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Aged heart is defined via structural and mitochondrial dysfunction of the heart. However, there is still no impressive compound to suppress and improve the abnormal alterations in cardiac function result from aging. Gallic acid (GA) is known to be an effective agent in improving cardiovascular disorders. In the present study, we exhibit the protective effects of GA against cardiac aging. Male Wistar rats were randomly divvied into four groups: Control, Control treated with GA at 25 mg/kg (GA25), aged rats induced by D-galactose (D-GAL), aged rats treated with GA at 25 mg/kg (D-GAL + GA25).Aging induced by D-GAL at 150 mL/kg via intraperitoneal injection for eight weeks. Aged rats treated with GA at 25 mg/kg (D-GAL GA25) by gavage for eight weeks. The blood samples were used to assessment biochemical factors and heart tissue was assessed for evaluating oxidative stress and the gene expression of molecular parameters. Histological examination of the heart was occurred. The D-GAL rats indicated cardiac hypertrophy, which was associated with reduced antioxidant activity of enzyme, increased oxidative marker and alterations in Sirtuin 1 (SIRT1), Peroxisome proliferator-activated receptor-gamma coactivator (PGC)-1alpha and Transcription Factor A, Mitochondrial (TFAM) genes expression in comparison to the control animals. Co-treatment with GA improved all these alterations. Taken together, GA could protect the heart against D-GAL-induced aging via antioxidant effects, and the enhancement of SIRT1, PGC-1α, and TFAM genes expression.

Neural synchronization has been engaged in several brain mechanisms. Previous studies have shown that the interaction between the time of spiking activity and phase of local field potentials (LFPs) plays a key role in many cognitive functions. However, the potential role of this spike-LFP phase coupling (SPC) in neural coding is not fully understood. Here, we sought to investigate the role of this SPC for encoding the sensory properties of visual stimuli. To this end, we measured SPC strength in the preferred and anti-preferred motion directions of stimulus presented inside the receptive field of middle temporal (MT) neurons. We found a selective response in terms of SPC strength for different directions of motion. Remarkably, this selective function is inverted with respect to the spiking activity. In other words, the least SPC occurs for the preferred direction (based on the spike rate), and vice versa; the strongest SPC is induced in the anti-preferred direction. Altogether, these findings imply that the neural system may use spike-LFP phase coupling in the primate visual cortex to encode sensory information.

In this research, zero-dimensional (quantum dots) of graphitic carbon nitride (g-C3N4) and Fe3O4 nanoparticles were decorated on MoS2 nanosheets to prepare MoS2/Fe3O4/g-C3N4 quantum dots. Photocatalytic activities of newly synthesized nanocatalyst were investigated by the degradation of methylene blue (MB) and methyl orange (MO) under visible LED lamp light. In these degradation reactions, the parameters effective such as dyes concentration, pH, amount of catalyst, and irradiation time were also investigated. The systematic investigations revealed that 10 mg of MoS2/Fe3O4/g-C3N4QDs catalyst was optimum to degrade 10 mg/L of MB and 40 mg of nanocatalyst to degrade 10 mg/L of MO with 60 W of LED irradiation. Nanocomposite can act as an excellent photocatalyst for degradation of MB and MO at short time intervals and also can be easily separated by an external magnet and reused several times. The kinetic data acquired for the degradation of dyes were matched to first-order rate equations, and also the apparent rate constants for the degradation of MB and MO were calculated as follows: K = 0.285 min−1 and K = 0.263 min−1, respectively. The novelty of catalyst is due to metal (Mo) and non-metal (S) in the structure of substrate (MoS2), so Fe3O4 and g-C3N4 QDs can be strongly connected to the substrate. The structure and morphology of prepared nanocomposite were characterized by X-ray diffraction (XRD), vibrating sample magnetometer (VSM), transmission electron microscopy (TEM), scanning electron microscopy (SEM) energy dispersive X-ray spectroscopy (EDS), and UV–Vis spectroscopy.

