Isfahan University of Medical Sciences Journal of Isfahan Medical School 1027-7595 28 107 2010 06 22 Evaluation of Fat Cell’s Size, Number and Their Mediators in Ischemic Heart Disease Patients Evaluation of Fat Cell’s Size, Number and Their Mediators in Ischemic Heart Disease Patients 13277 FA Mehrdad Roshdi Benam Resident, School of Medicine, Isfahan University of Medical Sciences, Isfahan Masumeh Sadeghi Associate Professor,Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, School of Medicine, Isfahan University of Medical Sciences, Isfahan 0000-0001-7179-5558 Hamid Sanei Associate Professor of Cardiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan Reza Mashayekhi Pathologist, Heart Center, Tehran University of Medical Sciences, Tehran Shahram Taheri Assistant Professor, Department of Nephrology, School of Medicine, Isfahan University of Medical Sciences, Isfahan Amir Atapour Assistant Professor, Department of Nephrology, School of Medicine, Isfahan University of Medical Sciences, Isfahan Nazal Sarrafzadegan Professor of Cardiology, Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Mohammad Arash Ramezani Community Medicine Specialist, Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan Mohammad Reza Akhbari Resident, Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, School of Medicine, Isfahan University of Medical Sciences, Isfahan Iraj Jafaripour Resident, Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, School of Medicine, Isfahan University of Medical Sciences, Isfahan Fariba Maleki General Practitioner, Isfahan Reza Madadi Resident, Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, School of Medicine, Isfahan University of Medical Sciences, Isfahan Journal Article 2011 02 17 Background: Excessive body fat is associated with increasing risk of ischemic heart disease (IHD). Some fat cell mediators such as adiponectin and leptin have been recognized as possible new IHD risk factors. We assessed the association of fat cell’s size and number, serum leptin and adiponectin with IHD. Methods: The study was designed as a “case control” study in 40 to 60 years old patients with ischemic heart disease symptoms underwent coronary angiography. The cases had significant stenosis in coronary angiography. The control subjects had normal angiography. Serum lipid levels, adiponectin, leptin, and insulin were examined in all cases and controls by Enzymayic method. The biopsies from abdominal and gluteal fat tissue regions were fixed and stained using the Hematoxilin-eosin method. Slides were photographed with a microscopic digital camera. Fat cell’s size and number were assessed using Image tool V3 software. Data were analyzed with SPSS software. Findings: There were no significant difference between cases and controls in fat cell’s size and number, serum leptin and adiponectin. However, serum leptin was correlated not only to waist circumference (r = 0.31, P = 0.036), but also to body mass index (r = 0.32, P = 0.033). Conclusion: Although Leptin and adiponectin are correlated with obesity and are introduced as IHD risk factors; they showed no association with ischemic heart disease in our study. More investigation is required to confirm this relationship in the Iranian population. Background: Excessive body fat is associated with increasing risk of ischemic heart disease (IHD). Some fat cell mediators such as adiponectin and leptin have been recognized as possible new IHD risk factors. We assessed the association of fat cell’s size and number, serum leptin and adiponectin with IHD. Methods: The study was designed as a “case control” study in 40 to 60 years old patients with ischemic heart disease symptoms underwent coronary angiography. The cases had significant stenosis in coronary angiography. The control subjects had normal angiography. Serum lipid levels, adiponectin, leptin, and insulin were examined in all cases and controls by Enzymayic method. The biopsies from abdominal and gluteal fat tissue regions were fixed and stained using the Hematoxilin-eosin method. Slides were photographed with a microscopic digital camera. Fat cell’s size and number were assessed using Image tool V3 software. Data were analyzed with SPSS software. Findings: There were no significant difference between cases and controls in fat cell’s size and number, serum leptin and adiponectin. However, serum leptin was correlated not only to waist circumference (r = 0.31, P = 0.036), but also to body mass index (r = 0.32, P = 0.033). Conclusion: Although Leptin and adiponectin are correlated with obesity and are introduced as IHD risk factors; they showed no association with ischemic heart disease in our study. More investigation is required to confirm this relationship in the Iranian population. https://jims.mui.ac.ir/article_13277_1dbb1c25df6942683e7b1317f0e13db6.pdf

