Feasibility of lactiplantibacillus plantarum postbiotics production in challenging media by different techniques.

The postbiotic derived from Lactiplantibacillus plantarum bacteria was produced in three culture media: milk, MRS, and whey, and its antibacterial and antifungal properties were evaluated. To investigate the production efficiency of postbiotics, three methods, heating, sonication and centrifugation, were utilized to prepare postbiotics in MRS broth culture medium. The antibacterial potency of the postbiotic was evaluated using the agar well-diffusion method, and MIC and MBC tests were conducted for different treatments. The results of the study showed that the postbiotic prepared in food environments such as milk and cheese whey can have antibacterial and antifungal properties similar to the postbiotic prepared in the MRS culture medium. However, it is possible to enrich food matrices such as milk and cheese whey and make further adjustments in terms of pH settings. Additionally, the thermal process was able to create a nanoscale postbiotic, which is a significant achievement for the application of postbiotics in the food and pharmaceutical industries. The future outlook of postbiotics clearly indicates that the emergence of this generation of probiotics can have an attractive and functional position in the food and pharmaceutical industries. Therefore, future research focusing on this subject will contribute to the development of this generation of postbiotics.

Exploring the mechanisms of kaempferol in neuroprotection: Implications for neurological disorders.

Kaempferol, a flavonoid compound found in various fruits, vegetables, and medicinal plants, has garnered increasing attention due to its potential neuroprotective effects in neurological diseases. This research examines the existing literature concerning the involvement of kaempferol in neurological diseases, including stroke, Parkinson's disease, Alzheimer's disease, neuroblastoma/glioblastoma, spinal cord injury, neuropathic pain, and epilepsy. Numerous in vitro and in vivo investigations have illustrated that kaempferol possesses antioxidant, anti-inflammatory, and antiapoptotic properties, contributing to its neuroprotective effects. Kaempferol has been shown to modulate key signaling pathways involved in neurodegeneration and neuroinflammation, such as the PI3K/Akt, MAPK/ERK, and NF-κB pathways. Moreover, kaempferol exhibits potential therapeutic benefits by enhancing neuronal survival, attenuating oxidative stress, enhancing mitochondrial calcium channel activity, reducing neuroinflammation, promoting neurogenesis, and improving cognitive function. The evidence suggests that kaempferol holds promise as a natural compound for the prevention and treatment of neurological diseases. Further research is warranted to elucidate the underlying mechanisms of action, optimize dosage regimens, and evaluate the safety and efficacy of this intervention in human clinical trials, thereby contributing to the advancement of scientific knowledge in this field.

Effects of Probiotic Lactobacilli plantarum in Treatment of Experimentally Induced Periodontal Disease in Rabbits.

The aim of this study was to evaluate the therapeutic effects of probiotic Lactobacillus plantarum in experimentally induced periodontal disease in rabbits. The incisor teeth of 24 rabbits were scaled under general anesthesia. Two weeks later, silk ligatures were placed at the gingival margin of the incisor teeth to induce periodontal disease. After confirming the presence of periodontal disease by periodontal probing four weeks later, incisor mucogingival flaps were created and gingival pocket lavage and debridement was performed. The rabbits were randomly divided into four groups. Group 1: Control; Group 2: Microencapsulated form of the probiotic; Group 3: Planktonic form of the probiotic; and Group 4: Biofilm form of the probiotic. The rabbits were euthanized eight weeks later, and gingival connective tissue and epithelium were resected for histopathological and histomorphometric evaluation. The results showed that the rate of epithelial regeneration was lower and bone regeneration was significantly higher in the treatment groups compared to the Control group. The highest level of bone regeneration was in Group 2 (Microencapsulated probiotic). There was no significant difference in bone regeneration observed between the biofilm and planktonic probiotic groups. This study showed that applying the probiotic Lactobacillus plantarum in microencapsulated form improved bone regeneration in experimentally induced periodontal disease in rabbits.

Prevalence of surgical wound infection and related factors in patients after long bone surgery: A systematic review and meta-analysis.

