Background: The use of large doses of opioid analgesics to treat pain after cardiac surgery can prolong the time to tracheal extubation and interfere with the recovery of the BOWEL and bladder function in the postoperative period. Therefore, we sought to investigate the efficacy of a continuous infusion of Bupivacaine 0.5%, at the median sternotomy site, for 48 hours after cardiac surgery in reducing the opioid analgesic requirement and improving the recovery process.Methods: In this prospective, randomized, placebo-controlled, double-blind clinical trial, 36 consenting patients undergoing open heart surgery with a standardized general anesthetic technique had two indwelling infusion catheters placed at the median sternotomy incision site at the end of surgery. The patients were randomly assigned to receive normal saline (control), Bupivacaine 0.5% via an elastomeric infusion pump at a constant rate of 4 ml/h for 48 hours. In addition, the postoperative opioid analgesic requirements and opioid-related adverse effects were recorded.The patients" satisfaction with their pain management was assessed at specific intervals during the postoperative period. Duration of mechanical ventilation and time of ventilation were assessed in the two groups.Results: Compared with the control group, there was a statistically significant reduction in ambulatory time 13.7±2.5 vs.16.5±4.6 hours (P=0.03). Hospital stay was also shorter in the case group (5±0.6 vs.6.1±0.9 with P=0.01). Extubation time and ICU stay were not statistically significant (P=0.93 for extubation time and P=0.70 for duration of ICU stay), and also patient satisfaction in the two groups was not statistically significant. Opioid dose, used in the case group, was 1.1±0.8 and in the control group was 3.7±1.3, with the difference being statistically important (P=0.02).Conclusion: A continuous infusion of Bupivacaine 0.5% at 4 ml/h is effective for decreasing pain and the need for opioid analgesic medication as well as for improving patient satisfaction with pain management after cardiac surgery. Patients in the Bupivacaine-0.5% group were able to ambulate earlier, leading to a reduced length of hospital stay.

Sepsis is a systemic inflammatory response SYNDROME caused by an infection and remains as a major challenge in health care. Many studies have reported that pioglitazone may display anti-inflammatory effects. This study was designed to evaluate the effect of subchronic treatment with pioglitazone on highgrade septic mice survival and nitrergic system involvement. Diffused sepsis was induced by cecal ligation and puncture (CLP) surgery in male NMRI mice (20-30 g). Pioglitazone (5,10 and 20 mg/kg) was administered by gavage daily for 5 days prior to surgery. Nitric oxide involvement was assessed by subchronic administration of a non-selective nitric oxide synthase inhibitor, L-NAME and a selective inducible nitric oxide synthase inhibitor, aminoguanidine. TNF-a and IL-1b plasma levels were measured by ELISA. Pioglitazone (10 and 20 mg/kg) significantly improved survival rate in septic mice. The chronic intraperitoneally co-administration of L-NAME (0.5 mg/kg, daily) or aminoguanidine (1 mg/kg, daily) with a daily dose of pioglitazone, 5 mg/kg, significantly increased the survival rate. This survival improving effect was accompanied by a significant reduction in pro-inflammatory cytokines TNF-a and IL-1b plasma levels. In conclusion, sub-chronic pioglitazone treatment can improve survival in mouse sepsis model by CLP. Inhibition of nitric oxide release, probably through inducible nitric oxide synthase at least in part is responsible for this effect. Suppression of TNF-a and IL-1b could be another mechanism in pioglitazoneinduced survival improving effect in septic mice.

