Outcomes of the Fluoroscopically-Guided vs. Computed-Tomography-Guided Transforaminal Epidural Steroid Injection in Low Back Pain: A Propensity-matched Prospective Cohort.

Background: Low back pain (LBP), the most common musculoskeletal condition, imposes a significant burden on healthcare and triggers mental and physical disorders. Before surgery, patients are eligible for minimally-invasive treatments, including transforaminal epidural steroid injection (TFESI). We aimed to compare fluoroscopically- and CT-guided TFESI in patients with subacute (4-12 weeks) and chronic (≥12 weeks) LBP. Methods: In this prospective cohort study, 121 adults with subacute or chronic LBP were recruited. Using propensity score matching (PSM), we created two age, sex, and body mass index (BMI) matched groups of fluoroscopically- and CT-guided TFESI, each including 38 patients. The outcomes of interest were the Oswestry disability index (ODI) and numerical rating scale (NRS), which were measured in all patients before the procedure and at the three-month follow-up. Then, the ODI and NRS mean changes were compared between Fluoroscopy and CT groups using repeated measures ANOVA. All analyses were performed with IBM SPSS Statistics for Windows, version 26 (IBM Corp., Armonk, NY, USA). Results: Of the total 76 matched patients with a mean (SD) age of 66.22 (13.49), 81 (66.9%) were female. ODI and NRS scores significantly decreased from baseline to the three-month follow-up in both treatment groups. The ODI score mean change from baseline to follow-up compared between the two groups was insignificant (fluoroscopy vs. CT mean difference (95% CI): 1.092 (-0.333-2.518), P = 0.131). Similarly, the NRS score mean change from baseline to follow-up compared between the two groups was insignificant (fluoroscopy vs. CT mean difference (95% CI): -0.132 (-0.529-0.265), P = 0.511). Conclusion: Fluoroscopically- and CT-guided TFESI show similar therapeutic effectiveness in patients with subacute and chronic LBP.

Localization of long-term synaptic plasticity defects in cerebellar circuits using optokinetic reflex learning profile.

Objective.Functional maps of the central nervous system attribute the coordination and control of many body movements directly or indirectly to the cerebellum. Despite this general picture, there is little information on the function of cerebellar neural components at the circuit level. The presence of multiple synaptic junctions and the synergistic action of different types of plasticity make it virtually difficult to determine the distinct contribution of cerebellar neural processes to behavioral manifestations. In this study, investigating the effect of long-term synaptic changes on cerebellar motor learning, we intend to provide quantitative criteria for localizing defects in the major forms of synaptic plasticity in the cerebellum.Approach.To this end, we develop a firing rate model of the cerebellar circuits to simulate learning of optokinetic reflex (OKR), one of the most well-known cerebellar-dependent motor tasks. In the following, by comparing the simulated OKR learning profile for normal and pathosynaptic conditions, we extract the learning features affected by long-term plasticity disorders. Next, conducting simulation with different massed (continuous with no rest) and spaced (interleaved with rest periods) learning paradigms, we estimate the detrimental impact of plasticity defects at corticonuclear synapses on short- and long-term motor memory.Main results.Our computational approach predicts a correlation between location and grade of the defect with some learning factors such as the rate of formation and retention of motor memory, baseline performance, and even cerebellar motor reserve capacity. Further, spacing analysis reveal the dependence of learning paradigm efficiency on the spatiotemporal characteristic of defect in the network. Indeed, defects in cortical memory formation and nuclear memory consolidation mainly harm massed and spaced learning, respectively. This result is used to design a differential assay for identifying the faulty phases of cerebellar learning.Significance.The proposed computational framework can help develop neural-screening systems and prepare meso-scale functional maps of the cerebellar circuits.

Syncope risk factors among military training soldiers; A case-control study.