BACKGROUND: This study examines the changes in segmental and global cervical sagittal parameters after single-level anterior cervical discectomy and fusion (ACDF) in patients with cervical radiculopathy or myelopathy. We also investigate whether these changes have any relation with postoperative pain and functional outcome of the patients. METHODS: Sixty patients (37 females and 23 males) with a mean age of 45.9 ± 9.5 years who were candidates of single-level ACDF due to cervical myelopathy or radiculopathy participated in the study. At baseline, 1 month, and 6 months after ACDF, outcomes of the study including sagittal balance parameters, pain intensity, and Neck Disability Index (NDI) were measured among the patients. Intensity of pain and neck disability were measured using the visual analog scale (VAS) and validated version of NDI, respectively. Using a standard lateral cervical radiography, the Cobb angle for occiput–C2, C1–C2, and C2–C7 as well as operation-level angle (OA; Cobb's angle at the level of discopathy), the thoracic inlet angle, and C7 and T1 slope angles were measured. RESULTS: The intensity of pain and neck disability of patients improved significantly during the follow up of the study comparing with baseline measurements (P < .001). There was a significant correlation between the increase of C2–C7 angle, C1–C2 angle, and OA and improvement in neck pain and NDI at 1- and 6-month follow ups. CONCLUSIONS: We found that changes at C2–C7 angle, C1–C2 angle, and OA have positive significant correlation with clinical outcome including pain improvement and decrease of disability in patients who undergo ACDF. LEVEL OF EVIDENCE: 3. CLINICAL RELEVANCE: The results of this study might be beneficial in selection of cervical cages with appropriate size during ACDF surgery, as our findinds showed that larger cages could lead to better functional outcome in patients.

The high transmissibility, mortality, and morbidity rate of the SARS-CoV-2 Delta (B.1.617.2) variant have raised concerns regarding vaccine effectiveness (VE). To address this issue, all publications relevant to the effectiveness of vaccines against the Delta variant were searched in the Web of Science, Scopus, EMBASE, and Medline (via PubMed) databases up to 15 October 2021. A total of 15 studies (36 datasets) were included in the meta-analysis. After the first dose, the VE against the Delta variant for each vaccine was 0.567 (95% CI 0.520–0.613) for Pfizer-BioNTech, 0.72 (95% CI 0.589–0.822) for Moderna, 0.44 (95% CI 0.301–0.588) for AstraZeneca, and 0.138 (95% CI 0.076–0.237) for CoronaVac. Meta-analysis of 2,375,957 vaccinated cases showed that the Pfizer-BioNTech vaccine had the highest VE against the infection after the second dose, at 0.837 (95% CI 0.672–0.928), and third dose, at 0.972 (95% CI 0.96–0.978), as well as the highest VE for the prevention of severe infection or death, at 0.985 (95% CI 0.95–0.99), amongst all COVID-19 vaccines. The short-term effectiveness of vaccines, especially mRNA-based vaccines, for the prevention of the Delta variant infection, hospitalization, severe infection, and death is supported by this study. Limitations include a lack of long-term efficacy data, and under-reporting of COVID-19 infection cases in observational studies, which has the potential to falsely skew VE rates. Overall, this study supports the decisions by public health decision makers to promote the population vaccination rate to control the Delta variant infection and the emergence of further variants.

The multi-country outbreak of monkeypox virus (MPXV) infection, while the coronavirus disease 2019 pandemic is still an ongoing issue, has caused a new challenge. The re-emergence of MPXV and the rising incidence in non-endemic countries is turning into an upcoming threat to global health. Hence, rapid identification of the virus with appropriate methodology with the lowest false results plays a critical role in estimating the global extent of the crisis and providing preventive measures. This review summarised the main applicable strategies for primary detection and confirmation of MPXV and highlighted available data in biosafety, requirements, standard operating procedures, specimen collection, transportation and storage of clinical samples, and waste disposal of the viral agent. Also, various assays including molecular techniques, immunoassays, histopathological methods, electron microscopy, genomic sequencing, and cell culture have been illustrated. Moreover, we reflected on current knowledge of the advantages and disadvantages of each approach.

