Management of oxidative stress for cell therapy through combinational approaches of stem cells, antioxidants, and photobiomodulation.

Over the recent decades, stem cell-based therapies have been considered as a beneficial approach for the treatment of various diseases. In these types of therapies, the stem cells and their products are used as treating agents. Despite the helpful efficacy of stem cell-based therapies, there may be challenges. Oxidative stress (OS) is one of these challenges that can affect the therapeutic properties of stem cells. Therefore, it seems that employing strategies for the reduction of OS in combination with stem cell therapy can lead to better results of these therapies. Based on the available evidence, antioxidant therapy and photobiomodulation (PBM) are strategies that can regulate the OS in the cells. Antioxidant therapy is a method in which various antioxidants are used in the therapeutic processes. PBM is also the clinical application of light that gained importance in medicine. Antioxidants and PBM can regulate OS by the effect on mitochondria as an important source of OS in the cells. Considering the importance of OS in pathologic pathways and its effect on the treatment outcomes of stem cells, in the present review first the stem cell therapy and effects of OS on this type of therapy are summarized. Then, antioxidant therapy and PBM as approaches for reducing OS with a focus on mitochondrial function are discussed. Also, a novel combination treatment with the hope of achieving better and more stable outcomes in the treatment process of diseases is proposed.

Evaluation of chitosan-gelatin films for use as postoperative adhesion barrier in rat cecum model.

BACKGROUND: Postoperative adhesions remain a significant complication of abdominal surgery and can result in pain, infertility and potentially lethal bowel obstruction. Pharmacotherapy and barrier devices have reduced adhesion formation to varying degrees in preclinical studies or clinical trials. MATERIALS AND METHODS: In this study, we produced blends between chitosan (Ch) and gelatin (G) with various compositions (Ch/G 100/0, 75/25, 50/50, 25/75 w/w) as candidate materials for prevention of postoperative abdominal adhesion. For in vivo analysis, 30 female rats weighing 200-250 g were divided into 5 groups (One control and 4 treatment groups). Under general anesthesia, the anterior surface of serous membrane in rat was scraped slightly with sterile gauze until obvious congestion and small bleeding drops appeared, then sample films set on the cecum in treatment groups and the intestine was put back into the abdominal cavity, which were then closed. After 4 weeks, the abdominal cavity was reopened and the grades of peritoneal adhesion were studied by macroscopic and pathologic assessments. RESULTS: Our results showed Ch1/G3 films had an insignificant reduction effect on postoperative adhesion, but surprisingly, the sample with more than 25% by weight of chitosan did not have any effect on reducing adhesion formation but also increased inflammation near the cecum. CONCLUSION: Administration of chitosan-gelatin films with higher than 25% weight of chitosan had no effect on reduction of adhesion formation in the rat cecum model.

Macroscopic and pathological assessment of methylene blue and normal saline on postoperative adhesion formation in a rat cecum model.

BACKGROUND: Adhesion formation after abdominal surgery is a major cause of postoperative bowel obstruction, infertility, and chronic abdominal pain. In this study, we evaluated the effect of normal saline and methylene blue (MB) on postoperative adhesion formation in a rat cecum model. METHODS: A total of 30 Wistar female rats in 2 treatment and 1 control groups underwent midline laparotomy and standardized abrasion of the visceral peritoneum. Normal saline and methylene blue were administrated intraperitoneally at the end of the surgical procedure in 2 treatment groups. Fourteen days after surgery, a re-laparotomy was performed for macroscopic and pathological assessment. RESULTS: The adhesion grade and extent of the normal saline group was lower than control and MB groups in macroscopic assessment (P<0.05 for both). A comparison of adhesion stages in pathological assessment showed increment in abdominal adhesion by usage methylene blue 1% and demonstrated significant difference between MB and 2 other groups (P<0.05). CONCLUSIONS: Administrated normal saline individually reduce the adhesion grade near cecum. Conversely, usage of methylene blue 1% may unpredictably increase risk of adhesion formation.

Designing a model for trauma system management using public health approach: the case of Iran.

