Synthesis and molecular docking studies of new aryl imeglimin derivatives as a potent antidiabetic agent in a diabetic zebrafish model.

Diabetes mellitus (DM) is a persistent, progressive, and multifaceted disease characterized by elevated blood glucose levels. Type 2 diabetes mellitus is associated with a relative deficit in insulin mainly due to beta cell dysfunction and peripheral insulin resistance. Metformin has been widely prescribed as a primary treatment option to address this condition. On the other hand, an emerging glucose-reducing agent known as imeglimin has garnered attention due to its similarity to metformin in terms of chemical structure. In this study, an innovative series of imeglimin derivatives, labeled 3(a-j), were synthesized through a one-step reaction involving an aldehyde and metformin. The chemical structures of these derivatives were thoroughly characterized using ESI-MS, 1H, and 13C NMR spectroscopy. In vivo tests on a zebrafish diabetic model were used to evaluate the efficacy of the synthesized compounds. All compounds 3(a-j) showed significant antidiabetic effects. It is worth mentioning that compounds 3b (FBS = 72.3 ± 7.2 mg/dL) and 3g (FBS = 72.7 ± 4.3 mg/dL) have antidiabetic effects comparable to those of the standard drugs metformin (FBS = 74.0 ± 5.1 mg/dL) and imeglimin (82.3 ± 5.2 mg/dL). In addition, a docking study was performed to predict the possible interactions between the synthesized compounds and both SIRT1 and GSK-3ß targets. The docking results were in good agreement with the experimental assay results.

Anterior endoscopic sublabial transmaxillary access to middle cranial base lesions.

BACKGROUND: Anterior endoscopic access to middle cranial base lesions becomes feasible in the presence of infratemporal fossa (ITF) involvement. Various approaches, including endoscopic endonasal, transoral sublabial, and transorbital methods, have been described for accessing the ITF through a transmaxillary corridor. Among these approaches, endonasal access is the most commonly preferred, while the transorbital approach is a novel technique gaining popularity. The transoral sublabial approach is considered suitable for selected lesions. METHODS: Patients who underwent the anterior endoscopic transoral/sublabial transmaxillary approach to middle cranial base lesions at a single institute from 2016 to 2023 were included in this retrospective study. Malignant lesions were excluded from the study. The sublabial approach was exclusively performed in all cases, with the exception of one patient who required a combined approach. RESULTS: The anterior endoscopic transoral sublabial transmaxillary approach to the infratemporal fossa, upper parapharyngeal space, and middle cranial fossa was performed on 14 patients. The underlying conditions for these patients were as follows: trigeminal schwannomas (n = 8), meningiomas (n = 2), juvenile nasopharyngeal angiofibroma, osteochondroma, arachnoid cyst and encephalocele (n = 1 each). Gross total resection was achieved in 11 cases. The most common complication was numbness in the territory of the maxillary and mandibular nerves (n = 4). Two patients needed endoscopic maxillary antrostomy for persistent suppuration. No wound problems or CSF rhinorrhea occurred. The average follow-up time was 26.6 months. CONCLUSION: The endoscopic sublabial transmaxillary approach provides direct access to the infratemporal fossa and middle cranial base, enhancing the surgical range of maneuverability while sparing the sinonasal cavity. This procedure is safe, less invasive, and could be used as an efficient corridor for the resection of selected infratemporal fossa lesions with or without extension to the middle cranial base and parapharyngeal space.

The effect of minimally invasive suturectomy with postoperative cranial remolding orthotic treatment for an infant with bilateral coronal craniosynostosis.

Minimally invasive suturectomy has been reported to significantly decrease the economic cost of treating infants with craniosynostosis. Nonetheless, treatment should be accompanied by a cranial remolding orthosis to maintain the constant correction and reshaping of the skull throughout the infant's development.

Assessment of Insulin, GLUT2 and inflammatory cytokines genes expression in pancreatic ß-Cells in zebrafish (Danio rario) with overfeeding diabetes induction w/o glucose.

