What Is the Most Appropriate Comparator to Use in Assessing the Comparative Performance of Primary Total Knee Prostheses? A Registry-Based Study

Background

The Australian Orthopedic Association National Joint Replacement Registry has developed a standardized multi-stage approach to identify prostheses with a higher-than-anticipated rate of revision when comparing a prosthesis of interest to all other prostheses within the same broad class. However, the approach does not adequately differentiate between the conventional and complex design prostheses, and the comparator classes need to be re-evaluated. This study aimed to identify a more relevant comparator to better reflect conventional and complex surgical practices according to the stability design and also explore how the rate of revision estimated in the comparator groups affects the identification of "prosthesis outliers."

Methods

The cumulative percent revision (CPR) was calculated for 640,045 primary total knee replacements (TKRs) undertaken for Osteoarthritis from 1 January 2003 to 31 December 2019. At first, survivorship analyses were undertaken to calculate the rate of revision for primary TKR by stability design. A modified TKR comparator group was developed by excluding the "complex" group of prostheses with fully stabilized and hinged designs. The effectiveness of the modified comparator groups, including cruciate retaining and posterior stabilized designs, was evaluated based on the ability to detect additional prostheses by performing the Australian Orthopedic Association National Joint Replacement Registry standardized method for identifying prosthesis outliers.

Results

The modified comparator to include only conventional designs had a 10-year CPR of 5.2% (5.1, 5.3). When the fully stabilized and hinged design groups were combined as a comparator group of complex devices to reflect devices used only for specific purposes in primary TKR, the CPR at 10 year was 10.3% (8.6, 12.0).

Conclusions

The use of modified comparator groups led to identifying additional conventional prostheses but fewer complex designs as being at risk and has the potential to improve the early assessment of TKR prostheses.

What is the most appropriate comparator group to use in assessing the performance of primary total hip prostheses within the community?

BACKGROUND

There are variations in the performance of individual prostheses used in hip replacements. Some of which have unexpectedly higher revision rates - outliers. The Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) has established a standardised multi-stage approach for identifying these devices. This is done by comparing the revision rates of individual prostheses to all other prostheses in class, with the exception of large head metal-on-metal (LHMoM) prostheses. However, improvements in device design and performance over time have required a need to reconsider the comparator group. This study aimed to identify a more specific comparator to better reflect contemporary surgical practice.

METHODS

The time to first revision was estimated on the data of 413,417 primary total conventional hip replacements undertaken for osteoarthritis (OA) from 01 January 2003 to 31 December 2019. Survivorship analyses with stepwise exclusions were undertaken. The first exclusion was LHMoM, followed by other non-modern bearing surfaces (defined as all the bearing couples except metal or ceramic heads on cross-linked polyethylene and mixed ceramic-on-ceramic), and then devices with modular neck-stem design or used for specific purposes (incl. constrained, dual-mobility, and head size <28 mm). Lastly, all remaining prostheses previously identified as having a higher than anticipated rate of revision (HTARR) were also excluded.

RESULTS

These exclusions progressively reduced the cumulative percent revision (CPR) rate. The final comparator, which only includes satisfactory-performed prostheses of contemporary design and use, has a 10-year CPR of 4.30% (95% CI, 4.2-4.41) which is lower than 4.93% (95% CI, 4.84-5.02) for the current comparator used by the AOANJRR (all prostheses excluding LHMOM). Over the study period, 13 additional components were identified utilising the modified comparator.

CONCLUSIONS

The calculation of the comparator revision rate should be re-evaluated to include only modern prosthesis constructs to ensure that poorly performing prostheses are identified early.

Supervised machine learning for the prediction of post-operative clinical outcomes of hip and knee replacements: a review

Prediction models are being increasingly used in the medical field to identify risk factors and possible outcomes. Some of these are presently being used to develop guidelines for improving clinical practice. The application of machine learning (ML), comprising a powerful set of computational tools for analysing data, has been clearly expanding in the role of predictive modelling. This paper reviews the latest developments of supervised ML techniques that have been used to analyse data related to post-operative total hip and knee replacements. The aim was to review the most recent findings of relevant published studies by outlining the methodologies employed (most-widely used supervised ML techniques), data sources, domains, limitations of predictive analytics and the quality of predictions.

Microwave photonics doppler speed measurement based on sagnac loops and four-wave mixing effect in a highly nonlinear fiber

Photonic radars are increasingly being developed and offer a promising replacement for traditional RF radars. They feature higher precision, and smaller size compared to the current microwave radars. One important part of a moving target indicating (MTI) radar is the Doppler shift measurement used to measure the radial velocity of a moving target. Therefore, for any photonic radar operating at MTI mode, it is necessary to have a Doppler measurement subsystem. In this paper, a microwave photonic Doppler frequency measurement system is conceived and implemented for this purpose specifically. The operation is based on making a Doppler shift-dependent yet low-frequency voltage component. It is all-optical and hence has the potential to be integrated into many electronic warfare systems. This feature not only makes the system independent of any sophisticated electrical device but also makes the measurement time lower than that of the electrical counterparts. The specific design presented here provides a much better stability compared to the recent works. An error as low as 0.012 Hz at a 10 GHz radar frequency was obtained, and the system performance was demonstrated up to 40 GHz, at which a 4.75 Hz error was recorded.