Trauma is a leading cause of death and disability around the world. Injuries are responsible for about six million deaths annually, of which ninety percent occur in developing countries. In Iran, injuries are the most common cause of death among age groups below fifty. Trauma system development is a systematic and comprehensive approach to injury prevention and treatment whose effectiveness has been proved. The present study aims at designing a trauma system management model as the first step toward trauma system establishment in Iran. In this qualitative research, a conceptual framework was developed based on the public health approach and three well-known trauma system models. We used Benchmarks, Indicators and Scoring (BIS) to analyze the current situation of Iran trauma care system. Then the trauma system management was designed using the policy development phase of public health approach The trauma system management model, validated by a panel of experts, describes lead agency, trauma system plan, policy-making councils, and data-based control according to the four main functions of management: leading, planning, organizing and controlling. This model may be implemented in two phases: the exclusive phase, focusing on resource integration and the inclusive phase, which concentrates on system development. The model could facilitate the development of trauma system in Iran through pilot studies as the assurance phase of public health approach. Furthermore, the model can provide a practical framework for trauma system management at the international level.

A novel robotic tactile mass detector with application in clinical breast examination.

This paper presents a novel tactile sensing robot designed to detect breast lesions with minimum invasiveness to the tissue while providing exact documentation to make therapeutic and surgical decisions. The robot named "Robotic Tactile Breast Mass Identifier (Robo-Tac-BMI) consists of an indentation probe controlled by a robotic system and a visualization interface to manipulate the end-effecter. Geometrical maps of the test points with related tension-relaxation curves are provided during clinical examinations. Utilizing the curves, three functional stiffness parameters are extracted locally for each test point. These parameters are employed to provide objective information to facilitate the surgeon's task in the diagnostic procedure. Computational analysis is proposed for a real breast tissue model to study the capability of artificial tactile sensing in the mass detection. Indications of the mass existence are determined and employed as the basis of the Robo-Tac-BMI design and construction. Clinical trials are executed by the Robo-Tac-BMI on 161 cases. The results show that the robot has the potential to provide tissue mechanical properties unlike the conventional screening modalities carried out either by the surgeon or the imaging techniques which are not quantitative and lack documentation. Sonography with and without mammography is chosen as the "gold standard" tests.

Evaluation of intrapleural contrast-enhanced abdominal pelvic CT-scan in detecting diaphragm injury in stable patients with thoraco-abdominal stab wound: a preliminary study.

BACKGROUND: Many of the patients with thoraco-abdominal stab wound remain asymptomatic; in this regard, previous studies reported that 7-48% of asymptomatic patients had diaphragm injury (DI). Thoracoscopy or multidetector computed tomography (MDCT) scan is the best method to detect DI. We aimed to evaluate the role of CT scan with intrapleural contrast to rule out DI in stable thoraco-abdominal stab wounds. METHOD: In a prospective study, we evaluated all haemodynamically stable patients with thoraco-abdominal stab wound, from October 2009 to 2010. Exclusion criteria included patients who needed emergency thoracotomy or laparotomy, those who were haemodynamically unstable and those with blunt trauma or gunshot injury. In the CT-scan department, 500 cc of diluted meglumine diatrozate was transfused into the pleural space via a chest tube and the CT scan was performed from the dome of the diaphragm to the pelvic cavity. In the second step, all patients were taken for thoracoscopy within 24h after admission. The CT-scan slide was considered positive if one of the following signs was found: (1) the diaphragm was obviously injured as seen in CT-scan slides and (2) contrast agent was seen in the peritoneal cavity. Sensitivity and specificity were calculated for CT scan and thoracoscopy. RESULTS: Four out of 40 patients had DI according to thoracoscopy. CT scan with intrapleural contrast predicted diaphragmatic injury correctly in all four patients. Considering thoracoscopy as the gold-standard method, the CT scan had two false-positive cases. The sensitivity of the intrapleural-contrast CT scan was 100% and its specificity was 94.4%. CONCLUSION: Our study showed that CT scan with intrapleural contrast can be an acceptable approach to rule out DI and limit the use of thoracoscopy for final diagnosis and repair of DI in cases with suspicious or positive CT-scan results, especially in trauma centres with high load of trauma patients and little accessible equipment.

Impact of trauma dispatch algorithm software on the rate of missions of emergency medical services.