The goal of this systematic review and meta-analysis is to provide an overview of the prevalence of surgical wound infection and related factors in patients after long bone surgery. A comprehensive, systematic search was conducted in different international electronic databases, such as Scopus, PubMed, Web of Science and Persian electronic databases such as Iranmedex and Scientific Information Database using keywords extracted from Medical Subject Headings such as "Prevalence", "Surgical wound infection", "Surgical site infection" and "Orthopedics" from the earliest to the May 1, 2023. The appraisal tool for cross-sectional studies (AXIS tool) evaluates the quality of the included studies. A total of 71 854 patients undergoing long bone surgery participated in 12 studies. The pooled prevalence of surgical wound infection in patients who underwent long bone surgery reported in the 12 studies was 3.3% (95% CI: 1.5%-7.2%; I2 = 99.39%; p < 0.001). The pooled prevalence of surgical wound infection in male and female patients who underwent long bone surgery was 4.6% (95% CI: 1.7%-11.7%; p < 0.001; I2 = 99.34%) and 2.6% (95% CI: 1.0%-6.3%; I2 = 98.84%; p < 0.001), respectively. The pooled prevalence of surgical wound infection in patients with femur surgery sites reported in nine studies was 3.7% (95% CI: 2.1-6.4%; I2 = 93.43%; p < 0.001). The pooled prevalence of surgical wound infection in open and close fractures was 16.4% (95% CI: 8.2%-30.2%; I2 = 95.83%; p < 0.001) and 2.9% (95% CI: 1.5%-5.5%; I2 = 96.40%; p < 0.001), respectively. The pooled prevalence of surgical wound infection in patients with diabetes mellitus (DM), hypertension (HTN) and cardiovascular disease (CVD) was 4.6% (95% CI: 2.3%-8.9%; I2 = 81.50%; p < 0.001), 2.7% (95% CI: 1.2%-6.0%; I2 = 83.82%; p < 0.001) and 3.0% (95% CI: 1.4%-6.4%; I2 = 69.12%; p = 0.006), respectively. In general, the different prevalence of surgical wound infection in patients undergoing surgical treatment after long bone fracture may be caused by underlying factors (gender and co-morbidity) and fracture-related factors (surgery site and type of fracture).

Development and validation of SALT Triage method to facilitate the identification and classification of patients in Mass Casualty Incidents.

BACKGROUND: Mass Casualty Incidents (MCIs) have caused great financial losses. These incidents are referred to a situation in which the number of casualties caused by the accident temporarily increases to such an extent that it is not possible to treat all these patients with the facilities and capacities available in the area. To offer fair and proportionate medical services to all patients, it is necessary to use a process called patient triage. This study aimed to modify the Sort Assess Lifesaving Intervention Treatment/transport (SALT) triage method to simplify the differentiation of patients from green from yellow and gray from red. METHODS: This is a methodological study with a descriptive cross-sectional approach that by studying the SALT triage method and using the criteria defined in the Reference Standard, facilitates the identification of patients with a minor (Outpatient) and fatal injury (Expectant). Then, using two common and modified SALT triage methods, 100 simulated patients were triaged and the obtained data were evaluated and compared in terms of accuracy and speed. RESULTS: The improvement made in the SALT triage method was able to reduce 22% of the total triage error of the first nurse and improved 18% in green, 43% in yellow, 15% in red, and 13% in the gray category. In the second nurse, this method was able to reduce 29% of the errors and in the category of green patients, 41%, yellow 47%, red was unchanged, and gray 38% improvement was observed. Furthermore, the average triage rate was 4 and 5 seconds shorter per patient in the first and second nurses, respectively. CONCLUSIONS: With this modification, the diagnostic power has increased by 22% in the first nurse and 29% in the second nurse. Due to the significant increase in the accuracy of the mSALT (Modified SALT) triage method, this modification can be considered useful and can be used to advance the goals of triage in MCIs.

Preparation of milk-based probiotic lactic acid bacteria biofilms: A new generation of probiotics.

Biofilm is considered as a community of microorganisms in which cells adhere to each other on surfaces in a self-produced matrix of extracellular polymer compounds. In recent years, efforts to use the beneficial aspects of biofilm in probiotic research have intensified. In this study, probiotic biofilms of Lactiplantibacillus plantarum and Lacticaseibacillus rhamnosus were manufactured using milk and transferred to yogurt in whole and pulverized forms to test in real food conditions. Survival was assessed during 21 days of storage time as well as gastrointestinal conditions. The results indicated that Lp. plantarum and Lc. rhamnosus can form a very desirable and strong biofilm that can have a good protective effect on the survival of these bacteria in probiotic yogurt during processing, storage, and gastrointestinal conditions, in a way that, after 120 min of treatment in high acidic gastrointestinal conditions (pH 2.0), the survival rate decreased by only 0.5 and 1.1 log CFU/ml. Probiotic biofilm can be used as a natural way of utilizing bacteria in biotechnology and fermentation, which is an excellent way to increase the utility of probiotics.