Isfahan University of Medical Sciences Journal of Isfahan Medical School 1027-7595 28 107 2010 06 22 Anthropometric Indices and Dietary Intake in HIV-Infected Patients Anthropometric Indices and Dietary Intake in HIV-Infected Patients 13278 FA Iraj Karimi Assistant Professor, Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan Nazila Kasaeeian Research Assistant, Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan Behroz Atayi Assistant Professor, Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan 0000-0003-4528-1718 Katayun Tayeri Specialist Infectious Diseases, Behavioural Disorder, Health center, Isfahan University of Medical Sciences, Isfahan Maryam Zare Assistant, Endocrine and Diabetis Research Center, Isfahan University of Medical Sciences, Isfahan Leila Azadbakht Assistant Professor, Department of Nutrition, School of Public Health, Isfahan University of Medical Sciences, Isfahan Journal Article 2011 02 17 Background: Malnutrition is one of the most important complication in Human Immonodeficiency Virus (HIV)-infected patients. So, it is better to consider the nutrition status and food intake of these patients. There are not numerous studies in this field in Iran. Therefore, this study was conducted to assess the anthropometric indice and nutritional intake of HIV-infected patients in Isfahan. Methods: This was a cross-sectional study on 48 HIV-infected patients in Isfahan. Anthropometric measurments were done according to the standard method and food intake was assessed using a validated food-frequency questionnaire. Nutrients intakes of the patients was compared with the recommended dietary allowances (RDA), and the dietary intakes of sociodemographic matched group of healthy Isfahanian population. Findings: Mean of body mass index in men and women was 24 and 22 kg/m2, respectively. Mid arm circumference in men and women was 28 and 29 cm and the body fat percent was 21 and 31% respectively. Low nutrient intake was not seen in men however, women had low intake of vitamin B12, folate and vitamin E compared to RDA. However, the amount of vitamin B12 among infected men and energy intake among infected women were lower than Isfahanian healthy population’s intake. Conclusion: Although the body mass index of the patients was in the normal range but their body fat percentage was higher than standard and their lean body mass was lower than standard. Low intake of some nutrients shows the nessecity of the nutrition intervention. Background: Malnutrition is one of the most important complication in Human Immonodeficiency Virus (HIV)-infected patients. So, it is better to consider the nutrition status and food intake of these patients. There are not numerous studies in this field in Iran. Therefore, this study was conducted to assess the anthropometric indice and nutritional intake of HIV-infected patients in Isfahan. Methods: This was a cross-sectional study on 48 HIV-infected patients in Isfahan. Anthropometric measurments were done according to the standard method and food intake was assessed using a validated food-frequency questionnaire. Nutrients intakes of the patients was compared with the recommended dietary allowances (RDA), and the dietary intakes of sociodemographic matched group of healthy Isfahanian population. Findings: Mean of body mass index in men and women was 24 and 22 kg/m2, respectively. Mid arm circumference in men and women was 28 and 29 cm and the body fat percent was 21 and 31% respectively. Low nutrient intake was not seen in men however, women had low intake of vitamin B12, folate and vitamin E compared to RDA. However, the amount of vitamin B12 among infected men and energy intake among infected women were lower than Isfahanian healthy population’s intake. Conclusion: Although the body mass index of the patients was in the normal range but their body fat percentage was higher than standard and their lean body mass was lower than standard. Low intake of some nutrients shows the nessecity of the nutrition intervention. https://jims.mui.ac.ir/article_13278_edbdd777879cbb165a94951e6a425b3f.pdf