BACKGROUND: Syncope is a transient brief loss of consciousness accompanied with loss of postural tone. Of common places in which people experience syncope, military barracks can be named where training soldiers spend their military courses. The current study aimed to assess etiology and risk factors of syncope among military training soldiers. METHODS: This was a retrospective case-control study conducted on training soldiers of Army-501 hospital in Tehran, Iran, during the years 2017-2018. Cases were consisted of 50 soldiers who experienced syncope during military training, and controls were 150 soldiers who had not experienced syncope during their military training. Demographic data were recorded for cases and controls. RESULTS: Members of case and control groups were not statistically different regarding age (P = 0.46) and height (P = 0.70). Logistic regression test was performed and considering crude model, weight [odds ratio (OR): 0.94; 95% of confidence interval (95%CI): 0.90-0.98], body mass index (BMI) (OR: 0.72; 95%CI: 0.61-0.85), standing duration (OR: 1.007; 95%CI: 1.00-1.01), history of syncope (OR: 15.47; 95%CI: 4.15-57.60), positive family history of syncope (OR: 5.94; 95%CI: 1.66-21.25), smoking (OR: 3.5; 95%CI: 1.54-7.91), medical problems (OR: 7.97; 95%CI: 1.98-32.17), anxiety (OR: 2.02; 95%CI: 1.13-4.26), stress (OR: 6.68; 95%CI: 3.28-13.57), and depression (OR: 4.25; 95%CI: 2.15-8.39) were detected as significant predictors of syncope occurrence. CONCLUSION: Based on the findings of this study, lower BMI, positive history of syncope, smoking, depression, and stress were significant risk factors of syncope occurrence among training soldiers. Higher BMI has protective role in syncope occurrence.

Klotho gene expression decreases in peripheral blood mononuclear cells (PBMCs) of patients with relapsing-remitting multiple sclerosis.

BACKGROUND: we recently showed that a hypothesized anti-aging and anti-inflammatory protein, namely Klotho, may contribute to the etiology and/or pathogenesis of multiple sclerosis (MS). In addition, Klotho function and its gene expression are dependent on inflammatory pathways. Accordingly, the aim of this study was to investigate the Klotho gene expression within peripheral blood mononuclear cells (PBMCs) of patients with MS. METHODS: Altogether, 30 patients with relapsing-remitting MS (RRMS) along with 30 age and sex-matched healthy individuals were enrolled in this study. Blood samples were obtained from all participants and then PBMCs were isolated. The quantitative Real-Time PCR was carried out for Klotho mRNA derived from PBMCs. RESULTS: The results showed that klotho gene expression in the PBMCs of patients with RRMS is nearly 2.5-fold less than healthy individuals (P=0.0006). CONCLUSION: This is the first study demonstrating a possible role of Klotho in the PBMCs of MS patients.

Design, synthesis, molecular modeling and anticholinesterase activity of benzylidene-benzofuran-3-ones containing cyclic amine side chain.

AIM: A series of 2-benzylidene-benzofuran-3-ones were designed from the structures of Ebselen analogs and aurone derivatives and synthesized in good yields. MATERIALS & METHODS: The target compounds were prepared by the condensation reaction between appropriate benzofuranones with amino alkoxy aldehydes and evaluated as cholinesterase inhibitors by Ellman's method. RESULTS: The in vitro anti-acetylcholinesterase (AChE)/butyrylcholinesterase activities of the synthesized compounds revealed that 7e (IC50 = 0.045 µM) is the most active compound against AChE. Furthermore, the docking study confirmed the results obtained through in vitro experiments and predicted the possible binding conformation. CONCLUSION: The anticholinesterase activities of benzylidene-benzofurane-3-ones as aurone analogs revealed that the compounds bearing piperidinylethoxy residue showed better activities against AChE, introducing these compounds for further drug discovery developments. [Formula: see text].

A Study of Exertional Headache's Prevalence and Characteristics Among Conscripts.

BACKGROUND: Headache is one of the most common complaints in today's society. Patterns and prevalence of headache, especially headaches associated with physical activity (Exertional Headache) in the population of conscripts in our country is unknown. OBJECTIVES: In this cross sectional study we tried to answer these questions to some extent. PATIENTS AND METHODS: Using a Persian questionnaire based on international headache society criteria of headache types (ICHD-II) and a sample size of 300, filled by two trained medical doctors, we gathered our data and analyzed it with an acceptable P value of < 0.05 and a confidence interval of 95%. RESULTS: Headache prevalence among our conscript participants was 78.7%. The prevalence of exertional headache was 12.7%. EH sufferers' mean age was 22.16 (SD: 2.60) years. EH was found more often bilaterally and almost equally pulsating or compressive. The main location of pain was frontotemporal region. The most common aggravating and alleviating factors of EH were hot environment and discontinuation of exercise respectively. CONCLUSIONS: Our team provided a reasonable database of exertional headache and its characteristics in conscripts' population which could be used in further investigations to improve their general health and function.