Massive bone defects due to infection at the surgical site associated with a distal humeral fracture that was treated using fibula autograft: a case report.

Distal humerus fractures comprise between 2 and 5% of all fractures, and approximately one-third of all humerus fractures are of this type. In the present report, the authors described the massive bone defects due to infection at the surgical site associated with a distal humeral fracture that was treated using fibula autograft. Case presentation: A 28-year-old female patient experienced a fall from a height of 4 m and was referred to Poursina Educational and Medical Center. Clinical examinations and radiological imaging showed an open fracture of the right distal humerus. In the postoperative 50-day follow-up, the complication of infection at the surgical site causes bone loss of up to 8 cm. The posterior triceps-split approach (Campbell) to the distal humerus was used in this surgery. To evaluate the quality of surgery, standard radiographs of anteroposterior and lateral of the elbow joint and humeral shaft were performed after surgery. Clinical discussion: At 5 months postoperatively, the patient's initial results are good, and the range of motion of the elbow joint is ~10-120°. Conclusion: Based on the results of the present study, fibular transplantation in distal humerus fractures is considered one of the bone treatment options for repair.

Prevalence of pressure ulcer and related factors in orthopaedic wards: A systematic review and meta-analysis.

The aim of this systematic review and meta-analysis is to provide an overview of the prevalence of pressure ulcers (PU) in orthopaedic wards. A comprehensive, systematic search was conducted in different international electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database (SID) using keywords extracted from Medical Subject Headings such as "Prevalence", "Pressure ulcer", "Pressure sore", and "Orthopaedics" from the earliest to February 1, 2023. The appraisal tool for cross-sectional studies (AXIS tool) evaluates the quality of the included studies. Finally, 11 studies were included in the final analysis. The results indicated that the prevalence of PU in orthopaedic departments was 18% (ES: 0.18, 95% CI: 0.10-0.26, Z = 4.53, I2 : 99.09%). Although the odds ratio of PU was lower in men than women, it was not statistically significant (OR: 0.91, 95% CI: 0.74-1.11, Z = 0.95, I2 : 17.4%, P = .34). Also, results showed the prevalence of PU was higher among studies with a sample size of more than 200 (ES: 0.19, 95% CI: 0.10-0.28, Z = 4.07, I2 : 99.1%), Europe region (ES: 0.20, 95% CI: 0.14-0.26, Z = 6.7, I2 : 93.0%) and prospective design (ES: 0.23, 95% CI: 0.18-0.27, Z = 9.47, I2 : 83.3%) when compared with other sub-groups. In sum, considering the 18% prevalence of PU in the orthopaedic department, it is recommended to focus on detecting risk factors and design interventions to reduce PU in the patients admitted orthopaedic department.

Hyaluronic acid-rich burger separator edible disc prepared from slaughterhouse waste.

In this study, the edible films from chicken feet (CF), ovine muscle fascia (MF), and bovine bone gelatin (Gel) were prepared and their characteristics were analyzed, and we also evaluated the sensory quality of raw and cooked hamburgers using the edible films. The quantities of the CF and MF hyaluronic acid were evaluated using colorimetry and spectrophotometry. The CF, MF, and Gel films were prepared by solvent casting method. Results indicated that the concentration of hyaluronic acid in CF (124.11 ppm) was greater than MF (101.11 ppm). The antioxidative property of the CF film (18.47%) was greater than the Gel (1.88%) and MF (Undetectable) film. The CF film was more resistant to water vapor permeability (2.75 × 10-9 g/m.s.pa) than the MF (1.57 × 10-8 g/m.s.pa) and Gel (1.5 × 10-7 g/m.s.pa) films. The Gel film had more appropriate mechanical properties than CF and MF films. The films kept burgers patties independent from one another and prevented them from sticking and freezing together. MF and CF films were able to promote the organoleptic properties of raw and cooked hamburgers in taste and texture.

