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Background: Hip dysplasia is one of the most widespread hip disorders. Total hip arthroplasty (THA) is the preferred treatment in patients with cup placement choices in true or false acetabulum. The objective of this research was to compare the effectiveness of the two mentioned procedures. Materials and Methods: This study was a randomized, open-label, parallel-group clinical trial, in which 46 patients/51 hips with Crowe type 3 dysplastic hip having THA were assigned to two groups: Group 1 - patients who had cup placement in the true acetabulum and Group 2 - patients who underwent cup placement in the false acetabulum. The variables that were evaluated and analyzed included severity of pain using the visual analog scale (VAS), range of motion (ROM), gait ability, the need for repeated joint replacement, and the Harris Hip Score (HHS). Results: Forty-six patients/51 hips were included in the present study. The patients who were evaluated included 30 (65.2%) males and 16 (34.8%) females. The mean age in the population under study was 71.0 ± 10.22, and the mean body mass index of participants was 26.34 ± 2.22 kg/m2. The basic parameters in the two research groups were similar (P > 0.05). There were no significant differences between the two groups in terms of the mean values of VAS and ROM (P > 0.05); however, the mean HHS was significantly higher in the true acetabulum group, 57.90 ± 18.47 versus 48.29 ± 13.80 (P = 0.04). Conclusion: The effectiveness of cup placements both in the true and false acetabula was similar in all of the evaluated variables in terms of clinical outcomes except for HHS which was higher in the true acetabulum group. To further support the results of this research, it is recommended that more research be done on a greater population.
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PURPOSE: High-energy tibial fractures may cause compartment syndrome, which needs fasciotomy. However, in this procedure, close fractures become an open wound and choosing the best type of fixation for this situation has been a problem. We assumed early open reduction and internal fixation (ORIF) instead of late internal fixation or external fixation, or stage-based approach is a better method. METHODS: We collected fifty-seven medical records from 2012 to 2017 stored in Alzahra and Kashani University Hospital databases. We selected important information of their medical files, called the submitted phone numbers, and asked them to come to our clinic and examined their leg for any malunion and/or movement restriction postoperatively. We asked about pain and paresthesia in their leg. Twelve cases were excluded. RESULTS: Demographic variables were not significantly different between these two groups. Deep infection, malunion, decreased range of motion in both knee and ankle joints, pain and paresthesia mainly occurred in external fixation group, except malunion (p value = 0.032), other variables were not statistically significant between two groups. More surgeries were performed predominantly for external fixation group (p value < 0.001). External fixation stayed 4.7 days longer at hospital although it was not statistically significant (p value = 0.108). CONCLUSION: It is better to perform fasciotomy and ORIF simultaneously in one surgery to lower the number of surgeries, days of hospitalization, decrease the risk of deep infection, malunion and movement restriction although its postoperative outcomes were not considerably different from external fixation. We indicate that stage-based approach is accompanied by poor outcomes and lesser satisfaction.
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Fijadores Externos/efectos adversos , Fijación Interna de Fracturas/efectos adversos , Fracturas Mal Unidas/etiología , Fracturas de la Tibia/cirugía , Adulto , Síndromes Compartimentales/complicaciones , Síndromes Compartimentales/cirugía , Fasciotomía , Femenino , Estudios de Seguimiento , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Reoperación , Fracturas de la Tibia/complicaciones , Adulto JovenRESUMEN
BACKGROUND AND AIM OF THE STUDY: The surgical correction of functional mitral regurgitation (MR) remains challenging and controversial. The study aim was to systematically review the outcomes of surgical mitral valve repair (MVRpr) and mitral valve replacement (MVR) in patients with significant functional MR and left ventricular (LV) dysfunction. METHODS: A meta-analysis was performed of published data acquired from patients with moderate to severe functional MR and LV ejection fraction (LVEF) <40% who underwent surgical MVRpr or MVR. The data were meta-analyzed across studies using Bayesian hierarchical models when feasible. RESULTS: The search yielded 36 observational studies. The pooled proportion of operative mortality following MVRpr was 5% (33 studies; 2,231 patients; 95% credible interval (CrI) 4-7%), while that following MVR was 10% (10 studies; 389 patients; 95% CrI 5-18%). For patients undergoing MVRpr, pooled proportions of postoperative cerebrovascular accidents and renal failure were 2% (11 studies; 750 patients; 95% CrI 1-3%) and 9% (11 studies; 756 patients; 95% CrI 5-16%), respectively. The five-year actuarial survival rates following MVRpr across 12 studies ranged from 47% to 78% (median 66%). CONCLUSIONS: In selected patients with significant functional MR and LV dysfunction, surgical MVRpr and MVR can be performed with acceptable intermediate operative mortality risks.
