Systemic sclerosis (SSc) is an autoimmune rheumatic disorder distinguished with fibrosis and vascular injury and structural alteration, coexisting with Reynaud’s phenomenon. The crosstalk between activated fibroblasts, immune effectors, and endothelial cells are the primary culprits in disease process. Fractalkine (FKN) or CX3CL1 is an unremarkable membrane-bound soluble chemokine and an adhesion molecule expressed on pro-inflammatory cytokine. In this systematic review, FKN and its receptor’s (CX3CR1) role in mediating inflammatory processes focusing on the pathogenesis of SSc is investigated. FKN is one of the most influential molecules which monitors the trafficking of inflammatory cells through the endothelium and has been observed to have pronounced expression in inflammation. The correlation between increased CX3CL1 levels in SSc and interstitial lung disease was established, and it was noted that CX3CL1 is predominantly co-localized with infiltrating mononuclear cells and epithelia within the lungs. The interstitial lung disease prediction and its progression may be available through augmented concentrations in SSc patients. Conclusively, Emerging evidence claims that FKN could be expressed in numerous tissues, taking part in the CX3CR1 positive cell accumulation at sites of inflammation and, as a result, involved in countless rheumatic diseases such as rheumatoid arthritis, Systemic lupus erythematosus, and scleroderma. Besides, it may play a prominent part in the SSc pathogenesis, involving vascular injury and tissue inflammation. Its estimation could be used as a serological marker for the recognition and follow-up of skin and pulmonary complications.

Effective and Life-Saving Retrograde Femoral and Jugular Vein Double Lumen Catheter Insertion in Patients with Poor Hemodialysis Venous Access Who Needed Emergency Hemodialysis: A Case Series Running title: Retrograde double lumen catheter insertionAhmad Hosseinzadeh1, Farzad Dalfardi1, Reza Shahriarirad1, 2, Fatemehsadat Pezeshkian1, 2, *, Farhad Keikha31 Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, 7134814336, Iran2 Student Research Committee, Shiraz University of Medical Sciences, Shiraz, 7134814336, Iran3 School of Medicine, Shiraz University of Medical Sciences, Shiraz, 7134814336, IranCorresponding author: Fatemehsadat Pezeshkian; Shiraz University of Medical Sciences, Shiraz, 7134814336, Iran; ORCID:

Objective: To evaluate the efficacy and side effects of each medication regime, a comparison was drawn between the administration of misoprostol with the combined use of misoprostol plus oxytocin and misoprostol plus methylergometrine for full expulsion of retained intrauterine tissues in patients who underwent a miscarriage. Design: randomized, double-blind, clinical trial Setting: gynecology and obstetrics clinic in Jahrom, Southern Iran Population: 90 patients with gestational age below 12 weeks and having undergone a recent miscarriage. Methods: They were randomly allocated into three groups after being screened for underlying diseases and coagulative blood disorders. For the first group, labeled as the control group, misoprostol was administered alone, while as, the combination of misoprostol plus methylergometrine and misoprostol plus oxytocin was prescribed for the second and third groups, respectively. Main Outcome Measures: Primary: Expulsion of retained products of conception; Secondary: Pain, Hemorrhage Results: Despite no significant statistical difference being observed in the expulsion of retained products of conception (RPOC)by the administration of misoprostol alone or with combined medical therapy of misoprostol with oxytocin or methylergometrine (P-value< 0.329), all of them showed a successful treatment. Additionally, the patients treated with misoprostol and oxytocin showed good results in expelling the RPOC(P=0.013); while as, those treated by misoprostol plus methylergometrine reported controlled pain and hemorrhage after an abortion (P=0.004). Conclusion: The course of medications viz. methylergometrine, oxytocin, and misoprostol indicated a successful outpatient treatment in patients that had experienced a miscarriage or an incomplete abortion. They are cost-effective and have shown lesser side effects.

Introduction: Many patients with chronic diseases often use the traditional medicine approach in addition to conventional medicine. The aim of this study was to evaluate the epidemiological factors of patients with dermatologcal conditions referring to traditional Persian Medicine (TPM) clinic. Materials and Methods: In this cross-sectional study, we reviewed all the patients’ medical documents with dermatological conditions referred to the TPM clinic at Shiraz, Southern Iran in 2018. Then, the epidemiological factors of the patients were recorded to a researcher-made data collection form. SPSS software version 22 was conducted to data analysis. Results: Overall, 631 patients consist of 151 (23.9%) male individuals and 580 (76.1%) female individuals were enrolled to the study. Most of the patients were aged between 31 and 40 years, and 347 (55%) patients were married, and most of them were housewives. The frequency of patients in spring was higher than other seasons. Furthermore, the most of the patients were university educated. Acne, eczema and hair loss were the three most complaints of the patients referring to the traditional medicine clinic. 301(47.7%) patients reported gastrointestinal problems as another complaint concomitant with their skin problems. Conclusion: It seems that women with skin problems, including acne, eczema, and hair loss, were more likely to refer to the TPM clinic. Therefore, development of TPM clinics in dermatology field as a scientific and academic approach can be effective in the treatment of patients with dermatological condition accompanied by traditional medicine.