Edible hyaluronic acid-rich burger separator discs prepared from slaughterhouse waste.

In this study, edible films from chicken feet extract (CF), ovine muscle fascia extract (MF), and bovine bone gelatin powder (Gel) were prepared and their characteristics were analyzed. We also used the films as separators of burger cuts and evaluated the organoleptic characteristics of cooked burgers. Hyaluronic acid quantities of CF and MF were measured using colorimetric and spectrophotometry. Results indicated that the concentration of hyaluronic acid in CF (124.11 ppm) was greater than MF (101.11 ppm). The antioxidative property of the CF film (18.47%) was greater than the Gel (1.88%) and MF (Undetectable) films. The CF film was more resistant to water vapor permeability (2.75 × 10-9 g/m.s.pa) than the MF (1.57 × 10-8 g/m.s.pa) and Gel (1.5 × 10-7 g/m.s.pa) films. The Gel film had more appropriate mechanical properties than CF and MF films. The films kept burgers patties independent from one another and prevented them from sticking and freezing together. MF and CF films were able to promote the organoleptic properties of cooked burgers in taste and texture.

Accuracy of Triage Systems in Disasters and Mass Casualty Incidents; a Systematic Review.

Introduction: To prioritize patients to provide them with proper services and also manage the scarce resources in emergencies, the use of triage systems seems to be essential. The aim of this study was to evaluate the accuracy of the existing triage systems in disasters and mass casualty incidents. Methods: The present study is a systematic review of the accuracy of all triage systems worldwide. The results of this study were based on the articles published in English language journals. In this research, all papers published from the beginning of 2000 to the end of 2021 were sought through different databases. Finally, a total of 13 articles was ultimately selected from 89 articles. Results: 13 studies on the accuracy of triage systems were reviewed. The START, mSTART, SALT, Smart, Care Flight, ASAV, MPTT, Sieve and ESI triage systems, had an accuracy, sensitivity, and specificity of less than 90%. Only the Smart triage system had an overall accuracy of more than 90%. Conclusion: According to the findings of the current systematic review, the performance of the existing triage systems in terms of accuracy of prioritizing the injured people and other performance indexes is not desirable. Therefore, to improve the performance and increase the precision of triage systems, the world nations are recommended to change or revise the indexes used in triage models and also identify other influential factors affecting the accuracy of triage systems.

Sodium metabisulfite in dried plum and its cytotoxic effects on K-562 and L-929 normal cell lines.

In the present study, the concentration of sodium metabisulfite (SMB) in dried plums and its toxicity effects on the cell lines of K-562 (human leukemia cell line) and L-929 (normal fibroblast cell line) were measured. Samples of dried plums were randomly collected from the shops located in Neyshabur and Mashhad (Iran). SMB residue was measured using iodometric titration and high-performance liquid chromatography. To analyze the cytotoxicity, the cells were treated with various concentrations of SMB, and cell viability was determined by the MTT and LDH methods. The average concentration of SMB in the samples of dried plums was selected to evaluate the apoptosis/necrosis by flow cytometer. The expression analysis of apoptosis marker genes (BAX, Bcl-2, and P53) was also assessed. Results indicated that the average concentration of SMB residue in 12 samples of dried plum was 516 ± 285.39 mg/kg. When K-562 cells were treated with 500 mg/L of SMB, apoptosis increased significantly (p < 0.01). The IC50 of SMB for K-562 and L-929 cells after a 48-h exposure was 200.31 and 257.82 mg/L, respectively. SMB-treated cells showed that cell viability in both cell lines decreased in a dose-dependent manner after 72 h (p < 0.01). The percentage of apoptotic but not necrotic cells was 69.49% for K-562 and 77.32% for L-929 cells, whereas apoptosis of untreated control cells was 0.17%. Our findings also showed an opposite mRNA expression of Bcl-2 (anti-apoptotic marker) and Bax2 (pro-apoptotic marker) when k-562 cells were treated with SMB. The results indicated that the concentration of sulfite residue in some dried plums poses a cell toxicity risk for normal cells. PRACTICAL APPLICATION: The results of current study provide important information concerning the toxicological effects of SMB, and give a warning that it needs to be replaced by natural products for fruit drying processes.

The effect of melatonin on reduction in the need for sedative agents and duration of mechanical ventilation in traumatic intracranial hemorrhage patients: a randomized controlled trial.

