Identification of Acanthamoeba spp. from water and soil of public parks in the north of Iran.

Acanthamoeba, a free-living and opportunistic protozoan parasite, is a causative agent of severe human infections of the cornea and brain. The present study evaluated the distribution and genotyping of Acanthamoeba spp. in water and soil of recreational places in various areas in Guilan province in northern Iran. Eighty water and 20 soil samples were collected from the study area. Water samples were vacuum filtered through a 0.45 µm pore-size membrane filter. Soil samples were washed with sterile distilled water, and washings were similarly filtered, as mentioned for water samples. The filtered material was cultured on non-nutrient agar plates seeded with heat-killed Escherichia coli. Molecular analysis was performed by PCR and sequencing using specific primers for Acanthamoeba. Finally, 26 isolates were successfully sequenced. According to culture and PCR methods, 54% of water and 100% of soil samples were contaminated with Acanthamoeba. Based on the sequencing data, genotypes T4 (47%), T5 (35.29%), T3 (11.76%), and T11 (5.88%) were identified in water samples. Genotypes T4 (66.6%), T5 (22.2%) and T15 (11.1%) were identified in water samples. Most isolates might present a potential health hazard for humans in this region. To the best of our knowledge, this is the first comprehensive survey of water and soil of recreational areas in northern Iran and the first report on identifying genotype T15 from soil sources.

Evaluation of the efficacy of different concentrations of nano-capsules containing Talaromyces flavus with two forms of powder and suspension in reducing the incidence of cotton Verticillium wilt.

Previous domestic and foreign studies have shown the significant effect of Talaromyces flavus on growth inhibition of some important plant pathogens including Verticillium dahliae, Fusarium oxysporum f. sp. lycopersici and Fusarium oxysporum f. sp. cucumerinum. In Iran, it is necessary to produce new formulations of this fungus based on modern technologies given the importance of attracting companies producing biological control agents and transferring the technical knowledge of mass production of formulations of these agents to them. In the present study, based on the method presented in the Pesticide Research Department of the Iranian Plant Protection Research Institute, two types of T. flavus formulations in the form of nano-capsules containing Talaromyces flavus with two forms of powder and suspension were prepared using nanotechnology. In the next step, during the greenhouse examination, the efficiency of each of these new formulations in concentrations of one to five per thousand for soil addition method and concentration of five per thousand for seed impregnation method (six treatments for each of the two new formulations) was compared with the registered formulation of Talaromin in two methods of seed impregnation and soil addition with healthy control and infected control to control cotton Verticillium wilt disease, in the form of a randomized complete block design with 16 treatments and 5 replications. After statistical analysis of the data obtained by Duncan's Multiple Range Test by MS TAT C software, the results showed that in terms of disease severity among treatments with the previous formulation (Talaromin) with each of the methods of soil addition and seed impregnation, there was no statistically significant difference between nano-suspension with each of the concentrations of one, four and five per thousand by the soil addition method and nano-powder with each of the concentrations of two and three per thousand by soil addition method, and the mentioned treatments were included in one statistical group in terms of disease severity with healthy control.

Isolation and identification of nontuberculous mycobacteria from specimens of lower respiratory tract of transplanted patients based on the evaluation of 16SrRNA gene.