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Insuficiencia de la Válvula Mitral/fisiopatología , Insuficiencia de la Válvula Mitral/cirugía , Disfunción Ventricular Izquierda/fisiopatología , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Insuficiencia de la Válvula Mitral/mortalidad , Factores de Riesgo , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
AIMS: A comprehensive description of transcatheter heart valve (THV) failure has not been performed. We undertook a systematic review to investigate the aetiology, diagnosis, management, and outcomes of THV failure. METHODS AND RESULTS: The systematic review was performed in accordance with the PRISMA guidelines using EMBASE, MEDLINE, and Scopus. Between December 2002 and March 2014, 70 publications reported 87 individual cases of transcatheter aortic valve implantation (TAVI) failure. Similar to surgical bioprosthetic heart valve failure, we observed cases of prosthetic valve endocarditis (PVE) (n = 34), structural valve failure (n = 13), and THV thrombosis (n = 15). The microbiological profile of THV PVE was similar to surgical PVE, though one-quarter had satellite mitral valve endocarditis, and surgical intervention was required in 40% (75% survival). Structural valve failure occurred most frequently due to leaflet calcification and was predominantly treated by redo-THV (60%). Transcatheter heart valve thrombosis occurred at a mean 9 ± 7 months post-implantation and was successfully treated by prolonged anticoagulation in three-quarters of cases. Two novel causes of THV failure were identified: late THV embolization (n = 18); and THV compression (n = 7) following cardiopulmonary resuscitation (CPR). These failure modes have not been reported in the surgical literature. Potential risk factors for late THV embolization include low prosthesis implantation, THV undersizing/underexpansion, bicuspid, and non-calcified anatomy. Transcatheter heart valve embolization mandated surgery in 80% of patients. Transcatheter heart valve compression was noted at post-mortem in most cases. CONCLUSION: Transcatheter heart valves are susceptible to failure modes typical to those of surgical bioprostheses and unique to their specific design. Transcatheter heart valve compression and late embolization represent complications previously unreported in the surgical literature.
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Estenosis de la Válvula Aórtica/cirugía , Prótesis Valvulares Cardíacas , Falla de Prótesis/efectos adversos , Reemplazo de la Válvula Aórtica Transcatéter , Anciano , Anciano de 80 o más Años , Antiinfecciosos/uso terapéutico , Embolia/etiología , Endocarditis/tratamiento farmacológico , Endocarditis/etiología , Endocarditis/prevención & control , Femenino , Oclusión de Injerto Vascular/etiología , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Histoplasmosis/diagnóstico , Histoplasmosis/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Factores de RiesgoRESUMEN
Osteoid osteomata are rarely found in the distal phalanges of the hand. The usual presenting features are chronic pain, nail enlargement and increase in size of the terminal part of the digit. Diagnosis is difficult but surgical excision is effective for treating the patients' pain. We reported this tumor in distal phalanx of the middle finger.
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Bilateral hip dislocations are among the rarest traumatic incidents. We report a case of a 45-year-old, opium-addicted man with bilateral posterior hip dislocation and bilateral femoral head fractures proximal to the fovea with more comminution on the left side. After an unsuccessful closed reduction attempt, surgical reduction and internal fixation of the left and right femoral heads were performed on admission and 72 hours later. He was readmitted because of acute deep vein thrombosis (DVT) on the left side after six weeks and left femoral head avascular necrosis (AVN) after 14 months. All complications occurred on the left side regardless of the sooner intervention in this side compared with the right side. This may imply that the severity of the initial trauma could be a more important risk factor for AVN rather than other factors in case the reduction is delayed for more than six hours.
