Vol 47 No 6 (2018)


Review Article(s)

  • XML | PDF | downloads: 304 | views: 332 | pages: 779-787

    Background: Pycnogenol exhibits many biological activities, including control of blood pressure (BP). However, the reported results are inconsistent because of varied characteristics of participants and quality of studies. Thus, a meta-analysis was conducted to examine the effect of Pycnogenol supplementation on BP.

    Methods: This literature search of PubMed, the Web of Science and the Cochrane library was performed in May 2016 to identify eligible studies. Reference lists of the retrieved articles were also reviewed. Either a fixed-effects or, in the presence of heterogeneity, a random-effects model was used to calculate the effect of combined treatment.

    Results: We identified nine trials involving 549 participants who received Pycnogenol supplementation ranging from 150 mg/d to 200 mg/d. Compared with the control, the pooled estimate of change in systolic and diastolic BPs were -3.22 mmHg (95% CI: -6.20, -0.24) and -3.11 mmHg (95% CI: -4.60, -1.62), respectively. Subgroup analyses showed higher BP reduction among hypertensive participants or those who received intervention for more than 12 wk. However, this significant reduction was not observed in well-designed trials.

    Conclusion: This meta-analysis with nine trials provides better evidence that Pycnogenol exerts beneficial effects on BP.


Original Article(s)

  • XML | PDF | downloads: 318 | views: 358 | pages: 788-793

    Background: To investigate the effects of childbirth age on maternal and infant outcomes in pregnant women.

    Methods: The clinical data of 4552 singleton parturient women and their newborns treated in the Second People’s Hospital of Liaocheng, China from June 2015 to June 2017 were retrospectively analyzed. They were divided into group A (<20 yr old), group B (20-<30 yr old,), group C (30-<35 yr old), group D (35-<40 yr old), group E (≥40 yr old) according to the age of the parturient women. The incidence rates of pregnancy complications and adverse pregnancy outcomes of the pregnant and parturient women and their newborns in each group were compared.

    Results: With the increase of childbirth age, the incidence rates of pregnancy complications in pregnant women were increased gradually (P=0.028, 0.038, 0.042, 0.025, 0.012). The incidence rates of adverse pregnancy outcomes were increased gradually with the increase of childbirth age (P=0.006, 0.026, 0.010, 0.028). After correction of factors including pre-pregnancy body mass index (BMI), parity, gravidity and educational level, the incidence rate of cesarean section was reduced and the incidence rate of premature birth was increased in group A compared with those in group B. The incidence rates of cesarean section, premature birth, postpartum hemorrhage of pregnant women and the transference of newborns into NICU in group C, D and E were higher than those in group B (P=0.002, 0.019, 0.043, 0.015).

    Conclusion: Both low and high age pregnancy can increase the incidence rate of adverse pregnancy outcomes.



  • XML | PDF | downloads: 246 | views: 278 | pages: 794-802

    Background: Adult mortality is associated with different demographic and behavioral risk factors including approaches to health care financing. Adult mortality rate significantly reflects the effectiveness of public health-related program and intervention. The aim of this study was to find strength of association between key health's related indicators and adult mortality rate.

    Methods: This cross-sectional study used 5 sets of data combined into one from different organizations of 193 countries using record linkage theory. Eleven key health-related indicators were taken as independent variables and adult mortality of male and female were dependent variables from 2010 to 2013. Average mortality for male and female was shown by means and standard deviations, raw association by Pearson correlation and strength of association by hierarchical linear regression.

    Results: The average adult mortality rate (AMR) of male was 0.209±0.106 and of female, 0.146 ±0.105 in years. In raw correlation, almost all health indicators were associated with AMR of male and female. In regression analysis, Universal Health Coverage (UHC) significantly reduced (male ~0.43, female ~0.30) adult mortality, in contrast, population growth significantly increased (male ~ 0.37, female ~0.43). Alcohol consumption per year increased AMR in male by 0.41 (P<0.01) and vaccination coverage (DPT 3) significantly reduced the AMR (0.26) in female.

    Conclusion: It is necessary to extend the UHC in remaining countries and still a need to control the population where there is high population growth. Effectively control of alcoholic drink in male and full coverage of vaccination in childhood mitigates adult mortality. The UHC is ambitious goal for SDG and special attention should be provided nationally and globally



  • XML | PDF | downloads: 257 | views: 353 | pages: 803-813

    Background: Cancer is the leading cause of death in human disease and is a major public health problem around the world. Exosomes are a promising cancer biomarker and therapy target. Recent evidence demonstrate that tumor cells could inhibit natural killer (NK) cells’ immune surveillance function by releasing exosomes into tumor microenvironment. The intercelluar uptake of tumor cell-derived exosomes by NK cells is vital for using these exosomes in tumor diagnose and therapy. We aimed to investigate the efficiency of NK cell uptake of tumor exosomes.

