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Âssociation between billiary duct and bronchus is a rare finding. The etiology is defined as to be due to congenital pulmonary disease, history of trauma, particularly penetrating trauma, hepatic infectious disease such as, hydatid cyst. We had a case of bronchobiliary fistula secondary to hydatid cyst who had been under treatment for bronchitis for long term and finally due to dyspnea, with diagnosis of spontaneous pneumothorax was admitted in hospital. Final diagnosis was confirmed by ÇT SÇÂN of abdomen, thorax and fibrooptic bronchoscopy. The necessary treatment was taken by surgical incision of thorax.

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Macicnant plevral mesothestioma is a primary neoplasm of the plevra asbestos exposune Ïs known to bean important risk factor in abovt 80% of cases. Ths case report presents  32 yr oldman who has no history of asbestos onset plevrstsl chestpain whsch msmecs pulmonary in farction. Due to embols. By revewing the records there are few case of sudden onset pasn. Ïn addstion pleuritic pasn was awother unusuas Fea ture of the pasent.

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Background and purpose : Apical residual air space and prolonged air leakage are not uncommon entities following resection of upper lobe of the lung. This study was carried out to observe the efficacy of the pleural tenting in preventing complications.
Materials and methods : This is a case series study that compared with historical control. Pleural tenting after upper or upper and middle lobectomies was performed in 10 patients. In another 12 patients who underwent upper lobectomy or bilobectomy, pleural tenting was not performed. Both groups were compared with respect to duration of post operative air leak, drainage and hospital stay and need for any additional intervention for prolonged airleak.
Results : Age, sex, pathology and pulmonary function test of two groups were similar. Duration of the chest tube air leakage was shorter in those pleural tenting was performed on when compared to whom pleural tenting was not performed (2.6 ± 1.1 days versus 9.1 ± 8.1 days). Mean hospital stay was shorter in tented group (5.2 ± 1 days versus 10.8 ± 7.5).
Conclusion : Pleural tenting following upper lobectomy or bilobectomy of the lung shortens the duration of the chest tube drainage and hospital stay and it prevents apical residual airspace and related complications. Pleural tenting is a safe and relatively simple procedure, which has no associated morbidity.

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We report a case of paraesophageal varices presenting as a posterior mediastinal mass in a patient with long-standing portal hypertension and cirrhosis. The case is unusual because the varices were considerably larger than those usually encountered in portal hypertension. This report is a reminder that portal hypertension with paraesophageal varices can present as a retrocardiac mass on the chest radiogram. We suggest that in diagnostic work-up of patients with cirrhosis and masses in mediastinum modern imaging techniques, such as dynamic CT, color Doppler sonography and MRI, are most helpful (because they can demonstrate the vascular nature of these masses and have multiplanar capabilities) and precutaneous needle biopsy may be hazardous.

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Background and purpose : Screening and preventive programs are the important components in reduction of breast cancer morbidity and mortality.
Materials and methods : Ïn this cross-sectional descriptive study, above 15 years old females were selected and were randomly divided in 6 stratums based on the determined aims.
Results : We collected 400 questionnaires per stratum and totally 2400 cases with mean age of 25.01 ± 8.78 years and age range of 15-78 entered in this study. Âlso 46.9% were married, 86.7% had a medium to high education, 23.5% were housewives, 54.2% students and family history of breast cancer was reported in 25.8%. Knowledge about breast cancer prevention was good in 28.5%, low in 67.3%, and poor in 4.2%. Ït was shown taht 37% of the females 20 to 40 years and 48.8% above 40 years performed breast self-examination. But only 17.1% did it monthly. Âpproximately, 13.12% felt very confident about their correctly done self breast examination. Âlso 82.6% of the women 20 years and older did not refere to specialist for the last 2 years. Âmong women 40 years of age and higher, approximately 65.86% refered specialist once and 47.3% did mammoggraphy in the last two years and 61.07% have had at least one mommography in their life time.
Çonclusion: The Ïranian female population need for planning health education interventions and population-based specific regular screening programs to improve cancer prevention.

