This is a case of follicular thyroid carcinoma with extensive lung, bone and brain metastases. Multi-modality treatments including total thyroidectomy, modified radical neck dissection, cranial radiotherapy and Iodine-131 (RAI) therapy were instituted. Post RAI therapy planar whole body scan showed RAI avid metastases in the skull, cervical spine, bilateral lungs and abdomen. With the use of SPECTCT imaging, rare adrenal metastasis and additional rib metastasis were identified. Besides, management strategy was altered due to detection of non-RAI avid brain and lung metastatic lesions.

Background: Multiple sclerosis (MS) is the most widespread disabling neurological condition in young adults around the world. The purpose of this study was to investigate the impact of explicit information (EI) on motor-sequence learning in MS patients. Methods: Thirty patients with relapsing-remitting MS (RRMS), age: 29.5 (SD = 5.6) years and 30 healthy gender-, age-, and education-matched control group participants, age: 28.8 (SD = 6.0) years, were recruited for this study. The participants in the healthy group were then randomly assigned into an EI (n = 15) group and a no-EI (n = 15) group. Similarly, the participants in the control group were then randomly assigned into EI (n = 15) and no-EI (n = 15) groups. The participants performed a serial reaction time (SRT) task and reaction times. A retention test was performed after 48 hours. Results: All participants reduced their reaction times across acquisition (MS group: 46.4 (SD = 3.3) minutes, P < 0.001, and healthy group: 39.4 (SD = 3.3) minutes, P < 0.001). The findings for the within-participants effect of repeated measures of time were significant (F(5.06, 283.7) = 71.33. P < 0.001). These results indicate that the interaction between group and time was significant (F(5.06, 283.7) = 6.44. P < 0.001), which indicated that the reaction time in both groups was significantly changed between the MS and healthy groups across times (B1 to B10). The main effect of the group (MS and healthy) (F(1, 56) = 22.78. P < 0.001) and also the main effect of no-EI vs EI (F(1, 56) = 4.71. P < 0.001) were significant.Conclusion: This study demonstrated that that RRMS patients are capable of learning new skills, but the provision of EI prior to physical practice is deleterious to implicit learning. It is sufficient to educate MS patients on the aim and general content of the training and only to provide feedback at the end of the rehabilitative session.

Biological Nitrogen Fixation (BNF) process benefits the agriculture sector especially for reducing cost of nitrogen fertilizer. In the process, the diazotrophs convert N2 into ammonia (NH3) which is useable by plants. The BNF process is catalysed by nitrogenase enzyme that involved protons and electrons together with evolution of H2 therefore, the assessment of N2 fixation is also available via H2 production and electron allocation analysis. Thus, the aims of this experiment were to estimate the nitrogenase enzyme activities and observe the influence of diazothrophs on growth of legume (soybean) and non legume (rice) plants. Host plants were inoculated with respective inocula; Bradyrhizobium japonicum (strain 532C) for soybean while Azospirillum brasilense (Sp7) and locally isolated diazotroph (isolate 5) for rice. At harvest, the plants were observed for plant growth parameters, H2 evolution, N2 fixation and electron allocation coefficient (EAC) values. The experiment recorded N2 fixation activities of inoculated soybean plants at 141.2 μmol N2 h-1 g-1 dry weight nodule, and the evolution of H2 at 144.4 μmol H2 h-1 g-1 dry weight nodule. The electron allocation coefficient (EAC) of soybean was recorded at 0.982. For inoculated rice plants, none of the observations was successfully recorded. However, results for chlorophyll contents and plant dry weight of both plants inoculated with respective inocula were similar to the control treatments supplied with full nitrogen fertilization (+N). The experiment clearly showed that inoculation of diazotrophic bacteria could enhance growth of the host plants similar to plants treated with nitrogenous fertilizer due to efficient N2 fixation process

Background: We aimed to test a new approach for repairing cerebrospinal fluid (CSF) leaks and to determine the demographic, diagnostic, and treatment factors associated with the successful management of intracranial complication. Owing to the high frequency of endoscopic surgeries and the low cost of medical care in Iran, we decided to report our experience of reconstruction after CSF leaks. Methods: We retrospectively reviewed our experience in the diagnosis and management of CSF rhinorrhoea in Iran between 2005 and 2012. The locations of all pre-repair leaks were identified using simple, readily available methods. The follow-up time ranged from 2 to 72 months. Results: Of the 37 participants, 59.5% were men and the mean age was 33 years. The success rate was 86.1%, and the most common aetiological factor was trauma (57%). The most common location was the ethmoidal fovea (45.9%), followed by the sphenoid sinus (24.3%), the cribriform plate (13.5%), and the posterior table of the frontal sinus (5.4%). Conclusions: Medical care in Iran has considerable budget restrictions. This study advocates a practical method of treatment for patients in similar circumstances, with a success rate of 86.1% when compared to the 90.6% achieved with other techniques.

