relationship between dietary intakes of amino acids and bone mineral density among individuals with spinal cord injury

Objectives: The effect of dietary protein intake on bone mineral density [BMD] has not been explained in patients with spinal cord injury [SCI]. In this study, we looked at the relationship between BMD and higher protein intake in patients with SCI while controlling for possible confounders

Methods: Patients with SCI, who were referred to the Brain and Spinal Cord Injury Research Center between November 2010 and April 2012, were included in the study. In total, the dietary intakes of 103 patients were assessed by 24-hour dietary recall interviews. We used dual-energy X-ray absorptiometry to measure BMD in the femoral neck, trochanter, intertrochanteric zone, hip, and lumbar vertebras

Results: Eighty-six men and 17 women participated in this study. Protein intake was negatively associated with the BMD of lumbar vertebrae [p = 0.001, r = -0.37 for T-score and p = 0.030, r = -0.24 for Z-score]. The BMD of lumbar vertebrae were negatively associated with intake of tryptophan, isoleucine, lysine, cysteine, and tyrosine [p = 0.007, 0.005, 0.009, 0.008, and 0.008 for T-score, respectively]. Higher intakes of threonine, leucine, methionine, phenylalanine, valine, and histidine were related to a lower BMD of lumbar vertebrae [p = 0.006, 0.010, 0.009, 0.010, 0.009, and 0.008 respectively for T-scores]

Conclusions: We found that high protein intake led to a lower BMD of lumbar vertebrae in patients with SCI after controlling for confounders including demographic and injury-related characteristics and calcium intake. No relationship between higher amino acids intake and BMD of the femur and hip was detected. Intake of alanine, arginine, and aspartic acid were not related to BMD

Sono-elastography for differentiating benign and malignant cervical lymph nodes: a systematic review and meta-analysis

We did this systematic review to determine diagnostic accuracy of sono-elastography in evaluating cervical lymph nodes [LNs]. A highly sensitive search for sono-elastography and LNs was performed in MEDLINE, Cochrane Library, ACP Journal Club, EMBASE, Health Technology assessment, and ISI web of knowledge for studies published prior to December 2012. SPSS version 18 [SPSS Inc., Chicago, IL, USA] used for descriptive analysis and meta-disk version 1.4 applied for meta-analysis. Forest plots for pooled estimates and summery of receiver operating characteristic plots for different cut-offs were produced. The literature and manual search yielded 69 articles, of which 10 were eligible to include. A total of 578 individuals with a total number of 936 cervical LNs was evaluated [502 malignant and 434 benign]. The summary sensitivity of the scoring and strain ratio [SR] measurements for the differentiation of benign and malignant LNs were 0.76 [95% CI: 0.71-0.8] and 0.83 [95% CI: 0.78-0.87]. The summary specificities were 0.8 [95% confidence interval [CI]: 0.75-0.84] and 0.84 [95% CI: 0.79-0.88], respectively. Area under the curve for scoring system was 0.86 [standard error [SE] = 0.03] and 0.95 [SE = 0.02] for SR measurement. Sono-elastograohy has high accuracy in differentiating benign and malignant cervical LNs

Attitude toward plagiarism among Iranian medical faculty members

The goal of this study was to assess attitude towards plagiarism in faculty members of Medical School at Tehran University of Medical Sciences. One hundred and twenty medical faculty members of Tehran University of Medical Sciences were enrolled in this cross-sectional study. They were asked to answer to valid and reliable Persian version of attitude towards plagiarism questionnaire. Attitude toward plagiarism, positive attitude toward self-plagiarism and plagiarism acceptance were assessed. Eighty seven filled-up questionnaires were collected. Mean total number of correct answers was 11.6 +/- 3.1. Mean number of correct answers to questions evaluating self-plagiarism was 1.7 +/- 0.4 and mean number of correct answers to questions evaluating plagiarism acceptance was 1.4 +/- 0.2. There was no significant correlation between plagiarism acceptance and self-plagiarism [r=0.17, P=0.1]. It is essential to provide materials [such as workshops, leaflets and mandatory courses] to make Iranian medical faculty members familiar with medical research ethics issues such as plagiarism