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Background and purpose: A gastric conduit is usually used to reconstruct the foregut after esophagectomy for cancer. The gastric emptying may be impaired after this operation, so some esophageal surgeons routinely add a pyloric drainage procedure. The aim of this study was to determine the emptying of the intrathoracic stomach after esophagectomy and cervical esophagogastrostomy with or without pyloromyotomy.
Materials and Methods:Between January 2003 and April 2006, in a randomized controlled trial, 30 patients with esophageal carcinoma were randomized to have with or without pyloromyotomy as a gastric emptying procedure for the gastric conduit used for esophageal replacement. Patterns of gastric emptying in the vagotomized intrathoracic stomach were studied using radioisotope techniques. Gastric emptying (GE) was evaluated 8 weeks after the operation. Patients were available for 6 months follow-up.
Results:A total of 30 patients were enrolled in this study. Sixty percent (18) were male, and 40% (12) were female. Twenty three patients (76.7%) had squamous cell carcinoma and 7 (23.3%) had adenocarcinoma. Delayed GE was reported in 11 (73.3%) and normal GE in 4 (26.7%) of patients with Pyloromyotomy. Delayed GE was reported in 9 (60%) and normal GE in 6 (40%) of patients without Pyloromyotomy. There were not any significant differences between complications of post surgery in both groups.
Conclusion:These findings were showed that esophageal surgery can be don’t add a pyloric drainage procedure in esophagectomy and cervical esophagogastrostomy and that very few patients actually need it.

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Background and purpose: Although some studies have demonstrated the effect of magnesium sulphate on reducing the postoperative pain, some others have refuted this and showed that it has limited or no effect. In this study, the researchers investigated the effects of pre- and intraoperative magnesium sulphate administration on the postoperative pain and opioid consumption. Materials and methods: In a randomized double blind placebo controlled clinical trial, thirty-two patients with the age range of 15-74 undergoing inguinal surgery in Imam Khomeini Hospital in Sari were nonrandomly divided into two equal groups. The patients in the magnesium sulphate group received magnesium sulphate 50 mg/kg/h IV, 15 minutes before until one hour during the surgery, whereas patients in the control group received the same volume of normal saline 20cc (infusion with similar volume) over the same time. The data were analyzed using SPSS version 16. Results: Postoperative pain was significantly lower in magnesium sulphate group in comparison to control group. At 0, 2, 6, 12 and 24 hrs after the operation, the mean VAS for control and case groups were 8.50 ± 0.894, 7.06 ± 1.94, (P=0.012), 8.31 ± 1.07, 6.63 ± 1.360 (P=0.001), 8.06± 1.124, 4.75± 1.125 (P=0.001), 7.31 ± 1.45, 4.06 ±0.85 (P=0.001), 6.69 ±1.40, 0.63 ± 1.02 (P=0.001), respectively. Conclusion: Intraoperative magnesium sulphate infusion in inguinal surgery considerably decreases postoperative pain in the first 24 hours after operation. (Clinical Trials Registry Number: IRCT138809282883N1)

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Background and purpose: Mupirocin is a topical antibiotic. This antibiotic can inhibit most of gram-positive cocci. Shortly after consuming the antibiotic mupirocin, resistance has emerged. The main purpose of this study was to determine mupirocin resistance in Staphylococcus strains isolated from nosocomial infections in the city of Arak. Material and Methods: A total of 150 Staphylococcus isolates (sensitive and resistant to methicillin S.aureus, coagulase negative staphylococcus) were subjected to the present study. In this study, 150 isolates of staphylococci were examined. PCR amplification of Sa442 gene was used as the identification marker for the confirmation of phenotypic diagnosis through biochemical and biological methods. In order to determine the presence of mecA gene in S. aureus isolates that were resistant to methicillin. All isolates were tested for mupirocin susceptibility by a disc diffusion method according to CLSI guideline. The minimum inhibitory concentration (MIC) was determined by an E-test and they were also analyzed by a PCR for the presence of ileS-1, mupA and mupB genes. Results: Among the 150 strains examined, 11 isolates were known resistant in disc diffusion and E-test. PCR result indicated that one isolate contains gene ileS-1, four isolates contain genes mupA and 6 strains containing both genes mupA and ileS-1. There was no strain that contained genes mupB and PCR results were fully consistent with the results of the E-test. Conclusion: This is a report of low frequency of mupirocin resistance in the city of Arak. This result illustrated that the prescription of mupirocin by physicians in this geographical region is limited. However, incorrect use can lead to rise in resistant rate. In addition, the combination of phenotypic methods and PCR for the detection of resistance to mupirocin is recommended.

