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Introduction: Delivery of immediate medical interventions appropriate to the severity of clinical status of patients is a main public expectation of emergency departments. Waiting time and length of stay are the key measures to asses the quality of care in emergency departments. This study is done to investigate the waiting time and length of stay of attendants to emergency department of Vali-e-Asr Hospital, Arak-Iran. Materials and Methods: This analytical cross-sectional research was conducted in a general emergency department of a teaching hospital in Arak to asses the waiting time and length of stay of patients. In the first stage of the study all attendants during a 6 weeks period were classified regarding to the severity of their clinical status by an educated nurse and a general practitioner using a three category scale (guideline) presented by ministry of Health and Medical Education (2001). Also waiting time for a general practitioner visit was measured and documented by the resident general practitioner. In the second stage, a sample of 100 documents of patients in group 1 and 2 admitted for specialist visit were assessed for the waiting time and length of stay in emergency department. Mean of waiting time according to patients clinical status and the specialty of the first physician were analyzed by t-test and ANOVA (p =0.05). Results: During a 6 weeks period, of 1963 patients, 179(9.1%) were categorized as emergent (category 1), 391(19.9%) urgent (category 2) and 1393 (71%) non urgent. The mean waiting time for general practitioner visit was 5 minutes. The median and mean of waiting time for specialist visit in group 1 and 2 of patients were 225 and 262±156, 220 and 227±153 minutes, respectively. The median and mean of length of stay was 1 and 2 days, respectively. No differences were found between waiting time of various specialties visit in patients of categories 1 and 2. Conclusion: Regarding the long waiting time for specialist visit, using triage in emergency departments is necessary. This needs planning and organization for the presence of specialists in the hospital, over the time. Also regarding the large number of nonurgent patients, 24 hours presence of a general practitioner is necessary.

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Background: Since researchers were able to produce dendritic cells (DCs) from peripheral blood monocytes, many scientists have been in search of discovering the best way of producing dendritic cells and optimizing the DCs maturation processes in vitro to treat some diseases. The aim of this study was to investigate the maturation of DCs for tumor immunotherapy. Materials and Methods: In this experimental study, DCs were produced in two stages. In the first stage, monocyte cells were converted to immature DCs by GM-CSF and IL-4. In the second stage, immature DCs were made mature in the presence of human umbilical vein endothelial cells and PHA -activated T lymphocytes conditioned media and maturation factors. Results: The produced DCs with appropriate phenotype, phagocytosis ability, and proliferation of T lymphocytes stimulation traits could secrete high levels of cytokines. Conclusion: Endothelial cells and T lymphocytes conditioned media can produce Th1 and DC1 in vitro. Therefore, DCs produced through this method are suitable for immunotherapy treatment applications and cancer treatment through treatment cells.

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Background: Subacromial impingement is one of the most common complaints of shoulder. Treatments include avoiding of painful activities, oral anti-pain drugs, physical therapy modalities, corticosteroid injection and exercise therapy. Some studies have shown that platelet- rich plasma(PRP) is effective on tendinitis and tearing of tendons, ligaments and muscles, but evidence that has proved PRP as a conservative treatment in shoulder pathologies is very limited. This study aims to investigate the effect of PRP injection on relieving pain and improving daily function of patients with shoulder impingement syndrome.

Materials and Methods: In this clinical trial study, patients older than 40 with pain more than three months were included. If they had three of four positive diagnostic clinical tests of shoulder impingement that were confirmed by shoulder MRI, could be injected PRP twice. The time between injections was 1 month. Pain was measured by visual analog scale (VAS) and function was measured by two questionnaires named disabilities of the arm, shoulder and hand (DASH) and western Ontario rotator cuff  (WORC) index. Range of motion (ROM) of shoulder was measured in five directions by goniometry . All of these parameters were evaluated before intervention and in 1, 3, 6 months later.