Introduction:To evaluate and compare macular vasculature changes in 1 and 3-months after initiating treatment with either panretinal photocoagulation (PRP) or Intravitreal bevacizumab (IVB) injection.Methods: A total of 62 eyes from 33 diabetic patients without macular edema were included in this prospective case series. Of these, thirty-nine eyes (21 patients) were allocated to the PRP group, while 23 eyes (12 patients) were treated with IVB biosimilar (Stivantâ). Optical tomography angiography (OCTA) was performed to measure foveal avascular zone (FAZ) characteristics as well as superficial (SCP) and deep vascular plexus (DCP) densities.Results: After the initiation of IVB injections, the FAZ area and Perimeter expanded modestly at month 1 but returned to baseline level after three months. In the PRP group, however, FAZ area and Perimeter were rather steady. FAZ area changes were significantly different between treatment groups at month 1 (p=0.02), but not at month 3 (p=0.31). The comparison of two groups based on mean FAZ perimeter change revealed a significant difference at month 1, but no significant difference at month 3 (p=0.03 and p=0.48, respectively). There was no significant difference in the FAZ circularity index change between the two groups at each timepoints (p=0.55 and p=0.31). The foveal vessel density changes in the SCP were not statistically significant between the two groups, at both month 1 and 3 (all P>0.05). A comparison of two treatment arms based on mean DCP density change revealed a significant difference at month 1, but not at month 3 (p=0.01 and p=0.49, respectively).Conclusion: Some vascular metrics changes in OCTA (e.g., FAZ area, Perim, Foveal DCP vascular density) may be significantly different between two types of therapies in the very early short-term (1 month) after treatment initiation. In the third month following treatment, all of these differences diminished to insignificance.

Adipose- stem cells (ASCs) have received much attention in the recent years and several articles have investigated the role of these cells on burn wound healing. To understand the outcomes of the ASCs therapy on burn wound healing, a systematic review was performed. This study was conducted by searching in Pubmed, ISI, and Scopus until May 2021. Thirty-six animal studies were included in this study. The findings revealed that although treatment with ASCs somewhat enhanced the healing rate, cultured ASCs on scaffolds or its combination with hydrogels could significantly increase the viability of ASCs and promote rate of healing. However, clinical studies are necessary to gain a better understanding of the role of ASCs in burn wound healing.

In this study, fracture energy and fracture toughness are used to investigate the fracture behaviour of Asphalt Concrete Composites (ACC) in pure mode I and III using Edge Notch Disc Bend (ENDB) ge...

Moisture susceptibility is one of the most important distresses that affects the life of the flexible pavement. Various methods, such as adding the appropriate additive, have been proposed to improve the asphalt mix properties. Some of these additives have environmental, and some have economic characteristics. In this study, three additives were used to study the moisture susceptibility and rutting of Hot Mix Asphalt (HMA), including rubber powder (RP), Tire Reclaim (TR10), and Butyl Reclaimed (BR120). For this purpose, the Marshall Stability test, Marshall Ratio (for determining the rutting), and Indirect Tensile Strength (ITS) were performed on the samples. Also, the economic analysis of the additive's effects on HMA was evaluated. The results of the Marshall test showed that adding all three additives increased the Marshall Stability and the Marshall ratio. As a result, adding TR10 and BR120 improved the Marshall ratio or rutting more than rubber powder. Indirect tensile strength test results also showed that the addition of rubber powder and TR10 led to improved HMA performance against moisture susceptibility. However, the use of BR120 as an additive reduced HMA moisture susceptibility. On the other hand, the economic analysis showed that adding 20% of rubber powder and TR10 would make the project much more economical. Further, adding BR120 to the asphalt mix provided economic benefits in every percentage. Consequently, based on the presented arguments, adding 20% of rubber powder and TR10 for technical and economic reasons leads to the best result.

Purpose: To describe the optical coherence tomography (OCT) findings of toxoplasmic retinochoroiditis at different stages of activity.Methods: Observational case series.Results: A total of 32 eyes of 31 patients were included; 43 sets of OCT were reviewed. A total of 14 lesions were classified as active, 13 as partially active, and 16 as inactive. All active lesions demonstrated increased retinal thickness and reflectivity with blurring of details of retinal layers. Choroidal granuloma was detected in eight (61.5%) and serous retinal detachment in nine (64%). In partially active lesions, sustained thickening and/or attachment of posterior hyaloid face with fine epiretinal membrane was the hallmark. Scarified lesions showed decreased retinal and choroidal thickness starting from the periphery. Characteristic signs for decreased activity of a lesion seen in majority of both partially active and inactive lesions were RPE changes and retina-RPE approximation. We called this unique feature 'hourglass configuration'.Conclusion: Features in OCT are helpful to specify and monitor the activity of toxoplasmic retinochoroiditis.