BACKGROUND: Trauma still stands atop of the list of emergencies. Transfer of these patients via Emergency Medical Services (EMS) dispatch is critical with regard to importance of timing. This aspect has achieved greater importance due to population increase and telephone triage. OBJECTIVES: We aimed to decrease unnecessary Emergency Medical Services (EMS) missions via a computer program designed for an algorithmic approach for trauma care by nurses involved in EMS, to help them evaluate the case more accurately. We named our program "Trauma Dispatch Algorithm". MATERIALS AND METHODS: First, the most common chief complaints regarding traumatic events were chosen from searching all the calls in December 2008 recorded in Tehran, Iran's EMS center; and then an algorithm approach was written for them. These algorithms were revised by three traumatologists and emergency medicine specialists, after their approval the algorithms were evaluated by EMS dispatch center for their practicality. Finally all data were turned into computer software. The program was used at the Tehran EMS center; 100 recorded calls assessed with each system were selected randomly. They were evaluated by another traumatologist whether it was necessary to send a team to the site or not. RESULTS: The age average was 26 years in both groups. The "trauma dispatch algorithm" was significantly effective in reducing the unnecessary missions of EMS by 16% (from 42% to 26%) (P = 0.005). CONCLUSIONS: This program was effective in reducing unnecessary missions. We propose the usage of this system in all EMS centers.

Effect of Ilioinguinal Neurectomy on Chronic Pain following Herniorrhaphy.

BACKGROUND: Inguinal hernia is one of the most common male diseases all over the world with an incidence rate of 18-24% throughout life. Chronic inguinal pain is one of the complications that prolong return to work time. OBJECTIVES: The main aim of this study was to determine the effect of ilioinguinal neurectomy on postoperative chronic pain (PCP) in patients that underwent open inguinal hernia repair via the Lichtenstein method. MATERIALS AND METHODS: IN THIS RANDOMISED CONTROLLED CLINICAL TRIAL, MALE PATIENTS WITH UNILATERAL INGUINAL HERNIA WERE RANDOMIZED INTO TWO GROUPS: 74 cases in the preserved-nerve group and 66 cases in the nerve-excised group. The method of herniorrhaphy was the classic Lichtenstein method. Pain and numbness were evaluated at 1 day, 1 week, 1 month, 6 months and 1 year after surgery via visual analogue scale (VAS) system. We used SPSS ver.16 for analysis. RESULTS: All patients were male with mean age of 39.1 years (with a range of 18 to 68 years). The follow-up rate was 100% after 1 year. Pain severity was significantly lower in nerve-excised patients at 1 day, 1week, 1 month and 6 months after surgery; but it was not significant after one year, although overall pain severity was low. Numbness was significantly higher in excised patients at all endpoints (1 day, 1month, 3 months, 6 months and one year after surgery). CONCLUSIONS: Ilioinguinal nerve excision at the time of inguinal hernia repair decreased post-surgical inguinal pain, and it can be used as a routine method in herniorrhaphy.

Comparison of the efficacy of two local haemostatic agents.

BACKGROUND: In modern life, the incidence of traumatic injuries increases daily. In accidents which lead to trauma, massive bleeding is the main cause of death. Nowadays, many different chemical and herbal agents are available for quick control of bleeding. OBJECTIVES: In this study, we compare the effectiveness of two different types of chemical agents for control of bleeding in an animal model. MATERIALS AND METHODS: This research was done comparing two hemostaticagents- "Chitohem" and "Quikclot". Ten healthy IR Iranian sheep were chosen and were blindly divided into two different groups. In each of the groups, one of the aforementioned agents was to be applied. First, four main limb arteries of the sheep were dissected linearly and after measuring the volume of bleeding in the first 60 seconds, the chemical agent was applied to the site of bleeding. After that, the duration of bleeding, the volume of bleeding and the secondary blood pressure were measured and compared. RESULTS: There were no significant differences between the primary features of the animals in two groups (Weight, Baseline Systolic Blood Pressure and Pre-treatment Blood loss). In dependent quantities such as the volume of bleeding after the usage of chemical agents, secondary systolic blood pressure, the results were in favor of "Quick Clot" (P < 0.001 for volume of bleeding, P = 0.008 for secondary blood pressures and P < 0.001 for the necessary time for the bleeding to stop). CONCLUSIONS: In this study, it seems that activity of "Quikclot" in cessation of bleeding of large arterial vessels was slightly better than "Chitohem". Due to limitations which we had in this study, further studies are necessary to show the actual differences between these agents and their side effects.