Investigation of serum levels and tissue expression of two genes IGFBP-2 and IGFBP-3 act as potential biomarker for predicting the progression and survival in patients with glioblastoma multiforme.

BACKGROUND: Identification of genetic copy number changes in glial tumors is of importance in the context of improved/refined diagnostic, prognostic procedures and therapeutic decision-making. Blood-derived biomarkers, therefore, would be useful as minimally invasive markers that could support diagnosis and enable monitoring of tumour growth and response to treatment. OBJECTIVE: The aim of this study was to evaluate the clinical significance of IGFBP-2/3 in glioblastoma multiforme (GBM) and their value as predictors of survival. METHODS: We examined the plasma levels of IGFBP-2 and IGFBP-3 using ELISA in patient suffering from GBM and controls groups. Furthermore, immunohistochemistry method was used to evaluate the expression levels of these markers. RESULTS: Preoperative plasma levels of IGFBP-2 and IGFBP-3 were markedly higher in glioblastoma patients (mean±SD: 521.5±164.2ng/ml; 402.4±126ng/ml) when compared with healthy controls (301.28±73.12; 244±89.5ng/ml; p<0.001). Immunohistochemical results indicated that the median H score for glioblastoma tissues was higher when compared with normal tissues. The mean scores for IGFBP-2 expression in glioblastoma was higher than normal tissues (p<0.001). Our result showed that the median H score for glioblastoma tissues was higher when compared with normal tissue for IGFBP-3 expression. The mean scores for glioblastoma tissues was higher than normal tissues (p<0.001). We also evaluated whether plasma IGFBP-2 and IGFBP-3 levels were related to clinical features. The plasma IGFBP-2 level was strongly linked to the patient's age (R=0.769, P=0.001) that were strongly increased in patients with older age (>65), (mean±SD: 594.36±33.3ng/ml). On the other hand, plasma IGFBP-3 level was not correlated with age (P=0.462), sex (P=0.532), and tumor size (P=0.245). Our findings indicated that the tissue IGFBP-2 level was also markedly correlated with the patient's age (R=0.612, P=0.015). On the other hand, tissue IGFBP-3 expression level was not correlated with age (P=0.472), sex (P=0.512), and tumor size (P=0.241). Kaplan-Meier survival and log-rank analysis suggested that patients with high plasma level of IGFBP-2 and tissue expression of IGFBP-2 had shorter overall survival than those with low levels (log-rank test P=0.027; P<0.001). Kaplan-Meier survival and log-rank analysis suggested that patients with high plasma level of IGFBP-3 and tissue expression of IGFBP-3 had shorter overall survival than those with low levels groups (log-rank test P=0.018; P<0.001). CONCLUSION: These data suggest that plasma levels and tissue levels of IGFBP-2 and IGFBP-3 may be as potential biomarkers for predicting the progression and survival in patients with GBM.

Somatic CPEB4 and CPEB1 genes mutations spectrum on the prognostic predictive accuracy in patients with high-grade glioma and their clinical significance.

