Razi Journal of Medical Sciences

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Background: Heart patients with hypertension and myocardial infarction and hemodialysis patients are at risk of lowering of blood pressure during hemodialysis. Therefore, continuous monitoring of blood pressure in health centers is a priority for deciding the type of therapeutic treatment in these patients. The aim of this study was to provide a decision-making model based on neural network and quality control charts for monitoring and continuous monitoring of blood pressure.
Methods: This was an applied-developmental study carried out in cross-sectional method during 2014 to 2015, on 175 patients with hypertension in Ali ibn Abi Talib Hospital of Zahedan. The actual behavior of the systolic and diastolic blood pressure of these patients under the online model and its expected behavior was studied under the Offline model and in the form of an artificial neural network. By evaluating the true behavior of patients with their modeled blood pressure, residual values are produced and introduced as inputs of EWMA quality control charts in two steps to determine the state of the patient out of control and determine the status of the patient.
Results: Highest and lowest total rate of accuracy of the proposed model, in the state of the patient out of control stage were 98.75 and 95%   in the status of the patient stage, respectively, 83.75% and 70%. Narrower control limits with a confidence level (95.45% confidence interval) in the state of the patient out of control stage and more open limits with a confidence level (99.73% confidence interval) in the status of the patient stage. The higher overall total accuracy rate and lower error rates are provided in the model.
Conclusion: According to the results of the research in regard to the field of statistical quality control, ease of visual comprehension, affordability and attention to the last critical condition of the patient, it is a model suitable for physicians and patients for healthcare decision-makings.  
 

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Background & Aims: Thiamine (vitamine B1) serves as a cofactor for several enzymes involved in carbohydrate catabolism such as pyrovate dehydrogenase and transketolase and alfa-ketoglutarate.thiamine and related vitamine may improve the outcome in children with type 1 diabetes mellitus.Thiamine is absorbed efficiently in the gastrointestinal tract.adequate thiamine intake can be achived with a a varied diet that includes meat and enriched or whole _grain cereals.thiamine is water soluble and heat labile.The requirement of thiamine is increased when carbohydrates are taken in large amounts and during periods of increased metabolism,suc as diseases.thiamine deficiency is common in children with diabetic ketoacidosis (DKA) and treatment of diabetic ketoacidosis may exacerbate this deficiency. To prevent the complications of thiamine deficiency, ketoacidosis caused by diabetes must first be eliminated and then, if metabolic acidosis persists, other factors affecting this process must be addressed. Due to the importance of the subject and the limited studies that have been done to measure the serum level of thiamine, especially in children and adolescents with diabetes, we found the serum level of this vitamin in two groups of children and adolescents with diabetic ketoacidosis and diabetic patients without diabetic ketoacidosis.
Methods: This quasi-experimental study was performed by case-control method. The case group consisted of 30 patients with diabetic ketoacidosis who referred to aAliasghar children hospital which is subset of Iran university of medical science in Tehran city for one year. The control group consisted of 30 patients from diabetic patients without ketoacidosis referred to this hospital.The most important inclusion criteria for case group in this study was:age under eighteen years,diabetic ketoacidosis with polyuria and polydipsia,ph under 7.3,fasting blood sugar above 250 milligram in deciliters, keton in urine and not taking treatment for example intravein therapy and insulin infussion before admission in Ali asghar hospital and inclusion criteria for control group was diabetic patients without symptom and sign of ketoacidosis. At the time of admission, blood samples were taken from patients with diabetic ketoacidosis and evaluated for blood gas indices including HCo3, PCo2, pH, determination of serum levels of thiamine, sodium, potassium, hemoglobin, blood sugar, lactate and HbA1C. Serum thiamine levels were also measured in patients without diabetic ketoacidosis.For determine of serum levels of thiamine in two groups the samples of whole blood were froze in under 70 degrees centigrade and sent to the lab then measured serum levels of thiamine by HPLC method. After admission of patients, initial measures for the treatment of diabetic ketoacidosis including hydration with isotonic fluids, insulin injection at a rate of 0.1 Unit / Kg / hr were performed according to the same protocol for all patients in the case group. All demographic information of patients in both groups along with the results of laboratory tests and patients' consciousness status scores were recorded in information forms for each patient and analyzed and evaluated using SPSS software version 23.