BACKGROUND: Nontuberculous mycobacteria are pervasive microorganisms and are often present as saprophytes in humans, animals, and the environment. Today, these bacteria are known as the most important environmental opportunists and, in the last decades, infections by nontuberculous mycobacteria have multiplied, due to increased immunodeficiency (cancer, transplant recipients, HIV). STUDY DESIGN: This study aimed to investigate the infections by nontuberculous mycobacteria in transplanted patients. METHODS: The study was performed on 57 samples from respiratory secretions of transplant recipients taken by standard methods. Nontuberculous mycobacteria were identified by culture method and molecular identities of clinical isolates were investigated by PCR amplification using 16SrRNA gene and sequence analysis and Blast of the sequences. Demographic data were evaluated by Spss software. RESULTS: The prevalence of nontuberculous mycobacteria in transplant patients was 22.8%, the age of patients was between 23 and 52 years. The most common involvement of nontuberculous mycobacteria in our transplanted individuals were 6 strains of M avium-intracellulare Complex (42.87%), followed by 2 strains of M marinum (14.29%) and 1 strain each (7.14%) of M xenopi, M chelonae, M intracellulare, M kansasii, M simiae. At the conclusion of the tests, one final strain was identified as M tuberculosis (7.14%). CONCLUSION: The prevalence of nontuberculous mycobacteria indicates their importance in the fate of these patients. The identification of nontuberculous mycobacteria is a neglected part of microbiology laboratories, due to the lack of sufficient facilities and the risk associated with their culture. Therefore developing routine methods for the identification of these infections appears to be critical, especially in hospitals with the transplantation ward.

The impact of differential expression of the pectoral muscle proteome in two groups of Japanese quail with different growth rates on meat quality.

1. In this study, the proteomics method was applied to genetically evaluate the performance and carcase characteristics of Japanese quail and their molecular mechanisms, and to further determine and analyse the meat quality and muscle proteins. 2. Ten Japanese quail were selected from among 400 quail from the seventh generation of a population. Various traits were recorded and multivariate analysis was applied using Wombat software. 3. Differential expression of pectoral muscle proteins was performed, whereby nine spots were selected (P < 0.05) for determination. All proteins from the quail group with the highest breeding value showed significantly greater relative intensity, except for serum albumin. 4. The results showed that an increase in growth rate can cause disturbances in most organs and their metabolism, although the increase in the expression of some proteins indicated that the bird's body tends to adapt to special conditions. 5. The allocation of genetic resources is likely to maintain the balance between most organs, which does not overlap. However, most evidence shows that meat quality has been reduced, but to a limited extent, by selection for growth.

Impact of the Iranian Registry of Infective Endocarditis (IRIE) and multidisciplinary team approach on patient management.

BACKGROUNDS: The last 30 years have witnessed major improvements in understanding of all aspects of infective endocarditis (IE). The Iranian Registry of Infective Endocarditis (IRIE) was formed to address epidemiological aspects of IE vis-à-vis its main pathogens and underlying heart diseases over a 12-year period. Indeed, a multidisciplinary team (MDT) for IE was developed alongside. METHODS: In a longitudinal observational study, data of adult patients with definite or possible IE based on modified Duke criteria were collected from 2007 to 2016 in our tertiary centre, Iran. From 2016 until 2019, we run a prospective observational study using formation of an IE MDT to provide better patient management and compared data before and after this. RESULTS: Totally, 645 patients with mean age of 48 ± 17 years were enrolled. Data of 445 and 200 patients were compared before and after IRIE and MDT formation, respectively. We found significantly reduced type and number of applied antibiotics (p = 0.04) and higher rate of positive blood culture (p = 0.001). Hospital length of stay increased significantly after formation of the IRIE and IE MDT (p = 0.02). The rate of heart failure, new abscess formation and cerebral emboli were significantly decreased after IRIE and IE MDT (p < 0.001) and consequently in-hospital mortality reduced significantly (p = 0.05). CONCLUSION: Developing national registries and MDTs has potential to enhance patient management and reduce IE burden. Our results demonstrated that establishment of the Iranian IRIE and IE MDT conferred better diagnoses, standardised treatments and significantly reduced cardiac and extra cardiac morbidity.

Inherited thrombophilia in mechanical valve malfunction.