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Background: Background: Nowadays, surgical procedures are assessed based on the state of an individual. This study aimed to investigate the effect of lumbar spinal stenosis surgery on the patient's quality of life and motor functions in Kashani and Alzahra Hospital in Esfahan. Methods: In the present cross-sectional study, 40 patients aged between 50-70 were respectively evaluated who underwent lumbar spine stenosis surgery in Al Zahra and Kashani Hospitals in Esfahan University of Medical Sciences, Esfahan, Iran, during 2020-2021. The SF-36 questionnaire was used as a research tool. The visual analog scale (VAS), and spine functional index (SFI), were measured initially before surgery and 6 months and 9 months after surgery. Results: The mean scores of the SF-36, SFI, and VAS scores questionnaire were 87.95±4.94, 21.38±1.24, 6.07±0.69 (p<0.001) before surgery, 89.77±5.25, 19.73±1.40, 5.37±1.56 (p<0.001) six months after surgery, and 94.70±5.34, 18.63±1.56, 4.57±0.81 (p<0.001) nine months after surgery, and all were significant. Improvement in the domains of general health, role-physical, role disorder due to impaired physical health, social function, emotional role, and bodily pain was evident. Also, the overall quality of life was enhanced but energy levels and role disorder due to impaired mental health showed no improvement. Conclusion: Not only does lumbar spinal stenosis surgery significantly improve the general health, role-physical, and the social function of the patients but also enhances their quality of life.
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BACKGROUND: Adolescent idiopathic scoliosis is a 3D spine distortion with an unidentified etiology. It results in noticeable trunk deformity, decreased muscle strength and endurance at the trunk, changes in chest volume, breathing issues, and ultimately a decline in the quality of life. Trunk bracing and corrective exercises make up most of the treatment of patients with scoliosis when their deformity is between 20° and 45°, and they have not yet attained skeletal maturity. Evidence suggests that spinal deformity in people with scoliosis may result from improper motor control. Automatic response training is an exercise therapy technique that can modify the pattern of trunk muscle control for supporting the spinal column in normal alignment. An apparatus called a cantilever device is required for this type of exercise, which facilitates training at home. In spite of research showing the benefit of braces and therapeutic exercise in adolescents with scoliosis, less emphasis has been given to the impact of home-based training, especially when this intervention is paired with braces. OBJECTIVE: We aim to compare the efficacy of bracing and a conventional exercise program to a combination treatment that includes trunk bracing and exercises with a cantilever device performed at home on the degree of spine curvature, pulmonary function, trunk muscular endurance, and quality of life. METHODS: This study was a 2-arms parallel-group clinical study. A total of 16 adolescents with idiopathic scoliosis and single lumbar and thoracolumbar curves of 20°-45° were recruited and randomly assigned into 2 groups. Group A received a combination of trunk bracing and exercise using an instrument known as a "cantilever." Group B (controls) received trunk bracing and a conventional exercise program (without a tool). The study outcomes were the Cobb angle of the scoliotic curve, pulmonary function, the endurance of the trunk muscles, and quality of life. The study outcomes were measured at 2 time points: before the intervention (T1) and 12 weeks following the start of the intervention (T2; at this time, the intervention period has been completed). Multivariate analysis of variance was used to test between- and within-group differences. RESULTS: Recruitment for this study began in fall 2022 and is expected to be completed by the end of summer 2023. CONCLUSIONS: We studied the efficacy of a combined trunk bracing program and postural response exercises using a cantilever device in treating adolescent idiopathic scoliosis and compared it with trunk bracing and conventional home exercises. Exercises performed at home using a cantilever device are anticipated to raise the endurance of trunk muscles, which will help reduce trunk deformity, enhance pulmonary function, and improve the quality of life of participants. TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT20220330054371N1; https://www.irct.ir/trial/62811. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/43265.
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Objectives: The M1 macrophage is characterized by enhanced pro-inflammatory cytokines production, whereas macrophage (M2) has anti-inflammatory features. Macrophage polarization as a therapeutic target for controlling immune responses could be performed by gene transduction to control the regulation of exaggerated innate/adaptive immune responses. Materials and Methods: Macrophages were prepared from THP-1 cell line and human monocytes that were transduced with (Membrane-Associated RING-CH-type finger) MARCH-1 viral lentivector produced in HEK-293T cells. RT-PCR and Western blotting confirmed MARCH-1 gene transduction. Cytokine production, CD markers assay, macrophage phagocytosis potential activity and mixed leukocyte reaction (MLR) with CFSE were performed for M1/M2 plasticity. Results: The mean fluorescent intensity of HLA-DR and CD64 expression reduced in MARCH-1+ transduced macrophage population. However, CD206 and CD163 expression increased in these macrophages. The concentrations of IL-6, TNF-α and iNOS were decreased in MARCH-1 transduced cells, and TGF-ß production showed an augmentation in concentration. Western blotting and real-time PCR measurement confirmed that the expression levels of MARCH-1 protein and arginase-1 enzyme were increased in transduced macrophages. Conclusion: The anti-inï¬ammatory features of MARCH-1 revealed the reduced levels of pro-inflammatory factors and maintained M2 phenotype characterized by high levels of scavenger receptors. Therefore, targeting MARCH-1 in monocytes/macrophages could represent a new autologous cell-based therapies strategy for inflammatory conditions.