Results: According to the research finding in fifty percent of all patients of our study including diabetic ketoacidosis patients and nondiabetic ketoacidosis patients the serum level of thiamine was low. In this study 56.7 percent. of patients with diabetic ketoacidosis had thiamine deficiency at the time of admission and in patients without diabetic ketoacidosis 43.3 percent had thiamine deficiency In the present study, the serum level of thiamine at the time of admission in patients with diabetic ketoacidosis was significantly lower than patients in the control group. HbA1c levels were also significantly higher in diabetic ketoacidosis patients than in controls. Also, serum thiamine level in patients with diabetic ketoacidosis had a statistically significant relationship with HbA1c level. It means that poor control blood sugar is accompany with lower serum level thiamine.The present study is the first study that investigate serum level of thiamine in type one diabetic children and relation of it with HbA1C. Also results of this research show that diabetic ketoacidosis treatment worse the thiamine deficiency. There was no statistically significant relationship between serum thiamine level in diabetic ketoacidosis patients with lactate level, ketoacidosis severity, Hemoglobin, Blood sugar, sodium, potassium, and Blood urea nitrogen. The results showed that there was no statistically significant relationship between serum thiamine level in patients with diabetic ketoacidosis and age, sex, severity of diabetic ketoacidosis, history of diabetic ketoacidosis and duration of symptoms.
Conclusion: The results of the present study showed that the treatment of diabetic ketoacidosis exacerbates thiamine deficiency in these patients. Although the relationship was not statistically significant, a decrease in thiamine levels was observed. Therefore, it is recommended to consider thiamine supplements in children with diabetic ketoacidosis. On the other hand, the weaker the blood sugar controls, the lower the thiamine level. Therefore, it is recommended that due to the side effects of thiamine deficiency in diabetic patients, all of these patients be encouraged to eat a healthy diet include foods containing thiamine in the diet for example fish, poultry, rice, oat

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Background & Aims: Melanoma, caused by gene mutations of melanocytes, is the most aggressive skin cancer (1). The pathogenesis of melanoma is complex and involves genetic and environmental factors. The increased incidence of melanoma in developed countries is mostly due to excessive exposure to sunlight (ultraviolet light), which is the main risk factor for cutaneous melanoma (2). The interaction of melanoma cells with other cells residing in the tumor microenvironment significantly affects tumor biology such as proliferation, differentiation, and growth (3). Collective action of molecular chaperones is also necessary to maintain cellular homeostasis leading to survival (4). In human cells, stress-induced Hsp70 is expressed in the cytosol of many tumors, where it performs a wide variety of chaperone functions such as folding-unfolding and translocation of polypeptides across cell membranes, cloning and dissociation of protein complexes, and regulation of protein activity (5). High expression of Hsp70 is associated with tumor initiation, progression and survival in various types of cancer (7,8). Molecular studies show that subunits of the HSP70 protein family reduce the stability of extracellular matrix metalloproteinase-inducible protein (CD147) by increasing ubiquitin-proteasome degradation, thereby inhibiting lactate and glycolysis, and ultimately metastasis and cell migration (9). On the other hand, the tendency of melanoma cells to invade distant tissues depends on their interaction with tumor microenvironment cells and the efficiency of the immune response (10). CD147, also known as Basigin, is a highly glycosylated type I membrane protein of the large family of immunoglobulins (11). A previous study has shown that CD147 plays a key role in cell apoptosis (12).
In recent years, due to fewer side effects of herbal medicines, the use of plant-derived compounds as anti-cancer drugs has increased significantly. Clinical studies show that nettle species contain compounds that show activity against cancer cells (16,17). Exercise can also reduce the risk of cancer by changing the response of immune factors (18). Wennerberg et al. (2020) found in a breast cancer model that incorporating 30 minutes of treadmill running five days per week during the anti-PD-1/radiotherapy course reduced tumor-infiltrating myeloid-derived suppressor cells and increased the infiltration of tumor cells. becomes CD8+ T, which is more useful for the function of immune cells (19). However, in Crosby et al.'s (2021) research, there was no statistically significant change in quality of life, fatigue, physical performance, cardiorespiratory fitness, body composition, psychological distress, cognitive performance, or treatment-related side effects compared to physical activity or exercise (20). Previous reports have shown the antitumor activity of nettle in various human malignancies, such as breast, lung, and prostate cancers (17,22). However, despite the therapeutic benefits of nettle plant, the effects of nettle extract on changes in immune and growth factors in melanoma cancer are not clear. Considering the therapeutic benefits of nettle plant as well as the positive effect of exercise in reducing the effect of interval training and consumption of Urtica dioica hydroalcoholic extract on Heat shock protein 70 (HSP70) and Extracellular matrix metalloproteinase inducer (CD147) in C57 rats with melanoma cancer.