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Background and purpose: Health related quality of life (HRQOL) is a main outcome in irritable bowel syndrome (IBS). Several psychological factors are mentioned as effective factors in determining HRQOL in IBS patients. The aim of this study is to determine the association between patient’s illness perceptions and HRQOL in IBS sufferers. Materials and methods: In this cross-sectional study 160 patients with IBS who were referred to psycho-somatic clinic (related to Noor hospital of Isfahan) were participated. Patients’ illness perceptions and HRQOL were assessed by Brief Illness Perception Questionnaire (Brief-IPQ) and IBS specific quality of life questionnaire (IBS-QOL-34). Information gathered from questionnaires was finally analyzed by descriptive statistic methods, Pearson correlation and Canonical correlation method. Results: Results of analysis performed by canonical correlation method showed significant association between patient’s illness perception and HRQOL in IBS sufferers (Canonical correlations: 0.84, P<0.001). Among illness perception subscales, Emotions (P<0.001, r=0.69), Consequence (P<0.001, r=0.67), Identity (P<0.001, r=52), Concern (P<0.001, 0.51), Timeline (P<0.001, r=49) and Personal Control (P<0.001, r=0.19), respectively, had the most significant correlation with HRQOL, and there was no relation found between Illness Comprehensibility or treatment control and HRQOL. Conclusion: Patient’s illness perceptions seem to play a role in determining HRQOL in IBS sufferers. Therefor [psychological interventions based on patients’ Illness perceptions are recommended for these patients.

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Introduction: Nurses are the largest group of professionals in the health care systems whose the most important aim is enhancing patients’ quality of life, but nurses’ own quality of life and health promoting behaviors are the issues that have not been dealt with sufficiently. The present study was performed to measure the amount of health promoting behaviors of nurses working in educational hospitals of Sari affiliated to Mazandaran University of Medical sciences 2013. Material & Methods: The present research is a descriptive cross- sectional study which was done through using stratified random sampling in 226 working nurses in four educational hospitals in Sari city in 2013.Data were gathered using a two-section questionnaire including demographic characteristics and 52 likert-type (from 0 to 4 score) questions which was based on Health Promoting Lifestyle Profile-HPLP- II and its validity and reliability were confirmed. Data analysis was performed using T-test and One-way ANOVA tests. Results: The mean score of HPLP- II was 135.33±18.55 (the total score is 208). The highest score was in the area of nutrition (25.53±4.37) and the least score was in the area of physical activity (16.85±5.05).The total score of HPLP- II and all its area except nutrition were higher in the male nurses than that of female nurses, but the significant difference was observed in the area of physical activity (p=0.001). Conclusion: Nurses should obey health promoting behaviors in a high level and this study is a beginning of increasing researchers and hospital managers’ knowledge to implement health promoting plans among the working nurses in the hospitals to achieve a desirable level of health promoting behaviors especially in the physical activity domain.