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Background: Sacroiliac pain is one of the causes of low back pain, representing with discomfort and tenderness in the sacroiliac joint. Interventional procedures might be beneficial in cases unresponsive to medical treatments. Here, we aimed to investigate the effects of intra-articular corticosteroid injections in patients with sacroiliac pain. Materials and Methods: This is a clinical trial performed in 2017-2018 in Kashani Hospital, Isfahan, on patients with low back pain and formerly diagnosed with sacroiliac pain. Patients were recruited based on inclusion and exclusion criteria. Corticosteroid injections were performed for patients. Patients were visited within 2 weeks, 4 weeks, and 6 months after interventions, and pain and disabilities of patients were assessed using the numerical rating scale (NRS) and Oswestry Disability Questionnaire. Results: A total number of 27 patients entered our clinical trial. We showed that the mean NRS score among patients before interventions was 8.01 ± 0.96. Assessments of disability score also indicated that the mean disability scores was 41.48 ± 7.48. Our data also indicated that there was a significant reducing trend in both NRS and disability score after interventions (P < 0.001 for both items). Conclusion: Intra-articular steroid injection is associated with significantly reduced pain and disability in patients with sacroiliac pain. Previous studies evaluated variable methods and reported that this method has high values and significant advantages compared with other techniques which were in line with our results.
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BACKGROUND: Treatments of pilon fracture is an important operative challenge due to high prevalence of post-operative complications. In this paper, we aimed to evaluate the complications of the use of low profile plates for pilon fractures. METHODS: This clinical trial that was performed in 2017-2021 in Isfahan on 27 patients with pilon fractures. Demographic data of patients such as age, gender, type of pilon fracture and baseline pathology of pilon fractures were collected. Patients were treated using low profile plates under surgical procedures. Within 1 month, 3 months and 6 months after surgeries, patients were visited and assessed regarding superficial wound infections, deep wound infections, and evidence of osteomyelitis, vascular injuries, non-union and mal-union using both physical examinations and imaging studies via X-ray. We also measured the functions of cases using The American Orthopedic Foot and Ankle Score (AOFAS) questionnaire. RESULTS: Most cases had 3 days (33.3%) and 5 days (33.3%) of hospitalization. Superficial wound infection was observed in 7 cases (26%). Deep surgical site infections were observed in 2 cases (7.4%) and we had only 1 case of osteomyelitis (3.7%). No vascular injuries were observed in this study. Evaluation of union among patients showed that 2 cases (7.4%) had non-union and 5 cases (18.5%) had malunion in the anterior-posterior axis, but none of the patients had malunion in the coronal axis. Based on AOFAS questionnaire, the mean score in patients was 88.36±14.20. CONCLUSION: Treatments of pilon fractures by low profile plates have similar complications compared to other treatment options.