The Photobiomodulation effect of 980 nm Diode Laser on Patients with Xerostomia

PURPOSE

Xerostomia is not a disease in itself. This condition is associated with systemic diseases, medication use, and radiotherapy. Oral and general health suffer when the salivary gland´s function is reduced. The effectiveness of therapeutic methods in resolving this issue thus far has been inadequate. This study aimed to determine the photobiomodulation (PBM) effect of a 980 nm laser on xerostomia.

METHODS

A quasi-experimental study was carried out using a 980 nm diode laser on 28 patients with xerostomia. A diode laser (980 nm) was used extortionally over the submandibular glands and parotids and it was used internally in the sublingual glands. The laser beam (extrorally 6 J, 300mW, 20 s, and introrally 4 J, 200mW, 20 s) was applied bilaterally every other day for 10 sessions. It should be noted that 8 points of the parotid, 2 points of the submandibular glands, and 2 points of the sublingual glands were irradiated. The saliva was collected each session using the Navazesh technique, 5 min before and after PBM. The Wilcoxon test was used to study the effect of laser therapy on saliva flow rate (volume and weight). The P < 0.05 level was considered a significant level.

RESULTS

The volume (P < 0.0001) and the weight (P < 0.0001) of the saliva were increased by using a 980 nm diode laser. While, in smokers and diabetic patients with hypertension, no significant difference was observed in either saliva volume (P = 0.593, P = 0.092) or weight (P = 0.785, P = 0.089).

CONCLUSION

In this study, the volume and weight of the unstimulated saliva in most patients with xerostomia increased with using PBM.

Gallium-Containing Materials and Their Potential within New-Generation Titanium Alloys for Biomedical Applications

With the rising demand for implantable orthopaedic medical devices and the dominance of device-associated infections, extensive research into the development of novel materials has been prompted. Among these, new-generation titanium alloys with biocompatible elements and improved stiffness levels have received much attention. Furthermore, the development of titanium-based materials that can impart antibacterial function has demonstrated promising results, where gallium has exhibited superior antimicrobial action. This has been evidenced by the addition of gallium to various biomaterials including titanium alloys. Therefore, this paper aims to review the antibacterial activity of gallium when incorporated into biomedical materials, with a focus on titanium-based alloys. First, discussion into the development of new-generation Ti alloys that possess biocompatible elements and reduced Young's moduli is presented. This includes a brief review of the influence of alloying elements, processing techniques and the resulting biocompatibilities of the materials found in the literature. The antibacterial effect of gallium added to various materials, including bioglasses, liquid metals, and bioceramics, is then reviewed and discussed. Finally, a key focus is given to the incorporation of gallium into titanium systems for which the inherent mechanical, biocompatible, and antibacterial effects are reviewed and discussed in more detail, leading to suggestions and directions for further research in this area.

Valley-optical absorption in planar transition metal dichalcogenide superlattices

In this study, we investigate the optical absorption of a planar superlattice comprising alternatively arranged two-dimensional Transition Metal DiChalcogenide semiconductors. Within a semi-classical model and using the Dirac-like equation in the presence of light interaction as a perturbation, we obtained the governing Hamiltonian. Using this Hamiltonian, we derived a fully analytical relationship for the absorption coefficient of the structure. By calculating the effective mass for different bands and using the Drude-Lorentz model, our approach is able to determine the oscillator strength and the effective refractive index of the structure. We found that the spin-orbit coupling has important effect on the absorption coefficient and energy bands where it reduces the absorption coefficient of the structure from typical value of [Formula: see text]-[Formula: see text], also the valence band experiences a significant blue shift, while the conduction band shows minor changes due to spin orbit coupling. Moreover, the role of incident light angle and light polarization were studied in details at different valleys of [Formula: see text] and [Formula: see text]. The most important finding is that by changing the polarization of incident light, it is possible to increase the absorption coefficients of [Formula: see text] and [Formula: see text] valleys by up to 30 times. For light propagation direction close to perpendicular to the plane of the superlattice, the right-circular polarization is absorbed only by [Formula: see text] valley in contrast to the left-circular polarization, which is absorbed by the [Formula: see text] valley. Our model might be used to design newly developed 2D optovalleytronic devices.

An Overview of the Stability and Fretting Corrosion of Microgrooved Necks in the Taper Junction of Hip Implants

Fretting corrosion at the head-neck interface of modular hip implants, scientifically termed trunnionosis/taperosis, may cause regional inflammation, metallosis, and adverse local tissue reactions. The severity of such a deleterious process depends on various design parameters. In this review, the influence of surface topography (in some cases, called microgrooves/ridges) on the overall performance of the microgrooved head-neck junctions is investigated. The methodologies together with the assumptions and simplifications, as well as the findings from both the experimental observations (retrieval and in vitro) and the numerical approaches used in previous studies, are presented and discussed. The performance of the microgrooved junctions is compared to those with a smooth surface finish in two main categories: stability and integrity; wear, corrosion, and material loss. Existing contradictions and disagreements among the reported results are reported and discussed in order to present a comprehensive picture of the microgrooved junctions. The current research needs and possible future research directions on the microgrooved junctions are also identified and presented.

