Search

Non-arteritic anterior ischaemic optic neuropathy (NAION) typically presents with sudden painless vision loss in those with vascular risk factors and a ‘disc-at-risk’.[1][1] Following the initial insult, most patients remain stable or may notice slight improvement in their vision. However, a

To assess the effectiveness of psychosexual education on promoting sexual function and genital self-image and reducing sexual distress through e-learning among women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome.Randomized controlled trial.Imam Khomeini Hospital "Pelvic Floor Clinic" in Tehran.Thirty-eight 15- to 49-year-old women with MRKH syndrome who had undergone surgical or nonsurgical vaginal reconstruction techniques more than 6 months before the intervention were assigned to 2 parallel intervention and control groups of 19 each.Psychosexual education was delivered through e-learning for the intervention group over an 8-week period, with no limitations of time and space. Sexual function, genital self-image, and sexual distress were evaluated at baseline, and at 4 and 8 weeks after the intervention.The data collection tools included the Persian version of the Female Sexual Function Index, Female Genital Self-Image Scale, and the Revised Female Sexual Distress Scale.The between group mean differences of sexual function, genital self-image, and sexual distress after 4 weeks (-1.2 [95% CI, -2.1 to -0.1], P = .025; -1.9 [95% CI, -2.9 to -0.9], P.001; 4.2 [95% CI, 2.0-6.4], P.001, respectively), as well as after 8 weeks (-1.8 [95% CI, -3.1 to -0.5], P = .009; -3.0 [95% CI, -4.5 to -1.5], P.001; 6.7, 95% CI, 3.9-9.6], P0.001, respectively) after baseline were significant.Psychosexual education improved sexual function and genital self-image and reduced sexual distress in women with MRKH syndrome. Therefore, using this approach, we can raise individuals' sexual knowledge and skills and correct their sexual beliefs and attitudes.

Introduction In this study, we aim to assess the intra-operative effect of dexmedetomidine administration on the hemodynamic parameters and bleeding volume during hip fracture surgery. Patients and methods we designed and implemented a triple-blinded randomized clinical trial to objectively compare the effects of 0.5 µg/kg/h infusion of dexmedetomidine with placebo (equal amount of normal saline) during hip fracture surgery. All included cases were between 30 and 70 years old and underwent surgery for fixation of a proximal femur fracture from September 26, 2020 until February 15, 2021. They were all ASA class I or II with preoperative hemoglobin levels of 10 mg/dL or higher. Surgical blood loss and hemodynamic parameters were documented. Results 76 patients were enrolled. There were no significant differences in baseline patient characteristics. The bleeding rate was 620 ± 190.0 mL for the normal saline group and 476 ± 177.98 mL in the dexmedetomidine group (P = 0.04). No significant effect on hemodynamic parameters was observed. Conclusion Based on the current study, intravenous infusion of dexmedetomidine during hip fracture surgery under general anesthesia reduced the amount of intraoperative bleeding without causing any significant hemodynamic disturbances. Registration number IRCT20191222045857N1 (Iranian Registry of Clinical Trials)

Introduction Calcaneal fractures may have lifelong debilitating sequences, if not treated properly. Identifying different types of calcaneal fractures based on the computed tomography (CT) scans can increase our conception about these fractures. Methods In a cross-sectional study, the available CT images of all consecutive patients with the diagnosis of calcaneal fracture, from January 2015 to December 2018, were reviewed to determine different patterns and types of these fractures. Results CT images of 886 patients (mean age, 41.29 ± 14.9; range, 3–89 years; male/female, 4.86; pediatric: 3.7%) with 957 calcaneal fractures were evaluated. The peak incidence of calcaneal fractures was seen in patients between 30 to 39 years of age (29%). The rate of open fractures and bilateral involvements were 2.4% and 8.0%, respectively. Among 680 (71.0%) intra-articular calcaneal fractures, subtalar calcaneal fractures were the most common type (94.3%). The majority of intra-articular subtalar calcaneal fractures were displaced (95.0%) with calcaneocuboid joint (CCJ) involvement (59.9%). Fracture lines were extended to the CCJ in about 86.9% of Sanders type IV, 66.3% of type III, and 60.2% of type II. Among 261 extra-articular fractures (27.3%), calcaneal body fracture (55.6%) was the most frequent type, followed by medial tubercle fracture (24.1%), calcaneal tuberosity fracture (10.4%), Degan type I anterior process fractures (5.4%), Degan type II anterior process fracture (3.4%), and isolated lateral tubercle fracture (1.1%). Most of bilateral calcaneal fractures were intra-articular subtalar fractures with involvement of CCJ. Although majority of intra-articular calcaneal fractures were displaced; less than half of the extra-articular fractures were displaced. Conclusion Displaced intra-articular subtalar calcaneal fractures with CCJ involvement are the most frequent type of unilateral and bilateral calcaneal fractures. It appears that there is a correlation between Sanders type and the probability of CCJ involvement. Unlike intra-articular subtalar calcaneal fractures, the CCJ in the majority of extra-articular calcaneal body fractures was intact. Level of evidence Level IV.