Results: with due attention to a six-month folloe-up, PRR injection was effective in pain reduction and improvement of patient's function (p<0.05). Shoulder Rom increased in all directions except external rotation and the power of shoulder muscles was evidently improved statistically in flexion, abduction and internal toration.

Conclusion: PRP injection could effectively reduce pain and improve daily activities in patients with shoulder impingement syndrome.

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Background and Aim: Tamoxifen is a group of drugs of selective estrogen receptor modulators, and is one of the drugs effective in the prevention and treatment of some cancers (such as breast cancer). In this study, the interaction of tamoxifen with DNA is investigated experimentally. Also, the electronic structure (at atomic scale) of the molecular system of tamoxifen was theoretically investigated, using atom in molecule (AIM) theory.
Methods & Materials: First, in the experimental section of this study, the interaction of Tamoxifen with DNA were investigated by UV-ViS technique and hydrodynamic method (Viscometry). In addition, the analysis of the experimental results shows the obvious effect of concentration on the mechanism of how the tamoxifen molecule binds to DNA. Then, in the theoretical part of this research, using computational biophysical chemistry methods, some properties of tamoxifen molecular system, such as electronic Density of States (DOS), boundary orbital’s energy (HOMO/LUMO), Electrostatic Potential Energy (EPS) and electronic contour maps of the electron density and its Laplacian, will be calculated.
Ethical Considerations: This article is a meta-analysis with animal sample.
Results: Result of the UV-ViS spectroscopy technique and viscometry indicated hyperchromism and hypochromism effect. In addition, the result were depend on the concentration of the drug and affected the kind of binding of Tamoxifen to DNA. the analysis of computational studies on the drug tamoxifen suggests that the mechanism of the local charge/energy distribution in the molecular system of tamoxifen plays an important role in how this drug binds to DNA.
Conclusion: Based on the experimental results of UV-ViS technique and viscometry, as well as the electronic/vibrational properties of the tamoxifen molecular system, it was defined that the Tamoxifen interacts significantly with all the binding sites of DNA.

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Background:  Rotator cuff injuries are one of the most common causes of shoulder pain.
There are different therapeutic approaches in this disease. The evidence of the positive effect of exercise therapy in this pathology is inconclusive. This study aimed to investigate the effect of a complete exercise protocol on improvement of the patients with rotator cuff injuries.
Methods: The patients with shoulder pain received the 12-week exercise protocol in 4 phases if they had confirmed rotator cuff injuries in clinical examination and shoulder MRI. 
Pain was measured by visual analog scale (VAS) and function was measured by two questionnaires; disabilities of the arm, shoulder and hand (DASH) and western Ontario rotator cuff index (WORC). Range of shoulder joint motion (ROM) was measured in five directions by goniometry. All of the outcomes were evaluated before intervention and in 6, 12, 24 weeks after starting the intervention.
Ethic: This study was registered in Iranian Registry of Clinical Trials (IRCT20100718004409N13). A written consent was taken from All participants before the study. 
Results: In this study Twenty-four patients with rotator cuff tendinopathy and tear were analyzed finally in terms of effectiveness of exercise therapy. The average of their age was 51.7 years old. 14 patients (53.8%) with Supraspinatus tendinopathy, 6 patients (23%) with Supraspinatus tear, 3 patients (12.5%) with Supraspinatus plus biceps tendinopathy, and one patient (4.16%) with Subscapularis plus Biceps tendinopathy were assessed. The pain score (Visual Analog Scale) decreased at all fallow-ups specially after 24 weeks (3±0.1) versus before intervention (8±0.1) (P value < 0.001). Shoulder range of motions by goniometer and also the patients function based on WORC and DASH Questionnaires were improved after 24 weeks versus before intervention that was significant statistically and clinically (P value < 0.001). 
Conclusion: A 12- week exercise protocol including strengthening, stretching, PNF and dynamic stabilizer exercises was effective on pain reduction and improvement of function and shoulder joint range of motion improvement in the patients with shoulder rotator cuff tendinopathy and partial tear. The improvement of the variables lasted 6 months.
 

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