Trauma care system in Iran.

OBJECTIVE: The high burden of injuries in Iran necessitates the establishment of a comprehensive trauma care system. The purpose of this paper is to describe the current status of trauma system regarding the components and function. METHODS: The current status of trauma system in all components of a trauma system was described through expert panels and semi-structured interviews with trauma specialists and policy makers. RESULTS: Currently, various organizations are involved in prevention, management and rehabilitation of injuries, but an integrative system approach to trauma is rather deficient. There has been ongoing progress in areas of public education through media, traffic regulation reinforcement, hospital care and prehospital services. Meanwhile, there are gaps regarding financing, legislations and education of high risk groups. The issues on education and training standards of the front line medical team and continuing education and evaluation are yet to be addressed. Trauma registry has been piloted in some provinces, but as it needs the well-developed infrastructure (regarding staff, maintenance, financial resources), it is not yet established in our system of trauma care. CONCLUSIONS: It seems that one of the problems with trauma care in Iran is lack of coordination among trauma system organizations. Although the clinical management of trauma patients has improved in our country in the recent decade, decreasing the burden of injuries necessitates an organized approach to prevention and management of trauma in the context of a trauma system.

A novel haptic robotic viscogram for characterizing the viscoelastic behaviour of breast tissue in clinical examinations.

BACKGROUND: This paper presents a novel tactile sensing robot designed to characterize the viscoelastic behaviour of breast tissue during clinical breast examination (CBE). The robot, named the 'robotic tactile breast mass identifier' (Robo-Tac-BMI), mainly consists of an indentation probe controlled by a robotic system and a visualization interface to manipulate the end-effector. Major high order mechanical parameters are extracted to characterize the viscoelastic behaviour of the tissue in order to certify mass detection and judge the mass type. By fusing the measurements over both breasts, the probe can generalize a mechanical image to visualize the viscoelastic distribution within the internal tissue. The viscoelastic properties provide additional and objective information to facilitate the surgeon's task in the decision-making process. METHODS: A new computational method is presented for characterizing mass existence in a real breast model. The effect of the strain rate on the mechanical properties is considered to study the viscoelastic behaviour of different mass types. A creative method is proposed to find the optimum strain rate for different mass positions and consistencies, which improves nodule detection. The computational results would be used as the basis for the design and set-up of the Robo-Tac-BMI. Clinical tests with statistical analyses were performed on 161 cases, using the Robo-Tac-BMI. RESULTS: The results include analysis of two high-order mechanical properties. Robo-Tac-BMI's capability of nodule detection and differentiation between benign and malignant mass types are investigated. The results were validated by 'gold standard' tests. CONCLUSION: The results show that Robo-Tac-BMI has the potential to provide high-order mechanical parameters, unlike the conventional screening modality carried out by the surgeon, which is not inclusive or quantitative and lacks effectiveness and documentation. The nodule detection ability of this device is confirmed statistically in clinical breast examinations. Differentiation between different mass types is reported as the preliminary result of Robo-Tac-BMI utilization.

Survival after In-Hospital Cardiopulmonary Resuscitation in a Major Referral Center during 2001-2008.

Despite efforts to save more people suffering from in-hospital cardiac arrest, rates of survival after in-hospital cardiopulmonary resuscitation (CPR) are no better today than they were more than a decade ago. This study was undertaken to assess the demographics, clinical parameters and outcomes of patients undergoing CPR by the code blue team at our center during 2001 to 2008. Data were collected retrospectively from adult patients (n=2262) who underwent CPR. Clinical outcomes of interest were survival at the end of CPR and survival at discharge from the hospital. Factors associated with survival were evaluated using binomial and tests. Of the patients included (n=2262), 741 patients (32.8%) had successful CPR. The number of male patients requiring CPR was more than females in need of the procedure. The majority of patients requiring CPR were older than 60 years (56.4±17.9). The number of successful CPR cases in long-day shift (7:00 to 19:00) was more than that in the night shift (19:00 to 7:00). Furthermore, 413 (18.4%) cases were resuscitated on holidays and 1849 (81.7%) on the working days. The duration of CPR was 10 min or less in 710 (31.4%) cases. Cardiopulmonary resuscitations which lasted less than 10 minutes were associated with better outcomes. The findings of the present study indicate that some manageable factors including the duration of CPR, working shift, working day (holiday or non-holiday) could affect the CPR outcomes. The findings might also be taken as evidence to suggest that the allocation of more personnel in each shift especially in night shifts and holidays, planning to increase the personnel's CPR skills, and decreasing the waste time would result in the improvement of CPR outcome.