Many studies evaluated the effect of systemic tranexamic acid (TXA) administration on blood loss reduction during spine in the past decade. However, topical use of TXA during cervical spine surgery is rarely investigated. The present study was conducted to assess the role of topical administration of TXA on intraoperative and postoperative blood loss of patients undergoing posterior cervical laminectomy and lateral mass screw fixation (PCLF) compared to a control group.The data of 88 patients that underwent PCLF surgery, including 41 females and 47 males, were included in this retrospective study. Data elements including intraoperative blood loss (IBL), postoperative blood loss (PBL), amount of blood transfusion, surgical time, use of hemostatic agents, length of hospital stay, and time to return to work were extracted from medical records and compared between those who received topical TXA during surgery (irrigation of the surgical field with a solution of 3 g TXA in 100 ml normal saline) and an age- and sex-matched control group.There were 48 patients in the TXA group and 40 patients in the control group. There were no significant differences in the baseline measurements and the level of operation between the two groups. The results showed that IBL and PBL were significantly lower in the TXA group compared to the control group (p= 0.03 and p 0.01, respectively). There were no significant differences in the need for blood transfusion, surgical time, and hospital stay between the two groups (p 0.05). Moreover, the use of hemostatic materials during surgery and the time to return to work were significantly lower in the topical TXA group (P= 0.04 and p 0.01, respectively).Topical TXA efficiently reduces intraoperative and postoperative bleeding in patients undergoing posterior cervical laminectomy and lateral mass screw fixation (PCLF) surgery. These results need further investigation in future studies to draw a definite conclusion.

Background: One of the most important objectives in the deformity correction surgery of spine is to achieve appropriate sagittal alignment, to improve patient outcome and reduce the risk of junctional failure. Intra-operative rod bending is crucial to achieve desired alignment. Objectives: Assessment of accuracy of rod bending by spine surgeons with or with-out template and/or correction. Methods: Spine surgeons were asked to bend two rods; one in-situ on three-dimensional (3D) printed moulage, designed based on schematic representation of a patient with Kyphoscoliosis, the other rod was asked to bend with correction angles. The differences were measured and correlated with experience and specialty. Results: 21 fellowship trained spine surgeons participated in this study, for in-situ rod, mean thoracic and lumbar bend were 65.2 (P = 0.033) and 49.3 (P = 0.077) degrees, respectively and for the correction rod, mean bend in thoracic and lumbar were 53.8 (P = 0.001) and 51.8 (P = 0.004) degrees, respectively, with significant difference from cut-off point. Each curve was over-bend and it was more pronounce in thoracic, both on in-situ and correction rods, 61.9 and 71.1 %, respectively. Level of experience showed positive correlation with degree of rod bending more than five years in thoracic in-situ bend (P = 0.003) and thoracic bend with correction (P = 0.004). Field of specialty showed positive correlation as well; with orthopedic in-situ bend (P = 0.002) and with correction (P = 0.003). Conclusions: Spine surgeons tend to over-bend rods, when given target angles and when correction is needed. However, when provided with template, a 3D printed moulage in our study, accuracy of rod bending improved significantly.

Background: Percutaneous iliosacral screw fixation in posterior pelvic ring fractures is challenging and commonly performed under fluoroscopy or navigation techniques. This study aimed to assess the safety and efficacy of percutaneous iliosacral screw implantation under fluoroscopy guidance with only inlet and outlet views. Methods: This retrospective study included 58 consecutive unstable posterior pelvic injury patients (36 sacral fractures and 22 sacroiliac joint disruptions) treated with percutaneous iliosacral screws between January 2015 and November 2019. Acceptable inlet radiographs show the anterior cortex of the S1 body superimposed on the S2 body. Acceptable outlet radiographs show the superior pubic symphysis at the level of the S2 foramen and visualize the S1 and S2 sacral foramina. In our technique, the screw was inserted at the inferior half of the outlet view and the posterior half of the inlet view. The time needed for screw insertion and the radiation exposure time was recorded. Intra and postoperative complications were documented. Postoperative computed tomography (CT) scans assessed screw position. Results: In total, 69 iliosacral screws were inserted in 58 patients. In postoperative CT scans, the screw position was assessed, 89.8% were in a secure position, and 10.2% had malposition. The mean operation time per screw was 21.18 min and the mean fluoroscopy time per screw was 112 s. There was no evidence of wound infection or iatrogenic neurovascular injury. No reoperation was performed. Conclusion: Percutaneous iliosacral screws can be placed using the only outlet and inlet fluoroscopic views with comparable radiological and clinical outcomes to the conventional method.