The Role of the Assembly Force in the Tribocorrosion Behaviour of Hip Implant Head-Neck Junctions: An Adaptive Finite Element Approach

The cyclic loading, in the corrosive medium of the human body, results in tribocorrosion at the interface of the head-neck taper junction of hip implants. The resulting metal ions and wear debris adversely affect the local tissues. The force applied by surgeons to assemble the junction has proven to play a major role in the mechanics of the taper junction which, in turn, can influence the tribocorrosion damage. Recently, finite element method has been used to predict the material loss at the head-neck interface. However, in most finite element studies, the contribution of electrochemical corrosion has been ignored. Therefore, a detailed study to investigate the influence of the assembly force on the tribocorrosive behaviour of the head-neck junction, which considers both the mechanical and chemical material removal, is of paramount interest. In this study, a finite-element-based algorithm was used to investigate the effect of assembly force on the tribocorrosion damage at the junction interface, for over four million cycles of simulated level gait. The patterns of the material removal in the modelling results were compared with the damage patterns observed in a group of retrieved modular hip implants. The results of this study showed that for different cases, chemical wear was in the range of 25-50% of the total material loss, after four million cycles. A minimum assembly force (4 kN for the studied cases) was needed to maintain the interlock in the junction. The computational model was able to predict the damage pattern at the retrieved head-neck interface.

Phosphonate analog of 2-oxoglutarate regulates glutamate-glutamine homeostasis and counteracts amyloid beta induced learning and memory deficits in rats

BACKGROUND

Metabolic alteration is a mainstream concept underlying the cognitive decline in neurodegenerative disorders including Alzheimer's disease (AD). Mitochondrial enzyme α-ketoglutarate dehydrogenase complex (α-KGDHC) seems to play a dual-edged sword role in cytotoxic insult. Here, using succinyl phosphonate (SP), a specific α-KGDHC inhibitor, we aimed to examine its potential action on AD progression.

METHODS

Male Wistar rats were assigned to two separate experiments. First, they were bilaterally microinjected into the dorsal CA₁ area by amyloid-beta (Aβ)_25-35 for four consecutive days. Seven days after the last injection, they were trained to acquire Morris Water Maze (MWM) task for three successive days when they were treated with SP after each training session. In the second experiment, SP was administered 30 min after the first Aβ microinjection and behavioral tests were performed one week after the last Aβ administration. The activity of glutamate dehydrogenase (GDH), and glutamine synthetase (GS), as key enzymes involved in glutamate-glutamine homeostasis and histological assays were evaluated in the hippocampi.

RESULTS

Our behavioral results indicated that post-training SP treatment enhanced task acquisition but did not change memory performance in Aβ-treated rats. However, administration of SP at the time of Aβ injection precludes the deteriorative effect of Aβ and neuronal injury on both spatial learning and memory performances indicating its preventive action against Aβ pathology at its early stages. Measurement of enzymes activity shows that α-KGDHC activity was reduced in the Aβ treated group, and SP administration restored its activity; also, GDH and GS activities were increased and decreased respectively due to Aβ, and SP reversed the action of Aβ on these enzymes.

CONCLUSIONS

This study proposes that SP possibly a promising therapeutic approach to improve memory impairment in AD, especially in the early phases of this disease.

In silico identification of the specific pathways in each stage of colorectal cancer and the association of their top genes with drug resistance and sensitivity

Investigating the specific pathways and their relation with survival, mutation, sensitivity, and resistance to various drugs in different stages of colorectal cancer (CRC) could be effective in cancer treatment. In this study, identifying the specific pathways in each stage of CRC compared to other stages was considered via meta-analytic methodology. The Cancer Genome Atlas (TCGA) data with gene set enrichment analysis (GSEA) software, and CRC RNA-Seq data were used to enrich and determine specific pathways as well as to evaluate the expression level of TOP RANK genes. In addition, The Cancer Cell Line Encyclopedia (CCLE) data were used to correlate candidate genes with drug resistance. Finally, using Gene Expression Omnibus (GEO) data, drugs that could affect the expression level of these genes were identified. Three specific molecular pathways, including oxidative phosphorylation (OXPHOS), regulation of transporter activity (RTA), and negative regulation of transmembrane receptor protein serine threonine kinase (NRSTK) have been identified as hub pathways for stages II, III, and IV, respectively (P < 0.01). The expression level of TOP RANK genes in each stage increased on average twice compared to other stages (P < 0.01), and CCNB1, DKK1, NOG genes were associated with survival in stages II and IV, respectively (P < 0.01). The expression of some selected genes had a correlation with drug resistance and sensitivity (P < 0.05). GEO data revealed that gamma-tocotrienol (g-T3), NSC319726, and Casiopeina Cas-II-gly may reduce the expression of, NDUFAF1, CCNB1, DKK1 genes, respectively (P < 0.01). Specific pathways and TOP RANK genes could lead to cancer progression and malignancy, resistance to chemotherapy drugs, poor survival in patients, and metastasis. Therefore, identification and targeting these pathways at each stage could be crucial in inhibiting progression at different stages of CRC.

