History and Objectives: Due to discrepancies on the effect of low power Helium-Neon laser on healing of bone fracture, the present study intends to investigate such effect on healing of bone deformation of rabbit tibia.

Materials and Methods: An experimental study on 39 albino rabbits was carried out. They were randomly divided into control and experimental groups. Under aseptic condition and using anesthesia, an incision was made on skin with deep fascia on the internal surface of tibia bone on the left side of the animal. With an electric drill (2mm), a small deformation or hole was created on this surface. The day of surgery was considered as zero day and animals were divided into 3 groups of 14, 21 and 28 days. A low power laser, 1.2 J/cm², was applied daily once every day. Animals were killed and the left tibia bone was removed. Biomechanic studies were performed on the bones. The degree of fragility was determined by using 3 point bending of the bones. The absorbed energy at the point of fracture and the extent of bone deformation and elastic stability was measured.

Results: The extent of elastic stability and absorbed energy was significant in 21st and 28th day of experimental group respectively (P<0.05). Augmentation of biomechanic specificities was observed in the 3 experimental groups and differences were significant for day 14-28 and 21-28.

Conclusion: Laser radiation with low power Helium-Neon with energy density of 1.2 J/cm² is performed according to the procedure in the present study increases the speed of bone healing at the site of tibia bone deformation.

History and Objectives: Increase in attention is paid for the use of various techniques such as ultrasound to improve connective tissue healing. The present research will study the effect of ultrasound therapy on bone regeneration in rabbits from histological point of view.

Materials and Methods: In an experimental study, 28 white male Dutch rabbits with 3 month of age and 1200gr weight underwent medical open partial osteomy of tibia bone under general anesthesia and sterile conditions. Rabbits were divided randomly into experimental and control groups. In each seven subgroup (5th, 7th, 9th, 13th, 15th, 20th and 27th days) were formed. The experimental group was treated with 1 w/cm² ultrasound pulse 2:8 with 1.5MHz frequency for 5 min for 7 days (As mentioned above) against control group. Measurements wee done in above mentioned time intervals after surgery. After the time intervals, animals were killed and tibia was examined for fracture macroscopically as well as microscopically.

Results: Histological findings (Light microscopy measurements indicated that healing process in experimental group was faster compared to control group in inflammation and proliferation phase (15th days after surgery). Healing process in experimental group was slower than control group in callus formation and remodeling phase (From 15th to 27th days after surgery).

Conclusion: Ultrasound therapy with 1.5MHz frequency accelerates bone healing in initial stage (Inflammation and proliferation) in rabbits.

History and Objectives: Delivery is associated with severe pain and it is one of the most severe types of pain. Regardless of recent progress in medical-surgical operations, management of delivery with reduced pain is one of the challenges of medicine. The present study was conducted to address the effect of childbirth preparation in order to reduce pain and duration of delivery without therapeutic use in the Imam Khomeini hospital in the city of Semiroom in Iran in 1999-2000.

Materials and Methods: A clinical trial was carried out on 100 primigravida mothers. They were selected by random-sequential sampling into two groups (50 experimental and 50 control groups). The two groups were matched for age, weight/height percentage, educational status, condition of cervix before delivery and history of dysmenorrhea. Experimental group (32±2 weeks of pregnancy) participated in the childbirth preparation classes held weekly for 2 hours for 4 to 6 weeks prior to delivery. Mothers received information about pregnancy, delivery and related techniques. Members of experimental group were accompanied by research team during labor and delivery. The control group received routine care. The intensity of pain was measured by Mac Gill ruler. Chi-square and t-test statistical analysis were carried out.

Results: In the first stage of delivery, the occurrence of moderate and severe pain in the experimental group were 46% and 48% respectively and 18% and 70% in the control group. There was a significant difference in the two groups (P<0.0001). There was no mild and moderate pain in the second stage of delivery. Severe and more severe pain in the experimental group were 12% and 88% respectively and 4% and 96% in the control group. Average duration of the first and second stage and total duration of delivery in the control group were 336.5±54.5, 50.6±12.3 and 405±56.5 and in the experimental group were 243.2±72.5, 30.7±12.2 and 284±77.7 min respectively. There was a significant difference between the two group (P<0.0001).