ABSTRACT: In recent years, zebrafish have been proposed as a model for rapid analysis of gene function and biological activity due to high genetic similarities with humans. The aim of this study was to determine the effects of overfeeding-induced diabetes w/o glucose on inflammatory cytokine as well as insulin and glucose transporter-2 genes (GLUT2) genes expression in the pancreas in zebrafish. MATERIALS AND METHODS: The experiment was performed on 120 zebrafish (duplicated sample) with a specific genetic mapping (AB-Wild type). A total of 8 tanks, each containing 15 fish per 2-liter water, were used and divided into four groups: (1) Control group, (2) regular diet with glucose,3) Only Artemia overfeeding and 4) Combined Artemia with glucose. We induced T2DM zebrafish using glucose monohydrate solution in water and repeated daily Artemia feeding. In this model, fasting blood glucose increase is preceded by obesity and glucose intolerance. The experiment lasted for two months. Blood glucose and fish biometrics were measured in two steps. The expression of TNFα, IFNγ, GLUT2 and Insulin genes were quantified by a Real-Time qPCR System (Applied Biosystems, USA) using a set of specific primers. RESULTS: The highest mortality rate was observed in combined Artemia and glucose (p < 0.05). We showed significantly higher expression of IL-1B and TNF-α as well as inhibitory cytokines such as IFNγ genes in overfeeding induced diabetes(OID) which was highest in the combined Artemia and glucose group.(p < 0.05)The GLUT2 gene expression was higher in the pure artemia group which decreased to a lower level by adding glucose to Artemia in the diet. (p < 0.05). Also, the lowest insulin gene expression was observed in the combined group (p < 0.05). CONCLUSIONS: In zebrafish, diabetes induction with overfeeding and supraphysiological glucose in diet accompanied with higher expression of inflammatory cytokines genes in the pancreas as well as lower insulin and GLU2 genes. These epigenetic factors appeared to initiate pancreatic beta dysfunction alongside insulin resistance and could have a crucial role in the pathogenesis of overfeeding-induced diabetes using primitive animal models.

Correction to: Concurrent metformin and silibinin therapy in diabetes: assessments in zebrafish (Danio rerio) animal model.

[This corrects the article DOI: 10.1007/s40200-020-00637-7.].

Cranial remolding orthosis for postoperative management of bilateral lambdoid and sagittal synostosis: A case report.

CASE DESCRIPTION: This is a report of a 2.5-month-old infant with bilateral lambdoid and sagittal synostosis who underwent minimally invasive suturectomy followed by cranial remolding orthosis (CRO). OBJECTIVES: To evaluate the result of minimally invasive suturectomy followed by CRO treatment in an infant with bilateral lambdoid and sagittal synostosis. STUDY DESIGN: This is a case report. TREATMENT: We fabricated the orthosis based on a computer-aided design and with computer-aided manufacturing technology. Cranial remolding orthosis compliance was measured subjectively. The child's parents were asked to complete a survey using visual analog scales to assess their satisfaction of their child's head appearance, problems with donning/doffing the orthosis, and feedback received from other people. OUTCOMES: At the time of fitting, the posterior skull hemisphere volume was 389.4 cm3. The values of cephalic index and cranial vault asymmetry index (CVAI) were 81% and 5%, respectively. After 6 months of CRO treatment, the cephalic index and CVAI were 83% and 1.5%, respectively. Moreover, the posterior skull hemisphere volume was 589.2 cm3. Average compliance with CRO wear was 88%. According to the parental questionnaire results, pressure sores occurred 0% of the time, displacement occurred 15% of the time, contact dermatitis occurred 10% of the time, problems with donning/doffing of the orthosis occurred 27% of the time, difficulties in breastfeeding occurred 30% of the time, negative feedback from other people upset them 55% of the time, and they were 100% satisfied with treatment. CONCLUSIONS: After 6 months of using CRO, the CVAI and skull volume improved and reached their normal proportions. Our results may help ongoing research and clinical care regarding the role of postoperative CRO treatment in patients with complex synostosis.

Serotonin level as a potent diabetes biomarker based on electrochemical sensing: a new approach in a zebra fish model.