Despite significant insights into the neural mechanisms of acute placebo responses, less is known about longer-term placebo responses, such as those seen in clinical trials, or their interactions with brain disease. We examined brain correlates of placebo responses in a randomized trial of a then controversial and now disproved endovascular treatment for multiple sclerosis. Patients received either balloon or sham extracranial venoplasty and were followed for 48 weeks. Venoplasty had no therapeutic effect, but a subset of both venoplasty- and sham-treated patients reported a transient improvement in health-related quality of life, suggesting a placebo response. Placebo responders did not differ from non-responders in total MRI T2 lesion load, count or location, nor were there differences in normalized brain volume, regional grey or white matter volume or cortical thickness (CT). However, responders had higher lesion activity. Graph theoretical analysis of CT covariance showed that non-responders had a more small-world-like CT architecture. In non-responders, lesion load was inversely associated with CT in somatosensory, motor and association areas, precuneus, and insula, primarily in the right hemisphere. In responders, lesion load was unrelated to CT. The neuropathological process in MS may produce in some a cortical configuration less capable of generating sustained placebo responses.

Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12·2 million (95% UI 11·0–13·6) incident cases of stroke, 101 million (93·2–111) prevalent cases of stroke, 143 million (133–153) DALYs due to stroke, and 6·55 million (6·00–7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8–12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1–6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0–73·0), prevalent strokes increased by 85·0% (83·0–88·0), deaths from stroke increased by 43·0% (31·0–55·0), and DALYs due to stroke increased by 32·0% (22·0–42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0–18·0), mortality decreased by 36·0% (31·0–42·0), prevalence decreased by 6·0% (5·0–7·0), and DALYs decreased by 36·0% (31·0–42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0–24·0) and incidence rates increased by 15·0% (12·0–18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5–3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5–3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57–8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97–3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01–1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7–90·8] DALYs or 55·5% [48·2–62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3–48·6] DALYs or 24·3% [15·7–33·2]), high fasting plasma glucose (28·9 million [19·8–41·5] DALYs or 20·2% [13·8–29·1]), ambient particulate matter pollution (28·7 million [23·4–33·4] DALYs or 20·1% [16·6–23·0]), and smoking (25·3 million [22·6–28·2] DALYs or 17·6% [16·4–19·0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries. Funding Bill & Melinda Gates Foundation.

Clean air is considered as a basic need for human health. However, air pollution is a significant threat to health in developed and developing countries. The aim of this study was to estimate the health effects attributed to PM2.5 pollutants in the air of Ardabil in 2018 (using Air Q + model). Raw data related to particles were collected from the Department of Environment and processed in Excel software and converted into an input file of the Air Q + model, and in the final stage, by considering appropriate epidemiological parameters and combining these data with air quality data, it was possible to estimate the health effects of air pollution. The results showed that the average annual concentrations of PM2.5 and PM10 were 15.47 and 30.94 in the study year, respectively. The total number of deaths due to ALRI, COPD, lung cancer, IHD, and stroke deaths on average during the study period were estimated to be 73, 11, 7, 15, and 14 deaths, respectively, which include 14.62, 15.78, 4.9, 12.43, and 11.6% of deaths due to ALRI, COPD, lung cancer, IHD, and stroke deaths, respectively. In conditions of concentration above 5 µg/m3, attributed proportion, total number of attributed cases and number of attributed cases per 100,000 population (with moderate relative risk and confidence interval of 95%) for cardiovascular diseases have been estimated to be 0.95% 103 people and 42.19 people. Also, the attributed proportion, the total number of attributable cases, and the number of attributable cases per 100,000 population (with moderate relative risk and confidence of 95%) for the admission of respiratory diseases have been estimated at 97.1%, 68 persons and 3 persons, respectively. Our results suggest that particle exposure even at low concentrations is associated with an increased risk of overall mortality and specific cause mortality and hospital admissions for respiratory and cardiovascular diseases.

Objectives The cytomorphologic findings of bronchoalveolar lavage (BAL) in pediatrics were correlated with clinical symptoms. Methods Patient demographics, clinical symptoms/history, cytomorphologic findings, and oil red O (ORO) staining of 100 pediatric patients who underwent BAL between 2014 and 2016 were reviewed at a large academic institution. Results Of the 100 patients (males/females, 62:38), the most common conditions for BAL included cough (46/100), reflux (39/100), pneumonia (30/100), dysphagia (22/100), asthma (19/100), and cystic fibrosis (15/100). Sixteen of 100 patients were admitted with pulmonary symptoms from the emergency department. Cytomorphologic findings showed acute inflammation in 37 BALs and chronic inflammation in 9. Abundant thick mucin was present in 3 cytology cases from patients with cystic fibrosis. Fungal elements were detected in 3 cases (Candida, Aspergillus, and Pneumocystis jirovecii) and viral effects (rhinovirus) in one. Thirty-seven of 100 had rare ORO-positive lipid-laden macrophages (LLMs), 7 of 100 had moderate LLMs, 11 of 100 had numerous LLMs, 18 of 100 had positive staining without the degree of staining, 25 of 100 had negative ORO staining, and 2 of 100 had noncontributory ORO staining. An iron stain was done on 15 BALs (2 positive, 9 negative, and 4 noncontributory). Conclusions BAL cytology is a useful tool in pediatrics to discriminate underlying causes of aerodigestive system conditions, while ORO staining may occasionally help.