PURPOSE: This study aimed to determine the effect of exogenous melatonin on the number of sedative drugs and the duration of mechanical ventilation in traumatic intracranial hemorrhage patients in ICU. METHODS: This double-blind randomized clinical trial study was conducted in the ICU wards of Golestan Hospital, Ahvaz, Iran, from September 2017 to March 2018. In this study, 52 patients with intracerebral hemorrhage were selected by convenient sampling (26 patients in each group) and were randomly assigned to two groups of melatonin and control. Sedation and pain management package was applied to both groups. OUTCOMES: Amount of the sedative and opioid drug; mechanical ventilation time; ICU staying time; Glasgow Coma Score; hemodynamic parameters. RESULTS: There was no significant difference between them in terms of demographic characteristics. Cumulative doses of morphine and mechanical ventilation time were significant in two groups. (P < 0.05) The mean length of ICU staying was not significant. Glasgow Coma Score on the 6th day was significant in two groups (P < 0.05). Diastolic blood pressure was significant between groups (P < 0.001). CONCLUSION: This study presented that morphine consumption and mechanical ventilation time were significantly lower in the melatonin group than in the control. Also, rise in GCS in the melatonin group was faster in the melatonin group than in the control. The use of melatonin can be recommended for patients with ICH in the ICU for better outcomes.

Treatment of Posterior Cruciate Ligament Tibial Avulsion: A New Modified Open Direct Lateral Posterior Approach.

The optimal operative technique for the treatment of the tibial-side avulsion injuries of the posterior cruciate ligament (PCL) is debatable. This study was aimed to evaluate the postoperative outcomes and complications if any after an open direct, posterolateral approach using cannulated cancellous screw fixation of a PCL tibial avulsion. From January 2016 to June 2018, 17 patients (14 males and 3 females) with PCL avulsion fraction treatment-who underwent open reduction and internal fixation using cannulated cancellous screws-were included in this prospective study. A direct posterolateral approach in the prone position was used in all cases. The Lysholm's knee score and International Knee Documentation Committee (IKDC) score were assessed preoperatively and during regular follow-up examinations for at least 1 year (12-20 months) postoperatively. All patients had fracture union and all of their knees were stable upon physical examination. No nerve or blood vessel injuries occurred. The mean Lysholm's scores and mean IKDC scores were improved significantly at the last follow-up. This study provides evidence that open direct posterolateral approach may be reliable for the treatment of tibial-sided bony PCL avulsion fractures. This approach can provide direct visualization of the posterior capsule and PCL avulsion site associated with good reduction and stable fixation, easy application of the screws directly from posterior to anteriorly without extensive soft tissue damage. Nevertheless, long-term follow-up is recommended.

Developing a Context-Bound Model for Hospital Triage in Disasters and Mass Casualty Incidents in the Health System of Iran.

OBJECTIVE: The aim of this study was to develop a context-bound model of hospital triage in disasters and mass casualty incidents in the health system of Iran. METHODS: This study was done using a sequential mixed method. Data were analyzed using Expert Choice software program. RESULTS: In the qualitative phase, 27 specialists were interviewed. Walking and purposeful movement, airway and respiration, circulatory status, and mental indices were included in the finalized model. In the quantitative phase, 21 participants responded to a questionnaire for weighting and ranking the final indices based on 3 competing options, including clinical importance of the index, lack of complexity and simplicity in implementation, and speed of implementation. The index of walking and purposeful movements weighing 0.300 and ranking 1, airway and respiration weighing 0.276 and ranking 2, blood circulatory status weighing 0.245 and ranking 3, and finally mental status weighing 0.179 and ranking 4 were obtained. CONCLUSIONS: This is the first attempt to design and develop a new context-bound model of hospital triage in disasters and mass casualties in Iran. The development of new triage models is a dynamic and continuous process, and changes will be applied to them, in case further developments and improvements are required.

Biofilm formation and antagonistic activity of Lacticaseibacillus rhamnosus (PTCC1712) and Lactiplantibacillus plantarum (PTCC1745).