Serotonin (5-HT) levels have been associated with several exclusively metabolic disorders. Herein, a new approach for 5-HT level as a novel biomarker of diabetes mellitus is considered using a simple nanocomposite and HPLC method. Reduced graphene oxide (rGO) comprising gold nanoparticles (AuNPs) was decorated with 18-crown-6 (18.Cr.6) to fabricate a simple nanocomposite (rGO-AuNPs-18.Cr.6). The nanocomposite was positioned on a glassy carbon electrode (GCE) to form an electrochemical sensor for the biomarker 5-HT in the presence of L-tryptophan (L-Trp), dopamine (DA), ascorbic acid (AA), urea, and glucose. The nanocomposite exhibited efficient catalytic activity for 5-HT detection by square-wave voltammetry (SWV). The proposed sensor displayed high selectivity, excellent reproducibility, notable anti-interference ability, and long-term stability even after 2 months. SWV defined a linear range of 5-HT concentration from 0.4 to 10 µg L-1. A diabetic animal model (diabetic zebrafish model) was then applied to investigate 5-HT as a novel biomarker of diabetes. A limit of detection (LOD) of about 0.33 µg L-1 was found for the diabetic group and 0.15 µg L-1 for the control group. The average levels of 5-HT obtained were 9 and 2 µg L-1 for control and diabetic groups, respectively. The recovery, relative standard deviation (RSD), and relative error (RE) were found to be about 97%, less than 2%, and around 3%, respectively. The significant reduction in 5-HT level in the diabetic group compared to the control group proved that the biomarker 5-HT can be applied for the early diagnosis of diabetes mellitus.

Improving physical and biological properties of nylon monofilament as suture by Chitosan/Hyaluronic acid.

One way to give some properties such as antibacterial and good frictional properties to sutures is the application of natural antibacterial and hydrophilic components on their surfaces through layer by layer assembly (LBL) technique. In this regard, Chitosan as an antibacterial polycationic natural polymer along with Hyaluronic acid (HA) as a polyanionic polysaccharide could be used to form a polyelectrolyte complex. In this study, HA was extracted from rooster comb using different solvents. Characterization of the extracted HA by FTIR and GPC analysis showed extracted HA with Mw = 2.53 × 105 Da had no cytotoxicity. Then, a nylon monofilament (NMy) was coated by the extracted HA and chitosan with different concentrations using bilayer coating technique. Two dyes also were loaded to coating layer to investigate the release behavior of these two drug models. The morphology of coated layer showed that coating NMy by chitosan (4% w/v) following by HA (8% w/v) with roughness of 164 ± 129 nm and friction coefficient of 0.26 had suitable interaction between two layers to prevent from exfoliation of coating layers. The antibacterial activity and controlled release of coated NMy indicated how a NMy coated by Chitosan and HA is a promising material for using as a suture.

Concurrent metformin and silibinin therapy in diabetes: assessments in zebrafish (Danio rerio) animal model.

OBJECTIVE: In this study, zebrafish was used as a biological model to induce type 2 diabetes mellitus through glucose. Then, the effect of metformin and silibinin combination was examined on elevated blood glucose, intestinal tissues, liver enzymes, and TNF-α, IFN-γ, INL1ß genes as inflammation marker genes. METHODS: The liver enzymes (AST, ALT, and ALP) derived from fish viscera homogenate supernatants were assayed in an auto-analyzer. The expression of target genes was quantified on RNA extracted from the tails by an in-house RT-PCR method, with fine intestine tissue staining performed by hematoxylin and eosin protocol (H&E). RESULT: In the glucose-free treatments, metformin and silymarin decreased the levels of AST, ALT, and ALP enzymes in the blood. The combination of these two drugs had also a significant role in reducing glucose levels. The body weight increased significantly in the control group which was affected by glucose concentration, with the lowest body weight gain observed in the metformin group. The expression of INL-1ß gene was significantly enhanced in the control group and the highest IFN-γ expression was observed in both control groups with glucose (G + CTRL) and without glucose (G-CTRL) (p < 0.05). The lowest level of TNF-α gene expression was observed in the control + glucose group (G + CTRL) (p < 0.05). Diabetic state causes weak absorption whereby the fish body demands to increase absorption level by enhancing the amount of acidic goblet cells thereby acidifying the environment in the gastric tracts. CONCLUSION: Collectively, this study indicated that treatment with metformin and Silibinin could improve metabolic-mediated performances by reducing the expression of inflammatory genes and blood glucose, modulating liver enzymes, and ameliorating the intestinal inflammation in type 2 diabetic zebrafish model.