Conclusion: Childbirth preparation reduced intensity of pain in the first stage of delivery and duration of first, second and total duration of delivery. It seems that childbirth preparation should be included in the prenatal instructions for mothers. Further research is needed to study other methods of childbirth preparation.

Background : Lumbar and thoracolumbar fractures are among the most common fractures of spine. Some instable fractures require fixation and TLSO brace. Nowadays, pedicular screw are more commonly applied for rapid fixation and bone fusion, thus, it seems as if brace may be used less commonly. The present study was performed to determine the role of brace in lumbar instable fracture after fixation with pedicular screw in Loghman hospital.

Materials and methods : For this clinical trial patients were assigned in 2 groups of with and without brace. Radiologic and clinical examination data of 1, 3, and 12 months after surgery were used to determine bone fusion. Chi square and Fisher's exact test were used for data analysis.

Results : Of 56 cases with thoracolumbar fracture, 48 were fixated with pedicular screw. Falling was the most common etiology, L1 was the most common affected vertebra, and burst was the most common fracture type. Groups were similar according to demographic features. Fusion rate was 60% with brace and 58% without brace in a 3-month follow up however, it was 100% in both groups after one year. Residual back pain did not differ significantly between groups.

Conclusion : Brace did not influence the outcomes. Thus, patients with instable thoracolumbar fracture may not require TLSO brace following the pedicular screw surgery.

 Background: Chronic hepatitis B is among the prevalent causes of chronic hepatitis and cirrhosis. The aim of this article is to discuss the indications for treatment, available drugs, and identify drug resistance or intolerance and primary treatment failure in chronic hepatitis B.

 Materials and Methods: A summary of epidemiology, natural course and treatment options of chronic hepatitis B is presented in this paper according to AASLD practical guidelines for treatment of hepatitis B (2009). On the basis of serum HBV DNA, alanin aminotransferase and HBe Ag level as well as the liver histological findings the natural course of chronic hepatitis B is divided into four phases: immune tolerance, immune clearance, inactive carrier state and relapse. These phases indicate the patient's immune system activation against the virus and the leading histological liver damage.

 Results: Patients in immune tolerance and inactive carrier state phases do not need treatment and should only be followed up while those in immune clearance and relapse phases do need treatment. Selection of PEG IFN or nucleoside analogues should be based on the presence of cirrhosis, viral load and genotype, drug resistance and also the patient's preference. Drug intolerance or resistance can lead to relapse and drug should be stopped or changed in these occasions.

 Conclusion: Due to the rapid increase of information about chronic hepatitis B treatment and generation of new antiviral medicines, the guidelines for treatment are changing rapidly. Appropriate early treatment decreases mortality and morbidity rate caused by liver disease.

Background: As a worldwide problem, hepatitis C Virus (HCV) infection similar to HIV and vaccine studies on HCV is among the hottest research topics in the field. Such a vaccine should elicit strong humeral and cellular responses against HCV antigens (Ags). The major aim of the present study was to compare and optimize the responses against HCV core protein (HCVcp) immunization formulated in novel human compatible adjuvants.

Materials and Methods: BALB/c mice were immunized by HCVcp, purified in native conditions and in different adjuvant formulation in separate following groups: Ag+CpG, Ag+M720 (Montanide ISA 720), Ag+F127 (Pluronic acid) and cocktails of Ag+F127+CpG and Ag+M720+CpG. ELISA-based assays were used to analyze IgG, cytokine and CTL responses.

Results: The M720 (+CpG) immunized mice developed the highest HCVcp-specific titrations of total IgG,IgG1, 2a, 2b, and that of IFN-γ and IL-4 cytokines. HCVcp-specific-CTLs against relevant MHC class I peptides were detected only for Ag+M720+CpG, Ag+M720, and Ag+CpG groups, could be blocked by antimouse-CD8 antibodies and were stable for one year post-immunization.

Conclusions: The M720 formulation of HCVcp (with a synergistic effect by inclusion of CpG) induces equally strong Th1/Th2 responses and stable CTLs.

Background: Non-alcoholic fatty liver disease is among the prevalent causes of chronic hepatitis and cirrhosis. Here, we discuss the best diagnostic and therapeutic approaches for the disease.

