cancerous and normal tissues from patients with colorectal cancer

Methods: Levels of UBE2Q2 mRNA in cell lines were assessed by Real-Time PCR. Western blotting was employed to investigate the levels of the UBE2Q2 protein in 8 colorectal cell lines and 43 colorectal tumor samples

Results: Expression of UBE2Q2 was observed at the level of both mRNA and protein in colorectal cell lines, HT29/219, LS180, SW742, Caco2, HTC116, SW48, SW480, and SW1116. Increased levels of UBE2Q2 immunoreactivity was observed in the 65.11% [28 out of 43] of the colorectal carcinoma tissues when compared with their corresponding normal tissues. Difference between the mean intensities of UBE2Q2 bands from cancerous and normal tissues was statistically significant at P<0.001 [paired t test]

Conclusion: We showed the expression pattern of the novel human gene, UBE2Q2, in 8 colorectal cell lines. Overexpression of UBE2Q2 in the majority of the colorectal carcinoma samples denotes that it may have implications for the pathogenesis of colorectal cancer

Expression Levels of Vascular Endothelial Growth Factors A and C in Patients with Peptic Ulcers and Gastric Cancer

PURPOSE: Vascular endothelial growth factor (VEGF) is one of the most important growth factors for metastatic tumors. To clarify the role of VEGF-A and C in patients with peptic ulcer disease (PUD) or gastric cancer (GC), we evaluated the expression levels of these two molecules. We also analyzed the effect of Helicobacter pylori infection on VEGF-A and C expression levels. MATERIALS AND METHODS: Patients with dyspepsia who needed diagnostic endoscopy were selected and divided into three groups: non-ulcer dyspepsia (NUD), PUD, and GC, according to their endoscopic and histopathological results. Fifty-two patients with NUD, 50 with PUD, and 38 with GC were enrolled in this study. H. pylori infection was diagnosed by the rapid urease test. After RNA extraction and synthesis of cDNA, the expression levels of VEGF-A and C were determined by quantitative reverse transcriptase polymerase chain reaction. RESULTS: The VEGF-C expression level in the PUD and GC groups was significantly higher than that in the NUD group. Moreover, the VEGF-A expression level in the PUD and GC groups was higher than in the NUD group, although the differences were not statistically significant. Significant positive correlations were also observed between the expression levels of these two molecules in the PUD and GC groups. In addition, the expression levels of these two molecules were higher in H. pylori positive patients with PUD or GC than in H. pylori negative patients of the same groups; however, these differences did not reach statistical significance. CONCLUSIONS: Up-regulation of VEGF-C expression during gastric mucosal inflammation may play a role in the development of peptic ulcers or GC.

Comparison of the patients' satisfaction after inpatient and outpatient operations for haemorrhoidal disease

To compare the patients' satisfaction between outpatient and inpatient haemorrhoidectomy. Cross-sectional study. Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran, from January to July 2011. A total of 208 patients were involved in this cross-sectional study. All patients were examined by their specialists and after definite diagnosis of haemorrhoid, they were randomly allocated to two groups: outpatient and inpatient. Data for this study was collected by a satisfaction questionnaire. There was no statistical significant difference between the two groups' satisfaction. Both groups were quite satisfied. Also, there was no statistical significance regarding the variable of time of visit. In addition, there was no association between the patients' satisfaction and with, occupation, and level of education. Based on the results of the study, minor operations such as haemorrhoidectomy are better to be done in clinics since they do not differ from the operating room regarding the patients' satisfaction

Prevalence of EPIYA motifs in Helicobacter pylori strains isolated from patients with dyspeptic disorders in northern Iran

Cytotoxin-associated gene A [CagA]-positive strains of Helicobacter pylori are associated with gastroduodenal diseases. Evidences have suggested that the type of H. pylori CagA EPIYA motifs may be associated with recurrent dyspepsia [i.e. gastritis, peptic ulcer, or gastric cancer]. We investigated the prevalence of different EPIYA motifs [A, B, C, or D] in H. pylori strains isolated from patients with recurrent dyspepsia who underwent upper gastrointestinal [GI] endoscopy. We investigated the prevalence of different EPIYA motifs [A, B, C, or D] in H. pylori strains isolated from patients with recurrent dyspepsia who underwent upper gastrointestinal [GI] endoscopy. H. pylori strains were isolated from biopsy specimens of 220 patients with recurrent dyspepsia. The presence of glmM gene, as a housekeeping gene, CagA gene, and pattern of CagA EPIYA motifs were determined using polymerase chain reaction [PCR] method. The association between the type of motifs and disease state was determined by the Chi-square test, Fisher's exact test, and logistic regression. CagA-positive H. pylori strains were identified in 125 [57%] of patients, including 36 [28.6%] gastritis, 31 [24.6%] duodenal ulcer, and 58 [46.4%] gastric cancer. The frequency of pattern of CagA EPIYA motifs were detected as 39 [31.2%] AB motifs, 54 [43.2%] ABC motifs, 32 [25.6%] ABCC motifs,and no D motifs. The risk of gastric cancer occurrence was estimated to be 2.57 times higher in patients infected by strains with ABCC motif when compared with gastritis and duodenal ulcer patients [p=0.03]. Moreover, patients with C-containing motifs were 2.27 times more likely to be afflicted with gastric cancer than with duodenal ulcer. AB motif was more associated with gastritis and duodenal ulcer than ABC and ABCC motifs. The results suggested that CagA-EPIYA ABCC might be associated with gastric cancer, while EPIYA-AB might be associated with duodenal ulcer