Background Over the last two decades, breast cancer remains the main cause of cancer deaths in women. To treat this type of cancer, radiation therapy (RT) has proved to be efficient. RT for breast cancer is, however, challenged by intrafractional motion caused by respiration. The problem is more severe for the left-sided breast cancer due to the proximity to the heart as an organ-at-risk. While particle therapy results in superior dose characteristics than conventional RT, due to the physics of particle interactions in the body, particle therapy is more sensitive to target motion. Conclusions This review highlights current and emerging strategies for the management of intrafractional target motion in breast cancer treatment with an emphasis on particle therapy, as a modern RT technique. There are major challenges associated with transferring real-time motion monitoring technologies from photon to particles beams. Surface imaging would be the dominant imaging modality for real-time intrafractional motion monitoring for breast cancer. The magnetic resonance imaging (MRI) guidance and ultra high dose rate (FLASH)-RT seem to be state-of-the-art approaches to deal with 4D RT for breast cancer.

The ability to quickly learn fundamentals about a new infectious disease, such as how it is transmitted, the incubation period, and related symptoms, is crucial in any novel pandemic. For instance, rapid identification of symptoms can enable interventions for dampening the spread of the disease. Traditionally, symptoms are learned from research publications associated with clinical studies. However, clinical studies are often slow and time intensive, and hence delays can have dire consequences in a rapidly spreading pandemic like we have seen with COVID-19. In this article, we introduce SymptomID, a modular artificial intelligence–based framework for rapid identification of symptoms associated with novel pandemics using publicly available news reports. SymptomID is built using the state-of-the-art natural language processing model (Bidirectional Encoder Representations for Transformers) to extract symptoms from publicly available news reports and cluster-related symptoms together to remove redundancy. Our proposed framework requires minimal training data, because it builds on a pre-trained language model. In this study, we present a case study of SymptomID using news articles about the current COVID-19 pandemic. Our COVID-19 symptom extraction module, trained on 225 articles, achieves an F1 score of over 0.8. SymptomID can correctly identify well-established symptoms (e.g., “fever” and “cough”) and less-prevalent symptoms (e.g., “rashes,” “hair loss,” “brain fog”) associated with the novel coronavirus. We believe this framework can be extended and easily adapted in future pandemics to quickly learn relevant insights that are fundamental for understanding and combating a new infectious disease.

Objective: The objective of this study was to compare the biomechanical differences of different rod configurations following anterior column realignment (ACR) and pedicle subtraction osteotomy (PSO) for an optimal correction technique and rod configuration that would minimize the risk of rod failure.Methods: A validated spinopelvic (L1-pelvis) finite element model was used to simulate ACR at the L3–4 level. The ACR procedure was followed by dual-rod fixation, and for 4-rod constructs, either medial/lateral accessory rods (connected to primary rods) or satellite rods (directly connected to ACR level screws). The range of motion (ROM), maximum von Mises stress on the rods, and factor of safety (FOS) were calculated for the ACR models and compared to the existing literature of different PSO rod configurations.Results: All of the 4-rod ACR constructs showed a reduction in ROM and maximum von Mises stress compared to the dual-rod ACR construct. Additionally, all of the 4-rod ACR constructs showed greater percentage reduction in ROM and maximum von Mises stress compared to the PSO 4-rod configurations. The ACR satellite rod construct had the maximum stress reduction i.e., 47.3% compared to dual-rod construct and showed the highest FOS (4.76). These findings are consistent with existing literature that supports the use of satellite rods to reduce the occurrence of rod fracture.Conclusion: Our findings suggest that the ACR satellite rod construct may be the most beneficial in reducing the risk of rod failure compared to all other PSO and ACR constructs.

BACKGROUND: This review summarizes the literature on sleep quality in neuromyelitis optica spectrum disorder (NMOSD) and discusses these findings in the context of current knowledge of sleep physiology. METHODS: A literature search was performed using Ovid MEDLINE, Embase, and Scopus from inception to September 3, 2020. All included studies reported at least 1 measure of sleep quality in individuals with NMOSD. Pittsburgh Sleep Quality Index (PSQI) scores of individuals from 4 studies were compared with those from a data set of controls. RESULTS: Thirteen studies (1041 individuals with NMOSD) were included in the review. Disturbed sleep was demonstrated across subjective metrics based on patient surveys and objective metrics such as polysomnography. An estimated 70% of individuals with NMOSD can be classified as poor sleepers. Standardized mean difference between PSQI scores of 183 individuals with NMOSD and those of 9284 controls was 0.72 (95% CI, 0.57–0.86; P < .001). Decreased sleep quality was significantly associated with decreased quality of life and increased anxiety, depression, and disability status. Sleep disturbances in NMOSD were similar in severity to those in multiple sclerosis. CONCLUSIONS: Sleep disturbances are a major contributor to NMOSD disease burden and may arise from the disruption of sleep circuitry, in addition to physical and psychological complications. Multiple processes involved in sleep regulation may be affected, such as, but not limited to, neural circadian circuit disruption, direct effects of inflammation, aminergic projecting system abnormalities, glymphatic system impairment, and development of sleep disorders such as restless legs syndrome/sleep apnea. A better understanding of these mechanisms is necessary for developing effective therapies for NMOSD-associated sleep disturbances.