Isfahan University of Medical Sciences Journal of Isfahan Medical School 1027-7595 28 107 2010 06 22 The Assessment of Establishment and Maintenance of the Health Man-agement System in Schools and Grading for Awarding Stars (H.S.E-ms) The Assessment of Establishment and Maintenance of the Health Man-agement System in Schools and Grading for Awarding Stars (H.S.E-ms) 13279 FA Mir Masih Moslemi Aghili Senior Expert of Occupational Health and MPH of Environmental Health, Responsible Expert of Occupational Health and Advisor and Senior Expert of the Office, Office of the Minister, Ministry of Health and Medical Education, Tehran Sayed Mahmood Hosseiny Department of Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad Ahmad Jonidi Jafari Associate Professor, Department of Environmental Health, School of Health, Iran University of Medical Sciences, Tehran Reza Karami Medical Student, School of Medicine, Mashhad University of Medical Sciences, Mashhad Hasan Zia-oddini General Practitionnaire, Director General of the Bureau of Health and Prevention of Social Problems, Deputy of Training and Physical Education, Ministry of Education, Tehran Zahra Gholamnejad Department of Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad Efat Khoshnoud Department of Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad Journal Article 2011 02 17 Background: Addressing school health and safety is an important public health issue. The aim of this study was to identify the status of safety and health (HSE) in Iranian schools, and to provide a monitoring and evaluation scoring system to produce a management system to handle health and safety issues in schools systematically. Methods: An 81-item checklist was applied to obtain data regarding the performance of HSE in 60 schools in five Iranian provinces to award health stars (15-level stars). In all provinces, inadequacies and limitations were documented in safety measures. Findings: Health and safety in Iranian schools need more attention; for example only 48.2% of surveyed schools have suitable space (4 m3 per capita) for studying and only 21.4% of piloted schools have suitable and ergonomic tables; additionally 69.6% of schools have no emergency exits or access to them. Conclusion: By passing this pilot phase, now an agreement is signed between the Ministry of Health and Medical Education and the Ministry of Education, and this plan is implemented as a national program in Iran for improvement of the safety and health in schools. We suggest that establishment and maintenance of the health management system in schools and ranking and granting stars to them is one of the most appropriate plans in this regard to be implemented in the region. Background: Addressing school health and safety is an important public health issue. The aim of this study was to identify the status of safety and health (HSE) in Iranian schools, and to provide a monitoring and evaluation scoring system to produce a management system to handle health and safety issues in schools systematically. Methods: An 81-item checklist was applied to obtain data regarding the performance of HSE in 60 schools in five Iranian provinces to award health stars (15-level stars). In all provinces, inadequacies and limitations were documented in safety measures. Findings: Health and safety in Iranian schools need more attention; for example only 48.2% of surveyed schools have suitable space (4 m3 per capita) for studying and only 21.4% of piloted schools have suitable and ergonomic tables; additionally 69.6% of schools have no emergency exits or access to them. Conclusion: By passing this pilot phase, now an agreement is signed between the Ministry of Health and Medical Education and the Ministry of Education, and this plan is implemented as a national program in Iran for improvement of the safety and health in schools. We suggest that establishment and maintenance of the health management system in schools and ranking and granting stars to them is one of the most appropriate plans in this regard to be implemented in the region. https://jims.mui.ac.ir/article_13279_2808e33b0ef26bac248b17936f0f1938.pdf