    Methods: Exosomes derived from different tumor cells, RAW264.7 cells and NK cells were labeled by fluorescent dye and co-cultured with NK cells. The uptake rates of NK cells were observed by fluorescence microscope and analyzed by flow cytometry.

    Results: NK cells could take up more exosomes from themselves and cell lines originating from bone marrow. Epithelial cell lines can take up more exosomes from epithelial cells. There was no significant difference in uptake efficiency between Jurkat cells and RAW264.7 cells by NK cells, indicating that maybe the origin other than species affects the efficiency of recipient cell uptake of exosomes. Different tumor cells derived exosomes had different uptake efficiency by NK cells.

    Conclusion: There is certain pattern of NK cells uptake tumor exosomes, which provide important insights on how tumors affect NK cells and develop appropriate countermeasures. In addition, it can be also helpful to select and design proper exosomes as a drug carrier in future.


  • XML | PDF | downloads: 241 | views: 195 | pages: 814-823

     Background: The prevalence of functional disability is very high among elderly people. Malnourished individuals are less likely to recover from limited mobility and have higher risk of deterioration of functional disability. This study investigated factors influencing mobility relative to nutritional status in elderly women with diabetes mellitus.

    Methods: We analyzed data of 464 elderly women with diabetes mellitus, obtained from the 2014 cross-sectional survey of the Korea Institute for Health and Social Affairs.

    Results: In the well-nourished group, body mass index, difficulties in daily activities due to visual acuity loss, muscle strength, and depressive symptoms were significant predictors of mobility; the explanatory power of this model was 24.0% (F=12.905; P<0.001). In the malnourished group, muscle strength, depressive symptoms, and nutritional status were significant predictors of mobility; the explanatory power of this model was 40.5% (F=16.589; P<0.001).

    Conclusion: The level of mobility relative to nutritional status varied widely among elderly women with diabetes mellitus. Therefore, to improve mobility in malnourished elderly people, public health nurses must provide comprehensive nutrition management and a support system in addition to physical and psychological interventions.



  • XML | PDF | downloads: 207 | views: 251 | pages: 824-829

    Background: To investigate the clinical efficacy of trimetazidine and holistic management in the treatment of coronary heart disease.

    Methods: A total of 128 cases of patients with coronary heart disease were admitted in The Second Affiliated Hospital of Dalian Medical University from October 2014 to June 2017. These patients were divided into control group and experimental group, with 64 patients each. The patients in the control group underwent conventional treatment. On this basis, the patients in the experimental group were treated with trimetazidine. Both groups underwent holistic management. The clinical conditions, echocardiography indexes, life quality, and mental states of patients were compared between the two groups.

    Results: The total efficient rate of patients in the control group was significantly lower than that of the experimental group, and the difference was statistically significant (P<0.05). After treatment, the left ventricular ejection fraction of patients in the experimental group was higher than that of the control group; the left ventricular end diastolic diameter and left ventricular posterior wall thickness of patients in the experimental group were lower than those of the control group, and the differences were statistically significant (P<0.05). The physiological health score, mental health score, Hamilton Depression Scale and Hamilton Anxiety Rating Scale of patients were significantly decreased compared with the control group, and the differences were statistically significant (P<0.05).

    Conclusion: The efficacy of trimetazidine in the treatment of coronary heart disease is definite. The assisting holistic management can significantly improve the mental status and life quality of patients by enhancing the cardiac function, which has clinical reference and promotion values.


  • XML | PDF | downloads: 204 | views: 261 | pages: 830-837

    Background: Urinary incontinence is prevalent among older adults worldwide and associated with lower quality of life. Obesity is highly associated with development or exacerbation of urinary incontinence. We examined the impact of different types of obesity (general obesity and abdominal obesity) on urinary incontinence.

    Methods: We employed 2007-2009 Korean National Health and Nutrition Examination Survey (KNHANES) with 4648 females over 19 yr of age. Body mass index, waist circumstance, total body fat percentage, trunk fat percentage, demographic variables, and potential confounding factors were assessed. Chi-square tests and logistic regression analysis were used. 

    Results: There were significant trends of increasing risk of urinary incontinence with increasing body mass index (P =.002), waist circumstance (P = .001), percent total body fat (P =.029) and percent trunk fat (P =.005). Regarding the association of urinary incontinence prevalence with different types of obesity, nonobese women with abdominal obesity had the highest odds ratio of urinary incontinence, followed by obese women with abdominal obesity (odds ratio = 1.59 and 1.55, respectively).