Decision-making process in patients with lumbar spinal canal stenosis.

BACKGROUND: The aim of this study was to develop a strategy to determine a sound methodology for decision-making in lumbar spinal canal stenosis (LSCS). METHODS: This was a retrospective study of patients with LSCS to determine the rationale for those who underwent surgery and those who received conservative treatment. All case records were assessed to extract information on the morphology grade and dural sac cross-sectional surface area (DSCA) on MRI. Patients' functionality and satisfaction were examined as outcome measures in order to understand factors that were associated with benefit from either treatment strategy. RESULTS: In all 357 patients, case records were reviewed. The mean age of patients was 57.5 (SD=10.9) years. Of these, 176 patients underwent surgery. Post-treatment satisfaction was found in a large portion of the surgical group (93.2%) whereas this was 84.5% for those who received conservative treatment. Most patients (86.4%) who underwent surgery were identified as having grade C and grade D stenosis, while those who received conservative treatment were identified as having grade A and grade B stenosis (P<0.01). Overall satisfaction with surgery was found to be higher among patients with grade D stenosis (95%). Satisfaction by cross-sectional surface area did not show a consistent pattern. However, those with a cross-sectional surface area less than 100 mm2 benefited more from surgery. According to the findings, a decision matrix was proposed. CONCLUSIONS: The findings suggest that the morphological grade and the DSCA jointly are useful parameters for helping clinicians to make clinically sound decisions in LSCS patients.

Use of artificial neural networks to decision making in patients with lumbar spinal canal stenosis.

BACKGROUND: A lack of consensus exists regarding indications for surgery for lumbar spinal canal stenosis (LSCS). Hence, the aim of this study was to develop an artificial neural network (ANN) model that is designed to accurately select patients for surgery or non-surgical options and to compare such with the traditional clinical decision making approach in LSCS patients. METHODS: An ANN model and a logistic regression (LR) model were used as predicting models. The data for a total of 346 of 379 patients (143 male, 203 female, mean age 59.5±11.5 years) were available for the analysis. The measured metrics included Visual Analog Scale (VAS) of leg pain/numbness, the Japanese Orthopedic Association (JOA) Score, the Neurogenic Claudication Outcome Score (NCOS), the Oswestry Disability Index (ODI), the Swiss Spinal Stenosis Score (SSS), the Stenosis Bothersomeness Index (SBI), the dural sac cross-sectional surface area (DSCA), the Stenosis Ratio (SR), the Self-Paced Walking Test (SPWT), morphology grade presented by Schizas et al. and grading system introduced by Lee et al. Successful outcome was recorded based on the criteria presented by Stucki et al. Twelve measures and age, gender, and duration of symptoms, were recorded as the input variables for the ANN and LR, and the ANN was fed with patients. A sensitivity analysis was applied to the developed ANN model to identify the important variables. Receiver operating characteristic (ROC) analysis, Hosmer-Lemeshow (H-L) statistics and accuracy rate were calculated for evaluating the two models. The study was not supported by a grant and the authors declare that they have no conflict of interest. RESULTS: The patient information was divided into training (N.=174), testing (N.=86), and validation (N.=86) data sets. Successful outcome were achieved in 93.4% of the patients selected for surgery and 89.4% for non-surgery at 1-year follow-up. The SR, morphology grade and grading system were important variables identified by the ANN. The ANN model displayed better accuracy rate (97.8 %), a better H-L statistic (41.1 %) which represented a good-fit calibration, and a better AUC (89.0%), compared to the LR model. CONCLUSIONS: The findings showed that an ANN model can predict the optimal treatment choice for LSCS patients in clinical setting and is superior to LR model. Our results will need to be confirmed with external validation studies.

An Outcome Measure of Functionality and Pain in Patients with Low Back Disorder: A Validation Study of the Iranian version of Low Back Outcome Score.