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Background and purpose: Due to the emergence of antibiotic resistance bacteria, treatment of urinary tract infection is becoming more problematic. Integrons are mobile genetic elements that play an important role in dissemination and accumulation of resistance genes of multidrug resistance in bacteria. The aim of the present study was to determine the antibiotic resistant profile, frequency of integron genes (Classes 1,2,3) and investigate the role of integrons in the development of antibiotic resistance among Escheria coli and Klebsiella pneumoniae isolated from urinary tract infections. Material & methods: 50 E.coli and 50 K.pneumoniae isolated from the urine samples of patients who referred to Valiasr Hospital, Arak, Iran were subjected to this study. All the isolated samples were confirmed by standard biochemical tests. Isolates were tested for susceptibility to 16 antimicrobial drugs by using disk diffusion method and the distribution of different integron classes was determined by polymerase chain reaction (PCR). Results: The highest rate of antibiotic resistance in K. pneumoniae isolates was found in rifampin (90%), erythromycin (90%), ceftriaxone (76%), amoxicillin-Clavulonic acid (76%), cotrimoxazole (70%), cefotaxime (70%) ceftazidime (66%) and for E.coli isolates in cotrimoxazole (88%), ceftriaxone (76%), amoxicillin-Clavulonic acid (74%), ceftazidime (72%) and cefotaxime (72%). All the E.coli isolates were susceptible to Imipenem, while only three (6%) of K.pneumoniae isolates were resistant to this antibiotic. Ninety percent of K.pneumoniae and 86% of E. coli isolates carried class 1 integrons, whereas class 2 integrons were found in 8% and 2% of E. coli and K.pneumoniae isolates, respectively. Class 3 integrons were not found. Conclusion: The high frequency of Class 1 integron in E.coli and k. pneumoniae isolates associated with the high rate of antibiotic resistant indicate that may be integrons play an important role in facilitating the spread of antimicrobial resistance in this region.

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Background and purpose: Misabortion is a disorder resultant of numerous causes such as infections. It is clear that bacterial infections due to genital mycoplasma, Listeria and brucella can cause septic abortion. A right time diagnosis of these infections can improve women fertility. This study was conducted to survey the efficiency of PCR in detecting the specimens with negative culture results in women suffering from septic abortion. We also did this by considering individual variables. Material & methods: In this analytical and descriptive study, appropriate samples were collected from a total of 87 women with septic abortion who referred to Karaj’s hospitals. The samples were cultured into mycoplasma, Listeria and brucella specific media. Then, the bacterial genus was verified by different biochemical tests. PCR test is performed on negative culture cases and SPSS-18 software is used for the statistical analysis of data. Results: From the total of 87 blood samples, 37 samples (42.5 %) were positive for mycoplasma and ureaplasma (25 cases) and Listeria monosytogenes (12 cases) with both culture and PCR method. Our result showed no positive cases for brucella. From the total cultured specimens, 12 cases (13.8%) were positive and 75 cases (86.2%) were negative. We performed PCR test for negative cultured results. With PCR method, 25 cases (33.33 %) showed positive results and 50 cases (66.67%) showed negative results. The results also showed a significant statistical relation between PCR test results with recurrent abortion and level of education (P< 0.05). Conclusion: The results show that PCR is a more sensitive, easier and faster method in comparison to culture for detecting bacterial cause septic abortion. It is obvious that quick diagnostic and starting antimicrobial therapy at the right time can prevent and decrease abortion’s complications, so it recommended then that using PCR in detecting this bacterial cause septic abortion can be more effective.