    Conclusion: Abdominal obesity may be more likely to be associated with urinary incontinence compared to overall obesity. Early screening and identification of abdominal obesity may be needed for older women to prevent or reduce urinary incontinence episodes.


  • XML | PDF | downloads: 212 | views: 209 | pages: 838-843

    Background: We investigated the combined effects of Kanglaite (KLT) and cisplatin on tumor associated macrophage (TAM) and expression of hypoxia inducible factor-1 alpha (HIF-1α) in Kunming mice with Lewis lung carcinoma.

    Methods: Kunming mice with Lewis lung carcinoma were randomly divided into four groups: the control (NS) group, KLT group, cisplatin (DDP) group and DDP+KLT group in Hebei People's Hospital, Hebei China from 2016 to 2017. Tumors were harvested 14 days after corresponding interventions.

    Results: The percentage of TAM was determined by flow cytometry and HIF-1α mRNA was detected by realtime-PCR. Tumor weight of mice in KLT group, DDP group and DDP+KLT group was significantly lower than that of NS group (P<0.01). Tumor growth inhibition rate in DDP+KLT group was higher than DDP group, (P=0.205). The spleen index was lower in the DDP group than in the NS group (P=0.005), but was significantly increased when combined with KLT (P<0.01). The percentage of TAM was higher in the DDP group than in the NS group (P=0.898); the combination with KLT significantly decreased the percentage (P=0.009<0.01). Expression of HIF-1α was lower in the KLT group and DDP+KLT group than in NS group; it was decreased more in DDP+KLT group (P<0.05).

    Conclusion: KLT led to pronounced antitumor activity in mice with Lewis lung carcinoma. It enhances the chemotherapeutic effect and improves immunity function when combined with cisplatin, which can be accomplished by decreasing the TAM levels and improving hypoxia status.


  • XML | PDF | downloads: 176 | views: 217 | pages: 844-851

    Background: The aim of this study was to explore the associations of haplotypes of the glucose transporter 9 (SLC2A9) genes with type 2 diabetes mellitus (T2DM) complicated with hyperuricemia (HUA).

    Methods: Overall, 608 Chinese males, enrolled from the Affiliated Hospital of Medical College of Qingdao University in 2009-2012, were genotyped. The subjects included 167 withT2DM (average age of onset (58.07±11.82 yr), 198 with HUA subjects (average age of onset (39.20±9.73) yr), 115 with T2DM complicated with HUA (average age of onset (51.24±10.09) yr), and 128 control subjects (average age (41.92±10.01) yr). Patients genotypes of the SNPs; including rs734553 was determined by PCR method. Each genotype was regressed assuming the co-dominant, dominant and the recessive models of inheritance with covariates of duration of total glucose, uric acid, urea nitrogen, triglyceride, cholesterol, and creatinine levels.

    Results: Chi-square test revealed that rs734553polymorphism was both significantly associated with HUA as well as T2DM complicated HUA, but not with pure T2DM. After adjustment for age and gender, analysis showed that people with C allele had higher risk of HUA andT2DMcomplicated HUA than those without C allele. And none of the subjects had the homozygous genotype for SLC2A9 (CC).

    Conclusion: The SLC2A9 mutation increases the risk for T2DM complicated HUA in Chinese population, which suggested that intron variants between two relatively conserved exons could also be associated with diseases. In patients of T2DM complicated with HUA, the diagnosis and detection of SLC2A9 gene variants should be caused enough attention.


  • XML | PDF | downloads: 207 | views: 245 | pages: 852-860

    Background: Physicians and nurses are core staff who are the first points of contact in care provision to patients. We aimed to examine physicians’ and nurses’ perceptions of patient safety in a case hospital by administering the Chinese Safety Attitude Questionnaire (CSAQ), developed from the Taiwan Joint Commission on Hospital Accreditation, in order to provide the patients with a safe environment and excellent medical service.

    Methods: An intra-organizational online survey was conducted. Confirmatory factor analysis (CFA) was first performed on the assessment of the measures for patient safety culture and seven dimensions with 33 items were identified. Pearson correlation analysis was subsequently used to examine the strength and direction of the relationships between seven dimensions of patient safety culture.

    Results: A total of 800 questionnaires were issued and 405 valid questionnaires were collected, the effective response rate being 50.6%. The findings highlighted that safety climate (SC) was positively and significantly related to teamwork climate (TC) and perception of management (PM), whereas stress recognition (SR) was negatively related to burnout (BUR).