Background & Objective: Asthma is a Lifestyle inflammatory and reversible disease of airways. Change in Lifestyle by increasing obesity and decreasing physical activity is the main cause of its high prevalence. Asthmatic patients are less fit than their healthy control subjects. Evidence reveals the association between mechanical life, inadequate physical activity, and increased daily calorie expenditure with adolescent obesity SYNDROME, On the other hand, overweight and obesity has increased the risk of asthma and inefficiency of lung function. Therefore, the role of the respiratory system in adjusting the acid-free balance during exercise can be considered very important. If an efficient respiratory system leads to a better refinement of toxic substances, attention to pulmonary capacity and volume in different individuals, and the impact of environmental factors on it seems to be necessary. Accordingly, one of the most critical indicators of respiratory function is vital; vital capacity is a reflection of a large amount of respiratory capacity that results in better air purification in the lagoon of the lungs. Pulmonary vital capacity and output volume (FEV) are a strong indicator of lung function that has been reduced due to obesity and inactive Lifestyle. One of the known methods for the treatment of asthma patients is rehabilitation; rehab programs have added therapeutic value to patients with asthma. They cause a significant improvement in these patients, which is one of the essential components of pulmonary rehabilitation. Therefore, this study aimed to evaluate the effect of aerobic training on pulmonary function (FEF, PEF, MVV, FEV) in middle-aged women with mild asthma. Methods: This semi-experimental study was performed on two groups of 30 obese women with mild asthma, referring to medical centers in Urmia. The subjects were randomly assigned to control (n = 15) and exercise (n = 15). The exercise group performed aerobic exercise for eight weeks in the form of fast-paced walking and intermittent running and aerobic base movements. The program of each exercise session from the first week to the third week consisted of 50 minutes of aerobic exercise with an intensity of 50% of maximum heart rate. Lasted seven to eight weeks, every 60 minutes of aerobic exercise with an intensity of 70-75% of the maximum heart rate given by the Polar machine was measured. In this study, spirometric measurements used for factors such as expiratory flow, maximum voluntary ventilation, expiratory flow maximal in 75% of the vital capacity, and expiratory volume ratio in the first seconds to mandatory vital capacity. Statistical analysis performed using the Shapiro-Wilk test and covariance analysis, and the significance level was 0. 05. Data analyzed by SPSS version 22. Results: The results showed that MVV, FEF, FEV, and PEF and their changes in pretest and post-test stages after eight weeks of aerobic training evaluated. The results of the covariance analysis showed that there was a significant difference between the two groups of training and control in all the respiratory variables by maintaining the pretest and post-test scores (p<0. 05). The findings indicated that eight weeks of aerobic exercise had a significant effect on the increase of MVV (p=0. 003), FEF (p=0. 024), FEV (p<0. 001), and PEF (p=0. 002) in the research sample. No significant changes observed in the control group. Conclusion: Performing asthma exercises can contribute to the improvement of asthma treatment for asthmatic patients. Therefore, considering the beneficial effects of exercise, especially aerobic exercise, the protocol of treatment of asthma patients in our country must also be modified to use sports protocols under the supervision of medical specialists and with their advice. Patients with asthma improve their respiratory rate by participating in the exercise rehabilitation program; they can better handle daily tasks, as a result of the aerobic exercise presented in the present study. Effective treatment intervention for obese people asthma is mild because this exercise volume reduces the body composition index, which is a factor in asthma.