Interpersonal Emotion regulation has become an important research topic in emotional studies. In this study, we examined the psychometric properties of the interpersonal emotion regulation questionnaire (IERQ) in the nonclinical and clinical populations. Data were drawn from two studies. One study was conducted in a general population (N = 428) and the other in a clinical setting with individuals diagnosed with emotional disorders (N = 220). To assess the convergent validity of IERQ in the first study, questionnaires assessing emotion regulation, anxiety, depression, attachment style, and emotional intelligence were also conducted. Confirmatory Factor Analysis (CFA) results showed that the four-factor model of the IERQ fit the data in the nonclinical sample and emotional disorders sample well. The IERQ questionnaire showed excellent internal consistency for all subscales in the nonclinical and clinical samples. Test-retest reliability analysis also showed high levels of test-retest reliability in the nonclinical sample. The convergent validity results demonstrated the significant relationship of IERQ with almost all measures assessing emotion regulation, anxiety, depression, attachment style, and emotional intelligence. Findings of discriminant validity showed significant differences between the clinical and nonclinical population in subscales of IERQ, but there are not any significant differences between clinical groups in these subscales. The convenience sampling method was used for the first sample, and some measures could not be used in the clinical samples, and some analyses could not be conducted in this sample. Furthermore, limited emotional disorder diagnostics were included in the clinical sample, and a large number of disorders were not considered. Thus, the generalizability of our findings is limited. Overall, the current study provided evidence supporting the reliability and validity of IERQ in the Iranian community and emotional disorders samples and pave the way for further cross-cultural research on IER.

BackgroundMyelomeningocele (MMC) is the most common and severe form of spina bifida and imposes a significant burden on patients and the healthcare system. Recently, the multidisciplinary management of MMC has become popular. Herein, we aimed to review the orthopedic management, outcomes, and complications of the of patients with MMC eyeing a multidisciplinary approach.MethodsWe searched PubMed and EMBASE to find relevant studies published before August 2020. All studies that included clinical management of MMC patients and published earlier than 2000 were considered for review on the condition that they reported at least one orthopedic intervention and the rate of complications. We excluded review articles, case reports, case series, letters, commentaries, editorials, and conference abstracts. The primary and secondary goals of our review were to report the outcomes and complication rates of multidisciplinary management for MMC patients.ResultsTwenty-six studies included data for the management of 229,791 patients with MMC and were selected. Sixteen studies reported multidisciplinary management in addition to orthopedic management. From those, 11 (42.31%) included urologic management, 13 (50%) neurosurgical management, 11 (42.31%) neurologic management, and 5 (19.23%) gastrointestinal management. All studies included postnatal operations and related management. No randomized clinical trial was found in our search.ConclusionOrthopedic approaches play a key role in MMC management by alleviating spinal deformities, particularly scoliosis, and hip, foot, and ankle complications. However, the most appropriate management, whether surgical or non-surgical, may vary for different patients, given disease severity and the age of patients.Graphical abstract

The aim of this study was to determine the toxicity of cefixime in the inlet solution and effluent treated with the sono-electro-Fenton process using standard strains of microorganisms. This research was performed as an experimental study, which was conducted on a laboratory scale. The standard strains of Escherichia coli (gram-negative) and Staphylococcus aureus (gram-positive) were used for bioassay. First, the stock solution of 1000 mg/L containing Cefixime was prepared, and for each bacterium (gram-positive and gram-negative), 5 samples from the inlet solution of the reactor and 5 samples from effluent treated with the sono-electro-Fenton process were collected under optimal conditions. Finally, each sample was transferred to 10 mL of sterile lactose broth, and a loop of E. coli or S. aureus was dissolved in each sample. Toxicity changes were investigated by calculating the percentage of growth inhibition. The results showed that after 10 hours, the growth rate of both bacteria in the control and the effluent samples was higher, while the growth of bacteria in the inlet solution was lower and had higher toxicity. Based on the results of the study, the toxicity rate for E. coli was reduced from 70% in the inlet solution to 9.3% in the effluent (86.7% reduction in toxicity), and in the case of S. aureus, it was diminished from 25.3% in the inlet solution to 7% in the effluent (72.3% reduction in toxicity) after 10 hours. Based on the results of the present study, bioassay using microorganisms is an effective and useful method to study changes in the toxicity of cefixime.

Migraines are commonly associated with a visual aura that has a characteristic clinical presentation. Cortical lesions within or in close proximity to the retrochiasmal visual pathways may also present in a manner that mimics migrainous visual phenomena and, in some cases, may be too small to manifest with a visual field defect on formal testing. We present 4 patients (3 females and 1 male) with an average age of 48.5 (range 28–67) years who had migraine-like visual disturbances related to a right temporal meningioma, occipital cavernoma, occipital lobe infarction, and demyelination in the optic radiations, which was the presenting sign of multiple sclerosis. No patient underwent neurosurgical intervention, and 1 patient (occipital lobe infarct) had complete resolution of the symptom after initial presentation. All patients had normal visual fields at follow-up and no thinning evident on optical coherence tomography. Our cases emphasize the importance of a history in assessing patients with transient positive visual phenomena and identify pathology that may present without visual field defects. Clinical features that should raise a doubt about a diagnosis of migraine visual aura include the absence of headache, brief visual disturbance lasting 60 min, and age >40, especially with no past medical history of migraine.