Efficacy of pre-hospital care in trauma patients in Iran.

OBJECTIVES: Pre-hospital care plays a vital role in the management of trauma patients. The present study was designed to evaluate the efficacy of the pre-hospital care performed by the Tehran Emergency Medical Service (EMS) in trauma patients. METHODS: The prospective study was performed on trauma patients referred to the emergency department of a teaching hospital by the Tehran EMS from September 2004 until 2005. Considering the lack of scientific observation-based protocols on pre-hospital care, certain protocols were developed based on the available up-to-date protocols in the emergency medicine text books and were used as the gold standard for comparing the provided care by EMSs. RESULTS: The effectiveness of pre-hospital care performed by Tehran emergency technicians, compatible with the patients' condition, was evaluated in 994 patients. Wound bandaging and haemostasis were done correctly in 80% of the indicated cases. Splint was applied correctly in 50% of patients in need for such a device, whereas collar and spinal bed were not performed in 80% of the indicated cases. CONCLUSIONS: Tehran's EMS is not capable of providing trauma patients with effective and accurate pre-hospital care, indicating that major changes are needed to improve this.

Does drill-induced noise have an impact on sensorineural hearing during craniotomy procedure?

OBJECTIVE: It is well known that exposure to noise can lead to hearing loss. Craniotomy drills have significant noise and vibration. Since a noise induced by the drill during craniotomy is thought to be one of the causes, we examined its effect on the sensorineural hearing in this study. METHODS: Thirty-nine patients who had undergone craniotomy operations served as the basis for this study between Jul. 2007 and Dec. 2008. Standard pure-tone audiometry (PTA) and speech recognition thresholds (SRT) were calculated for all subjects before, one week and 1 year after craniotomy. RESULTS: Statistically significant differences were not observed at the lower and middle frequencies (0.25-2 kHz), however, differences in the hearing thresholds at higher frequencies (4-6 kHz) were statistically significant before and after craniotomy. Mean pure-tone thresholds obtained was significantly more in older subjects when compared to young patients. Moreover, the correlation between increased number of burr holes and sensorineural hearing loss (SNHL) was statistically significant. CONCLUSIONS: We conclude that drill-generated noise during craniotomy has been incriminated as a cause of SNHL. Possible noise disturbance to the inner ear can only be avoided by minimizing the number of burr holes and the duration of harmful noise exposure to the cochlear structures.

A medical tactile sensing instrument for detecting embedded objects, with specific application for breast examination.

BACKGROUND: In this paper, having considered the tactile sensing and palpation of a physician in order to detect abnormal masses in the breast, we simplified and then modelled the tissue containing a mass and used contact elements to analyse the tactile sensor function. METHODS: By using the finite element method, the effects of the mass existence appeared on the surface of the tissue. This was due to exerting mechanical load on the modelled tissue surface. Following this, a tactile sensing instrument called the 'tactile tumour detector' (TTD) was designed and constructed. This device is able to detect abnormal objects in the simulated models by making contact with model surfaces. In order to perform a series of precise experiments, a robot that could hold the tactile probe was used. The velocity of the linear movement of the probe is low enough to ensure that the tissue behaves in the linear elastic range, so that dynamic effects can be neglected. RESULTS AND DISCUSSION: The maximum value of stresses was chosen as the comparison criterion. The variation of this criterion vs. the mass parameter changes was investigated and good agreements between numerical and experimental results were obtained. Moreover, the sensitivity and specificity of TTD and clinical breast examination (CBE) in the detection of breast masses, in comparison to sonography as the 'gold standard', were calculated by performing clinical trials on 55 cases.

A reassessment and review of the Bam earthquake five years onward: what was done wrong?