Mechanical valve malfunction due to thrombosis is an important and life-threatening complication in patients with prosthetic valves. Our study was performed to determine the prevalence of thrombophilia genes among patients with acute thrombosis of the mechanical pulmonary valves despite acceptable anticoagulation levels. In this cross-sectional comparative study thirthy two consecutive patients with acute thrombosis of pulmonary mechanical valve who had international normalized ratio (INR) levels for prothrombin time of at least 2 at the time of presentation and in the preceding three months were enrolled and the prevalence rates of thrombophilia factor genes among them was assessed. The results showed that 24 patients (75%) had thrombophilia gene mutations. The affected patients had mutations in one gene in 37.5% of cases, two genes in 31.3%, and three genes in 6.3%. Prevalence rate of Factor V Leiden (FVL), prothrombin (PTH), Plasminogen activator inhibitor-1 (PAI-I), Methylenetetrahydrofolate Reductase (MTHFR), and endothelial protein C receptor (EPCR) gene mutations was 3.1%, 6.3%, 50%, 37.5%, and 25%, respectively. In our study the prevalence of thrombophilia factor gene mutations of patients with acute thrombosis of pulmonary valve was higher than that reported in the general population.

Prevalence of allergic bronchopulmonary aspergillosis in cystic fibrosis patients using two different diagnostic criteria.

Summary: Objective.There are different diagnostic criteria for the diagnosis of Allergic bronchopulmonary aspergillosis (ABPA) in CF patients. In this present study we evaluated the prevalence of ABPA in Iranian CF patients by two more usual diagnostic criteria as ISHAM working criteria (A) and CF Foundation Consensus Conference criteria (B). Methods.Eighty-six CF patients were included in the study. All CF patients underwent for Aspergillus skin prick test (AST), Aspergillus-specific IgE (sIgEAf) and Aspergillus-specific IgG (sIgGAf), total IgE. The ABPA prevalence was estimated by two diagnostic criteria, (A) and (B) and compared. Results. The frequency of positive AST, total IgE, sIgEAf and sIgGAf were 47 (54.6%), 9 (10.5%), 42 (48.8%) and 67 (77.9%), respectively. The obtained rate of ABPA prevalence (10.5%) was identical in two diagnostic criteria A and B (kappa value of 1.000). Conclusions.The applied diagnostic criteria had no significant effect on the reported rate of ABPA prevalence.

Successful control of exacerbation of Allergic Bronchopulmonary Aspergillosis due to Aspergillus terreus in a cystic fibrosis patient with short-term adjunctive therapy with voriconazole: A case report.

A 12-year-old boy with cystic fibrosis (CF) and a history of glucocorticoid-dependent allergic bronchopulmonary aspergillosis (ABPA) was referred to our hospital. The ABPA was diagnosed when he was 8 years old and he had been treated with several course of oral glucocorticoids for recurrent exacerbations. He was readmitted when aged 12 with a history of worsening shortness of breath and chest tightness. A recurrence of ABPA was diagnosed based on eosinophilia and elevation of Aspergillusspecific IgE and IgG, and total IgE. Thoracic high-resolution computed tomography (HRCT) showed central bronchiectasis with parenchymal infiltrates. The treatment started with itraconazole and oral corticosteroid. After 2 months of treatment, he was re-admitted to the hospital due to a progressive worsening of respiratory symptoms. Chest HRCT revealed the a sub segmental atelectasis in the left lung. Microscopic examination of sputum and BAL samples demonstrated septate hyphae consistent with Aspergillus species. Sputum and BAL culture yielded Aspergillus ochraceus and Aspergillus terreus, which were both sensitive to itraconazole and voriconazole. The treatment was switched to voriconazole and the patient showed significant clinical, serological and mycological improvement after three months. This case shows that voriconazole may be used as an alternative for treatment of ABPA due to Aspergillus terreus.

The Influence of Brass Compensator Thickness and Field Size on Neutron Contamination Spectrum in 18MV Elekta SL 75/25 Medical Linear Accelerator with and without Flattening Filter: A Monte Carlo Study.