Methods: In this experimental study, 20 C57 rats were randomly divided into four groups include control (cancer), Urtica dioica (cancer), and Urtica dioica - interval training (cancer). One week after the induction of melanoma cancer, the experimental group consumed 30 mg/kg/day nettle ethanol extract orally for 8 weeks. The interval exercise program included running on a treadmill 60 minutes at a speed of 28 meters per minute, five days a week for six weeks. The HSP70 and CD147 ranks were measured by Real time PCR. The data were analyzed and analyzed by One -way variance analysis and the Toky's test at the p<0.05.
Results: The results showed that interval training, Urtica dioica hydroalcoholic extract and interval training with Urtica dioica hydroalcoholic extract consumption led to significant increase in the amount of HSP70 and significant decrease in the amount of CD147 in C57 rats with melanoma cancer (P<0.001).
Conclusion: The findings of the present research show that interval training led to a significant increase in the level of heat shock protein 70 and a significant decrease in the level of extracellular matrix metalloproteinase inducer in C57 mice with melanoma cancer. The findings of the present research are consistent with some results of previous studies (19,25). HSP70 induction depends on exercise intensity. High-intensity exercise has a greater effect on stimulating heat shock reactions (26). It seems that one of the effective mechanisms of exercise training on the levels of heat shock proteins is the increase in body temperature and the occurrence of oxidative stress during physical activity, which can be the reason for the increase of these markers after exercise. One of the important mechanisms of CD147 effect in promoting cancer metastasis is the metabolic regulation of the tumor microenvironment through interaction with specific MCTs, such as MCT4, which helps to facilitate lactate transport and tumor glycolysis (29,30). Little is known about the regulation of heat shock proteins in CD147 expression. In one study, it was shown that the reduction of the HSP70 protein family was associated with the increase of CD147 protein expression in human cancer cell tumors, suggesting that the negative regulation of the HSP70 protein family maybe It can increase the migration of cancer cells by upregulating CD147. This hypothesis is supported by findings that the HSP70 protein family negatively regulates the abundance and membrane expression of CD147 protein in cancer cells (9). Also, the results of our study show that nettle hydroalcoholic consumption led to a significant increase in the level of heat shock protein 70 and a significant decrease in the level of extracellular matrix metalloproteinase inducer in C57 mice with melanoma cancer. Stinging nettle extract may exert biological anticancer activities through various mechanisms, including antioxidant and antimutagenic properties, induction or inhibition of key processes in cellular metabolism, and the ability to activate apoptotic pathways (17). The most likely explanation for the significant anticancer effect of nettle is its content of flavonoids and other known molecules and/or as yet unknown substances. In addition, the findings of our study show that interval training with the consumption of nettle hydroalcoholic significantly led to a further decrease in the level of extracellular matrix metalloproteinase inducer in C57 mice with melanoma cancer. Therefore, it is possible that intermittent exercises in combination with nettle hydroalcoholic consumption may lead to a more effective regulation of immune factors in melanoma cancer, but a definitive statement requires more research in this field. The main strength of the present study is to compare the effectiveness of several interventions to identify the best intervention. The current approach results in more informed decisions. There were also limitations in the present research, among which we can point out the small number of samples in the present research, therefore, a similar study with the measurement of these indicators in a high number of samples is suggested. It is also suggested that similar research be done by measuring immune growth factors following other exercise protocols. The results of the present study showed that interval training, nettle hydroalcoholic consumption and interval training combined with nettle hydroalcoholic consumption were associated with a significant increase in heat shock protein 70 and a significant decrease in extracellular matrix metalloproteinase inducer in C57 mice with melanoma cancer. Therefore, it seems that intermittent exercises and nettle hydroalcoholic consumption can help regulate growth and immune factors in melanoma cancer.