Materials and Methods: Epidemiology, pathogenesis, etiologies, natural course, differential diagnosis, treatment options, complications and follow up of the disease are reviewed in this paper.

Results: Non-alcoholic fatty liver disease seems to be the hepatic manifestation of the metabolic syndrome. Liver function tests and sonography can be used as the appropriate screening tests for diagnosis. Weight loss and control of hyperlipidemia and diabetes mellitus might be the best therapeutic approaches.

Conclusion: Early diagnosis and appropriate treatment may decrease mortality and morbidity rate associated to the cardiovascular complications of the metabolic syndrome.

Background: Touch cytology is one of the sensitive ways of diagnosing Helicobacter pylori in stomach biopsies. The current study was designed to compare touch cytology with histology method in the diagnosis of Helicobacter pylori infection.

Materials and Methods: This study was performed on 150 dyspeptic patients undergoing upper gastrointestinal endoscopy in Kashan Shahid Beheshti Hospital. Antrum samples (2-4) were taken from each of 150 patients. One biopsy sample was considered for touch cytology and the remaining biopsy samples were studied for histological examination.

Results: Eighty-three out of 150 patients (55.3%) were men with the mean age of 46.63±5.93 years. The sensitivity, specificity, positive predictive value and negative predictive value in the touch cytology method were 95.65%, 100%, 100% and 66%, respectively, while in the histology method they were 84.78%, 100%, 100% and 36.36%, respectively. The sensitivity of the touch cytology was more than that of the histology method (P<0.001) in the diagnosis of H. pylori.

Conclusion: Since the cytology method is more sensitive with equal specificities in relation to histology method, when the histological information is not necessary, the cytology method can be considered more reliable for diagnosing Helicobacter pylori.

Background: Diabetes Mellitus is one of the most common metabolic disorders causing pathophysiologic changes in multiple organs. Considering the burden of diabetes and its complications, this study aimed to evaluate the frequency of musculoskeletal complications in diabetic patients.

Materials and Methods: This cross-sectional study was performed on 327 diabetic patients referred to Kashan diabetes center during 2009-10. Age, the type of diabetes and clinical manifestations such as arthralgia, paresthesia, and limited range of movement of joints were obtained from the hospital medical records of patients and then musculoskeletal complaints (e.g., adhesive capsulitis, carpal tunnel syndrome, dupuytren's contracture, trigger finger, and limited range of movement of joints) were diagnosed and recorded by a rheumatologist.

Results: The mean ages of type II and I diabetic patients were 54.6±12.61 and 29.7±10.36 years, respectively. Carpal tunnel syndrome (49.8%), knee osteoarthritis (45%), sclerodactyly (27.2%), dupuytren's contracture (14.1%), trigger finger (11.9%), adhesive capsulitis (11.9%), limited joint movements' syndrome (8%) and Charcot joint (0.6%) were seen in patients. There was a significant relationship between the type of diabetes and knee osteoarthritis (P<0.003 OR=1.86 CI=1.05-3.30) and also carpal tunnel syndrome (P<0.045). A significant relationship was also seen between duration of disease and trigger finger, dupuytren's contracture (OR=3.76 CI=1.9-7.41) and limited joint movements.

Conclusion: The findings of this study indicated that type of diabetes and also its duration (over 15 years) may increase the risk of musculoskeletal complications. Hence, careful periodic examinations of all diabetic patients are recommended.

Background: Stroke as a sudden death of brain cells due to insufficient blood supply may impair the postural balance. The disturbance in balance may increase and decrease the risk of fall and self-confidence, respectively. Therefore, the aim of this study was to examine the effect of aquatic and land-based exercises on postural balance of women after stroke.

Materials and Methods: In this observational study, 36 women with stroke were randomly allocated into three groups: Exercise in water (Group 1), Exercise on land (Group 2) and control. Groups 1 and 2 were participated in a 8-week exercise program. The Control group did not participate in any exercise during this period. All participants performed the functional reach test.

Results: Results showed that postural balance of the patients was improved after the exercise therapy (P<0.001). Exercise in water and on land improved the postural balance of the patients (P<0.001). The effect size for exercise in water was 10% more than exercise on land.

Conclusion: While the exercise therapy can improve the active balance of patients with stroke, the exercise in water is more effective on postural balance than the land-based exercise.