BACKGROUND: One of the most significant Intensity Modulated Radiation Therapy treatment benefits is a high target to normal tissue dose ratio. To improve this advantage, an additional accessory such as a compensator is used to deliver doses. Compensator-based IMRT treatment is usually operated with an energy higher than 10 MV. Photoneutrons, which have high linear energy transfer and radiobiological effectiveness, are produced by colliding high-energy photon beams with linear accelerator structures, then they deliver the unwanted doses to patients and staff. Therefore, the neutron energy spectra should be determined in order to calculate and reduce the photoneutron risk. OBJECTIVE: We have conducted a comprehensive and precise study on the influence of brass compensator thickness and field size on neutron contamination spectrum in an Elekta SL 75/25 medical linear accelerator with and without the flattening filter by Monte Carlo method. MATERIAL AND METHODS: MCNPX MC Code version 2.6.0 was utilized to simulate the detailed geometry of Elekta SL 75/25 head components based on Linac's manual. This code includes an important feature to simulate the photo-neutron interactions. Photoneutrons spectrum was calculated after the Linac output benchmarking based on tuning the primary electron beam. RESULTS AND CONCLUSION: Based on the Friedman and Wilcoxon nonparametric tests results (P<0.05), photoneutron fluence directly depends on the field size and compensator thickness. Moreover, the unflattened beam provides lower photoneutron fluence than the flattened beam. Photoneutrons fluence is not negligible in compensator-based IMRT treatment. However, in order to optimize treatment plans, this additional and unwanted dose must be accounted for patientss.

Protective Effect of Gastric Distension Preconditioning on Renal Ischemia/Reperfusion Injury in Rats.

The stomach mechanoreceptors can be stimulated by gastric distension (GD) and through afferent vagal nerve, increased activity of the renal sympathetic pathways. Because renal sympathectomy can abolish the protective effect of ischemic preconditioning, it seems that GD preconditioning can be effective in renal ischemia/reperfusion (I/R) injury. Gastric inflate (8 ml of 37°C water for 20 min) by a latex balloon inserted into the stomach through the fundus; I/R group was subjected to 45 min of bilateral ischemia and 24 h of reperfusion. GD preconditioning decreases blood urea nitrogen, creatinine, kidney damage score, and alkaline phosphatase levels compared to the sham GD group (P < 0.05). GD preconditioning may protect renal I/R injury through anti-inflammatory activity, but this efficacy requires extensive studies on the methods and mechanisms.

Comparison and Evaluation of Different Treatment Plans with IFRT Field and 6 and 18 MV Energies in Hodgkin's Lymphoma Involvement Neck and Mediastinum.

BACKGROUND: Radiotherapy with large mantle field is an effective technique in increasing the risk of secondary cancers among HL (Hodgkin Lymphoma) patients; therefore, it is essential to choose an effective treatment field including the least medical conditions in radiotherapy. OBJECTIVE: The present study aimed to plan separate fields for neck and mediastinum using various energies, to compare dose distribution with MLC and to block field formation. MATERIALS AND METHODS: In this study, 3D conformal treatments, Siemens Oncor accelerator equipped with multi-leaf collimator (MLC) were performed to create anterior-posterior fields. CT-scan data of 18 female patients with neck and mediastinal involvement was imported in TIGRT treatment planning system, and then treatment plans were introduced. RESULTS AND CONCLUSION: Using treatment plan 1, photon 6 MV in neck weighting 1 from interior, 0.5 from posterior, photon 18MV in mediastinum weighting 1 from interior and 0.5 from posterior, it was shown that regarding the common treatment plan used with photon 6 MV, mean dose delivered to breast, lung, esophagus and larynx reduced 6, 7, 41 and 10 percent, respectively and uniformity index improved by 10 percent. Using block compared to MLC in all treatment plans offered improved average dose in all organs under study. To protect breast and lung while using MLC and block in the first treatment plan seemed to be more appropriate; however, using blocks in comparison to MLC increased delivered mean dose in all organs under study. Using separate fields with Pb blocks, though, showed smaller increase.