INTRODUCTION: An earthquake measuring 6.6 on the Richter scale on 23 December 2003 devastated the city of Bam in southeastern Iran. During the response and recovery phases, considerable shortcomings were discovered. The dire situation in the affected area, a variety of urgently required interventions, and the large number of aid organizations involved brought about difficulties in management, coordination, and communication among authorities and aid organizations. This article highlights flaws in management in the various aspects of this disaster in order to assess what was done, and what should be done to overcome these shortcomings in future disasters. METHODS: A retrospective review of the various aspects of management related to the Bam disaster was done via the assessment of files, multi-center studies, governmental data, and available literature from 2003-2008. RESULTS: A review of the available data relevant to search and rescue operations and short-term aid provision revealed flaws in different aspects of disaster management including personnel, the transfer of the injured, availability medical supplies, treatment planning, problems concerning the composition of treatment forces dispatched to the region, distribution of tasks among treatment workers, transferring of equipment, availability of facilities, and lack of coordination among the organizations responsible for the management of the disaster. Most of the aforementioned issues have been addressed. CONCLUSIONS: A comprehensive disaster management plan must not be limited only to the response phase, but rather must include: preparedness, recovery with optimal legislation and budgeting, improvement of healthcare facilities, and organized communication channels between the different governmental departments. This important issue has been addressed, and a disaster management organization under the supervision of the President has been established, developing a national search and rescue strategy and protocol for unified managerial organization, an alert system, an international disaster command system (under which search and rescue and emergency medical service teams can be deployed, increasing the efficacy and coordination of the arrival of foreign teams and the construction field hospitals), and developing a flowchart to coordinate international agencies and the domestic authorities in charge. Continuous education, training of the general population, conducting periodic exercise drills, and provision for prepared task force mobilization in disaster management all are important aspects of the management of disasters due to natural hazards.

A fundamental, national, medical disaster management plan: an education-based model.

During disasters, especially following earthquakes, health systems are expected to play an essential role in reducing mortality and morbidity. The most significant naturally occurring disaster in Iran is earthquakes; they have killed >180,000 people in the last 90 years. According to the current plan in 2007, the disaster management system of Iran is composed of three main work groups: (1) Prevention and risk management, (2) Education, and (3) Operation. This organizational separation has resulted in lack of necessary training programs for experts of specialized organizations, e.g., the Ministry of Health and Medical Education (MOHME).The National Board of MOHME arranged a training program in the field of medical disaster management. A qualified training team was chosen to conduct this program in each collaborating center, based on a predefined schedule. All collaborating centers were asked to recall 5-7 experts from each member university. Working in medical disaster management field for greater than or equal to 2 years was an inclusion criterion. The training programs lasted three days, consisted of all relevant aspects of medical disaster management, and were conducted over a six-month period (November 2007-April 2008). Pre-test and post-tests were used to examine the participants' knowledge regarding disaster management; the mean score on the pretest was 67.1 +/-11.6 and 88.1 +/-6.2, respectively. All participants were asked to hold the same training course for their organizations in order to enhance knowledge of related managers, stakeholders, and workers, and build capacity at the local and provincial levels. The next step was supposed to be developing a comprehensive medical disaster management plan for the entire country. Establishing nine disaster management regional collaborating centers in the health system of Iran has provided an appropriate base for related programs to be rapidly and easily accomplished throughout the country. This tree-shaped model is recommended as a cost-benefit and rapid approach for conducting training programs and developing a disaster management plan in the health system of a developing country.

Comparing presentation and diagnostic accuracy for conscripts and nonconscripts who have already been selected for appendectomy.

BACKGROUND: The evaluation of acute appendicitis (AA), the most common cause of acute abdomen, in conscripts is important, specifically when it seems that the probability of malingering for secondary gains (such as exemption) is high, and surgeons may lose some cases of AA through this assumption. METHODS: In this analytic cross-sectional study, 455 male conscripts with suspected AA were compared with 142 male individuals between 14 and 26 years of age who had already been selected for appendectomy. RESULTS: The mean age (+/-SE) was 20.4+/-0.08 years. There were no statistically significant differences between the case and control groups in terms of age, rates of different symptoms and signs, quality and duration of pain, vital signs, and laboratory findings. CONCLUSIONS: There was no significant difference between conscripts and others in terms of the presentation of AA and its accurate diagnosis. Therefore, it is recommended that military physicians approach conscripts with suspected AA like other patients.