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BACKGROUND: Instrumented fusion is the standard treatment in adolescent idiopathic scoliosis (AIS). In patients with both thoracic and lumbar curves there is a trend toward fusing the major curve and keeping the spine mobile with greater function in the future. To evaluate the results of selective fusion in patients with AIS, we aimed to do this research in eligible patients with adolescent idiopathic scoliosis referred to educational hospitals in Isfahan, Iran. METHODS: This is a retrospective cross-sectional study which was performed in 2019 in educational hospitals in Isfahan. The study population consisted of 21 patients with idiopathic scoliosis who had been treated with the selective fusion method in 2010-2018. Demographic data of patients including age, sex, and previous medical history and operation results were noted from medical documents of all patients. Cobb's angle measurements and assessments related to complications, Patients' satisfaction and outcome of the surgery were assessed using Patient Outcome Questionnaires developed by Scoliosis Research Society (SRS-22) and 36-Item Short Form Survey (SF-36) questionnaires. RESULTS: A total of 21 patients with idiopathic scoliosis were enrolled in the study. The lowest follow-up duration was 2 years and the longest duration was 10 years. We showed that the mean upper curve before interventions were 50.66±7.55 and the mean lower curve before interventions was 35.19±3.86. These amounts improved significantly after surgeries (P<0.001). Evaluation of thoracic apical vertebral translation (AVT) to thoracolumbar or lumbar AVT ratio also showed significant improvements (P<0.001). CONCLUSION: Patients undergoing selective fusion benefit from this surgical procedure. The upper and lower curves improved significantly and 85.8% of patients were satisfied with the surgery. Stopping fusion above the L2 in all patients left the lumbar spine mobile which is an important factor in patient satisfaction. We suggest that selective fusion be considered for surgical treatment of some patients with idiopathic scoliosis.
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BACKGROUND: Osteoporotic vertebral fracture (OVF) is a common spinal fracture in the elderly population treated with conservative or surgical techniques. Patients with such fractures may experience chronic pain due to nonunion and instability, deformity with kyphosis and neurologic symptoms due to neural compression. Surgical interventions have definite roles in treatments especially when conservative therapy fails. Cement augmentation in forms of vertebroplasty and kyphoplasty or even surgical fixation with or without column reconstruction are among our armamentarium to deal with problems arising during the treatment of these patients. METHODS: We entered patients with OVF who did not respond to conservative treatments for more than 4 weeks and were candidates for vertebroplasty. Pain Visual Analog Scale (PVAS) was assessed for patients before the procedure, in the first month and 6 months after surgeries. We also analyzed factors including time passed from fractures, amounts of injected cement, age, sex, types of fractures, segmental kyphosis and sites of fractures. Data were collected and analyzed using SPSS software version 24. RESULTS: A total number of 140 patients entered. The mean age of the patients was 64.90±7.97 years. Mean preoperative pain level was 8.35±0.97 points on VAS (0-10) score. The mean Post-operative VAS score after one month and after six months were 4.65±0.66 and 5.28±0.75 respectively. The mean consumed cement volume was 5.77±1.40 ml. Cement volume of more than 5 ml was injected for 53.6% of patients. 78.7% of fractures were located in T10-L2 levels (thoracolumbar fractures). 14.2% of fractures in L3-L5 (lumbar fractures) and 7.1% in T4-T9 (thoracic fractures). 53.6% of the patients had kyphosis levels below 20 degrees. Reduction of pain in patients younger than 60 years was more than patients older than 60 years but both groups indicated pain reduction (P<0.001). The end-plate fracture had a higher likelihood of pain relief compared with burst or retropulsed fractures (OR=1.161). Patients with thoracolumbar fractures had higher chances of pain reduction compared with other locations (OR=1.870). Kyphosis less than 20 degrees and also cement volume more than 5 ml had also significant effects on reducing the pain after surgeries (OR=2.054 and OR=2.412 respectively (P<0.05)). CONCLUSION: Vertebroplasty is an effective option in treating patients with OVF who have not respond to conservative treatment. Factors such as younger age, OVFs involving either end-plates, more than 5 ml of cement injection, segmental kyphosis below 20 degrees and thoracolumbar fractures are associated with better results for pain amelioration.
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BACKGROUND: The best method for repairing intertrochanteric fractures is still controversial. The fixation methods include extramedullary (EM) and intramedullary (IM). Studies that compare IM and EM fixations for unstable hip fractures are rare. In this study, our goal was to compare the efficacy of EM and IM fixation in treatment of unstable intertrochanteric fractures. METHODS: A total of 113 patients with unstable intertrochanteric were randomized in this cohort study between March 2016 and June 2018 in trauma center of Kashani and Alzahra Hospitals, Isfahan, Iran. The patients were followed for a period of 12 months with sequential clinical and imaging evaluations. Baseline data were recorded at the time of injury. Radiographs were evaluated immediately post-operatively and at the scheduled follow-up intervals. RESULTS: A total of 20 of patients were excluded during the study and finally 93 patients (43 males and 50 females) with mean age of 62.74±16.4 completed the follow-up sessions. Mann-Whitney test indicated a significant difference in tip-apex distance between the two groups. While the two groups were homogeneous in the baseline LEM score, it was not significantly different between two groups after 1 and 3 months of surgery as well. However, the LEM score was significantly higher in IM group after 6 and 12 months of surgery. CONCLUSION: According to our findings, IM nails (such as the cephalomedullary nail) afforded more advantages over EM devices (such as the DHS and DCS) in the treatment of unstable intertrochanteric fractures. Our results indicated that the final LEM scores as well as the time to union were better in IM fixation group.
