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Introduction: Ascending aortic pseudoaneurysm (AAP) rupture is a surgical emergency that needs immediate medical and surgical attention and treatment. This rupture can be caused by a variety of risk factors. Prior cardiovascular surgery is a common cause, and prior aortic valve operation is a rare cause. Case Presentation: In this case report, we describe a 47-year-old male with AAP who had a history of aortic valve replacement because of aortic stenosis.

Background: Neurogenic bowel dysfunction (NBD) caused by spinal cord injury (SCI) is a major life limiting issue for many patients. However, studies detailing the factors contributing to bowel problems are scarce. The aim of this cross-sectional questionnaire-based study was to evaluate the associations between different aspects of bowel problems and characteristics of SCI, such as time since injury (TSI), level of injury (LOI), and the cause of injury. Methods: Two questionnaires (the NBD score questionnaire and the Cleveland clinic constipation system score questionnaire) were administered to complete, traumatic patients with SCI that matched the designated criteria. The total scores and the subscales were then regressed to TSI and LOI, and the distribution patterns of NBD score severity according to LOI and cause of injury were shown in a diagram. Results: Within the subscales of the NBD score, frequency of defecation, digital stimulation or evacuation of the anorectum, and perianal skin problems were all significantly and positively correlated with the TSI, yet the frequency of fecal incontinence was negatively associated with this variable. Moreover, uneasiness, headache, or perspiration during defecation and regular use of drops against constipation were negatively associated with the LOI. In the diagrams, patterns of NBD score severity were similar according to LOI, but visibly differed according to cause. With respect to the CCCS score (Cleveland Clinic Constipation Scoring System), the score itself was shown to be positively associated with TSI. Within the subscales, difficulty, time spent in lavatory, and duration of constipation were positively correlated with TSI. Furthermore, type of assistance was negatively associated with the LOI. Conclusion: Different characteristics of SCI, TSI, LOI, and cause, each are significantly and distinctly associated with different aspects of the bowel problems that patients with SCI face.

This is a phase I clinical trial. Our objective was to assess the safety and feasibility of autologous mucosal olfactory ensheathing cell (OEC) and bone marrow mesenchymal stem cell (MSC) co-transplantation in people with chronic, complete (American Spinal Injury Association (ASIA) Impairment Scale (AIS) classification A) spinal cord injury (SCI). This study was performed at Shohada Tajrish Hospital, Tehran, Iran. Three individuals with the traumatic SCI of the thoracic level were enrolled. They received the autologous OEC and MSC combination through the lumbar puncture. All adverse events and possible functional outcomes were documented performing pre- and post-operative general clinical examination, magnetic resonance imaging (MRI), neurological assessment based on the International Standard of Neurological Classification for SCI, and functional evaluation using Spinal Cord Independence Measure version III (SCIM III). No serious safety issue was recorded during the 2 years of follow-up. MRI findings remained unchanged with no neoplastic tissue formation. AIS improved from A to B in one of the participants. SCIM III evaluation also showed some degrees of progress in this participant’s functional ability. The two other research participants had negligible or no improvement in their sensory scores without any changes in the AIS and SCIM III scores. No motor recovery was observed in any of the participants. Overall, this 2-year trial was not associated with any adverse findings, which may suggest the safety of autologous OEC and bone marrow MSC combination for the treatment of human SCI.

Background: Massive pulmonary embolism (PE) is a devastating medical situation which correlated to a much higher mortality rate rather than non-massive PE. While surgical embolectomy can be an effective way to treat asystolic patients with massive PE, a satisfactory outcome is heavily reliant on the technique and skill with which the surgery is performed. Objectives: In this article, we suggest the procedure with a single technique to subject the pulmonary arteries to a minimal amount of damage. Patients/Methods: We have performed this sequence of techniques on 19 patients who were experiencing asystole due to massive PE. These patients, while continuing to perform closed cardiac massage on the non-beating heart of the patient, transferred to the operating room. In the operating room, following a median longitudinal sternotomy, open chest cardiopulmonary resuscitation is performed. After that, one incision is made on the main pulmonary artery the thrombus is then removed using forceps and suction. Results: 14 of these patients survived the embolectomy and 5 died due to failure to reverse asystole, culminating in a mortality rate of 26%. When diagnosing the patients, it was observed that the RV/LV diameter in all of them was greater than one. Upon the discharge of the surviving patients, this value had returned to Conclusions: Eventually, we suggest that surgical embolectomy, in our experience, has been shown to have merit over other modes of treating PE patients experiencing cardiac arrest, esp. cardiac arrests with a non-shockable rhythm such as asystole.