BACKGROUND: Glioblastoma (grade IV glioma/GBM) is characterized by extremely aggressive invasion and proliferative nature. OBJECTIVE: The main goal of this study was to evaluate the expression patterns of CPEB1 and CPEB4 in glioma patients. METHODS: 41 paraffin-embedded tissue samples with glioma (WHO I-IV) were collected between January 2008 and December 2012 in Tehran, Iran. MRI of patients was done before and within 24 h after surgery and gliomas investigated using quantitative real-time PCR and immunohistochemistry. Kaplan-Meier survival and Cox regression were applied to assess the prognosis of patients. RESULTS: The mRNA level of CPEB4 was strongly increased in tumor tissues (0.67±3.154 vs. 1.671±0.51; P=0.001). Furthermore, CPEB1 mRNA was significantly decreased in tumor tissues compared to normal tissues (2.852±0.587 vs. 1.471±0.862; P=0.025). Our findings showed that CPEB4 levels was markedly increased in patients with advanced grade gliomas (P=0.003). In addition, CPEB1 mRNA levels were not associated with clinicopathological features. Of the 41 cases, high CPEB4 expression was found in 29 patients (70.73%), while 12 cases (29.26%) showed weak expression levels, while the protein expression of CPEB4 were remarkably weak in normal tissues (P=0.001). However, no correlation was found between expression levels of CPEB1 and clinicopathological characteristics. Kaplan-Meier survival and log-rank test indicated that high expression of CPEB4 was correlated with shorter overall survival (log-rank test P<0.001). Furthermore, low expression of CPEB1 was linked to shorter overall survival (log-rank test P=0.021). Multivariate Cox proportional hazards model showed that high CPEB1 (P=0.027), low CPEB4 expressions (P=0.021), and advanced tumor grade (P=0.036) were independent predictor of overall survival. CONCLUSION: Our data indicated expressions levels of CPEB4 and CPEB1 are correlated with overall survival in patients with glioma.

Expression and prognostic value of the aldehyde dehydrogenase 1 (ALDH1) and N-myc downstream regulated gene 2 (NDRG2) as potential markers in human astrocytomas.

In this study, immunohistochemical analysis was used to evaluate the expression of ALDH1 and NDRG2 in astrocytoma tissue samples and normal brain tissues. ALDH1 protein staining displayed that AlDH1 expression was not detectable in eight astrocytoma tissues (8/36) and in all of normal brain tissues. There was a significant difference between ALDH1 expression and WHO grades (P = 0.03). Furthermore, no correlation was determined between expression levels of ALDH1 and other clinicopathological characteristics including age, sex, and tumor size. Immunohistochemistry showed that a high level of NDRG2 protein expression was markedly detected in normal brain tissues and expression of NDRG2 protein was significantly decreased in astrocytoma tissues. There was a significant association between pathological grading and NDRG2 expression level (P < 0.001, Table 1), but no correlation was determined between expression levels of NDRG2 and other clinicopathological characteristics including age, sex, and tumor size. We also obtained detailed follow-up data and evaluated the association of ALDH1/NDRG2 expressions with overall survival. Kaplan-Meier survival and log-rank analysis indicated that the patients with high proportion of ALDH1-positive cells and low proportion of NDRG2-positive had shorter overall survival (P < 0.001; P = 0.001). Univariate analysis indicated that the high proportion of ALDH1-positive cells (P < 0.001), the low proportion of NDRG2-positive cells (P = 0.009), and the advanced grade (P < 0.005) were markedly linked to the prognosis in patients. Furthermore, in the multivariate analysis, ALDH1 cells' expression (P = 0.012), low proportion of NDRG2-positive cells (P = 0.025), and advanced grade (P < 0.03) were linked to poor overall survival. Our results suggest that NDRG2 expression is related to decreased survival rates and NDRG2 may be a potential marker in the astrocytoma prognosis. NDRG2 may be a potential marker in the astrocytoma prognosis. ALDH1 expression was related to advanced pathological grade and survival rate in astrocytoma patients.

Resistant Strains of Enterotoxigenic Staphylococcus aureus; Unknown Risk for Multiple Sclerosis Exacerbation.