STUDY DESIGN: Cross-sectional study. PURPOSE: This study aimed to cross-culturally translate and validate the low back outcome score (LBOS) in Iran. OVERVIEW OF LITERATURE: Lumbar disc hernia (LDH) is the most common diagnoses of low back pain and imposes a heavy burden on both individual and society. Instruments measuring patient reported outcomes should satisfy cetain psychometric properties. METHODS: The translation and cross-cultural adaptation of the original questionnaire was performed using Beaton's guideline. A total of 163 patients with LDH were asked to respond to the questionnaire at three points in time: preoperative and twice within 1-week interval after surgery assessments. The Oswestry disabilty index (ODI) was also completed. The internal consistency, test-retest, convergent validity, and responsiveness to change were assessed. Responsiveness to change also was assessed comparing patients' pre- and postoperative scores. RESULTS: The mean age of the cohort was 49.8 years (standard deviation=10.1). The Cronbach's alpha coefficients for the LBOS at preoperative and postoperative assessments ranged from 0.77 to 0.79, indicating good internal consistency. Test-retest reliability as performed by intraclass correlation coefficient was found to be 0.82 (0.62-0.91). The instrument discriminated well between sub-groups of patients who differed in the Finneson-Cooper score. The ODI correlated strongly with the LBOS score, lending support to its good convergent validity (r=--0.83; p<0.001). Further analysis also indicated that the questionnaire was responsive to change (p<0.001). CONCLUSIONS: The Iranian version of LBOS performed well and the findings suggest that it is a valid measure of back pain treatment evaluation among LDH patients.

Outcomes of Surgery in Patients with Lumbar Spinal Canal Stenosis: Comparison of Three Types of Stenosis on MRI.

The aim of the study was to compare outcome of surgery in patients with lumbar canal stenosis (LCS) based on magnetic resonance imaging (MRI) morphology. This was a prospective study of 96 consecutive patients who underwent surgery at 143 levels of LCS (from L3-L4 to L5-S1). Using patterns on T2 axial MRI, the type of stenosis was determined for each patient. The Swiss Spinal Stenosis Score (SSS) was used to evaluate patients' functionality and outcomes. The definition of treatment success was based on the criteria developed by Stucki et al. Demographic characteristics and post-operative outcomes were compared between trefoil, triangular, and pin-hole groups. Finally, correlation between SSS score and the MRI morphology was assessed. The mean age of patients was 58.4 (SD = 8.9) years. Post-treatment satisfaction was observed in a large portion of the patients (87.5%). The trefoil group (n = 44), triangular group (n = 38), and pin-hole group (n = 14) had similar pre-operative Swiss Spinal Stenosis Score and were not significantly different in age, operative time, blood loss, duration of symptoms, walking distance, symptom severity and physical function (all p>0.4). No correlation between SSS score and the MRI morphology was observed. The findings suggest that the type of stenosis based on magnetic resonance imaging morphology is not indicative of surgical outcome among lumbar canal stenosis patients who undergo surgery at 1-year follow-up.

Outcome Measure of Pain in Patients with Lumbar Disc Herniation: Validation Study of the Iranian version of Pain Sensitivity Questionnaire.

STUDY DESIGN: Cross-sectional. PURPOSE: To translate and culturally adapt an Iranian version of the Pain Sensitivity Questionnaire (PSQ) in Iran. OVERVIEW OF LITERATURE: Instruments measuring patient reported outcomes should satisfy certain psychometric properties. METHODS: The PSQ was translated following cross-cultural adaptation guidelines. A total of 101 patients with lumbar disc herniation (LDH), and 39 healthy cases were included in the study. All participants completed the PSQ and the Pain Catastrophizing Scale (PCS). The internal consistency, test-retest reliability, known group comparison, criterion validity and item-scale correlations were assessed. RESULTS: The mean age of participants was 51.7 years. Reliability, validity and correlation of PSQ and PCS showed satisfactory results. Cronbach's alpha coefficients were 0.81 for PSQ-total, 0.82 for PSQ-minor, and 0.82 for PSQ-moderate. The intraclass correlation coefficients value was 0.84 (0.616-0.932) indicating an excellent test-retest reliability. The instrument discriminated well between sub-groups of patients who differed in a standard predictive measure of LDH surgery (the Finneson-Cooper score). Total PSQ were also significantly correlated with the total scores of the PCS, lending support to its good convergent validity. Additionally, the correlation of each item with its hypothesized domain on the PSQ indicated acceptable results, suggesting that the items had a substantial relationship with their own domains. CONCLUSIONS: The adapted Iranian PSQ is a valid and reliable questionnaire for the assessment of pain in patients with LDH.