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Introduction: Previous studies have reported a relatively high incidence of total and subtotal thyroidectomy complications in Iran. Fear of this complication has led some internists and patients to avoid thyroid surgery. The aim of study was to determine the recent decade frequency of total and subtotal thyroidectomy complications in Sari, Iran. Material & Methods: In this cross-sectional study, the patients underwent total or subtotal thyroidectomy during 2001-2011 at two referral hospitals in sari (Imam Khomeini as academic and Shafa as private hospital) were enrolled. The questionnaire included demographic information, diagnosis and pathology of the disease, type of thyroid surgery, serum calcium level after the surgery, recurrent laryngeal nerve injury, and hematoma data. Frequencies, Odds ratio and their 95%CI were reported. Results: Among the 382 subjects (66 men and 316 women), 86 cases (22.5%) underwent total and 296 cases (77.5%) underwent subtotal thyroidectomy. The final pathology was malignant in 25.1%. Hypocalcaemia occurred in 40.3% of patients (CI95%: 35.5-45.3) that 4.2% (CI95%: 2.3-6.6) were permanent. Recurrent laryngeal nerve injury was reported in 0.8% (CI95%: 0.3-2.3) [0.3% permanent (CI95% :0.05-1.5)] and two cases (0.5%) complicated by cervical hematoma (CI95%: 0.1-1.9). Total thyroidectomy was associated with more complications than subtotal. [OR: 6.4 (CI95%: 2.6-16.1), P = 0.0001]. Conclusion: The findings of this study show that total and subtotal thyroidectomy complications has significantly decreased that can be due to improved surgical techniques and increased proficiency of surgeons.

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Background and purpose: Intravenous regional anesthesia (IVRA) is a simple and reliable method for upper extremity injuries. Different additives have been combined with local anesthetics to improve block quality, decrease tourniquet pain and postoperative analgesia in IVRA. This study was performed to evaluate the effect of (NTG) in quality improvement when added to lidocaine in IVRA. Material and methods: In a clinical trial, 40 patients ASA (American Society of Anesthesiologists) I-II, the candidates with upper extremity injury were scheduled for IVRA randomly allocated into two groups. Under identical condition, the control group received 3mg/kg mg lidocaine %0.5 and the study group received 3mg/kg mg lidocaine %0.5 plus 200µg nitroglycerine. Hemodynamic variables were measured and recorded at 5, 10, 15, 20, and 30 min after anesthetic solution administration. The onset and recovery times of sensory and motor block were measured and recorded and tourniquet pain based on visual analog scale (VAS) score in all patients. After the tourniquet deflation, at 30 min and 2, 4, 6 and 12 h, hemodynamic variables, VAS score, total analgesic consumption in the first 24 h after operation, and the side effects were noted. Results: Sensory block onset time was less in NW in comparison with the control group (2.45±0.51042 vs 4.35±1.26803) Sensory and motor recovery times were prolonged in NW group compared to the control group (8.25±2.1734 vs 3.825±0.99041 min) for sensory, (4.2000±1.15166 vs 3.025±0.80255 min) for motor recovery with statistical significance (P<0.05). The onset time tourniquet pain was prolonged in NW in comparison with the control group (22.5±3.12039 vs 19.4±2.77963 min). Pulse rate at 0.5, 2 and 4 hr postoperatively was lower in the study group (P<0.05). Postoperative analgesia after 0.5h of tourniquet deflation was prolonged with statistically significant difference in VAS scores (1.1±0.30 vs 1.05±0.22). Conclusion: Totally, according to the obtained results, it may be concluded that the use of nitroglycerine added to lidocaine would result in an increase in the effect of anesthetic without additional adverse effects.

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Background and purpose: Nosocomial infections are a major health problem worldwide. Hospital environment is a reservoir for nosocomial pathogens. This study aimed at determining the prevalence of antimicrobial resistance pattern of bacteria isolated from the environment and medical equipment in Valiasr Hospital in Arak. Material and Methods: A total of 210 samples was collected from hospital and identified. Inducible clindamycin resistance in Staphylococcus was determined with D Zone and sensitivity to vancomycin was identified by using Mueller Hinton agar and E-test. The sensitivity of these strains to cefoxitin and oxacillin was determined by disk diffusion method. The resistance was confirmed by investigating the presence of mec A gene using PCR technique. To identify the ESBL producing gram-negative bacill standard method was used. Amp C beta lactamase resistance was assessed by Amp C disk test, and for carbapenemase resistant MHT was applied. E-test with imipenem and imipenem+EDTA were used to identify the resistance pattern of metalo beta lactamase. Results: There were 240 isolates of which 185 (77%) were Staphylococcus. Among these isolates 136 (73.5%) were resistant to oxacillin and cefoxitin. Inducible clindamycin resistance was found in 46 (25%) isolates. Two samples of the Staphylococcus epidermidis were vancomycin resistant. The presence of Sa442 genes in Staphylococcus aureus and the mecA gene of MRSA was confirmed in all isolates expect in two. The frequency of gram-negative bacteria was 55(23%). ox51 gene was identified in acinetobacter baumannii. Fifteen nonfermenting gram-negative bacill and 40(65%) strains of Enterobacteriaceae were ESBL producers. Among the Klebsiella pneumoniae six (33.33%) were AmpC producers. MHT positive was found in nine (60%) nonfermenting bacills. Conclusion: According to this study presence of microorganisms in Valiasr Hospital environment and high incidence of antibiotic resistance are considered as major health problems. By determining potential pathogens in hospital setting and the pattern of antibiotic resistance markers physicians can perform more successful treatments.