A linear elastic fracture mechanics method is proposed to investigate the fracture behavior of hot mix asphalt and warm mix asphalt; this method was used in this study to calculated the fracture toughness of hot mix asphalt and warm mix asphalt containing 3% Sasobit at low temperatures (0, − 10, and – 20 °C) and two types of bitumen (60/70 and 85/100). A semi-circular specimen with an edged crack under three-point bending load mode was used to create different loading modes, including pure mode I and pure mode II, to test the fracture toughness. The critical stress intensity factor was calculated using the critical load obtained from the failure test. The shape factor was determined from finite element analysis. The results show that hot mix asphalt has a higher fracture toughness against crack growth than the warm mix asphalt containing Sasobit. In addition, the fracture toughness of asphalt mixture with a penetration grade of 85/100 against crack growth is more than that of the mixture with a penetration grade of 60/70. The minimum fracture toughness of hot mix asphalt and warm mix asphalt occurred in pure mode I loading condition.

Purpose: Determine the risk of immunomodulatory therapy (IMT) for COVID-19 infection morbidity.Method: A telemedicine survey on patients of a referral uveitis clinic was performed. Signs of infection, habits, and hospitalizations during the 7 months of the COVID-19 pandemic prior to the study date were recorded. Suggestive findings in chest CT scan and/or positive RT-PCR were considered as confirmed COVID-19 infection while those with only suggestive symptoms were considered as suspected cases. Risk factors including sanitary measures and IMT were compared between patients with confirmed cases and patients without infection.Result: 694 patients were included. Eight patients were identified as confirmed cases and 22 patients as suspected cases of COVID-19 infection. Close contact with infected persons was the only significant risk factor for contracting COVID-19.Conclusion: Using IMT did not affect hospitalization and/or ICU admission and can thus be continued during the pandemic, provided that instructions for preventive measures are followed.

Abrasion susceptibility of roadway pavements has a significant effect on the skid resistance, and consequently accident rate. In this study, the mechanical properties of concrete pavement were inve...

Fuchs uveitis (FU) is a chronic and often unilateral ocular inflammation and characteristic iris atrophic changes, other than heterochromia, are common in FU and are key to the correct diagnosis in many cases. With the advent of anterior segment optical coherence tomography (AS-OCT), some investigators attempted to quantitatively study these atrophic changes; mostly by introducing various methods to measure iris thickness in AS-OCT images. We aimed to present an automated method in an observational case series to measure the smoothness index (SI) of the iris surface in AS-OCT images. The ratio of the length of the straight line connecting the most peripheral and central points of the anterior iris border (in nasal and temporal sides) to the actual length of this border on AS-OCT images, was defined as SI. In a uveitis referral center, twenty-two eyes of 11 patients with unilateral Fuchs uveitis (FU) (7 female) and 22 eyes of 11 healthy control subjects underwent AS-OCT imaging. Image J and a newly developed MATLAB algorithm were used for manual and automated SI measurements, respectively. Agreement between manual and automated measurements was evaluated with Bland–Altman analysis and interclass correlation coefficient. The inter-eye difference of SI was compared between the FU group and the control group. Automated mean overall SI was 0.868 ± 0.037 and 0.840 ± 0.039 in FU and healthy fellow eyes, respectively (estimated mean difference = − 0.028, 95% CI [− 0.038, − 0.018], p p = 0.01). We concluded that the automated algorithm can rapidly and conveniently measure SI with results comparable to the manual method.