Surgical Outcomes and Correlation of the Copenhagen Neck Functional Disability Scale and Modified Japanese Orthopedic Association Assessment Scales in Patients with Cervical Spondylotic Myelopathy.

STUDY DESIGN: Cross-sectional. PURPOSE: Clinical outcome study comparing the Copenhagen Neck Functional Disability Scale (CNFDS) and modified Japanese orthopedic association (mJOA) assessment scales in patients with cervical spondylotic myelopathy (CSM). OVERVIEW OF LITERATURE: Comparison of instruments that measure patient-reported outcomes is needed. METHODS: A cross-sectional analysis was conducted. Ninety five patients with CSM were entered into the study and completed the CNFDS and the mJOA preoperatively and postoperatively. Correlation between the CNFDS and the mJOA was evaluated preoperatively and at the end of follow-up. Responsiveness to change of CNFDS and mJOA was also assessed. Clinical outcomes were also measured with the recovery rate of mJOA score at end of follow-up. RESULTS: The mean age of patients was 58.2 (standard deviation, SD=8.7) years. Mean follow-up was 2.1 years (range, 1 to 4 years). The mJOA correlated strongly with the CNFDS score preoperatively and postoperatively (r=-0.81 and -0.82, respectively; p<0.001). The CNFDS and the mJOA were able to detect changes after the surgery (p<0.001). The mean mJOA recovery rate was 51.8% (SD=13.1%). CONCLUSIONS: Surgery for the treatment of patients with CSM is an efficacious procedure. CNFDS and mJOA scores have a strong correlation in measuring disability among CSM patients.

The prediction of successful surgery outcome in lumbar disc herniation based on artificial neural networks.

BACKGROUND: The aim of this study was to develop an artificial neural networks (ANNs) model for predict successful surgery outcome in lumbar disc herniation (LDH). METHODS: An ANN model and a logistic regression (LR) model were used to predict outcomes outcomes. The age, gender, duration of symptoms, smoking status, surgical level, visual analog scale (VAS) of leg/ back pain, the Zung Depression Scale (ZDS), and the Japanese Orthopaedic Association (JOA) Score, were determined as the input variables for the established ANN model. The Macnab classification was used for outcome assessment. ANNs on data from LDH patients, who had surgery, were trained to predict 2-year successful discectomy using several input variables. Sensitivity analysis to the established ANN model was used to identify the relevant variables. For evaluating the two models, the area under a receiver operating characteristic (ROC) curve (AUC), accuracy rate of predicting, and Hosmer-Lemeshow (H-L) statistics were considered. RESULTS: A total of 203 (96 male, 107 female, mean age 48.3±9.8 years) patients were caterigized into training, testing, and validation data sets consisting of 101, 51, and 51 cases, respectively. Surgical successful outcome was: categorized as excellent, 32%; good, 40.9%; fair, 20.7% and poor, 6.4% at 2-year follow-up. Compared to the LR model, the ANN model showed better results: accuracy rate, 95.8%; H-L statistic, 41.5%; and AUC, 0.82% of patients. CONCLUSIONS: The findings show that an ANNs can predict successful surgery outcome with a high level of accuracy in LDH patients. Such information is of use in the clinical decision-making process.

Decision-Making Process in Patients with Thoracolumbar and Lumbar Burst Fractures with Thoracolumbar Injury Severity and Classification Score Less than Four.