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Although epidural corticosteroids have been evaluated for the lumbar spinal stenosis (LSS) as an alternative treatment, oral corticosteroids have not been considered as a possible option for the patients with constant pain who have resistant against routine treatments. Therefore, this study aimed to investigate the efficacy of the short-term, low-dose oral prednisolone for refractory LSS. In this double-blinded randomized placebo-controlled clinical trial, 100 participants with the refractory LSS were selected from the out-patient clinics; however, 7 of them excluded before randomization. The patients were randomly allocated into two groups with a 1:1 ratio: the intervention group that received 10 mg prednisolone per day for 1 week and the control group that received the exact placebo. The patients' severity of pain in terms of the numerical rating scale, ability to walk in meters, and Oswestry Disability Index (ODI) were assessed and then compared to the baseline after 2 months. The baseline variables were NS between these two groups. At the 2-month follow-up, the ability to walk in meters has increased and the severity of pain and ODI have decreased in both groups. Notably, except for the walking distance, none of the differences were statistically significant. Except for the significant change in walking distance between the groups, no other significant difference was observed in any variables when comparing the delta of each variable (after-before). One-week treatment with daily 10 mg oral prednisolone was not effective on the patients with refractory LSS in the short-term follow-up.
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Glucocorticoides/uso terapéutico , Dolor de la Región Lumbar/tratamiento farmacológico , Vértebras Lumbares/fisiopatología , Prednisolona/uso terapéutico , Estenosis Espinal/tratamiento farmacológico , Administración Oral , Evaluación de la Discapacidad , Método Doble Ciego , Femenino , Humanos , Dolor de la Región Lumbar/fisiopatología , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Estenosis Espinal/fisiopatología , Caminata/fisiologíaRESUMEN
OBJECTIVE: The purpose of this study was to investigate effect of plasma-derived exosomes of refractory/relapsed or responsive diffuse large B-cell lymphoma (DLBCL) patients on natural killer (NK) cell functions. MATERIALS AND METHODS: In this cross-sectional and experimental study, NK cells were purified from responsive patients (n=10) or refractory/relapsed patients (n=12) and healthy donors (n=12). NK cells were treated with plasma-derived exosomes of responsive or refractory/relapsed patients. We examined the expression levels of hsa-miR-155-5p, hsalet- 7g-5p, INPP5D(SHIP-1) and SOCS-1 in NK cells quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Percentages of NK cells expressing CD69, NKG2D and CD16, NK cell cytotoxicity and NK cell proliferation (using flow-cytometry) as well as interferon-gamma (IFN-γ) level in the supernatant of NK cells using ELISA were also investigated. RESULTS: We observed an increased level of hsa-miR-155-5p and a decreased level of SOCS-1 in NK cells treated with exosomes compared to untreated NK cell in healthy donors and DLBCL patients. An increase in hsa-miR-155-5p level was associated with an increased level of IFN-γ in healthy donors. The decreased levels of hsa-let-7g-5p were observed in NK cells treated with exosomes in comparison with untreated NK cells in DLBCL patients (P<0.05). There was no significant difference in the percentage of CD69+ NK cells and NKG2D+ NK cells in the absence or presence of exosomes of DLBCL patients in each group. Furthermore, we observed significant reduction of NK cell proliferation in DLBCL patients and healthy donors in the presence of exosomes of refractory/relapsed patients (P<0.05). A significant decrease was observed in cytotoxicity of NK cell in patients with DLBCL treated with exosomes of responsive patients. CONCLUSION: Our findings demonstrated adverse effect of plasma-derived exosomes of DLBCL patients on some functions of NK cell. It was also determined that low NK cell count might be associated with impaired response to R-CHOP and an increased recurrence risk of cancer.