Endomyocardial Biopsy via the Femoral Vein Using a Long, Curved Sheath.

BACKGROUND: Endomyocardial biopsy (EMB) has been defined as the gold standard method for surveillance of rejection after heart transplantation, and it has also been used in the diagnosis of myocarditis and the unknown causes of cardiomyopathies. The procedure, however, is not free from complications. Access through the jugular vein or the femoral vein is the standard approach. In this study, we performed biopsies by using a long, curved sheath and evaluated the rate of complications with this technique. METHODS: In this descriptive case series study, 97 EMBs were performed in 72 patients who were referred to a cardiovascular and medical research center in Tehran, Iran, between October 2011 and May 2013. The procedures were performed via the femoral approach by using a long bioptome with a long, curved sheath. RESULTS: Adequate specimens were obtained in 97.9% of the total EMBs, with an average of 5 fragments per procedure. No deaths occurred, and there were no cases of pericardial effusion, myocardial rupture, papillary muscle rupture, increase in the severity of tricuspid regurgitation, atrioventricular block, sustained and nonsustained ventricular tachycardia, or atrial fibrillation. There was one case of persistent right bundle branch block. CONCLUSIONS: Using a long, curved sheath can facilitate access to the interventricular septum compared with common sheaths and can be used safely in EMB via the femoral approach.

Going beyond audit and feedback: towards behaviour-based interventions to change physician laboratory test ordering behaviour.

Studies indicate there are a variety of contributing factors affecting physician test ordering behaviour. Identifying these behaviours allows development of behaviour-based interventions. Methods Through a pilot study, the list of contributing factors in laboratory tests ordering, and the most ordered tests, were identified, and given to 50 medical students, interns, residents and paediatricians in questionnaire form. The results showed routine tests and peer or supervisor pressure as the most influential factors affecting physician ordering behaviour. An audit and feedback mechanism was selected as an appropriate intervention to improve physician ordering behaviour. The intervention was carried out at two intervals over a three-month period. Findings There was a large reduction in the number of laboratory tests ordered; from 908 before intervention to 389 and 361 after first and second intervention, respectively. There was a significant relationship between audit and feedback and the meaningful reduction of 7 out of 15 laboratory tests including complete blood count (p = 0.002), erythrocyte sedimentation rate (p = 0.01), C-reactive protein (p = 0.01), venous blood gas (p = 0.016), urine analysis (p = 0.005), blood culture (p = 0.045) and stool examination (p = 0.001). Conclusion The audit and feedback intervention, even in short duration, affects physician ordering behaviour. It should be designed in terms of behaviour-based intervention and diagnosis of the contributing factors in physicians' behaviour. Further studies are required to substantiate the effectiveness of such behaviour-based intervention strategies in changing physician behaviour.

Application of CdS quantum dots modified carbon paste electrode for monitoring the process of acetaminophen preparation.

In this research article, a novel, selective, and sensitive modified carbon paste electrode (CPE) using CdS quantum dots (QDs) is presented. The highly stable CdS QDs were successfully synthesized in an in situ process using Na2S2O3 as a precursor and thioglycolic acid as a catalyst and capping agent. The synthesis of CdS QDs was studied using X-ray diffraction (XRD) and transmission electron microscopy (TEM) techniques. The synthesized CdS QDs were used for preparation of a modified carbon paste electrode (CdS/CPE). The electrochemical behavior of the electrode toward p-aminophenol (PAP) and acetaminophen (Ac) was studied, and the results demonstrated that the CdS/CPE exhibited good electrocatalytic performance toward PAP and Ac oxidation. The oxidation peak potential of each analyte in the mixture was well separated. As a result, a selective and reliable method was developed for the determination of PAP and Ac simultaneously without any chemical separations. Application of the fabricated electrode for monitoring the process of Ac preparation from PAP was investigated. The obtained results show that CdS/CPE has satisfactory analytical performance; it could be a kind of attractive and promising nanomaterial-based sensor for process monitoring via the electrochemical approach.