Objective:To explore the cytotoxicity effects of Caspian cobra (Naja oxiana or N.oxiana) venom on hepatocytes and mitochondria obtained from the liver of HCC rats.Methods:In this study,HCC was induced by diethylnitrosamine (DEN),as an initiator,and 2-acetylaminofluorene (2-AAF),as a promoter.Rat liver hepatocytes and mitochondria for evaluation of the selective cytotoxic effect of N.oxiana venom were isolated and mitochondria and cellular parameters related to apoptosis signaling were then determined.Results:Our results showed a raise in mitochondrial reactive oxygen species (ROS)level,swelling in mitochondria,mitochondrial membrane potential (△ψm) collapse and release of cytochrome c after exposure of mitochondria only isolated from the HCC group with the crude venom of the N.oxiana (12.5,25,and 50 μg/mL).This crude venom also induced caspase-3 activation (P ＜ 0.001) in the hepatocytes obtained only from the HCC rat liver.Conclusions:Based on the over all results,we suggested that N.oxiana may be considered as a promising complementary therapeutic agent for the treatment of HCC.

· AIM: This study was conducted to compare the outcomes of amniotic membrane transplantation (AMT) with conjunctival autograft transplantation (CAT) in primary and recurrent pterygium. The main outcome measurement was the recurrence rate after surgery.· METHODS: This study was designed as a prospective study on consecutive cases of pterygium from April 2004 to Feb2006. The cases were randomly divided into two groups of AMT (26 cases) and CAT (24 cases). All subjects were operated with an extensive excision of the fibro vascular tissues with AMT or CAT approach. Patients were followed for recurrence and complications for 24 months. The surgical procedures were performed by a single surgeon.The associations between demographic variables, surgical techniques (AMT, CAT), recurrences and postoperative complications were analyzed.· RESULTS: The patients' male to female ratio was 4:1. Involvement of right to left eye ratio was 3:2. Pterygium in70% of cases was primary and in 30% was recurrent. The most common clinical signs were red eye and reduced visual acuity while the most common complications were recurrence and corneal scar. In the first month of follow up, the recurrence rates in AMT and CAT approaches were 3.8% vs 8.3%respectively and these rates increased to 46.2% vs 25% respectively after 24 months of follow up.· CONCLUSION: The success rate of 2 years follow up was better in CAT technique. The AMT technique for pterygium surgery has an unacceptably high recurrence rate.

Background: The prevalence of metabolic syndrome (MetSyn) is increasing worldwide. The aim of this study was to determine the prevalence of MetSyn and insulin resistance (IR) in children and adolescents in Qazvin, Iran. Methods: A cross-sectional study was conducted in 338 children and adolescents aged 10–18 years old who were selected by a multistage cluster random sampling method. We performed standardised measurements of variables including waist circumference (WC), blood pressure, plasma glucose level, total cholesterol, high-density lipoprotein cholesterol (HDL), triglycerides, and insulin. MetSyn was defined according to the International Diabetes Federation criteria. IR was estimated by the homeostatic model assessment. Results: Of the 338 total subjects, 172 were female. The overall prevalence of MetSyn and IR were 3.4% and 18.2%, respectively. There was no sex difference for the prevalence of MetSyn. A total of 185 subjects (56.4%) had one or two components of MetSyn. The most common component was low HDL levels in both sexes, which was followed by high WC in females and high fasting plasma glucose levels in males. Conclusion: The lack of a standard definition of MetSyn in children and adolescents combined with the geographical and socioeconomic differences make it difficult to compare the results from different studies. Modification of lifestyle habits is an important strategy in preventing MetSyn and IR.

Aim: Autoantibodies against cyclic citrullinated peptide (anti-CCP) are considered to be a sensitive and specifi c marker for rheumatoid arthritis (RA). This study evaluated the diagnostic and analytical performances of the automated anti-CCP assay. Materials and Method: Sera from 80 patients with established RA, 65 from other rheumatic diseases (non-RA) and 55 from healthy controls were studied using second generation anti-CCP. Rheumatoid factor (RF) was also assayed in each sample, and the results were compared to the anti-CCP fi ndings. Serum pools were used to determine the precision and linearity. Results: At a cut-off of 7.4 U/ml for anti-CCP, the sensitivity and specifi city for RA were 65% and 98% respectively. RF had a sensitivity of 58% and a lower specifi city of 93 % than anti-CCP. Conclusion: The high specifi city of the assay suggests that anti-CCP is useful in the diagnosis of rheumatoid arthritis and in our cohort of study population anti-CCP exhibits a better diagnostic value than RF. A considerable proportion (28%) of RF-negative RA patients were anti-CCP positive. Based on analytical performance of the assay, we conclude that full automation and high throughput features of AxSYM makes it an ideal platform for routine testing of anti-CCP.

Traumatic diaphragmatic hernia is a well known complication of blunt trauma to the abdomen and thorax. In the acute setting, laparotomy is mandatory. In this current era, this condition can be managed with minimally invasive surgery. We hereby report a case of delayed large left diaphragmatic hernia that was repaired with a combination of laparoscopic and thoracoscopic approach.
Hernia, Diaphragmatic