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Background and purpose: Staphylococcus aureus is recognized as the most important pathogen responsible for nosocomial infections, mainly pneumonia, bloodstream infections, and surgical site infection. It also remains a major cause of community-acquired infections. The possibility of biofilm formation on the surface and implicated devices such as catheters is one of the most important virulence factors in S.aureus. The aim of this study was to investigate the biofilm formation ability and presence of ica genes in clinical isolates of S.aureus from intensive care unit. Material and methods: A total of 72 clinical S. aureus isolates was collected from three hospitals in Tehran. Antibiotic susceptibility testing was performed as recommended by the CLSI for 11 antibiotics using disk diffusion method. Ability of biofilm formation was measured by Microtiter plate assay. All isolates were then examined for presence of the icaABCD genes. Results: The microtiter plate assay results showed that attachment abilities in 26 (36.1%) strains were strong, in 30 (41.6%) strains were moderate, and in 16 (22.3%) strains were weak. The prevalence of the icaA, icaB, icaC and icaD genes among the studied isolates was as follows: icaA positive: 42 (58.3%), icaB positive: 34 (47.2%), icaC positive: 46 (63.8%) and icaD: 50 (69.5%). Conclusion: Our results suggest different biofilm formation ability in clinical isolates of S.aureus. Biofilm formation on devices such as intravascular catheters can increase the risk of infection. Moreover, bacterial biofilms show increased tolerance to antibiotics. This is a serious problem in medical centers specially, in intensive care units.

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Background and purpose: Diagnosis of acute appendicitis can be difficult due to similarity of symptoms to many abdominal diseases. Delayed diagnosis could expose the patient to serious conditions. In this study we compared the Artificial Neural Network (ANN) models and conventional laboratory tests in diagnosis of appendicitis. Materials and methods: The study population included 100 patients with suspected appendicitis. White Blood Cells (WBC), Procalcitonin (PCT), C-reactive protein (CRP) and PMN were measured as conventional diagnostic tests and ANN was applied as a combinational test. Definite diagnosis of appendicitis was made based on pathology results. For each test, Receiver Operating Characteristic (ROC) curve and sensitivity and specificity tables were used. Results: The mean age of patients was 28.01±12.68 years and 71 (71%) were male. The sensitivity of ANN model was 97.59 and the sensitivities of CRP and WBC were 92.77% and 85.54%, respectively. The highest accuracy in diagnosis of acute appendicitis was achieved by ANN (88%). Conclusion: This study showed that combinational test using ANN could be more beneficial in diagnosis of acute appendicitis.

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Background and purpose: Dyes from textile industry are amongst the major pollutants of the environment that are harmful for both human health and the environment. Azo dyes constitute the largest and the most important class of commercial dyes, accounting for 50% of all commercial dyes. This study investigated the efficacy of Cr-doped ZnO nanoparticles in removal of reactive black 5 (RB5) dye from aquatic solutions in presence of solar radiation.