A biocompatibility study of new nanofibrous scaffolds for nervous system regeneration.

The development of therapeutic approaches for spinal cord injury (SCI) is still a challenging goal to achieve. The pathophysiological features of chronic SCI are glial scar and cavity formation: an effective therapy will require contribution of different disciplines such as materials science, cell biology, drug delivery and nanotechnology. One of the biggest challenges in SCI regeneration is to create an artificial scaffold that could mimic the extracellular matrix (ECM) and support nervous system regeneration. Electrospun constructs and hydrogels based on self-assembling peptides (SAPs) have been recently preferred. In this work SAPs and polymers were assembled by using a coaxial electrospinning setup. We tested the biocompatibility of two types of coaxially electrospun microchannels: the first one made by a core of poly(ε-caprolactone) and poly(d,l-lactide-co-glycolide) (PCL-PLGA) and a shell of an emulsion of PCL-PLGA and a functionalized self-assembling peptide Ac-FAQ and the second one made by a core of Ac-FAQ and a shell of PCL-PLGA. Moreover, we tested an annealed scaffold by PCL-PLGA microchannel heat-treatment. The properties of coaxial scaffolds were analyzed using scanning electron microscopy (SEM), Fourier transform spectroscopy (FTIR), contact angle measurements and differential scanning calorimetry (DSC). In vitro cytotoxicity was assessed via viability and differentiation assays with neural stem cells (NSCs); whereas in vivo inflammatory response was evaluated following scaffold implantation in rodent spinal cords. Emulsification of the outer shell turned out to be the best choice in terms of cell viability and tissue response: thus suggesting the potential of using functionalized SAPs in coaxial electrospinning for applications in regenerative medicine.

Olfactory function in acute traumatic brain injury.

OBJECTIVE: Traumatic brain injury (TBI) represents a significant public health problem and is associated with a high rate of mortality and morbidity. Although TBI is amongst the most common causes of olfactory dysfunction the relationship between injury severity and olfactory problems has not yet been investigated with validated and standardized methods in the first days following the TBI. METHODS: We measured olfactory function in 63 patients admitted with TBI within the first 12 days following the trauma by means of the Sniffin' Sticks identification test (quantitative assessment) and a parosmia questionnaire (qualitative assessment). TBI severity was determined by means of the Glasgow Coma Scale (GCS) and by duration of post-traumatic amnesia (PTA) as measured by the Galveston Orientation and Amnesia Test. RESULTS: Poor olfactory scores correlated with a longer amnesia period, but not with GCS scores. Further, we observed higher parosmia scores in assault victims than in victims of falls or motor vehicle collisions. CONCLUSIONS: We show that PTA is intimately related to olfactory problems following a TBI. Thus, a thorough evaluation of olfaction is essential in order to detect posttraumatic olfactory dysfunction and to take appropriate actions early on to help the individual deal with this impairment.

Placental laterality and uterine blood flow at 20-40 weeks' gestation in low-risk pregnancies.

We sought to examine flow velocity waveforms of the uterine arteries with respect to placental location at 20-40 weeks' gestation. Blood flow (BF) volume, pulsatility index (PI), resistance index (RI), end-diastolic velocity, mean velocity, peak systolic velocity and systolic/diastolic ratio (S/D) were obtained by colour Doppler ultrasonography from bilateral uterine arteries in 288 low-risk singleton pregnancies. In cases with lateral placentation the mean PI and RI values at 36-40 weeks' gestation and the mean S/D value at 38-40 weeks were significantly higher in the contralateral than in the ipsilateral uterine arteries. Both BF volume and RI correlated inversely with gestational age in these groups (r = - 0.20 and p = 0.01; r = - 0.17 and p = 0.03, respectively). The contralateral and central uterine arteries were comparable for all Doppler indices. In conclusion, lateral placentation may affect uterine artery blood flow throughout gestation and some Doppler indices near term. Clinical significance of these findings needs to be elucidated.