BACKGROUND: Despite all advances in neurological sciences, there are unknown aspects in the epidemiology of multiple sclerosis (MS). Based on this hypothesis, the enterotoxigenic strains of Staphylococcus aureus (S. aureus) are possible risk factors for exacerbations of MS. OBJECTIVES: The present study was carried out to investigate the role of resistant strains of enterotoxigenic S. aureus in MS exacerbation. MATERIALS AND METHODS: Two-hundred nasal swab samples were collected from non-MS (n = 80), MS stable (n = 60) and MS exacerbation (n = 60) groups. Samples were cultured and those that were S. aureus-positive were analyzed for the presence of enterotoxins, using polymerase chain reaction (PCR). Antimicrobial susceptibility was performed using disk diffusion method. RESULTS: Ninety out of 200 nasal samples (45%) were positive for S. aureus. The highest levels of nasal colonization were seen in MS exacerbation group (68.33%). The most commonly detected enterotoxins were sea (30%), sec (15.55%) and seb (11.11%). There were significant differences between S. aureus colonization and type of samples (P = 0.026) and, also, between type of samples and prevalence of enterotoxins (P = 0.022). The highest levels of enterotoxigenic genes were seen in MS exacerbation group. The S. aureus strains had the highest levels of resistance against tetracycline (80%), ampicillin (72.22%), methicillin (66.66%), erythromycin (66.66%), oxacillin (63.33%), trimethoprim-sulfamethoxazole (61.11%) and cotrimoxazole (55.55%). CONCLUSIONS: Our findings should raise awareness about the role of sea and sec enterotoxins, in resistant strains of S. aureus, as a risk factor for MS exacerbation. It is better to keep MS patients away from polluted environments of hospitals and health centers.

Neuroprotective effects of erythropoietin in acute ischemic stroke.

BACKGROUND: Ischemic brain strokes consisttwo-thirdsof strokesand their complications bear a lot of disability for patient and society. In this study, we seek for effect of Erythropoietin on ischemic brain stroke's outcomes according to National Institutes of Health Stroke Scale (NIHSS) changes. METHODS: This study is a RCT (randomized clinical trial). All patients with focal neurologic deficit with primary suspicion of brain stroke undergone neuroimaging evaluations. After confirmation of new ischemic brain stroke, the patients with inclusion criteria'srandomized into two groups of cases and controls. NIHSS was defined for each patient and all patients received a routine treatment protocol. Erythropoietin 16,000 IU as a bolus intravenous dose was given to case patients as soon as neuroimaging study confirmed new ischemic stroke and continued as 8000 IU each 12 h up to total dose of 56,000 IU during 3 days. Patients re-evaluated at days 14 and 28 and NIHSS was assessed by another neurologist blinded to patient's group. Finally, NIHSS changes of both groups compared with each other's. RESULTS: Evaluations revealed that in days14 and 28 during follow-up, Erythropoietin was effective in NIHSS (P= 0.0001). This effect was of value in level of consciousness Commands (P= 0.024), facial palsy (P= 0.003), motor arm (P= 0.0001), motor leg (P= 0.0001), sensory (P= 0.009), and best language (P= 0.023). CONCLUSIONS: Administration of high-dose erythropoietin in first 24 h can be effective on reduction of ischemic stroke complication. A larger scale clinical trial is warranted.

Characteristics of Headache at Altitude among Trekkers; A comparison between Acute Mountain Sickness and Non-Acute Mountain Sickness Headache.

PURPOSE: Headache at altitudes has had an incidence of 25-62% through many related studies. Many reasons are identified concerning headache at altitudes such as acute mountain sickness (AMS), sinus headache, migraine, tension type headache, and frontal tension headache. This study tried to compare different types of headache among trekkers on Mount Damavand, a 5671m mountain, Iran, to find their incidence and related symptoms and signs. METHODS: Through a cross-sectional study, we evaluated headache incidence and its correlation to AMS among people who climbed Mount Damavand. Lake Louise Score, a self-report questionnaire, was applied to make AMS diagnosis through three separate stages of trekking programs. Chi-square test was employed as the main mean of analysis. RESULTS: Totally, 459 between 13-71 year olds participated in the study among which females were 148 (32.1%) and males 311 (67.8%). Headache was found in 398 (86.7%) among whom 279 (70%) were proved as AMS. Investigating the types of headache in the cases of AMS showed 64.5% to be of steady, 31% throbbing and 4.5% stabbing characters which had significant differences with a P value = 0.003. The majority of headaches were stated as frontal (38.9%) and the least prevalence belonged to the parietal area (4.4%), while global headache was reported in 27%. CONCLUSIONS: This study specifies the exact location of headaches at altitude in cases of AMS and non-AMS headaches. Many cases of high altitude non-AMS headache are resulted by tension and light reflection at altitude.