STUDY DESIGN: Cross-sectional. PURPOSE: To develop a strategy to determine a sound method for decision-making based on postoperative clinical outcome satisfaction. OVERVIEW OF LITERATURE: The ideal management of thoracolumbar and lumbar burst fractures (TLBF) without neurological compromise remains controversial. METHODS: This was a prospective study. Patients with thoracolumbar injury severity and classification score (TLICS) <4 were treated nonoperatively, with bed rest and bracing until the pain decreased sufficiently to allow mobilization. Surgery was undertaken in patients with intractable pain despite an appropriate nonoperative treatment (surgery group). The Oswestry disability index (ODI) measure was observed at baseline and at the last follow-up. Clinically success was defined at least a 30% improvement from the baseline ODI scores in both the conservative and surgery groups. All case records were assessed for gender, age, residual canal and angulations at the site of the fracture in order to determine which patients benefited from surgery or conservative treatment and which did not. RESULTS: In all 113 patients with T11-L5, TLBFs were treated. The patients' mean age was 49.2 years. Patients successfully completed either nonoperative (n=99) or surgical (n=14) treatment based on ODI. Clinical examinations revealed that all of the patients had intact neurology. The mean follow-up period was 29.5 months. There was a significant difference between the two groups based on age and residual canal. The mean ODI score significantly improved for both groups (p <0.01). According to the findings, a decision matrix was proposed. CONCLUSIONS: The findings confirm that TLICS <4, age, and residual canal can be used to guide the treatment of TLBF in conservative decision-making.

Outcome Measures of Functionality, Social Interaction, and Pain in Patients with Cervical Spondylotic Myelopathy: A Validation Study for the Iranian Version of the Copenhagen Neck Functional Disability Scale.

STUDY DESIGN: Cross-sectional. PURPOSE: To translate and validate the Iranian version of the Copenhagen Neck Functional Disability Scale (CNFDS). OVERVIEW OF LITERATURE: Instruments measuring patient-reported outcomes should satisfy certain psychometric properties. METHODS: Ninety-three cases of cervical spondylotic myelopathy were entered into the study and completed the CNFDS pre and postoperatively at the 6 month follow-up. The modified Japanese Orthopedic Association Score was also completed. The internal consistency, test-retest, convergent validity, construct validity (item scale correlation), and responsiveness to change were assessed. RESULTS: Mean age of the patients was 54.3 years (standard deviation, 8.9). The Cronbach α coefficient was satisfactory (α=0.84). Test-retest reliability as assessed by the intraclass correlation coefficient analysis was 0.95 (95% confidence interval, 0.92-0.98). The modified Japanese Orthopedic Association score correlated strongly with the CNFDS score, lending support to its good convergent validity (r=-0.80; p<0.001). Additionally, the correlation of each item with its hypothesized domain on the CNFDS was acceptable, suggesting that the items had a substantial relationship with their own domains. These results also indicate that the instrument was responsive to change (p<0.0001). CONCLUSIONS: The findings suggest that the Iranian version of the CNFDS is a valid measure to assess functionality, social interaction, and pain among patients with cervical spondylotic myelopathy.

The AOSpine thoracolumbar spine injury classification system: A reliability and agreement study.

AIM: Recently, AOSpine trauma knowledge forum proposed the AOSpine thoracolumbar injury classification (AOSTLIC) system and suggested that it was reliable. However, reliability data from additional institutions for the AOSTLIC system are not available. This study was to examine the reliability of the AOSTLIC system in patients with thoracolumbar (TL) fractures. MATERIALS AND METHODS: Between August 2009 and June 2012, 56 patients with 74 levels traumatic TL spinal injuries were recruited. Two classifiers, consisting of two spine surgeons, assessed clinical and imaging data. Initially, one surgeon reviewed the data in order to classify and calculate injury severity score according to the AOSTSIC system. This process was repeated on a 5-week interval by another surgeon. Then we analyzed data for intra-observer and inter-observer reliability using the kappa statistic (k). Finally, validity was assessed using the known-groups comparison. RESULTS: The mean age of patients was 59.5 ± 11.5 years. The κ values for the AOSTSIC system for intra-observer and inter-observer reliability ranged from 0.83 to 0.89, indicating nearly perfect agreement agreements. Known-groups analysis showed satisfactory results. The AOSTSIC system discriminated well between sub-groups of patients who differed in Oswestry disability index. CONCLUSION: The findings showed that the morphologic classification in AOSTSIC system appears to be reliable and reproducible classification.