Human astroviruses (HAstVs) have frequently been detected in individuals with acute gastroenteritis (AGE). However, a precise estimate of the overall prevalence of the virus in children with AGE as well as the possible association of the virus with gastrointestinal complications is not available up to now. The present study estimated the overall prevalence of HAstVs in children with gastrointestinal complications as well as the association between the virus and symptoms. We systematically searched four international databases (PubMed, Scopus, Web of Science, and Google scholar) to find studies on the prevalence of HAstVs in people with AGE published between Jan 2000 and Sep 2021. Analysis of the 223 included studies presented a 4.2% (95% CI 3.8%-4.8%) prevalence of the virus in AGE individuals. Based on case-control studies, a significant association between these viruses and AGE was detected (OR: 2.059, 95% CI; 1.438-2.949). HAstV-1 and HAstV-VA-2 is the most and least common genotypes in the AGE patients, respectively (59.0%, 95% CI: 52.1%-65.6% vs. 4.9%, 95% CI: 2.6%-9.1%). Due to the statistically significant association between HAstV and gastrointestinal complications, more attention should be paid to these viruses in people with AGE and more studies should employ case-control design.

Since the outbreak of the COVID-19 pandemic in the last days of 2019 in China, medical experts and organizations worldwide have proposed guidelines for its prevention and treatment. However, despite the availability of state-of-the-art technologies, modern medicine specialists have so far not been successful in controlling it. This has led traditional medicine experts to propagate their knowledge to prevent and cure COVID-19, creating an open debate. According to scientific literature, traditional medicine experts claim beneficial effects of herbal medicines against viral infections and their effectiveness in controlling the symptoms of respiratory disorders. Modern medicine specialists express their concerns about the quality, safety, and efficacy of herbal medicines, in addition to the risk of herb-drug interactions and the lack of randomized clinical studies. Herbal medicines have been popular since prehistoric times, and during the COVID-19 pandemic, they are increasingly used worldwide. The lack of definite cure and the high cost of available modern medicines have also promoted the use of herbal medicines. An evidence-based approach using herbal medicines with proven antiviral activities or containing compounds providing symptomatic relief in COVID-19 can be considered for clinical studies. The interaction of herbal medicines with modern drugs should also be considered in patients taking them. Traditional and modern medicine aim to provide effective and safe treatment and prevent COVID-19 infection. Considering the ground realities of the COVID-19 crisis and keeping in view the worldwide use of herbal medicines, in our opinion, the pros and cons of their use should be carefully weighed, and practical solutions should be considered.

This study was designed to explore the effects of valproic acid (VPA) on spatial and passive avoidance learning and memory as well as to assess the protective effects of L-Carnitine (LC) against VPA-induced memory deficit in the rat. Male Wistar rats received VPA (300 mg/kg/daily by i.p. injection), or LC (50 mg/kg/ daily by i.p. injection), or co-treatment with VPA and LC for 28 days. Following 28 days, Elevated Plus-Maze (EPM), Morris Water Maze (MWM), and Passive Avoidance Learning (PAL) tasks were used to evaluate the anxiety-like behavior and spatial and passive learning and memory, respectively. Our results showed that VPA has no effect on memory acquisition (in both MWM and PAL) but induced reference memory impairment. We demonstrated that treatment with LC partially ameliorated the impairment in the retrieval of reference memory and passive avoidance learning. Moreover, VPA increased anxiety-like behavior, which was partially reversed by the administration of LC. In conclusion, these results show that LC is effective in counteracting the anxiety-like behavior and reference memory impairment caused by VPA. Therefore, LC may serve as a possible therapeutic agent for VPA-induced memory change.

Glioblastoma multiforme (GBM) is the commonest primary malignant brain tumor and has a remarkably weak prognosis. According to the aggressive form of GBM, understanding the accurate molecular mechanism associated with GBM pathogenesis is essential. Growth differentiation factor 15 (GDF-15) belongs to transforming growth factor-β superfamily with important roles to control biological processes. It affects cancer growth and progression, drug resistance, and metastasis. It also can promote stemness in many cancers, and also can stress reactions control, bone generation, hematopoietic growth, adipose tissue performance, and body growth, and contributes to cardiovascular disorders. The role GDF-15 to develop and progress cancer is complicated and remains unclear. GDF-15 possesses tumor suppressor properties, as well as an oncogenic effect. GDF-15 antitumorigenic and protumorigenic impacts on tumor development are linked to the cancer type and stage. However, the GDF-15 signaling and mechanism have not yet been completely identified because of no recognized cognate receptor.