Background & Objectives: Autism Spectrum Disorder (ASD) is a neural– evolutionary SYNDROME, i. e., among the most significant disorders in childhood. In other words, autism indicates an evolutionary disability which affects verbal and non– verbal communication, as well as social interactions. Moreover, this disorder usually manifests before the age of three years, and has undesirable effects on educational functioning. Playing music is a multi– sensory process which involves motor planning, preparation, and execution systems in individuals. Purposeful musical– motor activities make children with ASD to shift focus from their inner world to their surrounding environment; subsequently, they create a mutual relationship with the community and social acceptance in children with ASD. The present study aimed to investigate the effects of musical– motor activities on autism symptoms in children with High– Functioning Autism (HFA) disorder. Methods: This was a quasi– experimental study with a pretest– posttest and a control group design. In total, 22 children with HFA disorder and the mean± SD age of 8. 5± 1. 5 years and the mean± SD IQ score of 89. 36± 2. 31 were selected as study participants. Moreover, they were randomly divided into three groups, as follows: exercise intervention with music (7 children, 5 boys and 2 girls), exercise intervention without music (7 children, 6 boys and 1 girl), and the control group, including music (8 children, 6 boys and 2 girls). The study participants in the exercise intervention with music and non– music groups, practiced in a 12– week program of three sessions per week; each session lasted from 45 to 60 minutes. The Orff music was used in this study ) guitar, tombak, xylophone, Flute, drum, metallophone, improvisation, singing, blows with the body, nursery rhymes and consistent with music therapist(. The exercise intervention program included 5 to10 minutes of warm– up )walking, hand and foot stretching, & reviewing the learned movements), 35 to 45 minutes of main practice, that included 20 to 25 minutes of gymnastic fundamental movements (walking, jumping, static and dynamic balance, rabbit, flamingo, cat, crabs, dog, cow, kangaroo, hopping, bridge on shoulders, push– up, & movement on trampoline(, 10 minutes of practice with ball (catching, throwing & dribble), and 10 minutes of rhythmic movements (hands and feet creative and rhythmic movements). additionally 5 to 7 minutes was considered for cool– down, including stretching movements and relaxation. Moreover, the Garss– 2 Measurement Scale (Gilliam) was used for collecting data concerning autism symptoms in children with HFA disorder. The obtained data were analyzed in SPSS. Furthermore, we implemented Levene's test, Analysis of Covariance (ANCOVA), Analysis of Variance (ANOVA), and Bonferoni test at a significance level of 0. 05 for data analysis. Results: Results indicated that two groups of exercise intervention with music and without music performed better in stereotyped behavior, communication skills, and social interactions, compared to the control group. Besides, there was a significant difference between the two experimental groups in terms of stereotyped behavior (p<0. 001), communication skills (p<0. 001), and social interactions (p<0. 001). Conclusion: According to the current research findings, musical– motor activities were effective in the control and improvement of stereotyped behavior, communication difficulties, and social interactions in children with HFA disorder; these progresses were achieved through providing sensory feedback and replacing similar mechanisms. Rhythmic games, as well as rhythmic and creative movements lead to the control and improvement of stereotyped behavior, social interactions, and communication skills in musical– motor activities. Therefore, musical– motor interventions could be used to control and reduce the symptoms of autism and should be considered in designing training programs for this population.

Mendelian susceptibility to mycobacterial diseases (MSMD) is a rare inheritance SYNDROME, characterized by a dissemi-nated infection with mycobacterium in children following BCG vaccination at birth. Regarding the vaccination pro-gram in Iran, it may consider as a public health problem. The pathogenesis of MSMD is dependent on either insuffi-cient production of IFN-gamma (g) or inadequate response to it. Here, we want to introduce three cases including two siblings and one girl from two unrelated families with severe mycobacterial infections referred to Immunology, Asth-ma and Allergy Research Institute (IAARI), from 2013 to 2015; their MSMD was confirmed by both cytokine assess-ment and genetic analysis. Regarding the clinical features of the patients, cell proliferation against a mitogen and BCG antigen was ordered in a lymphocyte transformation test (LTT) setting. ELISA was performed for the measurement of IL-12p70 and IFN- g in whole blood samples activated by BCG+recombinant human IFN-g and BCG+recombi-nant human IL-12, respectively. In contrast to mitogen, the antigen-dependent proliferation activity of the patients’ leukocytes was significantly lower than that in normal range. We identified a homozygous mutation in IL12RB1 gene for two kindred who had a homozygous mutation affecting an essential splice site. For the third patient, a novel frameshift deletion in IL12RB1 gene was found. The genetic study results confirmed the impaired function of stimu-lated lymphocytes to release IFN-g following stimulation with BCG+IL-12 while the response to rhIFN-g for IL-12p70 production was relatively intact. Our findings show that cellular and molecular assessments are needed for pre-cise identification of immunodeficiency disorders especially those without clear-cut diagnostic criteria.