    Conclusion: Patient safety culture in healthcare organizations has been considered a critical issue for improving the quality of healthcare. This study further focused on the contribution of a better patient safety culture for healthcare organizations in Taiwan.



  • XML | PDF | downloads: 218 | views: 199 | pages: 861-867


    Background: The posts related to Adverse Drug Reaction (ADR) on social websites are believed to be valuable resource for post-marketing drug surveillance. Beyond domain feature, the aim of this study was to find a more effective method to detect ADR related post.

    Methods: We conducted experiment on posts using sentiment features from March 8 to May 20 in 2016 in Shanghai of China. Firstly, the diabetes posts were collected; the 1814 posts were annotated by hand. Secondly, sentiment features set were generated and the (CHI) statistics were used to select feature. Finally, we evaluated the effectiveness of our method using the different feature sets.

    Results: By comparing the posts detection performance of different feature sets, using sentiment features by CHI statistics can improve ADR related post detection performance. By comparing the ADR-related group with the non-ADR group, performance of ADR related post detection was better than the performance of non-ADR post detection. We could obtain highest performance owing to introducing sentiment feature and using CHI feature selection technique, and the method was proved to be effective during detecting post related to ADR.

    Conclusion: By using sentiment feature and CHI feature selection technique, we can get an effective method to detect post related to ADR.


  • XML | PDF | downloads: 205 | views: 205 | pages: 868-874

    Background: We evaluated the anti-malarial activity of Heracleum persicum individually and in combination with chloroquine.

    Methods: This study was conducted at the School of Public Health, Tehran University of Medical Sciences, Tehran, Iran in 2015-2016. The Peter̛ s method was used for determining fifty percent effective dose (ED50) of the H. persicum extract and chloroquine individually against chloroquine sensitive P. berghei in small white mice. Six experimental groups for H. persicum and 6 groups for chloroquine and two control group (positive and negative) were considered for determination of ED50. Interaction between H. persicum and chloroquine also was evaluated based on fixed ratios method. Ratios of 0/100, 20/80, 40/60, 60/40, 80/20, 100/0 of ED50 of chloroquine and H. persicum respectively were tested against the parasite. Then inhibitory effects of two drugs were calculated and plotted in the relevant graphs.

    Results: Overall, 1500 mg/kg, and 1000 mg/kg concentrations of H. persicum against P. berghei resulted in ED50 and ED74 respectively. ED50 of chloroquine against the parasite was obtained as 1.4 mg/kg of mouse body weight. Moreover, combination of H. persicum and chloroquine showed a weak potentiation in ratios of 40/60 (chloroquine +H. persicum) with 64% inhibition, but not in other ratios.

    Conclusion: Although H. persicum individually showed a reasonable antimalarial efficacy against chloroquine sensitive P. berghei, in combination with chloroquine it showed additive or antagonism result except in ratios of 40%CQ+60%HP.


  • XML | PDF | downloads: 648 | views: 532 | pages: 875-883

    Background: Respecting patients confidentiality and privacy are considered as the patients’ rights. Confidentiality is the key virtue for trust building in physician-patient relationship. While law considers confidentiality as absolute except for legal situations, despite efforts to maintaining confidentiality, sometimes breaching confidentiality is unavoidable but not necessarily unethical. There is no Iranian unified ethical guideline to define clear approaches to patient confidentiality in clinical setting. To keep all medical data confidential it is necessary to identify the scope of the problem. In this study, we aimed at identifying the scope of the problem.

    Methods: This study was conducted in three phases including literature review, qualitative study (semi-structured interview) and focus group discussion. The literature review provided a framework for the second phase.

    Results: The content analysis of the interviews presented 3 main themes indicating problems in maintaining confidentiality in clinical setting including management issues, organizational ethics and physician-patient relationship.

    Conclusion: Based on the results a draft guideline in confidentiality in clinical setting was prepared and finalized in focus groups discussions.


  • XML | PDF | downloads: 251 | views: 249 | pages: 884-892

    Background: Laboratory services fragmentation creates problems such as non-accountability for costs and quality, not being patient-centered and unsustainability of services in long run. Therefore, health systems consider laboratory services integration an inevitable way. This study aimed to investigate the challenges and barriers to the integration of laboratory services in Iran.

    Methods: This qualitative case study was conducted in 2016. Using purposive sampling, semi-structured interviews were conducted with 34 informed participants. Each interview lasted between 30 to 60 min. Acceptability, transferability, reliability, and verifiability were used to assess the validity, accuracy and reliability of qualitative data. Framework approach was used to analyze data.