Widespread investigation has revealed the promising ability of suicidal genes in the treatment of glioma tumors; nevertheless, promoting their effects relies on the ability to apply suitable vehicles and techniques. In this study, the safety and feasibility of using bone marrow-derived mesenchymal stem cells (MSCs) in combination with prodrug for treatment of patients with primary and secondary glioblastoma multiform (GBM) was assessed. Five GBM patients were recruited. Following gross total resection of the tumor and adjuvant radiotherapy and chemotherapy, intracerebral injection of autologous MSCs transduced with lentivirus containing herpes simplex virus thymidine kinase (HSV-TK) was performed followed by intravenous administration of ganciclovir for 2 weeks. The treatment was well tolerated by all patients. Mild-to-moderate fever, headache, and cerebrospinal fluid leukocytosis were evident in three, two, and one patient, respectively. The progression-free survival (PFS) and overall survival (OS) of patients were 95.79 ± 51.40 and 128.85 ± 48.81 weeks, respectively. The 1-year PFS and OS were 60% and 100%, respectively, among our patients, and two patients had more than 3 years of OS and more than 2 years of PFS. It seems that intracerebral administration of bone marrow MSC containing the HSV-TK gene in combination with intravenous ganciclovir would be safe and feasible in the treatment of patients with GBM.

Background: In recent decades, improvement in sensory and motor function after spinal cord injury (SCI) is a major treatment goal. Stem cell therapy has become a promising treatment strategy in the regeneration of central nervous system injuries. Methods: We assessed the effectiveness of autologous Schwann cell (SC) and bone marrow-derived mesenchymal stem cell (MSC) for individuals with SCI in promoting sensory recovery. Five patients with a mean ± SD age of 38.80 ± 5.84 years were enrolled in the study. The follow-up course was 12 months. Results: We found sensory changes in two patients assessed by the American Spinal Injury Association’s (ASIA’s) impairment scale. Systemic complications were not observed during the course of the study. Conclusion: There were no adverse finding after cell transplantation. Also we observed improvement in sensory score in two patients. It seems that the use of this combination of cell therapy may be effective; but large group studies with control group are required to clarify the effect of either cells.

Background Cellular transplantations have promising effects on treating spinal cord injury (SCI) patients. Mesenchymal stem cells (MSCs) and Schwann cells (SCs), which have safety alongside their complementary characteristics, are suggested to be the two of the best candidates in SCI treatment. In this study, we assessed the safety and possible outcomes of intrathecal co-transplantation of autologous bone marrow MSC and SC in patients with subacute traumatic complete SCI. Methods Eleven patients with complete SCI (American Spinal Injury Association Impairment Scale (AIS); grade A) were enrolled in this study during the subacute period of injury. The patients received an intrathecal autologous combination of MSC and SC and were followed up for 12 months. We assessed the neurological changes by the American Spinal Injury Association’s (ASIA) sensory-motor scale, functional recovery by spinal cord independence measure (SCIM-III), and subjective changes along with adverse events (AE) with our checklist. Furthermore, electromyography (EMG), nerve conduction velocity (NCV), magnetic resonance imaging (MRI), and urodynamic study (UDS) were conducted for all the patients at the baseline, 6 months, and 1 year after the intervention. Results Light touch AIS score alterations were approximately the same as the pinprick changes (11.6 ± 13.1 and 12 ± 13, respectively) in 50% of the cervical and 63% of the lumbar-thoracic patients, and both were more than the motor score alterations (9.5 ± 3.3 in 75% of the cervical and 14% of the lumbar-thoracic patients). SCIM III total scores (21.2 ± 13.3) and all its sub-scores (“respiration and sphincter management” (15 ± 9.9), “mobility” (9.5 ± 13.3), and “self-care” (6 ± 1.4)) had statistically significant changes after cell injection. Our findings support that the most remarkable positive, subjective improvements were in trunk movement, equilibrium in standing/sitting position, the sensation of the bladder and rectal filling, and the ability of voluntary voiding. Our safety evaluation revealed no systemic complications, and radiological images showed no neoplastic overgrowth, syringomyelia, or pseudo-meningocele. Conclusion The present study showed that autologous SC and bone marrow-derived MSC transplantation at the subacute stage of SCI could reveal statistically significant improvement in sensory and neurological functions among the patients. It appears that using this combination of cells is safe and effective for clinical application to spinal cord regeneration during the subacute period.