Currently, the health benefits of probiotic bacteria are well known, and this has taken up a great deal of space in food science and health, both research and operational. On the other hand, anti-biofilm properties on food pathogens in the food and pharmaceutical industries have created an attractive challenge. This study aimed to describe the inhibitory activity of cell-free supernatants (CFS), planktonic cells, and biofilm form of lactobacilus strains (L. rhamnosus and L. plantarum) against food pathogens such as Pseudomonas aeruginosa and Listeria monocytogenes. Anti-bacterial activities of the CFS of lactobacillus strains were assessed by the microplate method and via violet staining. Evaluation of the antagonistic activity of planktonic cells and biofilm of LAB were performed by the spread plate method. The results showed the incubation time of 48 h was the best time to produce biofilm. Although the planktonic states reduce the pathogens bacterial about 1 -1.5 log, but in biofilm forms, decreased L. monocytogenes about 4.5 log compared to the control, and in the case of P. aeruginosa, a growth reduction of about 2.13 log was observed. Furthermore, biofilm formation of L. monocytogenes in the presence of L. rhamnosus cell-free supernatant was more weakly than L. plantarum CFS, but their CFS effect on reducing the bacterial population of P. aeruginosa was the same. According to the study, biofilm produced by probiotic strains can be considered a new approach for biological control. Also, cell-free supernatant can be used as postbiotic in the food and pharmaceutical industries.

A Phase IV Study of the Safety and Efficacy of CinnoPar® in Iranian Patients with Osteoporosis.

The safety of teriparatide has been studied in various phase III and phase IV trials. However, a postmarketing study of the biosimilar of teriparatide, CinnoPar®, has not been conducted on Iranian patients. This was a phase IV study conducted on osteoporotic patients who received an Iranian teriparatide biosimilar with a dose of 20 µg daily. The primary outcome of this study was to monitor for adverse events (AEs). Effectiveness as the secondary outcome was measured using the EQ-5D quality-of-life questionnaire and back pain Visual Analogue Scale (VAS) score. Among 193 analyzed patients between September 2015 and March 2019, the most common AEs were hypercalcemia (4%), nausea, and pain (3%). No deaths, serious AEs, or other significant AEs occurred in this study. The mean EQ-5D scores decreased after the course of the treatment from 2.3 ± 0.66 at the baseline to 2 ± 0.66. The mean back pain VAS scores also decreased from 4.9 ± 3.6 at baseline to 1.8 ± 2.1 at the end of the study. Both changes were statistically significant (p < 0.001). Consistent with the findings of previous studies and the drug monograph, no new safety concern was observed with this biosimilar teriparatide, and the drug was effective based on the VAS score and EQ-5D in osteoporotic patients.

Prevalence of Cervical Myofascial Pain Syndrome and its Correlation with the Severity of Pain and Disability in Patients with Chronic Non-specific Neck Pain.

BACKGROUND: Nonspecific chronic neck pain is increasing according to work-related gestures and modern lifestyle. Myofascial pain syndrome is a common problem and may be a primary disease. This study was designed to evaluate the prevalence of cervical myofascial pain syndrome in patients with chronic non-specific neck pain with normal MRI. We also examined the correlation between patients' age as well as pain severity and duration. METHODS: Patients with neck pain radiating to their upper extremity were examined despite normal MRI findings. We evaluated 10 different muscles based on myofascial pain syndrome criteria and also recorded pain intensity and functional ability using visual analogue scale and neck disability index, respectively. A physical therapist with at least 10 years of clinical experience with myofascial pain syndrome performed all physical examinations. RESULTS: A total of 126 patients (69 females and 57 males) participated in this study, out of whom, 14 patients (11.1%) had no muscular involvement, while 112 cases (88.9%) revealed at least one trigger point. The infraspinatus and scalene muscles were the most commonly involved muscles accounting for 38.9% and 34.9% of all the involvements, respectively. The severity of pain was significantly associated with the disability of the patients (r=0.64, P<0.001). However, the correlation between pain and the number of trigger points was not significant (r=-0.19, P=0.31). Finally, the least significantly correlated variables were disability and the number of trigger points (r=-0.17, P=0.05). Patient's age was significantly correlated neither with the number of trigger points (r=-0.04, P=0.62), nor the pain duration (r=0.07, P=0.39). CONCLUSION: Myofascial pain syndrome is a common disorder in patients with nonspecific chronic neck pain, despite normal MRI findings. Although, pain is not correlated with the number of trigger points in these patients, we demonstrated a small correlation between patients' disability and the latter variable.