Isfahan University of Medical Sciences Journal of Isfahan Medical School 1027-7595 28 107 2010 06 22 Allopourinol Effect on Reducing Proteinuria in Diabetic Retinopathy Allopourinol Effect on Reducing Proteinuria in Diabetic Retinopathy 13280 FA Ali Momeni Isfahan Kidney Diseases Research Center, Assistant Professor, Department of Nephrology, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord Shahrzad Shahidi Isfahan Kidney Diseases Research Center, Associate Professor, Department of Nephrology, School of Medicine, Isfahan University of Medical Sciences, Isfahan 0000-0002-5442-6424 Shiva Seirafian Isfahan Kidney Diseases Research Center, Associate Professor, Department of Nephrology, School of Medicine, Isfahan University of Medical Sciences, Isfahan 0000-0002-2149-8819 Shahram Taheri Isfahan Kidney Diseases Research Center, Associate Professor, Department of Nephrology, School of Medicine, Isfahan University of Medical Sciences, Isfahan Soleiman Kheiri Assistant Professor, Department of Statistics, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord Journal Article 2011 02 17 Background: Diabetic nephropathy is the most prevalent cause of end stage renal disease (ESRD). Besides, factors such as angiotensin-II, cytokines, and vascular endothelial growth factor (VEGF), uric acid may play a role as the underlying cause of diabetic nephropathy. Therefore, decreasing serum level of uric acid can be effective in treatment of diabetic nephropathy. Methods: This was a double-blinded, randomized, clinical trial in which 40 patients with type 2 diabetes mellitus (DM) and diabetic nephropathy with proteinuria (at least 500 mg/24h) and serum creatinine (Cr) level < 3 mg/dl were divided into two groups of 20. Case group received allopurinol (100 mg/day) and control group received placebo for four months. Administration of antihypertensive and renoprotective drugs (angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs)) continued for both groups, without changes in dosage. Findings: Each group consisted of 9 men and 11 women. There were no difference between two groups, regarding age, body mass index (BMI), duration of diabetes, systolic and diastolic blood pressure, fasting blood sugar, serum blood urine nitrogen (BUN), serum creatinine (Cr), serum potassium, and urine volume (P > 0.05). Serum level of uric acid and 24 hour urine protein were significantly lower in control group, after four months of receiving allopurinol, compared with control group (P < 0.05). Conclusion: Low dose allopurinol (100mg/day) reduces severity of proteinuria after four months of taking, which is probably due to decreasing the serum level of uric acid. So, allopurinol can be administered as an adjuvant, cheap, and low side-effect therapy for patients with diabetic nephropathy. Background: Diabetic nephropathy is the most prevalent cause of end stage renal disease (ESRD). Besides, factors such as angiotensin-II, cytokines, and vascular endothelial growth factor (VEGF), uric acid may play a role as the underlying cause of diabetic nephropathy. Therefore, decreasing serum level of uric acid can be effective in treatment of diabetic nephropathy. Methods: This was a double-blinded, randomized, clinical trial in which 40 patients with type 2 diabetes mellitus (DM) and diabetic nephropathy with proteinuria (at least 500 mg/24h) and serum creatinine (Cr) level < 3 mg/dl were divided into two groups of 20. Case group received allopurinol (100 mg/day) and control group received placebo for four months. Administration of antihypertensive and renoprotective drugs (angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs)) continued for both groups, without changes in dosage. Findings: Each group consisted of 9 men and 11 women. There were no difference between two groups, regarding age, body mass index (BMI), duration of diabetes, systolic and diastolic blood pressure, fasting blood sugar, serum blood urine nitrogen (BUN), serum creatinine (Cr), serum potassium, and urine volume (P > 0.05). Serum level of uric acid and 24 hour urine protein were significantly lower in control group, after four months of receiving allopurinol, compared with control group (P < 0.05). Conclusion: Low dose allopurinol (100mg/day) reduces severity of proteinuria after four months of taking, which is probably due to decreasing the serum level of uric acid. So, allopurinol can be administered as an adjuvant, cheap, and low side-effect therapy for patients with diabetic nephropathy. https://jims.mui.ac.ir/article_13280_ea87de84e18a339d4efa00144c5b0fe3.pdf