Background: Glioblastoma multiform (GBM) as a malignant brain tumor has poor prognosis despite the current therapies. Suicide gene therapy is one of the most widespread cancer gene therapies which requires mRNA encoding a pro-drug activating enzyme transduced into the vector such as Mesenchymal Stem Cells (MSCs) that injects into the tumor tissue and leads to tumor suppression. Case presentation: In this case report, the authors describe a 37-year-old man with two obvious foci of glioblastoma multiform at left frontal and left parietal lobes. After the resection of the foci, the patient received stem cell-mediated herpes simplex virus thymidine kinase (HSV-TK) gene at frontal focus of tumor besides ganciclovir as prodrug for 14 days after injection. Then he was followed up with regular magnetic resonance imaging (MRI). The growth and recurrence pattern of foci was assessed. After the injection on Feb 09, 2019, the patient’s follow-up revealed recurrence of parietal focus on Dec 19, 2019; however, frontal focus had a slight and unremarkable enhancement. Until our last radiological follow-up (on Mar 18, 2020) left frontal focus had no prominent recurrence and the size of the left parietal focus increased and extended to the contralateral hemisphere through the corpus callosum. Eventually patient has passed away on July 16, 2020 (PFS=293 days, OS=657 days).Conclusions: It seems that the gliomatous focus that undergone administration of bone marrow MSC containing the HSV-TK gene, had a different pattern of growth and recurrence compared to a non-treated one.

Background Esophageal injury after anterior corpectomy and fusion is a rare but life-threatening complication. It may cause mediastinitis due to anatomical continuity between the retropharyngeal space and the mediastinum, with reported high mortality rates. The acute and subacute injuries are most commonly of iatrogenic origin, while late perforation has been described several weeks to years later as a result of continuous friction or pressure of the instruments against the posterior wall of the esophagus, leading to ischemia and necrosis. This phenomenon is more common among quadriplegic patients who have undergone corpectomy and insertion of expandable or mesh cages and plate probably due to chronic erosion by hardware at the supine position. Methods Since 2015, we have applied the technique of using a patch of autologous fascia lata to cover the anterior cervical plate by suturing to the longus colli muscles in 58 quadriplegic patients; the mean follow-up was 35.2 (28–41) months. Results Since we started using this procedure, based on our follow-up at our center, there have been no cases of late esophageal perforation among quadriplegic patients. Conclusion As a technical note, it seems like this method would be able to reduce the prevalence of esophagus injury among quadriplegic patients. However, to substantiate the efficacy of this technique, long-term follow-up and larger sample size are needed because esophageal injury occurs rarely.