Background: Corrosion and scaling are major problems in the drinking water facilities causing problems such as water loss, recued life of facilities, pipe punctures, clogging of pipes, and pressure loss in drinking water distribution system. This study aims to determine the corrosion and scaling potential in drinking water distribution system of Meshginshahr, Ardebil, Iran.Methods: This descriptive cross-sectional study was conducted during the two seasons (summer and winter) in 2019. A total of 20 water samples, which were obtained by averaging 100 samples, were analyzed to determine the corrosion and scaling potential using Langelier Saturation Index and Ryznar Stability Index.Results: The results showed that the annual average of LSI and RSI were -1.34 and 10.03, respectively, indicating that the drinking water of Meshginshahr was corrosive and scale-forming.Conclusion: Therefore, it is necessary to constantly evaluate the drinking water supply resources of this city and try to adjust the pH of water and control other factors affecting corrosion, including concentrations of chloride, dissolved oxygen, and sulfate.

Background Grip strength is an essential component of physical fitness. The objective of this study was to develop normative handgrip strength data for Iranian healthy boys and girls comparing their handgrip strength with international reference values. Methods Handgrip strength was measured in 2637 healthy children/adolescents (1391 boys and 1246 girls), aged 7–18 years, using a standard adjustable Jamar hand dynamometer (Model 5030 J1, Sammons Preston Rolyan, Bolingbrook, IL, USA). Body mass (kg) and stature (cm) were measured and body mass index was computed in kg/m2. The sample was stratified by gender, age, and hand preference. Results Handgrip strength increased with age and was considerably higher in boys than in girls for all age groups (p p Conclusions The differences between present results and those of similar available in the literature in this field emphasize the significant role of using normative data specific to a particular population in research or clinical settings.

Controversy still exists regarding how to reduce and fix a displaced tibial avulsion fracture. Open reduction and internal fixation may lead to morbidity due to soft-tissue injury and arthrotomy. As a result, arthroscopic techniques are increasing in popularity. In the literature, sutures, K wires, and screws are suggested to be used as the fixation devices. Screws cannot be used in small or comminuted fractures, whereas K wires and sutures may not provide strong stability. Recently, with the advent of ultrahigh molecular weight polyethylene sutures like FiberWire, it has become possible to use it as the fixation device in even comminuted avulsion fractures with acceptable reduction stability. In this paper, we describe a simple arthroscopic technique using a FiberWire to manage the displaced tibial eminence avulsion fracture., Technique Video Video 1 Our arthroscopic technique for reduction and fixation of ACL avulsion fractures. The patient is in a supine position and his leg is hung from the edge of the table with a leg holder. The visual anterolateral and working anteromedial portal is applied. A cannula is used at the anteromedial portal to facilitate suture passage through the working portal. Two FiberWire sutures are inserted into the joint and tied at each ACL borders (lateral/medial) separately. Two tibial tunnels are drilled from the anteromedial side of the tibia toward the tibial plateau (proximal tunnel endings are set at the medial and lateral sides of the fractured fragment). The endings of the 2 FiberWire sutures are passed through the drilled tunnels and tied on the bone bridge between the 2 tibial tunnels (on a suture disc). (ACL, anterior cruciate ligament.)

This study’s objective was to assess biomechanical parameters across fused and contralateral sacroiliac joints (SIJs) and implants during all spinal motions for both sexes. Various SIJ implant devices on the market are used in minimally invasive surgeries. These implants are placed across the joint using different surgical approaches. The biomechanical effects of fusion surgical techniques in males and females have not been studied. The validated finite element models of a male, and a female spine–pelvis–femur were unilaterally instrumented across the SIJ using three screws for two SIJ implants, half threaded and fully threaded screws placed laterally and posteriorly to the joint, respectively. Motion and peak stress data at the SIJs showed that the female model exhibited lower stresses and higher reduction in motion at the contralateral SIJ in all motions than the male model predictions with 84% and 71% reductions in motion and stresses across the SIJ. Implants exhibited higher stresses in the female model compared to the male model. However, chances of SIJ implant failure in the female patients are still minimal, based on the calculated factor of safety which is still very high. Both lateral and posterior surgical approaches were effective in both sexes; however, the lateral approach may provide a better biomechanical response, especially for females. Moreover, implant design characteristics did not make a difference in the implants' biomechanical performance. SIJ stabilization was primarily provided by the implants which were the farthest from the sacrum rotation center.

Many human cancers predominantly metastasize to the bone which causes bone pain and other symptoms. However, the management of bone metastases is challenging. Radionuclide therapy using low-energy beta-emitting radionuclides has yielded encouraging results. The aim of this therapy is to deliver the maximum dose to the metastatic sites but a minimal dose to the normal tissue. Samarium-153 [153Sm]Sm-Ethylenediamine tetramethylene phosphonate (EDTMP) is an FDA and European Medicine Agency approved (Quadramet) radionuclide and is widely used for bone pain palliation. 153Sm is reactor produced, and the presence of europium impurities is thus unavoidable. This in turn causes an increase in the hospital radioactive waste burden and in radiation absorbed doses to the patients, and therefore it is a concern. The effective removal of these impurities is thus highly desirable before its administration to the patients. In this article, we present a detailed review of the various methods described in the literature for separation of 153Sm and Eu, that is solvent extraction, ion-exchange chromatography, electrochromatography, electrochemical separation and supported ionic liquid phase.