Surgical decompression, deformity correction, and instrumentation of the upper cervical spine are challenging problems in cervical kyphosis, especially in infants and pediatrics. According to patients' age, surgical exposure is difficult and selecting the appropriate instrument for rigid fixation is crucial. In this article, we present a case of 2 years old with cervical angular kyphosis, which was approached posteriorly at first. Through posterior approach, C3–C5 laminectomy with complete excision of spinous process was performed. Then, the patient's position was changed to supine and C3–C5 corpectomies were performed anteriorly with a longitudinal incision, and the thecal sac was decompressed. A titanium cage with appropriate size and graft was placed after possible deformity correction conducted with head traction and neck extension. Anterior fixation was performed with two, 2-mm T-shaped metacarpal plates with two screws in C2 and four screws in C6. The patient's position was changed to prone again, and posterior fixation was done with two metacarpal plates located on lateral masses. We showed that a novel technique in correction and fixation of cervical kyphosis in pediatric is using metacarpal plates while they are fixed to lateral masses.

Summary In a large‐scale study, 128176 non‐pregnant patients (228 studies) and 10000 pregnant patients (121 studies) confirmed COVID‐19 cases included in this Meta‐Analysis. The mean (confidence interval [CI]) of age and gestational age of admission (GA) in pregnant women was 33 (28–37) years old and 36 (34–37) weeks, respectively. Pregnant women show the same manifestations of COVID‐19 as non‐pregnant adult patients. Fever (pregnant: 75.5%; non‐pregnant: 74%) and cough (pregnant: 48.5%; non‐pregnant: 53.5%) are the most common symptoms in both groups followed by myalgia (26.5%) and chill (25%) in pregnant and dysgeusia (27%) and fatigue (26.5%) in non‐pregnant patients. Pregnant women are less probable to show cough (odds ratio [OR] 0.7; 95% CI 0.67–0.75), fatigue (OR: 0.58; CI: 0.54–0.61), sore throat (OR: 0.66; CI: 0.61–0.7), headache (OR: 0.55; CI: 0.55–0.58) and diarrhea (OR: 0.46; CI: 0.4–0.51) than non‐pregnant adult patients. The most common imaging found in pregnant women is ground‐glass opacity (57%) and in non‐pregnant patients is consolidation (76%). Pregnant women have higher proportion of leukocytosis (27% vs. 14%), thrombocytopenia (18% vs. 12.5%) and have lower proportion of raised C‐reactive protein (52% vs. 81%) compared with non‐pregnant patients. Leucopenia and lymphopenia are almost the same in both groups. The most common comorbidity in pregnant patients is diabetes (18%) and in non‐pregnant patients is hypertension (21%). Case fatality rate (CFR) of non‐pregnant hospitalized patients is 6.4% (4.4–8.5), and mortality due to all‐cause for pregnant patients is 11.3% (9.6–13.3). Regarding the complications of pregnancy, postpartum hemorrhage (54.5% [7–94]), caesarean delivery (48% [42–54]), preterm labor (25% [4–74]) and preterm birth (21% [12–34]) are in turn the most prevalent complications. Comparing the pregnancy outcomes show that caesarean delivery (OR: 3; CI: 2–5), low birth weight (LBW) (OR: 9; CI: 2.4–30) and preterm birth (OR: 2.5; CI: 1.5–3.5) are more probable in pregnant woman with COVID‐19 than pregnant women without COVID‐19. The most prevalent neonatal complications are neonatal intensive care unit admission (43% [2–96]), fetal distress (30% [12–58]) and LBW (25% [16–37]). The rate of vertical transmission is 5.3% (1.3–16), and the rate of positive SARS‐CoV‐2 test for neonates born to mothers with COVID‐19 is 8% (4–16). Overall, pregnant patients present with the similar clinical characteristics of COVID‐19 when compared with the general population, but they may be more asymptomatic. Higher odds of caesarean delivery, LBW and preterm birth among pregnant patients with COVID‐19 suggest a possible association between COVID‐19 infection and pregnancy complications. Low risk of vertical transmission is present, and SARS‐CoV‐2 can be detected in all conception products, particularly placenta and breast milk. Interpretations of these results should be done cautiously due to the heterogeneity between studies; however, we believe our findings can guide the prenatal and postnatal considerations for COVID‐19 pregnant patients.