[Cost-effectiveness of homograft heart valve replacement surgery: an introductory study]

The clinical effectiveness of heart valve replacement surgery has been well documented. Mechanical and homograft valves are used routinely for replacement of damaged heart valves. Homograft valves are produced in our country but we import the mechanical valves. To our knowledge the cost-effectiveness of homograft valve has not been assessed. The objective of the present study was to compare the cost-effectiveness of homograft valve replacement with mechanical valve replacement surgery. Samples were selected from 200 patients that underwent homograft and mechanical heart valve replacement surgery in Imam-Khomeini hospital [2000 - 2005]. In each group we enrolled 30 patients. Quality of life was measured using the SF-36 health survey and efficacy was measured in QALYs. For each group we calculated the price of heart valve and hospitalization charges. Finally the cost-effectiveness of each treatment modalities were summarized as costs per QALYs gained. Forty males and 20 females participated in the study. The mean score of quality of life was 66.06 [SD= 9.22] in homograft group and 57.85 [SD= 11.30] in mechanical group [P< 0.05]. The mean QALYs gained in homograft group was 0.67 more than mechanical group. The incremental cost-effectiveness ratio [ICER] revealed a cost savings of 9,604,440 IRRials for each quality-adjusted life year gained in homograft group. Despite limitation of this introductory study, we concluded that homograft valve replacement was more effective and less expensive than mechanical valve. These findings can encourage healthcare managers and policy makers to support the production of homograft valves and allocate more recourse for developing such activities

Autologous in vitro expanded mesenchymal stem cell therapy for human old myocardial infarction

Stem cell transplantation after myocardial infarction has been claimed to restore cardiac function. Mesenchymal stem cells attract a lot of attention because of the feasibility of in vivo and ex vivo differentiation to cardiomyocytes and endothelial cells as well as their trophic effect on tissue repair. In this study, we investigated the efficacy of autologous bone marrow derived mesenchymal stem cells in improving heart function in patients with old myocardial infarction. Eight patients with old myocardial infarction and proper inclusion criteria were injected with mesenchymal stem cells at the time of coronary artery bypass grafting or percutaneous coronary intervention [test group] and compared with eight matched patients who received the same treatment without mesenchymal stem cell injection [control group]. Evaluation of heart function was done by echocardiography plus single-photon emission computed tomography before and six months after the procedure. Serial clinical examination was performed every month through New York Heart Association class. The mean New York Heart Association class and single-photon emission computed tomography scan results decreased significantly in the test group [P=0.000 and 0.002, respectively] and in the control group [P=0.049 and 0.007, respectively] after the procedure at six months follow-up. Left ventricular ejection fraction increased significantly in the test group [P< 0.005] but not in the control group. In comparison between the test and control groups the results of New York Heart Association class assessment and single-photon emission computed tomography demonstrated significant improvement in the test group [P=0.005 and 0.013, respectively]. There were no significant differences between the baseline variables in the two groups. In conclusion transplantation of ex vivo expanded bone marrow derived mesenchymal stem cell in patients with old myocardial infarction is a safe and feasible procedure. These cells improve the cardiac fimction without serious adverse effects

Subfascial endoscopic perforator vein surgery: the first report from Iran

Chronic venous stasis ulcers of the leg are still a challenge in vascular surgery. Innovation of new surgical techniques using endoscopic instruments have ushered in a new era with less complications and better results. This study was designed to evaluate the safety and long-term outcomes of this technique for the first time in Iran. Subfascial endoscopic perforator vein surgery was performed on 10 legs in 8 patients who had signs of chronic venous insufficiency [between September 2001 and September 2003]. Patients were followed up for a mean of period 12.5 months. The operations were performed successfully in all patients. No serious complications occurred intraoperatively. There was no mortality or significant morbidity. Complete healing of skin ulcers was observed in 5 active and 2 healed ulcers in less than 12 weeks. There were 2 recurrences after 4 and 27 months, respectively. Subfascial endoscopic perforator surgery is a safe procedure for the treatment of venous stasis ulcers. Rapid ulcer healing can be expected in selected patients