In December 2019, all nations learnt about the emergence of a pandemic of coronavirus disease (COVID-19), induced by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is a member of the β-coronavirus group. As SARS-CoV-2 has the potentiality of leading to life-threatening respiratory failure, its transmission routes need to be characterized. Yet, the possibility of airborne transmission is still debated. This study was performed to evaluate potential hospital indoor air viral quality in order to detect SARS-COV-2. For this purpose, an impinger method was used to monitor the SARS-COV-2 virus in the air. Thus, 33 samples were collected from 8 different hospital locations. The sampling time was between 50 and 60 min with a sampling flow rate of 28 L/min. Air samples were taken from 2 to 5 m away from the patients’ beds. Temperature, relative humidity, and CO2 concentration were 28, 37, and 438 ppm, respectively. The results indicated that air samples which were 2 to 5 m away from the patients’ beds were negative for the presence of the virus. According to the obtained results, it is suggested that airborne transmission may not have much effect on this pandemic. However, as the patients with SARS-CoV-2 were hospitalized in rooms with negative air pressure, the results might have been negatively affected. Graphical abstract

Background Glomus tumor is an uncommon soft tissue tumor. However, as the tumor causes significant disability, its early diagnosis is essential. It involves subungual areas of fingers and toes in most cases, and its extra-digital involvement is rarely seen. To the best of the authors' knowledge, only a few chest wall involvement cases have been reported in the literature. Case presentation In this paper, we describe a 63-year-old patient with a chest wall glomus tumor presenting with axillary paroxysmal pain and limitation in his shoulder range of motion that had been missed for nearly 15 years. His symptoms were relieved immediately following surgical excision. Conclusion Glomus tumors may involve any part of the human body. It is curable with surgical excision in most cases. Therefore, a correct early diagnosis has paramount importance. A high index of suspicion is needed for early diagnosis, especially when the tumor involves uncommon anatomic areas.

Background: Neurodegenerative diseases are often the consequence of alterations in structures and functions of the Central Nervous System (CNS) in patients. Despite obtaining massive genomic information concerning the molecular basis of these diseases and since the neurological disorders are multifactorial, causal connections between pathological pathways at the molecular level and CNS disorders development have remained obscure and need to be elucidated to a great extent. Objective: Animal models serve as accessible and valuable tools for understanding and discovering the roles of causative factors in the development of neurodegenerative disorders and finding appropriate treatments. Contrary to rodents and other small animals, large animals, especially non-human primates (NHPs), are remarkably similar to humans; hence, they establish suitable models for recapitulating the main human’s neuropathological manifestations that may not be seen in rodent models. In addition, they serve as useful models to discover effective therapeutic targets for neurodegenerative disorders due to their similarity to humans in terms of physiology, evolutionary distance, anatomy, and behavior. Methods: In this review, we recommend different strategies based on the CRISPR-Cas9 system for generating animal models of human neurodegenerative disorders and explaining in vivo CRISPR-Cas9 delivery procedures that are applied to disease models for therapeutic purposes. Results: With the emergence of CRISPR/Cas9 as a modern specific gene-editing technology in the field of genetic engineering, genetic modification procedures such as gene knock-in and knock-out have become increasingly easier compared to traditional gene targeting techniques. Unlike the old techniques, this versatile technology can efficiently generate transgenic large animal models without the need to complicate lab instruments. Hence, these animals can accurately replicate the signs of neurodegenerative disorders. Conclusion: Preclinical applications of CRISPR/Cas9 gene-editing technology supply a unique opportunity to establish animal models of neurodegenerative disorders with high accuracy and facilitate perspectives for breakthroughs in the research on the nervous system disease therapy and drug discovery. Furthermore, the useful outcomes of CRISPR applications in various clinical phases are hopeful for their translation to the clinic in a short time.

Background: Coronaviruses are a large family of viruses that have symptoms ranging from the common cold to severe respiratory syndromes. Objective: The purpose of this study is to provide appropriate strategies to raise knowledge and health behavior of students of the University of Medical Sciences to prevent COVID-19. Methods: This study was conducted as a cross-sectional and descriptive study, and the online questionnaire was used by random sampling. Our sample size was 360 subjects and the statistical population was the students of the University of Medical Sciences. We used the nonparametric test (Kruskal Wallis, Mann-Whitney U) and (Chi-Square & t-test) for statistical analysis. Results: The test results were statistically significant for students’ health behavior (p

ObjectiveAlthough gastric per-oral endoscopic myotomy (G-POEM) is considered a promising technique for the management of refractory gastroparesis, high-quality evidence is limited. We prospectively investigated the efficacy and safety of G-POEM in unselected patients with refractory gastroparesis.DesignIn five tertiary centres, patients with symptomatic gastroparesis refractory to standard medical therapy and confirmed by impaired gastric emptying were included. The primary endpoint was clinical success, defined as at least one score decrease in Gastroparesis Cardinal Symptom Index (GCSI) with ≥25% decrease in two subscales, at 12 months. GCSI Score and subscales, adverse events (AEs) and 36-Item Short Form questionnaire of quality of life were evaluated at baseline and 1, 3, 6 and 12 months after G-POEM. Gastric emptying study was performed before and 3 months after the procedure.ResultsOf 80 enrolled patients, 75 patients (94%) completed 12-month follow-up. Clinical success at 12 months was 56% (95% CI, 44.8 to 66.7). GCSI Score (including subscales) improved moderately after G-POEM (p2.6 (OR=3.23, p=0.04) and baseline gastric retention >20% at 4 hours (OR=3.65, p=0.03) were independent predictors of clinical success at 12 months, as was early response to G-POEM at 1 month after therapy (OR 8.75, pConclusionG-POEM is a safe procedure, but showed only modest overall effectiveness in the treatment of refractory gastroparesis. Further studies are required to identify the best candidates for G-POEM; unselective use of this procedure should be discouraged.Trial registration numberClinicalTrials.gov Registry NCT02732821.