Background Cellular transplantations have promising effects on treating spinal cord injury (SCI) patients. Safety alongside the complementary characteristics of Mesenchymal stem cells (MSC) and Schwann cells (SC) are suggested to be the two of the best candidates in SCI treatment. In this study, we assessed the safety and efficacy of intrathecal co-transplantation of autologous bone marrow MSC and SC in the patients with subacute traumatic complete SCI.Methods Eleven patients with complete SCI (American Spinal Injury Association Impairment Scale (AIS); grade A) were enrolled in this study during the subacute period of injury. The patients received intrathecal autologous combination of MSC and SC and were followed-up for 12 months. We assessed neurological changes by American Spinal Injury Association’s (ASIA) sensory-motor scale, functional recovery by spinal cord independence measure (SCIM-III), and subjective changes along with adverse events (AE) with our checklist. Furthermore, electromyography (EMG), nerve conduction velocity (NCV), magnetic resonance imaging (MRI), and urodynamic study (UDS) were conducted for all the patients at the baseline, 6 months, and one year after the intervention.Results Light touch ASIA score alterations were approximately the same as the pinprick changes (11.6 ± 13.1 and 12 ± 13, respectively) in 50% of the cervical and 63% of the lumbar-thoracic patients and both were more than the motor score alterations (9.5 ± 3.3 in 75% of the cervical and 14% of the lumbar-thoracic patients). SCIM III total scores (21.2 ± 13.3) and all its sub-scores (“respiration and sphincter management” (15 ± 9.9), “mobility” (9.5 ± 13.3), and “self-care” (6 ± 1.4)) had significant changes after cell injection. Our findings support that the most remarkable positive, subjective improvements were in trunk movement, equilibrium in standing/sitting position, sensation of the bladder and rectal filling, and ability of voluntary voiding. Our safety evaluation revealed no systemic complications and radiological images showed no neoplastic overgrowth, syringomyelia, or pseudo-meningocele.Conclusion The present study showed that autologous SC and bone marrow-derived MSC transplantation at the subacute stage of SCI could reveal significant improvement in sensory and neurological functions among the patients. It appears that using this combination of cells is safe and effective for clinical application to the spinal cord regeneration during the subacute period.

Background Some previous reports have shown a reduced number of admission in stroke cases during the coronavirus disease 2019 (COVID-19) pandemic period. The present study aimed to investigate this changing pattern and the potential causes behind it at an academic neurology and neurosurgery center in Iran. Methods Patients admitted to our center with the diagnosis of ischemic and hemorrhagic stroke, between March 1, 2019, Jun 1, 2019, and the similar 3-month period in 2020 (COVID-19 pandemic period), were compared in terms of clinical characteristics and outcome. Poisson regression was also conducted to assess the correlation between daily admissions and the COVID-19 pandemic period. Results A total of 210 patients with stroke (ischemic and hemorrhagic) in 2019 were compared with 106 patients in 2020. COVID-19 pandemic period was significantly associated with the decline in the number of daily admissions in ischemic stroke (IRR, 0.51 [95% CI, 0.4–0.64]). A significant reduction (P = 0.003) in time from onset to arrival at hospital from median 12 h [IQR, 5–32] in 2019 to median 6 h [IQR, 4–16] in 2020 was found in ischemic stroke cases. National Institute of Health Stroke Scale (NIHSS) was significantly increased (P < 0.001) from median 4 [IQR, 2–7] in 2019 to median 9 [IQR, 4–14] in 2020. Glasgow coma scale (GCS) was significantly decreased from 13.9 (SD, 2) in 2019 to 12.8 (SD, 2.9) in 2020 (P < 0.001). Conclusions The present study provided new pieces of evidence regarding the changed pattern of hospital admission in stroke especially the possible reasons for its decline.

Cerebellar ataxia (CA) is a form of ataxia that adversely affects the cerebellum. Cell replacement therapy (CRT) has been considered as a potential treatment for neurological disorders. In this report, we investigated the neuro-restorative effects of human chorionic stem cells (HCSCs) transplantation on rat model of CA induced by 3-acetylpyridine (3-AP). In this regard, HCSCs were isolated and phenotypically determined. Next, a single injection of 3-AP was administered for ataxia induction, and bilateral HCSCs implantation was conducted 3 days after 3-AP injection, followed by expression analysis of a number of apoptotic, autophagic and inflammatory genes as well as vascular endothelial growth factor (VEGF) level, along with assessment of cerebellar neurodegeneration, motor coordination and muscle activity. The findings revealed that grafting of HCSCs in 3-AP model of ataxia decreased the expression levels of several inflammatory, autophagic and apoptotic genes and provoked the up-regulation of VEGF in the cerebellar region, prevented the degeneration of Purkinje cells caused by 3-AP toxicity and ameliorated motor coordination and muscle function. In conclusion, these data indicate in vivo efficacy of HCSCs in the reestablishment of motor skills and reversal of CA.