Background: Milk is a highest quality source of wellbalanced nutrients and also displays a range of biological activities that affects digestion, metabolic responses to absorbed nutrients, growth and development of specific organs, and resistance to disease. Milk have two proteins, the caseins and whey which containing physiologically active peptides. The aim of review study is description of health promoting properties of bioactive peptide in order to induction of opportunities for nutritional and biomedical applications.Methods: literature review using the following databases: SciELO, Lilacs and Medline, pubmed, Scopus from 1990 to 2014. The key-words used were milk proteins, milk peptides, bioactive milk peptides.Results: Bioactive peptides could be released during gastrointestinal digestion, enzymatic hydrolysis and fermentation. The components include b -lactoglobulin, a-lactalbumin, bovine serum albumin, lactoferrin, immunoglobulins, lactoperoxidase enzymes, glycomacropeptides, proline rich polypeptides, lysozyme, aS1-casein, aS2-casein, b -casein, к-casein. These peptides directly influence numerous biological processes evoking behavioral, gastrointestinal, hormonal, immunological, neurological, and nutritional responses.Studies have shown that milk-derived bioactive peptides have many health promoting properties such as: antioxidant, antihypertensive, immunomodulatory, anticancer, cholesterol lowering, neurological transmission, anti-inflammatory, antimicrobial, insullinotropic, antithrombotic, hypolipidemic and promoting bone growth. For example, a-lactalbumin, Lactoperoxidase and lysozyme have good effects in prevention of cancer and control tumor size. Lysozyme applied in pharmaceutical products. Proline-rich polypeptide (PRP) was introduced to therapy of Alzheimer’s disease patients.The therapeutic usefulness of PRP was confirmed in several clinical trials and supported by studies on its mechanism of action. Casein derivatives are used in the dry mouth SYNDROME and hypertension. The products containing bioactive milk peptides used as therapeutic or preventive recourse for a wide range of pathological states in variety group of people with different age such as elderly, adults, infants, neonate and children with no adverse effects.Conclusion: The milk-derived preparations have found broad application in the food industry, production of infant formulas, and hygiene products as supplement for prevention and treatment of some diseases or condition.

Considering the importance of the mass campaign for measles- rubella vaccination in the elimination of measles and Congenital Rubella SYNDROME, and also the necessity of the accurate quantitative and qualitative assessment of the process of this program and the estimation of the information coverage regarding the passive launch of the program, this assessment has been carried out within the population covered by Tehran University of Medical Sciences using a standard method. This study is descriptive- analytical. The necessary sample size was defined as 390 people for the estimation of the immunization coverage, 190 people in each step of the information coverage (and a total of 570 people for the overall three steps), and finally 24 executive teams for the assessment of the quality of the service. Lot Quality Assurance Sampling and subsequent analysis were used for the assessment of service quality, with the upper threshold set at 80% and the lower threshold at 30%. Each lot was defined acceptable or unacceptable based on the quality of the vaccination, the cold chain, the competence of the human resource, and the availability of the necessary materials and equipment. Data analysis was done using the Chi-Square and Fisher's exact tests. 96.4% (95% CI: between 94.6% and 98.2%) of the people between 5 and 25 years old had received the MR vaccine. 7 people (1.8%) of the vaccinated people were not in the target group of vaccination. From the total 190 people who were studied on the basis of information coverage, 152 people (80.9%), 184 people (96.8%) and 190 people (100%) were informed about the mass campaign for MR vaccination in the first, second, and the third steps respectively. More than 80% of the people were informed about the program through TV. The quality of the vaccination was acceptable in 19 executive teams (79.1%) and unacceptable in the other 5 executive teams (20.9%). In this study, the quality of the cold chain was acceptable in 23 executive teams (95.8%) and unacceptable in one team (4.2%). The competence of the human resource, the necessary materials and equipment for MR vaccination was acceptable in all 24 executive teams under study (100%). The enforcement of the mass campaign in such short period of time compared to similar programs in other countries demonstrated the success of the collaborators in the execution of this program. Overall it seems that regarding the quality of vaccination, information coverage, and the provision of materials and equipment in health centers of the districts, the program has achieved its goals.      