The way workers perceive noise exposure can play an important role in the adoption of safety behaviors. Therefore, the determination of the relationship among risk awareness, behavior, and exposure can be an extremely important issue in controlling noise exposure. The aim of this study was to investigate the association between risk perception and practice of workers. Workers from 16 printing houses in Tehran province participated in present study. A questionnaire was used for determining the level of risk perception and practice about hearing conservation. The results revealed a significant relationship between risk perception and safety behavior adoption (P 0.001). A positive and significant correlation was found between these two variables (P 0.001; r

Background Utilizing intrawound vancomycin powder in TKA surgery has yielded rather contrasting results in the current literature. Furthermore, CDC criteria, although effective in general, are not specifically designed for post-TKA infections. Here, we present a 7-year experience of vancomycin use in primary TKA in a high-volume tertiary knee center in Iran. Also, new criteria are proposed to detect suspected superficial post-TKA infections. Methods This is a retrospective analysis of primary total knee arthroplasties performed in a tertiary knee center, from March 2007 to December 2018, by a single senior knee surgeon. All patients with follow-up periods of less than 1 year were excluded from the study. Since March 2011, all patients received vancomycin (powder, 1 g) before water-tight closure of the joint capsule. A comparison was made between this group and historical control subjects (operated from March 2007 to March 2011). Results Altogether, 2024 patients were included in the study. The vancomycin and the control groups included 1710 and 314 cases respectively. Patients were mostly women (male to female ratio, 1 to 4), with a mean age of 65.20 (SD = 10.83) years. In the vancomycin group, the rate of suspected SII (1.87%) and PJI (0.41%) was significantly lower than the control group (P = 0.002). Conclusions Our experience shows that application of local vancomycin during TKA surgery could be a reasonable infection prevention measure, although prospective randomized studies are required to evaluate its efficacy.

Closed pantalar dislocation mainly occurs among male adults aged 20 to 45 years and is usually associated with high-energy trauma, mostly falls (50.0%). The talus dislocates anterolaterally in about 85% of cases. Pure pantalar dislocation is more common (54.7%) than cases with concomitant fractures (45.3%). Ankle fractures are the most common associated fractures, followed by fractures of the talar posterior process. Among 40 reported cases, 24 had successful closed reduction (60%), 11 had unsuccessful closed reduction (27.5%), and 5 underwent open reduction without attempting closed reduction (12.5%). The success rate for closed reduction of closed pantalar dislocation is 68.5% (24/35 cases). Post-traumatic arthrosis occurs in 32.3%. Osteonecrosis occurs less often than previously reported. Infection after closed reduction of pantalar dislocation is very rare except after open reduction and fixation for concomitant talar fractures. Conclusively, closed pantalar dislocations are very rare injuries and may portend a poor prognosis. Urgent talar relocation restores ankle and hindfoot anatomy and reduces pressure on surrounding soft tissues to optimize outcome. A closed reduction maneuver should be attempted initially, followed by urgent open reduction when the talus is not accurately reduced through closed means.

Controversies exist on the relative contribution of sagittal spino-pelvic alignment on pathogenesis of lumbar disc herniation. Spinopelvic alignment parameters, pelvic incidence, pelvic tilt, sacral slope, pelvic radius-S1 end-plate ratio and pelvic radius-S1 angle, in 52 patients with lumbar disc herniation were compared with the same measurements in 43 healthy adult volunteers. Statistical analysis revealed significant difference in pelvic incidence and sacral slope between patients with lumbar disc herniation and normal population. Patients with lumbar disc herniation have a more vertical sacrum compared to the normal population which may result in higher intradiscal pressure in these patients.

Background and Aims It is unclear whether the common practice of postoperative day (POD) 1 esophagram impacts clinical care or reliably identifies significant adverse events (AEs) related to peroral endoscopic myotomy (POEM). Therefore, we aimed to correlate the most clinically relevant esophagram findings with postoperative outcomes after POEM. Methods Patients were retrospectively reviewed and included if they underwent POEM at 1 of the 3 study institutions between 2014 and 2018. Patient outcomes were assessed in relation to relevant POD 1 esophagram findings such as esophageal dissection or leak. Results One hundred seventy post-POEM contrast esophagrams (139 fluoroscopy-based vs 31 CT-based) performed on POD 1 were included. Most esophagrams (n = 98) contained abnormal findings but only 5 showed esophageal leak or dissection. Confirmed postoperative AEs of leak or dissection occurred in 4 patients. In 2 patients, POD 1 esophagram appropriately identified the leak or dissection, but in the other 2 patients the initial esophagram was negative, and the AEs were not recognized before clinical deterioration. One patient had a false-positive leak and dissection noted on esophagram leading to an unremarkable endoscopy. Conclusions Despite the low AE rate after POEM, follow-up esophagram on POD 1 frequently shows expected, unremarkable postprocedural findings and occasionally fails to diagnose serious AEs. This results in pitfalls in accuracy regarding agreement between esophagram versus clinical and endoscopic findings. Relying exclusively on esophagram for post-POEM clinical decision-making can lead to unnecessary additional testing or missed AEs.