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BACKGROUND: The purpose of this study is to report outcomes of total hip arthroplasty (THA) in patients under the age of 35 years regarding pain and joint function. MATERIALS AND METHODS: This preliminary analytic-descriptive study was performed in prospective consecutive series of forty-three patients younger than 35 years old who had undergone unilateral THA during a 36-month period. As the primary outcome, the severity of pain using visual analog scale (VAS) of 1-10, and as the secondary outcomes, joint range of motion (ROM) and the Harris Hip Score (HHS) were assessed in the preoperative visit, 1, 6, and 18 months after operation for each patient. Complications were recorded at 6 months and 18 months after surgery. RESULTS: The data of VAS showed the mean severity of pain was significant between preoperation measurements and postoperative assessments (P < 0.001). The means of HHS and hip ROM were also statistically significant before the operation in comparison with postoperative assessments (P < 0.001 for both means). A total of 19 patients had postoperative complications including periprosthetic fracture in two patients, infection in two patients, cup loosening in three patients, limb length discrepancy in 10 patients, and heterotopic ossification in two patients. Seven patients had been readmitted. CONCLUSION: We believe THA using uncemented prosthesis has a high survivorship with low rate osteolysis in young patients with good bone stock. It is necessary to have longer follow-up to have a better evaluation on outcomes.
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INTRODUCTION: Anterior cervical discectomy and fusion (ACDF) surgery is an accepted method for many spinal cord abnormalities. The purpose of this study was to evaluate the outcomes of treating patients with spinal cord lesions at one level or two levels through ACDF with cage-stand-alone (ACDF-CA) and ACDF with cage-with-plate fixation (ACDF-CP) surgery and comparing these results with each other. METHODS: In this prospective, cross-sectional, descriptive study, eighty patients undergoing ACDF surgery were enrolled according to the inclusion and exclusion criteria. Demographic data, before and after surgery findings, and clinical symptoms were investigated. Data were collected by means of visual analog scale (VAS) and Neck Disability Index (NDI) questionnaires. The adverse effects and surgical outcomes were evaluated based on Odom's criteria and patients' satisfaction. The collected data of the groups were then compared and assessed. RESULTS: There was no significant difference between the groups in regards of gender, age, duration of surgery to visit, surgical level, preoperative and postoperative VAS and cervical range of motion, preoperative NDI, results based on Odom's criteria, and satisfaction of patients (P > 0.05). The VAS, NDI, and range of motion scores were significantly reduced in the four groups after the operation compared to the preoperative stage. Postoperative NDI scores in the ACDF-CA group at one level were significantly lower than other groups (P < 0.05). CONCLUSION: Both of the methods revealed acceptable outcomes in comparison to the preoperative stage, and despite some minor differences, there are generally no significant differences in outcomes and complications.
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OBJECTIVE: Compare the outcome of spinal deformity correction between Ti-Ti and CrCo-Ti rods for the treatment of spinal Adolescent Idiopathic Scoliosis (AIS) using rods mentioned with all pedicle screws and translation technique. METHOD: 59 patients operated for spinal deformity (Lenke 1 or 2) AIS. The patients were divided into two groups by random allocation using Ti-Ti rods (n = 29) and CrCo-Ti rods (n = 30) and the alone difference among them in the surgical procedure was rod material (Ti-Ti or CrCo-Ti rods) and finally, radiological outcomes were compared preoperatively, postoperatively and at last follow-up for 12 months. RESULTS: Patients' main curve correction after surgical procedure regardless type of rod was 48.95±11.04 (13-75) degree. Success rate of spinal deformity correction following surgical procedure regardless of type of administered rod was 86.76 ± 11.30 percent (62.5-100%). Mean of deformity correction rate was 91.49±10.67% using CrCo-Ti rods versus 81.86±9.88% using Ti-Ti rods (P-value=0.01). Angle change was 3.29±6.60 for kyphosis angle and 0.59±7.76 for lordosis angle. Rate of main curve correction was not significantly different considering patients' gender (P-value0.657). Main curve correction success rate was in association with patients' age and type of rod (P-value=0.054, r=-1.863 and P-value=0.001, r=8.865 respectively). CONCLUSION: CrCo-Ti rods have the ability to produce higher correction rates in AIS compared to Ti-Ti rod of the same diameter. CrCo-Ti rods provide significant and stable spinal correction, especially in correction of main curve. This rate was associated with patients' age and type of rod administered but not gender.