Isfahan University of Medical Sciences Journal of Isfahan Medical School 1027-7595 28 107 2010 06 22 Implantation of small intestinal mucosa in colonic submucosal bed in cat Implantation of small intestinal mucosa in colonic submucosal bed in cat 13281 FA Gholamreza Mohajeri Assistant Professor of Thoracic Surgery, Department of Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan 0000-0001-5012-5782 Mansoor Safaei Associated Professor of Vascular Surgery, Department of Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan Reza Eshraghi Samani General Surgeon, Department of Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Roohallah Sobhani General Surgeon, Department of Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Journal Article 2011 02 17 Background: Short bowel syndrome is arbitrarily defined as the presence of less than 200 cm of residual small bowel in adults. Most of the patients are dependent to total parenteral nutrition (TPN), rather than high cost, it has many complications such as sepsis. The surgical procedures are associated with intestinal obstruction and their efficacy needs to be defined. This study was performed to implant small intestinal mucosa in colonic submucosal bed in order to find a new treatment for the patients suffering from short bowel syndrome and dependent to TPN. Methods: This study was experimental and performed in Torabinejad Research Center in Isfahan University of Medical Sciences in 2008. Eight Persian male cats was studied and during laparotomy a 1 × 1 cm mucosal patch of terminal ileum was implanted in submucosa of the colon. After 14 days, second laparotomy was done and the colon was examined hystologically. Findings: In 7 cats, colonic mucosal structure was seen in the site of the patch (87.5%) and in 1 cat, ileal mucosal structure was seen (12.5%). Conclusion: According to the results, implantation of small intestinal mucosa in colonic submucosal bed was unsuccessful but possibly it may be a new alternative treatment for short bowel syndrome. Background: Short bowel syndrome is arbitrarily defined as the presence of less than 200 cm of residual small bowel in adults. Most of the patients are dependent to total parenteral nutrition (TPN), rather than high cost, it has many complications such as sepsis. The surgical procedures are associated with intestinal obstruction and their efficacy needs to be defined. This study was performed to implant small intestinal mucosa in colonic submucosal bed in order to find a new treatment for the patients suffering from short bowel syndrome and dependent to TPN. Methods: This study was experimental and performed in Torabinejad Research Center in Isfahan University of Medical Sciences in 2008. Eight Persian male cats was studied and during laparotomy a 1 × 1 cm mucosal patch of terminal ileum was implanted in submucosa of the colon. After 14 days, second laparotomy was done and the colon was examined hystologically. Findings: In 7 cats, colonic mucosal structure was seen in the site of the patch (87.5%) and in 1 cat, ileal mucosal structure was seen (12.5%). Conclusion: According to the results, implantation of small intestinal mucosa in colonic submucosal bed was unsuccessful but possibly it may be a new alternative treatment for short bowel syndrome. https://jims.mui.ac.ir/article_13281_44680b5f7cefd57a0e580cfc11a9308f.pdf

Isfahan University of Medical Sciences Journal of Isfahan Medical School 1027-7595 28 107 2010 06 22 Determination of Streptococcus Sanguis in Gingivitis Disease and Effect of β-lactam Antibiotics on It Determination of Streptococcus Sanguis in Gingivitis Disease and Effect of β-lactam Antibiotics on It 13282 FA Mansoureh Azadeh MSc in Microbiology, Department of Science–Biology, Falavarjan Branch, Islamic Azad University, Isfahan Roha Kasra Kermanshahi Professor, Department of Basic Sciences–Biology, AlZahra University, Tehran Parichehr Ghalayani Associate Professor, Department of Oral Diseases, School of Dentistry, Isfahan University of Medical Sciences, Isfahan Mohammad Reza Zargarzadeh Pharmaceutics Specialist, Farabi Pharmacy, Isfahan Journal Article 2011 02 17 Background: Gingivitis is a destructive inflammatory disease. The results of some studies show that bacteria of plaques are different in diseased and healthy areas; so the identification and sensitivity to β-lactam antibiotics was the most important aim of this study. Methods: This study was performed on 361 strains of bacteria identified by biochemical tests; the number of streptococcus and its percentage were 204 and 55.9 respectively. The antimicrobial susceptibility of strains of streptococcus was determined by Disk plate or Kerby–Bauer. The difference between the mean zones of inhibition of gingivitis strains were studied by t-test. Findings: The percentages of streptococcus sanguis was 26.4% and of streptococcus sanguis more than 70%. These bacteria were sensitive to amoxicillin, co-amoxiclave, and erythromycin and also sensitive to tetracycline, penicillin, and cephalexin. 