Materials and methods: An experimental laboratory study was done by designing the surface-answer test. Cr-doped ZnO nanoparticles were synthesized using co-precipitation method. X-ray diffraction (XRD) and scanning electron microscopy (SEM) were used for characterization of the nanoparticles prepared. Effects of parameters such as pH, nanoparticle dosage, initial RB5 concentration, and contact time on the removal efficiency of RB5 were studied. The remaining concentration of RB5 was analyzed by UV/VIS spectrophotometer at a wavelength of 597 nm. Finally, the statistical analysis of the model was conducted by ANOVA.

Results: Results showed that removal efficiency increased by increasing nanoparticle dosage and contact time. Also, we found that removal efficiency decreased by increasing the initial dye concentration and pH. The optimum condition for dye removal was obtained at pH 4, nanoparticle dosage of 1.75 g/L, initial dye content of 112.5 mg/L, and 75 min contact time. In this condition the efficiency removal and desirability were 75.41 and of 0.905, respectively.

Conclusion: Removal of textile dyes was found to be quick and effective when using Cr-doped ZnO nanoparticles. Also, designing and performing the experiment (in low frequency) can help in optimizing the efficiency removal of pollutant from aqueous media.

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Background and purpose: Sternal Wound Infection (SWI) is a serious complication of median sternotomy that increases the rate of mortality. We report our experience of managing SWI in a regional cardiothoracic unit in Mazandaran province, Iran.

Materials and methods: We prospectively studied 4725 patients who underwent isolated coronary artery bypass grafting between March 2012 and March 2015. Information about age, sex, morbidities, surgical factors and nature of sternal wound infection were recorded. Treatment options were stratified by nature of infection, and timing and nature of management. Data analysis was done using Med calc soft ware and p-values less than 0.5 were considered significant.

Results: Sternal wound infection occurred in 49 (1%) patients. There were 26 (0.55%) superficial and 23 (0.48%) deep SWIs. SWI patients were found to be mainly females, with diabetes or hypertension, high body mass indices and longer aortic cross-clamp time. All patients with superficial SWI were managed by skin debridement and closure. Patients with deep SWI who had surgery within 48 hours of diagnosis were managed using skin and bone debridement and sternal rewiring following mediastinal drain. The mortality rate was found to be high in patients with SWI (12.2%).

Conclusion: Low sternal wound infection can be achieved with an ongoing focus on appropriate infection control. SWI significantly increases the risk of mortality which could be reduced through early intervention.

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Background and purpose: Exosome as drug delivery system is a novel and smart methodology enabling delivery of exosome cargo into specific tissue. This aim could be accessed by manipulation of exosome producer cells for expression of specific transmembrane-anchored ligand on exosomes surface. Accordingly, Lysosomal Associated Membrane Protein (LAMP) is one of the best choices for anchoring and chimerization with any ligand for this propose. In current study we designed a lentiviral vector which carries a chimeric gene for expression of LAMP2-DARPin in exosome to attach to HER2 on cancer cell surfaces.
Materials and methods: RNA was extracted from mouse skeletal muscle, then, cDNA was produced by RT-PCR and CDS of LAMP2b gene was amplified by specific primers. Two restriction sites were introduced between signal and mature peptide sequence by SOEing PCR. This fragment was inserted into pLEX-MCS lentiviral vector and cloned in E.coli. DARPin gene was designed, optimized and synthesized, then cloned between signal and mature peptide. Positive clone was confirmed by colony PCR and DNA sequencing.
Results: Electrophoresis of SOEing PCR product showed 1290 bp DNA fragment of LAMP2B CDS. Insertion of LAMP2 in pLEX vector was confirmed by electrophoresis and sequencing. Accordingly, DARPins was synthesized and inserted into pLEX-LAMP vector, electrophoresis and sequencing of purified plasmid from positive clone confirmed the insertion of DARPins into pLEX-LAMP vector.
Conclusion: We generated two lentiviral vectors, pLEX-LAMP for expression of any ligands in exosome surface and pLEX-LAMP DARPin for expression of DARPin on exosome surface for HER2 targeting.