The effect of wheat germ-enriched enteral formula on clinical and anthropometric factors in mechanically ventilated patients admitted to the intensive care unit

BACKGROUND & AIMS

Nutritional support is considered as an important therapeutic strategy among critically ill patients. To evaluate the effect of a wheat germ-enriched formula in patients admitted to the intensive care unit (ICU).

METHODS

This randomized controlled clinical trial study was conducted on 100 patients admitted to the ICU. Patients randomly received a wheat germ-enriched formula or a standard formula from the first day of admission until weaning from the ventilator. Then, the duration of mechanical ventilation, the length of ICU, hospital admission, body composition and mortality rate were compared between the two groups.

RESULTS

Based on the results, wheat germ-enriched formula caused a significant reduction in the length of mechanical ventilation (29.80 ± 21.99 days vs. 36.48 ± 8.78 days, P < 0.001), the ICU length of stay (32.92 ± 21.04 days vs. 37.70 ± 8.76, P < 0.001), and the SOFA score (4.60 ± 1.28 vs. 5.68 ± 1.25, P < 0.001) compared to the control group. However, the intervention group demonstrated a significant increase in the basal metabolic rate, mid upper arm circumference, skeletal muscle mass, body cell mass, and GCS score compared to the control group (P < 0.05). Finally, no significant difference was observed between the two groups in terms of the hospital length of stay, ICU mortality, and body fat percentage (P > 0.05).

CONCLUSION

In general, wheat germ enriched formula may exert beneficial effect on clinical and anthropomorphic variables in patients admitted to the ICU.

TRIAL REGISTRATION

The study was approved by the Ethics Committee of the Urmia University of Medical Sciences under number IR.umsu.rec.1396.88 and registered at the Iranian Registry of Clinical Trials Website as IRCT20171221037983N3.

Effect of coenzyme Q10 supplementation on oxidative stress and clinical outcomes in patients with low levels of coenzyme Q10 admitted to the intensive care unit

Today, trauma is known to be the third leading cause of death in most countries. Studies have demonstrated below-normal plasma levels of antioxidants in trauma patients. The present study aimed to assess the efficacy of Coenzyme Q10 (CoQ10) on oxidative stress, clinical outcomes and anthropometrical parameters in traumatic mechanical ventilated patients admitted to the intensive care unit. Patients were randomised to receive sublingual CoQ10 (400 mg/d) or placebo for 7 d. Primary and secondary outcomes were measured at the baseline and end of the study. We enrolled forty patients for this trial: twenty in the CoQ10 group and twenty in the placebo group. There was not any significant difference in the baseline variables (P > 0⋅05). At the end of the study, CoQ10 administration caused a considerable reduction in the Malondialdehyde (MDA) and Interleukin 6 (IL-6) concentrations (P < 0⋅001), Glasgow Coma Score (GCS; P = 0⋅02), ICU and hospital length of stay and mechanical ventilation (MV) duration (P < 0⋅001). We found that CoQ10 administration could increase Fat-Free Mass (P < 0⋅001) (FFM; P = 0⋅04), Skeletal Muscle Mass (SMM; P = 0⋅04) and Body Cell Mass (BCM) percent (P = 0⋅03). There was not any significant difference in other factors between the two groups (P > 0⋅05). CoQ10 administration has beneficial effects on patients with traumatic injury and has no side effects. However, since the possibility of the type II error was high, the outcomes on the duration of MV, ICU stay and hospital stay, and GCS may very well be false positives.

In vitro Comparison of the Accuracy (Precision and Trueness) of Seven Dental Scanners

Statement of the Problem:

The mechanisms of operation of dental scanners are based on different technologies. Considering these differences, there are many types of scanners available in the market.

Purpose:

This in vitro study aimed to compare the accuracy (precision and trueness) of seven commonly used dental scanners.

Materials and Method:

In this in vitro experimental study, the accuracy of 7 common extra oral scanners (Sirona ineos inLab, Sirona X5, Dentium, Imes Icore 350I, Amann Girrbach, 3shape D700, and 3Shape E3) were evaluated. Each of scanners performed 7 scans of implant abutment of SIC (SIC MAX.GH1). Data from each scanner were then compared to data received from 3Shape Trios intra oral scanner as a reference. For evaluating the accuracy of each scanner, trueness and precision was evaluated. Collected data were analyzed using Kruskal Wallis and Bonferroni tests via SPSS version 22.

Results:

Descriptive statistics showed the best trueness was for 3Shape E3 scanner with the average of 35.37µm and the worst trueness belonged to Sirona x5 scanner with the average of 51.75µm. Furthermore, the best precision was achieved for 3Shape E3 scanner with the average of 35.34, while the lowest precision was detected in 3Shape D700. The scanners had statistically significant differences with each other in terms of trueness and precision (p<0.05).