1% of these bacteria were sensitive to clindamyc. Conclusion: These bacteria were sensitive to β-lactam antibiotics, and we can use β-lactam antibiotics for treatment. Background: Gingivitis is a destructive inflammatory disease. The results of some studies show that bacteria of plaques are different in diseased and healthy areas; so the identification and sensitivity to β-lactam antibiotics was the most important aim of this study. Methods: This study was performed on 361 strains of bacteria identified by biochemical tests; the number of streptococcus and its percentage were 204 and 55.9 respectively. The antimicrobial susceptibility of strains of streptococcus was determined by Disk plate or Kerby–Bauer. The difference between the mean zones of inhibition of gingivitis strains were studied by t-test. Findings: The percentages of streptococcus sanguis was 26.4% and of streptococcus sanguis more than 70%. These bacteria were sensitive to amoxicillin, co-amoxiclave, and erythromycin and also sensitive to tetracycline, penicillin, and cephalexin. 1% of these bacteria were sensitive to clindamyc. Conclusion: These bacteria were sensitive to β-lactam antibiotics, and we can use β-lactam antibiotics for treatment. https://jims.mui.ac.ir/article_13282_ad1aee42344e7f7432abd116da321569.pdf

Isfahan University of Medical Sciences Journal of Isfahan Medical School 1027-7595 28 107 2010 06 22 The Role of Psychoneuroimmunological Processes in Pathogenesis of Coronary Artery Disease The Role of Psychoneuroimmunological Processes in Pathogenesis of Coronary Artery Disease 13276 FA Reza Bagherian Assistant Professor, Department of Psychiatry and Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. 0000-0002-4656-4747 Alireza Andalib Associate Professor, Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. 0000-0002-2032-6281 Journal Article 2010 11 07 Abstract It has been well-established that psychological factors can act as risk factors for acute coronary syndromes. While evidences indicate effects of psychological factors on immune system, the role of this system in progression of coronary artery disease (CAD) and its clinical manifestations was confirmed. Thus it seems that the association between psychological factors and CAD is mediated in part by immune system parameters. The purpose of this review is to explain the role of psychoneuroimmunological processes which may contribute to progression of established CAD and show that established CAD is a clinical manifestation of pathophysiological mechanisms accounting for the link between psychological risk factors, immune system factors, and acute coronary syndromes. Psychological risk factors for coronary artery disease can be classified into three categories. Chronic psychological risk factors … may be involved in early disease stages, episodic factors … are considerable for the transition from stable to unstable atherosclerotic plaques, and acute psychological factors may promote myocardial ischemia and plaque rupture. This review describes the role of the psychoneuroimmunological mechanisms for each of three categories of psychological risk factors for acute coronary syndromes. Keywords: Psychoneuroimmunology, Coronary artery disease, Psychological risk factors, Pathogenesis, Mediator. Abstract It has been well-established that psychological factors can act as risk factors for acute coronary syndromes. While evidences indicate effects of psychological factors on immune system, the role of this system in progression of coronary artery disease (CAD) and its clinical manifestations was confirmed. Thus it seems that the association between psychological factors and CAD is mediated in part by immune system parameters. The purpose of this review is to explain the role of psychoneuroimmunological processes which may contribute to progression of established CAD and show that established CAD is a clinical manifestation of pathophysiological mechanisms accounting for the link between psychological risk factors, immune system factors, and acute coronary syndromes. Psychological risk factors for coronary artery disease can be classified into three categories. Chronic psychological risk factors … may be involved in early disease stages, episodic factors … are considerable for the transition from stable to unstable atherosclerotic plaques, and acute psychological factors may promote myocardial ischemia and plaque rupture. This review describes the role of the psychoneuroimmunological mechanisms for each of three categories of psychological risk factors for acute coronary syndromes. Keywords: Psychoneuroimmunology, Coronary artery disease, Psychological risk factors, Pathogenesis, Mediator. https://jims.mui.ac.ir/article_13276_cca437dfff11995edc035566eabec9a7.pdf