The Paris System (TPS) for reporting urine cytology was developed for standardization of diagnosis focusing on the detection of high-grade urothelial carcinoma (HGUC). Probably the most challenging task for TPS is to provide criteria for the atypical urothelial cell (AUC) category. The TPS criteria for AUC include increased nuclear/cytoplasmic (N/C) ratio (0.5) and 1 of the 3 minor criteria including nuclear hyperchromasia (NH), coarse chromatin (CC) and irregular nuclear membrane (INM). We evaluated TPS-AUC diagnostic value and investigated whether other morphologic parameters can improve its criteria.Urine samples with diagnoses of AUC collected during a 6-month period were re-reviewed. Data captured included N/C ratio0.5, NH, CC, INM, and 2 additional criteria including enlarged nuclear size (ENS) and the presence of nucleolus (N). ENS was considered when the nucleus was 2 times larger than the urothelial cell or 3 times larger than lymphocyte.By applying the TPS-AUC criteria, the rate of atypia diagnosis reduced in comparison to Pre-TPS (9% versus 13%, P = 0.02). Among the AUC minor criteria, NH was the best criterion with the highest interobserver agreement (IOA) and correlation with HGUC (k = 0.342, r = 0.61, P0.001) and strong PPV (93.6%). ENS had the highest PPV (95.8%) and, after NH, had the highest IOA and correlation with HGUC (k = 0.29, r = 0.52, P0.001).TPS improves the diagnostic value of urine cytology, particularly in cases with atypia. ENS is a strong criterion for increasing the diagnostic value of AUC and potentially can improve TPS performance as a minor criterion.

Highlights • Isolated Trapezium fracture is difficult to be detected causing 1st carpometacarpal joint degeneration and limitation of thumb motion. • In order not to miss trapezium fracture, a high index of suspicion is required. • Persistent pain in the anatomical snuffbox or thenar eminence following a trauma should alert the physician to consider trapezium fracture. • Open reduction and internal fixation even without graft seem to be a plausible choice for managing comminuted trapezium fracture., Introduction and importance Trapezium, as a carpal bone positioned at the distal row, is often associated with other wrist injuries such as distal radius fracture. Isolated trapezium fracture, especially in a comminuted form, rarely occurs. There are only six reports of isolated comminuted trapezium fractures in the literature to the best of our knowledge. Case presentation We present a case with an isolated comminuted trapezium fracture presenting pain in his thenar eminence and thumb motion limitation. He was treated by Open Reduction and Internal Fixation (ORIF) with the K wire pin. Clinical discussion We searched the published related studies and summarized the signs and symptoms of patients presented with trapezium fracture. The most common presentation of trapezial fracture include pain/tenderness at the base of the first metacarpal bone, pain/tenderness at the snuffbox area and 1st digit motion limitation. The treatment options described in the literature for isolated comminuted trapezium fracture are also presented. Open reduction and fixation with pin is the most common treatment mentioned in the literature. The priority is restoring the scaphotrapezial and trapeziometacarpal joint congruency to save the 1st digit range of motion. Conclusion Comminuted trapezial fracture may happen following either low energy (like our patient) or high energy trauma. This paper highlights the fact that even a comminuted trapezium fracture can be easily missed. Regardless of the trauma mechanism (high energy versus low energy trauma), a high index of suspicion and delicate work up would be necessary in order not to miss this type of fracture.

Background/AimsOptic neuritis (ON) is the primary ophthalmic manifestation of myelin oligodendrocyte glycoprotein-IgG-associated disorder (MOGAD), but numerous reports have expanded the visual manifestations of this condition. The goal of this study was to synthesise the extensive literature on this topic to help ophthalmologists understand when testing for MOG-IgG should be considered.MethodA systematic review of the English-language literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searches were conducted using Ovid MEDLINE (from January 1, 1948 to April 1, 2020) and Ovid EMBASE (from January 1, 1947 to April 1, 2020). Inclusion criteria included studies describing non-isolated ON ophthalmic manifestations where cell-based assays were used for the detection of MOG antibodies.ResultsFifty-one articles representing 62 patients with a median age of 32.0 (range 2–65), female gender (51%) and follow-up of 20.0 months (range: 1–240) were included. Twenty-nine patients had non-isolated ON afferent visual manifestations: uveitis, peripheral ulcerative keratitis, acute macular neuroretinopathy, neuroretinitis, venous stasis retinopathy, large preretinal macular haemorrhage, orbital inflammatory syndrome, orbital apex syndrome, optic perineuritis, papilloedema and homonymous visual field defects. Incomplete recovery of ON was associated with a case of Leber’s hereditary optic neuropathy. Efferent ophthalmic manifestations included cranial neuropathies, internuclear ophthalmoplegia, central nystagmus, saccadic intrusions and ocular flutter. Cranial nerve involvement was secondary to enhancement of the cisternal portion or brainstem involvement. All included cases were treated with corticosteroids with 31% of cases requiring additional immunosuppressive therapy.ConclusionsMOGAD has been associated with various afferent and efferent ophthalmic manifestations apart from isolated ON. Awareness of these findings may result in earlier diagnosis and treatment.