Conclusion:

Based on the results of this study, the extra oral scanner, 3shape E3, had the best trueness and precision. The lowest amount of trueness among the studied scanners was for the extra oral scanner, Sirona x5, and the lowest precision was for scanner 3shape D700.

The mechanics of head-neck taper junctions: What do we know from finite element analysis?

Modular hip implants are widely used in hip arthroplasty because of the advantages they can offer such as flexibility in material combinations and geometrical adjustments. The mechanical environment of the modular junction in the body is quite challenging due to the complex and varying off-axial mechanical loads of physical activities applied to a tapered interface of two contacting materials (head and neck) assembled by an impact force intraoperatively. Experimental analogies to the in-vivo condition of the taper junction are complex, expensive and time-consuming to implement; hence, computational simulations have been a preferred approach taken by researchers for studying the mechanics of these modular junctions that can help us understand their failure mechanisms and improve their design and longevity after implantation. This paper provides a clearer insight into the mechanics of the head-neck taper junction through a careful review on the finite element studies of the junction and their findings. The effects of various factors on the mechanical outputs namely: stresses, micromotions, and contact situations are reviewed and discussed. Also, the simulation methodology of the studies in the literature is compared. Research opportunities for future are scrutinised through tabulating data and information that have been carefully retrieved form the reported findings.

A review on the finite element simulation of fretting wear and corrosion in the taper junction of hip replacement implants

Taperosis/trunnionosis is a scientific term for describing tribocorrosion (fretting corrosion) at the head-neck taper junction of hip implants where two contacting surfaces are undergone oscillatory micromotions while being exposed to the body fluid. Detached ions and emitted debris, as a result of taperosis, migrate to the surrounding tissues and can cause inflammation, infection, and aseptic loosening with an ultimate possibility of implant failure. Improving the tribocorrosion performance of the head-neck junction in the light of minimising the surface damage and debris requires a better understanding of taperosis. Given its complexity associated with both the mechanical and electrochemical aspects, computational methods such as the finite element method have been recently employed for analysing fretting wear and corrosion in the taper junction. To date, there have been more efforts on the fretting wear simulation when compared with corrosion. This is because of the mechanical nature of fretting wear which is probably more straightforward for modelling. However, as a recent research advancement, corrosion has been a focus to be implemented in the finite element modelling of taper junctions. This paper aims to review finite element studies related to taperosis in the head-neck junction to provide a detailed understanding of the design parameters and their role in this failure mechanism. It also reviews and discusses the methodologies developed for simulating this complex process in the taper junction along with the simplifications, assumptions and findings reported in these studies. The current needs and future research opportunities and directions in this field are then identified and presented.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

The impact of vitamin D3 intake on inflammatory markers in multiple sclerosis patients and their first-degree relatives

BACKGROUND & AIMS

In our previous study, a Seesaw model was proposed for the fluctuation of crucial anti- (IL-10) and pro-inflammatory (Il-6 & IL-17A) cytokines through vitamin D3. In this paper, however, it is intended to extend the mentioned model by assessing the expression mRNA levels of IL-27 and TGF-β1 as well as the changes of plasma levels of IL-27, TGF-β1, IL-17A, IL-10, and IL-6 after treatment by vitamin D3.

METHOD

Venous blood samples were drawn from Healthy Participants (HP, n = 25) and First-Degree Relative Participants (FDRP, n = 25) as control groups and Multiple Sclerosis Participants (MSP, n = 25) before and after eight weeks of supplementation with 50000 IU vitamin D3. The mRNA expression and plasma concentrations were gauged by using Real-Time PCR and ELISA assay, respectively.

RESULTS

The mRNA surfaces of IL-27, as well as TGF-β1, were up-regulated. However, the plasma levels of TGF-β1, IL-17A, and IL-6 were significantly different among the three groups. In addition, the plasma levels of IL-27, TGF-β1, IL-10, IL-17A, and IL-6 significantly changed following the administration of vitamin D3.

CONCLUSION

The findings of this paper illustrate that anti-inflammatory cytokines could have a key role in immunomodulatory functions due to their anti-inflammatory functions. To conclude, this might contribute to preventing the pathophysiological process of MS. Also, the proposed model could be used as a preventive way on disposed people to multiple sclerosis, particularly in first degree relatives of these patients.

Immunomodulatory and anti-inflammatory effects of probiotics in multiple sclerosis: a systematic review

Multiple sclerosis (MS) is an inflammatory and autoimmune neurological disorder which leads to demyelination. Although the etiology of MS is yet to be known, it appears that regulating the immune system and suppressing inflammatory pathways may possibly have a favorable effect on the healing of this disease. Evidence suggests that probiotics consumption via gut microbiome alteration devises beneficial effects in improving immune and inflammatory responses in MS. All articles were systematically searched (in the main databases) for this paper. Two investigators independently scrutinized full texts of the potentially eligible articles. The quality of the study was evaluated using standardized tools. The methodological quality of seven studies included in this review ranged from fair to good. The findings illustrated that there were statistically significant improvements in the static and dynamic balance in patients and animals with MS. In the paper in hand, the effects of probiotics administration on immune and inflammatory markers in MS disease are evaluated. In addition, the limitations and knowledge gaps were reported while proposing a possible mechanism of probiotics therapy in modulating immune and inflammatory responses. This systematic review indicated that the probiotics could improve immune and inflammatory parameters, the cytokines and cells in MS disease. Probiotics may have efficient effects in management and treatment of MS. More studies are required to clarify the effect of supplementation with probiotics and their mechanisms in MS disease.