Olfactory and executive dysfunctions following orbito-basal lesions in traumatic brain injury.

OBJECTIVE: To study the acute relationship between olfactory function and traumatic brain injury (TBI), cognitive functions and outcome. METHODS: Sixty-two patients with TBI were evaluated within the first 2 weeks following TBI. The Sniffin'Sticks identification test was used to assess olfaction. A neuropsychological evaluation was carried out to assess attention, verbal fluency, naming, memory, problem-solving and mental flexibility. The extended Glasgow Outcome Scale (GOSE) and the Disability Rating Scale (DRS) were rated at discharge from acute care. RESULTS: Traumatic lesions located in the basal frontal area resulted in odour identification scores that were significantly lower than when lesions were elsewhere (p < 0.001). A significant positive correlation was shown between odour identification scores and mental flexibility scores (p = 0.004) and patients with hyposmia had worse performances on executive tests measuring problem-solving, verbal fluency and mental flexibility (p < 0.01). Moreover, the odour identification score and the DRS total score were related (p = 0.019). CONCLUSIONS: These findings add information regarding acute olfactory status following TBI and provide evidence on the importance of assessing olfaction very early post-TBI in order to plan intervention and determine what accident prevention advice will be required for home or work re-integration.

Functional histology of the ovarian follicles as determined by follicular fluid concentrations of steroids and IGF-1 in Camelus dromedarius.

Ovaries were collected from sexually mature non-pregnant dromedary she-camels. Follicles 6 to 19 mm in diameter per pair of ovaries were randomly selected and classified into clear (n = 30), or opaque (n = 14) based on macroscopic examination of the follicle surface, and then were divided into four classes: clear follicles with 6- 9.9 and 10-19 mm diameter; opaque follicles with 6- 9.9 and 10-19 mm diameter. Follicular fluid (FF) was aspirated for measurement of estradiol-17ß, progesterone and IGF-I concentrations, and then a section of tissue through the exposed surface of the follicle wall was removed and fixed in and processed for histological examination. Mean (±SE) number of clear follicles observed on the ovaries that contained a large dominant follicle was less than that on the ovaries which contained a large atretic follicle (p < 0.05; 2.6 ± 1 vs 8.6 ± 0.6). In conclusion, the estrogenic large follicles have suppressive effects on the growth of other follicles.

The efficiency of orthotic interventions on energy consumption in paraplegic patients: a literature review.

Study design:This is a systematic literature review.Objectives:Different types of orthoses have been developed to enable and facilitate ambulation in individuals with paraplegia. However, their effect on energy consumption while ambulating is not clear. The objective of this review was to compare the energy expenditure required to walk with these devices.Methods:Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method, and based on selected keywords and their composition according to the Population Intervention Comparison Outcome (PICO) method, a search was performed in Science Direct, Google Scholar, Scopus, Web of Knowledge and PubMed databases. The searches were restricted to papers published in the English language and were conducted during February 2014; the last access to the database was on 25 February 2014. A total of 24 articles were chosen for final evaluation.Results:Hybrid orthoses reduce energy consumption compared with mechanical orthoses when used for walking by paraplegic patients. The isocentric reciprocating gait orthosis has been shown to be more effective than other reciprocating orthoses in reducing energy consumption. Energy consumption when walking with powered orthoses (PO) and hybrid orthoses was also reduced compared with when walking with conventional orthoses.Conclusions:The hybrid orthoses and PO could be effective alternatives in rehabilitation for spinal cord injury patients to help improve the energy consumption.Spinal Cord advance online publication, 20 January 2015; doi:10.1038/sc.2014.227.