Spermatozoa are highly specializedcells with the purpose of not onlydelivering competent paternal DNA to the oocyte but also to provide a robust epigenetic contribution to embryogenesis. The identification of sperm fertility markers and the ability to selecthealthy spermatozoa for ART have a dual objective of choosing the best treatment strategy and optimizing ART outcomes. Currently, sperm indexes determination in the clinical setting is generally based on cell morphology and DNA content. Both sperm morphology and DNA integrity results, obtained from raw semen samples, have been shown to be of prognostic value for unassisted and assisted conception and useful in the selection of the best assisted conception modality. These assays, however, provide an assessment of the distribution of cells in a given ejaculatethat may not be representative of the sperm population used in the ART treatment cycle.In fact, severe teratozoospermia, using Kruger’s strict criteria on pre-ART semen analysis, does notcorrelate to fertilization and embryo formation (including blastocyst development) in ICSI cycles. Nonetheless, if a more holistic approach to sperm morphology is taken, two prognostic groups can still be identified in cases of severeteratozoospermia (<4% normal) because certain morphology patterns and sperm abnormalities are known to affect ICSI outcomes.The first group includes mostly genetically determined sperm pattern defects, such asglobozoospermia, short tail SYNDROME and small-headed spermatozoa (in most cases combined with very small acrosomes). All of these types represent untreatable conditions that have been associated with abnormal sperm function andpoor ART outcomes. The second group includes unspecifiedor non-genetically determined sperm defects or patternscaused by environmental factors, medication, infection and related infertility conditions, including varicocele. Treatment of these conditions has been shown to optimize sperm morphology indexes with a positive impact on ART outcomes. Although the technician microscopically selects morphologically normal individual sperm during ICSI, form normalcy does not necessarily imply normal DNA content. As such, sperm DNA testing has been advocated to be an independent and reliable marker of fertility potential since sperm chromatin andDNA integrity is essential to ensure that the fertilizing sperm cansupport normal embryonic development of the zygote. At present, conflicting reports exist on the role of sperm DNA fragmentation index for embryo development, and it is apparent that DNA fragmentation does not significantly impair zygote and cleaving embryo morphology because major activation of the embryonic genome only beginafter the 4-cell stage. These observations do no underscore the importance of finding ways to increase sperm DNA integrity, since it has been suggested that DNA fragmentation is associated with late paternal effects that may lead to early miscarriages or diseases in the offspring. The etiology of sperm DNA damage is multi-factorial and may be due to primary (ageing, cryptorchidism, genetic defects, idiopathic) and or secondary (drugs, environmental, tobacco smoking, genital tract inflammation, infection, testicular hyperthermia and varicoceles) factors. Specific or non-specific treatments, including antioxidant supplements, are generally associated with reduced levels of sperm DNA damage and/or improved fertility potential. Taken in conjunction, it is apparent that there is no unique sperm factor able to predict embryo development, but several candidate biomarkers are involved in this complex process.As a result, a wide variety of techniques have been proposed, including externalization of phosphotidylserine (magnetic-activated cell sorting), cell charge (zeta charge), maturity markers (hyaluronic acid binding) and detailed morphological analysis (intracytoplasmic morphologically selection sperm injection). Currently, these are several shortcomings for the routine application of these new methods to a busy IVF laboratory, both financially and logistically, and current data fail to indicate superiority of any of these methods over conventional ICSI. It is clear that better sperm fertility tools are urgently required. In this context, metabolomics and proteomic sperm profiling are under investigation and may be translated into clinical practice in the near future.