Effect of Oral Versus Intramuscular Vitamin D Replacement on Oxidative Stress and Outcomes in Traumatic Mechanical Ventilated Patients Admitted to Intensive Care Unit

BACKGROUND

This study aimed to evaluate the safety and efficacy of 2 forms of vitamin D supplementation on oxidative stress and weaning from the ventilator in patients with traumatic injury and vitamin D deficiency.

METHODS

Seventy-two patients were randomly divided into 3 groups: receiving 50,000 IU pearl cholecalciferol daily for 6 days, 1 intramuscular injection of 300,000 IU of cholecalciferol, or a control group that did not receive any supplement. Duration of mechanical ventilation, body composition, and biochemical biomarkers were measured before and after the intervention.

RESULT

At the end of the study, the mean serum 25(OH)D increased in the intervention groups compared with the control group (P < .05). The interleukin 6, erythrocyte sedimentation rate, C-reactive protein levels, Sequential Organ Failure Assessment score, duration of mechanical ventilation, and length of intensive care unit admission significantly decreased; however, total antioxidant capacity concentration did not differ significantly between the 2 intervention groups. Among the body composition variables, extracellular water ratio changes were statically different in oral vitamin D group compared with the control group (P = .001). No side effects were reported with the supplements.

CONCLUSIONS

Vitamin D administration improved clinical signs and biochemical biomarkers in a small group of patients with traumatic injury. Well-designed multicenter clinical studies with longer intervention duration are necessary for this field.

Comparison of the effect of Dietary Approaches to Stop Hypertension diet and American Diabetes Association nutrition guidelines on lipid profiles in patients with type 2 diabetes: A comparative clinical trial

AIM

The present study aimed to compare the effects of the Dietary Approaches to Stop Hypertension (DASH) diet and American Diabetes Association (ADA) guidelines on the lipid profiles of patients with type 2 diabetes.

METHODS

In a 12-week clinical trial, 80 patients with type 2 diabetes aged 18-65 years were randomly allocated into the case (n = 40) and control (n = 40) groups. The case group received the DASH diet and the control group consumed a dietary pattern in accordance with the ADA guidelines. Fasting blood samples were measured for triglyceride (TG), low-density lipoprotein (LDL), total cholesterol (TC), high-density lipoprotein (HDL), very low-density lipoprotein (VLDL) and free fatty acid (FFA). Moreover, physical activity and 24-hour dietary recall (24 hours) were assessed at baseline and end of the study.

RESULTS

The DASH diet and diabetic diet (in accordance with the ADA guidelines) for 12 weeks significantly decreased TG, TC and VLDL (P < 0.05). FFA showed a significant decrease in both the groups, which was greater in the cases compared with the control group (P = 0.049).

CONCLUSIONS

Compliance with any DASH or diabetic diet for 12 weeks in patients with type 2 diabetes had beneficial effects on cardiometabolic risks.

Investigating the effect of DASH diet on blood pressure of patients with type 2 diabetes and prehypertension: Randomized clinical trial

BACKGROUND AND OBJECTIVES

Prehypertension in people with type 2 diabetes is associated with increased risk of cardiovascular disease and lower extremity damages compared to people with normal blood pressure. On the other hand, limited studies have conducted to investigate the effect of DASH diet on blood pressure and prehypertension in patients with type 2 diabetes. Therefore, in this study, we aimed to evaluate the effect of DASH diet on blood pressure and prehypertension in patients with type 2 diabetes.

MATERIALS AND METHODS

In this clinical trial, 80 patients with diabetes type 2 and prehypertension in the age range of 18-65 years were randomly allocated to intervention (n = 40) and control (n = 40) groups for 12 weeks. The intervention group had DASH diet and the control group received diabetic diet in accordance with the recommendations of the American Diabetes Association (ADA) with 24-h dietary recall; systolic and diastolic blood pressures were measured before and after study.

RESULTS

Taking DASH diet and diabetic diet for 12 weeks caused significant reduction in systolic blood pressure in the intervention group (P value = 0.003). Diastolic blood pressure showed no significant change in none of the two groups.

CONCLUSION

Following the DASH diet in patients with prehypertension has beneficial effects in improving systolic blood pressure and can be effective to prevent the development of hypertension. Hence, there are needs for long-term interventions with larger sample size in future studies.

Anti-inflammatory effects of dietary vitamin D3 in patients with multiple sclerosis

Objective

To assess the effects of dietary vitamin D₃ on proinflammatory (interleukin-17A [IL-17A] and IL-6) and anti-inflammatory (IL-10) cytokines.