    Results: Lack of economy of scale, unfair access, lack of grading, low quality, development of national strategies to create an integrated network of laboratories, criteria of the laboratories establishment, creation of necessary infrastructure, empowering the private sector and standardization of indicators were considered the most important problems of laboratory services integration in Iran; they were classified into two main themes.

    Conclusion: Identified issues are challenges which adversely impact the integration of laboratory services. Therefore, providing infrastructures with increased cooperation between various organizations to increase access to laboratory services in the form of an integrated network is essential.


  • XML | PDF | downloads: 312 | views: 261 | pages: 893-900

    Background: We aimed to evaluate the household food security status and associated factors in East-Azerbaijan, Iran (urban and regional areas).

    Methods: Data (n=1385) as a part of the major lifestyle promotion project conducted in northwest of Iran were collected in 2015, by short form of the Household Food Security Scale consisting six questions. The Chi-square and Logistic regression were used to for statistical analysis.

    Results: The prevalence of food insecurity was 58.4%. The rate of food insecurity in the residents of capital city (59.7%) was higher than those of residents of regional cities (57.18%), however, this difference was not statistically significant (P=0.36). The respondents with family size more than 3 (P=0.01), unemployed (0.001) and married (0.01) respondents and the ones with lower education levels (P<0.001) were significantly more food insecure than other respondents. After adjusting for depending factors, the marital status, household size, educational level and the employment status of the head of the family had significant association with food security.

    Conclusion: Family size, employment status and educational level of the head of the family were significant predictors of food insecurity. Policymakers should focus on increasing minimum education levels and employment situations to decrease food insecurity.


  • XML | PDF | downloads: 122 | views: 345 | pages: 901-907

    Background: Herbal distillates have been used for many centuries as herbal medicines in Traditional Persian medicine. The main purpose of this study was to determine methanol and ethanol contents in commonly-used industrial herbal distillates produced by three famous factories in Khorasan Razavi, Mashhad, Iran (2014-2015).

    Methods: Ninety herbal waters of ten types of most commonly used herbal distillates including Willow (Salix alba), Ajava seeds (Carum copticum), Fennel (Foeniculum vulgare), Poleigamander (Teucrium polium), Forty plants, Peppermint (Mentha piperita), Camel thorn (Alhagi camelorum), Chicory (Cichorium intybus), Fumitory (Fumaria officinalis) and Rose water (Rosa damascene) of three famous company in Mashhad were randomly bought from market. Methanol and ethanol contents of each sample were measured by Gas chromatography according to the standard method. Collected data were analyzed by SPSS using appropriate descriptive statistical tests.

    Results: The highest average amount of methanol of all tested distillates is for forty plants (46.06 mg/dl) and M. piperita (46.72 mg/dl) and the lowest for ajava seed (8.46 mg/dl). The maximum and minimum ethanol level was reported for rose water (0.39 mg/dl) and ajava seed (0.15 mg/dl), respectively.

    Conclusion: High methanol and ethanol concentrations may induce toxicity in people taking these products regularly for a long time. Therefore, considering the harmful effects of methanol and ethanol on human health, further studies are required for determining permitted levels of methanol and ethanol in herbal distillates.


  • XML | PDF | downloads: 193 | views: 293 | pages: 908-913

    Background: The presence of potentially pathogenic Free Living Amoebae (FLA) in hospital environment could be a health hazard for high-risk patients such as immunosuppressed patients. This study was carried out to investigate the presence of potentially pathogenic FLAs in the environment and medical instruments of different hospital wards, and nasal swabs of immunosuppressed patients of a hospital in Tehran, Iran.

    Methods: In this cross-sectional study, 60 environmental (26 samples) and nasal swab (34 samples) samples were collected between Dec 2015 and Feb 2016. The samples were assessed using culturing, staining and morphological methods based on page key. To decrease the bacterial and fungal contamination and better identification of FLAs, cloning was performed.

    Results: Overall, 17 (28%) samples, including 13 environmental samples and 4 nasal swabs samples, were found positive for FLAs. The most frequent amoebae were Acanthamoeba spp. and two plates had mix contamination of Acanthamoeba spp. and Vahlkampfiids/Vermamoeba. Overall, Acanthamoeba species (58%), Vahlkampfiids (26%) and V. vermiformis (15%) were identified in clinical and environmental samples.

    Conclusion: The occurrence of these FLAs in environmental and clinical samples of hospital may threat health status of patients directly, particularly in immunosuppressed patients, and can transmit other pathogens. Thus, the increasing awareness of clinical setting staffs about FLAs and improvement of disinfection methods in hospitals is needed.


Letter to the Editor