Late results of endorectal flap in management of high type perianal fistula

Fistula-in-ano is a problematic perianal disease for physicians and patients because of its occasional difficulty in management. Due to the different types of fistulas seen in patients, careful approach is necessary to correctly choose from among the various surgical techniques. One surgical method for complex fistula is the endorectal advancement flap which has been frequently performed because of its low complication rate. This study enrolled 40 [33 males, 7 females] patients who suffered from high type fistula [greater than 30%-50% involvement of the external sphincter] as noted on digital rectal examination and endoanalsonography. Patients were seen at Shahid Faghihi Hospital, affiliated with Shiraz University of Medical Sciences, between 2007 and 2011. All enrolled patients received similar preoperational preparation. We used the jackknife operative position and determined the internal orifice of the fistula by inserting a probe, with injection of methylene blue or oxygen peroxide. Endorectal advancement flap included the mucosa, submucosa and thin portion of the muscle that completely covered the sutured internal orifice area. The external orifice was opened to adjust the external border of the external sphincter to allow for effective drainage. All enrolled patients were followed for 36 months, which was noticeable statistically when compared with other study findings of high type fistula. The location of the external orifice, age, sex and bowel habits were not related to recurrence rate. Endorectal advancement flap in selected patients who suffer from high type fistula seems to have beneficial effects with a low recurrence rate. Therefore, management of complex high type fistulas remains a challenging topic.

healing effect of teucrium polium in acetic acid-induced ulcerative colitis in the dog as an animal model

Inflammatory bowel diseases [IBD], which include ulcer-ative colitis [UC] and Crohn's disease [CD], are debilitating and chronic disorders with unpredictable courses and complicated treatment measures. Therefore, an efficient treatment protocol seems necessary as therapeutic prophylaxis for these disorders. This study aims to determine the healing effect of Teucrium polium [T. polium] in acetic acid-induced UC in an experimental dog model. From September to December 2010, eight male [20-25 kg] crossbred dogs were used for induction of UC by 6% acetic acid, tran-srectally. After one week, three biopsies [10, 20 and 30 cm proximal to the anal verge] were taken from the colon of each animal for histological studies. In the presence of UC, 400 mg/kg/day of T. polium extract was administered orally and transrectally [via enema] for 30 days in six of the dogs. The remaining two dogs were used as controls and did not receive T. polium. Multiple biopsies were taken 7, 14, and 30 days after discontinuation of T. polium in the same manner as before treatment. After administration of acetic acid, we noted the presence of multiple ulcers, diffuse inflammation, PMN infiltration in the lamina propria, glandular destruction and goblet cell depletion. Treatment with T. polium restored the colonic architecture with an increased number of healthy cells and a reduction in inflammatory cells. Damage of the surface epithelial cells and mucosal layer of the lumen were reversed, which lead to faster ulcer healing. T. polium may be a treatment choice for UC and can broaden the current therapy options for UC

Determination of trace elements in patients with chronic hepatitis B

Chronic Hepatitis B virus [HBV] infection is a major liver disease worldwide and its clinical manifestations are linked to immune response. The purpose of this study was to evaluate the relationship between selenium, copper, and zinc in comparison with transaminase level in chronic HBV patients. Serum samples of the HBV infected patients were obtained from Tooba medical center, Sari, Iran. Sixty patients were enrolled in this study [36 men and 24 women], mean age: 39.6 +/- 12.2 years. The concentration of zinc, selenium, copper and transaminases were determined using an autoanalyzer system. Concentrations of selenium [0.273 +/- 0.056 micro g/dl] and zinc [2.1 +/- 0.037] was elevated in patients with low transaminase levels as were significantly different in comparison with patients with high transaminase level [P<0.05]. Serum copper concentration was similar in two groups of patients. Elevated levels of transaminase concentrations were independently associated with low zinc and selenium concentrations in chronic HBV patients. It is concluded that serum zinc and selenium levels are associated with less hepatic damage in chronic HBV patients and might have a protective role during liver injury