Methods

Our study was conducted on 75 participants who were divided into 3 groups: multiple sclerosis participants (MSPs, n = 25), first-degree relative participants (FDRPs, n = 25), and healthy participants (HPs, n = 25). All groups received 50,000 IU vitamin D₃/wk for 8 weeks. Serum 25-(OH) vitamin D₃ levels and messenger RNA (mRNA) expression levels of ILs were determined using electrochemiluminescence assay and real-time PCR, respectively.

Results

Vitamin D₃ affected the levels of IL-17A, IL-10, and IL-6 among the 3 groups (p < 0.001 for all). Levels of IL-17A (MSPs: fold change [FC] = 5.9, p = 0.014; FDRPs: FC = 5.2, p = 0.006; HPs: FC = 4.2, p = 0.012) and IL-6 (MSPs: FC = 5.6, p = 0.003; FDRPs: FC = 5.5, p = 0.002; HPs: FC = 5.1, p < 0.001) were downregulated after vitamin D₃ treatment. In addition, levels of IL-10 (MSPs: FC = 6.2, p = 0.005; FDRPs: FC = 4.6, p < 0.001; HPs: FC = 5.2, p < 0.001) were upregulated after 8 weeks.

Conclusions

Although supplementation with vitamin D₃ reduced the mRNA expression levels of IL-17A and IL-6, it increased the mRNA expression level of IL-10 in all groups. However, these effects were more considerable in the MSP group than in the other groups. Of interest, in a deficiency state of serum vitamin D3, IL-17A expression had a positive feedback effect on the expression of IL-6. Conversely, in the sufficient state, IL-10 expression had a negative feedback effect on the expression of IL-17A and IL-6.

Erythrocyte Sedimentation Rate Measurement Using as a Rapid Alternative to the Westergren Method

INTRODUCTION

Erythrocyte sedimentation rate (ESR) remains as one of the most reliable tests in clinical practices. Yet its use is time consuming and requires a large blood sample. The aim of this study was assessing a faster and reliable method of ESR estimation.

METHODS

An ESR estimation method was described and performed on 108 patients using capillary tube (micro ESR) and capillary peripheral blood. Micro ESR results at different intervals were measured and compared with Westergren ESR (conventional ESR) estimation by Pearson and Spearman's coefficients. A regression equation was derived to predict conventional ESR values based on micro ESR results. The agreement of two measurements was demonstrated using the Bland-Altman plot.

RESULTS

Micro ESR results at 20 minutes showed the earliest close correlation with conventional ESR results at one hour (r = 0.987). The presented regression equation was able to closely predict ESR values (r(2) = 0.974) and the Bland-Altman plot showed an acceptable agreement between converted and conventional ESR measurements.

CONCLUSION

Using capillary tube and capillary blood sample (micro ESR) appears to be a faster, cheaper, more reliable, and precise tool for ESR measurement in the ED. The results have acceptable correlation with conventional ESR, especially at 20 minutes of measurement.

Doppler broadening thermometry of acetylene and accurate measurement of the Boltzmann constant

In this paper, we present accurate measurements of the fundamental Boltzmann constant based on a line-shape analysis of acetylene spectra in the ν1 + ν3 band recorded using a tunable diode laser. Experimental spectra recorded at low pressures (0.25 - 9 Torr), have been analyzed using a Speed Dependent Voigt model that takes into account the molecular speed dependence effects. This line-shape model reproduces the experimental data with good accuracy and allows us to determine precise line-shape parameters for the P(25) transition of the ν1 + ν3 band. From the recorded spectra we obtained the Doppler-width and then determined the Boltzmann constant, k(B).

Investigating deaf students' knowledge of Persian syntax: further evidence for a critical period hypothesis

The present study aims to investigate syntactic deficits in 13 Iranian deaf students aged between 17 and 21 years. Four tests in the form of sentence-recognition and sentence-completion were administered to examine their knowledge of verb inflection, derivational morphology, word order, and prepositions. A between-category analysis of errors indicated a significant dissociation between categories, most notably between verb inflection and derivational morphology and between word order as the category with fewest errors and the three others. On theoretical grounds, the fact that subjects have not acquired much syntax even after years of learning seemed to strengthen the significance of acquiring syntax and morphology in the early years.

Epidemiological survey on pandemic influenza A (H1N1) virus infection in Kurdistan province, Islamic Republic of Iran, 2009

This study evaluated the epidemiology of suspected cases of pandemic influenza A (H1N1) virus infection in 2009-2010 in Kurdistan province, a frontier province of the Islamic Republic of Iran. A questionnaire covering demographic characteristics, clinical presentation and outcome, and history of exposure and travel was completed by patients attending health centres and hospitals in the province. Nasal and throat swabs were analysed by RT-PCR. A total of 1059 suspected cases were assessed; H1N1 influenza A was confirmed in 157 (14.8%). The highest proportion of confirmed cases was 30.0%, among children aged < 1 year. In multivariate analysis, previous contact with symptomatic influenza patients (OR = 2.17) and hospitalization (OR = 3.88) were the only significant risk factors for confirmed H1N1 infection. Age, sex, residency, presenting symptoms and history of national or international travel were not significant. Influenza A (H1N1) virus has spread in Islamic Republic of Iran; probably transmitted by travellers to Kurdistan.

Lipoic acid prevents hepatic and intestinal damage induced by obstruction of the common bile duct in rats

INTRODUCTION

Cholestatic liver diseases are characterized by impaired hepatocellular secretion of bile, resulting in intracellular accumulation of bile acids which result in a shift in the oxidant/prooxidant balance in favor of increased free radical activity and injury of different tissues including liver and intestine. The aim of this research was to study protective effect of lipoic acid (LA) as a potent antioxidant in cholestsis induced hepatic and intestinal injury in rats.

MATERIALS AND METHODS

Forty five adult male Wistar rats were randomly assigned to four groups each containing fifteen rats as follows: sham operation (SO) (control), bile duct ligating (BDL), and BDL+LA (25 mg/kg). After fourteen days hepatic and intestinal tissue sampled and blood serum sampled for pathologic and biochemical studies.

RESULTS

Levels of SOD and GPx antioxidant enzymes were higher in BDL+LA group comparing to BDL group, levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and γ-glutamyltranspeptidase (GGT), and pathologic scores in liver and intestine were lower in BDL+LA group comparing to BDL group significantly, but there is no significant difference in concentrations of total bilirubin between groups.

CONCLUSIONS

Our results showed the protective potential of LA with liver and intestine damage. Despite improvements in operative technique and the development of potent, broad-spectrum antibiotics, biliary tract surgery in patients with obstructive jaundice is still associated with high morbidity and mortality rates In summary, our results show that BDL induced hepatic and intestinal injury were significantly attenuated by LA administration and the administration of LA could effectively diminish this damage.

A comparison between craniofacial templates of Iranian and western populations

Templates are very useful tools for diagnosis of malocclusions. A number of templates have been provided for some populations in previous years. Since craniofacial characteristics of different ethnic groups are not the same, each population needs its own norms. The aim of this study was to provide orthodontic craniofacial templates for 8-16 year old Iranian boys and compare dentoskeletal features between Iranian and western populations. 3330 boys with the age range of 8-16 years were examined in Tehran, and 107 cases were finally chosen for the study and their lateral cephalograms were traced. Since there is no universal, consensus about the selection of one specific point or line for cephalometric superimposition, both the sella nasion (SN) and basion nasion (Ba-N) lines were chosen for this purpose. Based on both SN and Ba-N lines, a template was prepared for each age. Simple linear regression analysis was used to evaluate the angles and the multivariant regression analysis for evaluation of landmark vectors. Posterior cranial base, maxillary and mandibular lengths, upper and lower anterior facial heights (N-ANS and ANS-Me) and posterior facial height (S-Go) are greater in Iranian population. But anterior cranial base, height and inclination of the incisors and molar height are similar in two populations.

A latent process model for joint modeling of events and marker

The paper formulates joint modeling of a counting process and a sequence of longitudinal measurements, governed by a common latent stochastic process. The latent process is modeled as a function of explanatory variables and a Brownian motion process. The conditional likelihood given values of the latent process at the measurement times, has been drawn using Brownian bridge properties; then integrating over all possible values of the latent process at the measurement times leads to the desired joint likelihood. An estimation procedure using joint likelihood and a numerical optimization is described. The method is applied to the study of cognitive decline and Alzheimer's disease.

Metabolic and endocrinologic complications in beta-thalassemia major: a multicenter study in Tehran

ABSTRACT : BACKGROUND : The combination of transfusion and chelation therapy has dramatically extended the life expectancy of thalassemic patients. The main objective of this study is to determine the prevalence of prominent thalassemia complications. METHODS : Two hundred twenty patients entered the study. Physicians collected demographic and anthropometric data and the history of therapies as well as menstrual histories. Patients have been examined to determine their pubertal status. Serum levels of 25(OH) D, calcium, phosphate, iPTH were measured. Thyroid function was assessed by T3, T4 and TSH. Zinc and copper in serum were determined by flame atomic absorption spectrophotometry. Bone mineral density (BMD) measurements at lumbar and femoral regions have been done using dual x-ray absorptiometry. The dietary calcium, zinc and copper intakes were estimated by food-frequency questionnaires. RESULTS : Short stature was seen in 39.3% of our patients. Hypogonadism was seen in 22.9% of boys and 12.2% of girls. Hypoparathyroidism and primary hypothyroidism was present in 7.6% and 7.7% of the patients. About 13 % of patients had more than one endocrine complication with mean serum ferritin of 1678 +/- 955 micrograms/lit. Prevalence of lumbar osteoporosis and osteopenia were 50.7% and 39.4%. Femoral osteoporosis and osteopenia were present in 10.8% and 36.9% of the patients. Lumbar BMD abnormalities were associated with duration of chelation therapy. Low serum zinc and copper was observed in 79.6% and 68% of the study population respectively. Serum zinc showed significant association with lumbar but not femoral BMD. In 37.2% of patients serum levels of 25(OH) D below 23 nmol/l were detected. CONCLUSION : High prevalence of complications among our thalassemics signifies the importance of more detailed studies along with therapeutic interventions.