Lumbar sacralization and L4-L5 microdiscectomy, a prospective cohort study on radiologic and clinical outcomes.

Aim: To evaluate the role of lumbar sacralization (LS) on the surgical outcomes of L4-L5 microdiscectomy. Methods: This prospective cohort study was conducted in a university referral hospital. The patients with L4-L5 disc herniation and eligible for microdiscectomy were enrolled and allocated in G1 (with LS) and G2 (no LS). After the L4-L5 microdiscectomy patients were followed, clinical and radiological parameters were collected to investigate the influence on the outcomes. Recurrence, low back outcome score (LBOS), and the Oswestry disability index (ODI) were defined as main outcomes. Results: Two hundred and forty patients (n = 120, each), were reviewed in the final analysis. There was no difference between groups regarding baseline characteristics. Postoperative radicular and back pain was more severe in LS(P < 0.05). Univariate analysis showed recurrence was significantly higher in LS with a direct correlation with postoperative back pain persistence and low LBOS (p = 0.001). Age had a negative impact on G2 recurrence(p = 0.008). LS had a negative impact on LBOS and ODI scores. Postoperative radicular pain and higher lumbar lordosis were associated with a higher disability (ODI) index. Conclusion: L4-L5 microdiscectomy in patients with lumbar sacralization was associated with higher recurrence rates, worse ODI and LBOS scores, persistent postoperative axial back pain, and radicular pain. Postoperative axial back pain and poor LBOS results could effectively predict a higher recurrence rate following L4-L5 microdiscectomy in lumbar sacralization.

The Cytotoxicity of 27-Hydroxycholesterol in MCF-7 and MDA-MB-231.

Background: Although several roles of 27-hydroxycholesterol (27-HC), the most abundant oxysterol in blood circulation, in cancers have been elucidated, its impact on breast cancer proliferation and its pathway remain unknown. Materials and Methods: The effect of 27-HC on breast cancer cell proliferation and its pathway was evaluated using Michigan Cancer Foundation - 7 (MCF-7) and M.D. Anderson - Metastatic Breast 231 (MDA-MB-231) cell lines. The MTT assay was applied after 24- and 48-hour incubation to distinguish cell proliferation. To determine the cause of different viability results from the MTT assay, the Annexin-FITC/PI test was used at concentrations of 0.1, 1, and 10 µM after 24- and 48-hour incubation. Results: 27-HC in concentrations of 5, 10, and 20 µM induced cell cytotoxicity compared with control. Also, the annexin V conjugated with fluorescein isothiocyanate/propidium iodide (Annexin-FITC/PI) test revealed an increase in total apoptotic cells treated with 0.1, 1, and 10 µM of 27-HC after 48 hours (P value < 0.05). Besides, the cytotoxic effect of 27-HC was observed at 10 µM concentration in both cell lines, MCF-7 and MDA-MB-231 (P value < 0.05). Conclusion: The identification of 27-HC's cytotoxic effects on both estrogen receptor (ER)-negative and ER-positive breast cancer cell lines is a novel discovery that may be linked to LXRß.

Acute neurological symptoms in multisystem inflammatory syndrome in children: A case series.

Introduction: Severe acute respiratory syndrome coronavirus-2 infection mostly involves pediatrics lesser than adults; however, the multisystem inflammatory syndrome in children is shown to be the following condition in children infected with SARS-CoV-2, even asymptomatic ones. To date, there is few evidence of the association of multisystem inflammatory syndrome in children with acute neurological symptoms. Case presentations: This case series was recorded demographic, clinical, laboratory, radiographic and EEG data of patients with the multisystem inflammatory syndrome in children who diagnosed simultaneously with acute neurological symptoms. Children with the multisystem inflammatory syndrome in children and evidence of central nervous system involvements participated in the study. Data are reported as median (interquartile ranges) for quantitative data without normal distributions. The present study was conducted at the children's referral hospital of Isfahan province, Iran between March 1, 2020, and December 28, 2021. Simultaneous diagnosis of multisystem inflammatory syndrome in children and acute neurological symptoms was made in 12 children. The median age of patients was 4.5 years (10-144 months). The most common symptoms were seizures (58%). Cerebrospinal fluid analysis showed that only one patient had pleocytosis. In addition, one patient had a low glucose level. Finally, 11 patients were discharged in good condition and one patient died after full recovery from acute neurological symptoms due to her underlying disease. Conclusion: According to our series and other studies, children with MIS-C may present signs and symptoms of acute neurological symptoms. Although its pathophysiology is unclear, studies showed that immunomodulatory agents, i.e., intravenous immunoglobulins and corticosteroids, provide a relatively good prognosis.

Clinical predictors of abnormal brain computed tomography findings in mild traumatic brain injury: A cross-sectional study.

Mild traumatic brain injury (mTBI) is a health challenge world widely. Local evidence is essential to establish decision-making algorithms. According to the lack of sufficient evidence, the present study aimed to investigate the epidemiology of mTBI and predictive factors of abnormal brain computed tomography (CT) scans. The present analytical cross-sectional study was conducted between March 2021 to September 2022 on patients with the diagnosis of mTBI. Subjects were individuals who were diagnosed with mTBI in 2 Level I trauma centers located in Isfahan province, which serves as the referral center for the entire population of the province. Demographic and clinical data were recorded during a face-to-face interview. The brain CT scans were interpreted by an experienced radiologist. Data were analyzed using IBM SPSS Statistics for Mac, Version 24.0. 498 patients were enrolled in the study, consisting of 393 (78.9%) men and 65 (13.1%) children younger than 10 years old. 100 (20%) of them had abnormal CT scan findings. The mean age of participants was 33.39 ± 19.69, which was significantly higher in patients who had abnormal CT scans (P value = .002). Despite the most common mechanism in both groups being motor accidents, the rate of motor accidents was higher in patients with abnormal findings of CT scan (P value = .048). Multiple logistic regression revealed that post-traumatic vomiting (PTV) (odd ratios [OR]: 3.736), post-traumatic amnesia (PTA) (OR:3.613), raccoon eyes (OR:47.878), and Glasgow coma scale (GCS) of 15 (OR:0.11) are predictive factors for abnormal findings. The present study suggested the presence of PTV, PTA, raccoon eyes and GCS of 13 or 14 as predictive factors for abnormal findings in mTBI populations.

Multilocus VNTR analysis-ompA typing of Chlamydia trachomatis isolates in Tehran, Iran.

INTRODUCTION: This study is the first to describe the genetic diversity of C. trachomatis strains derived from patients with signs and symptoms of genitourinary infections admitted to Tehran health centers and hospitals using the high-resolution genotyping method, multilocus variable-number tandem-repeat analysis with ompA sequencing (MLVA)-ompA. METHODS: One hundred and sixty-seven urogenital specimens were collected from October 2019 to July 2020. Specimens were inoculated to cell culture and examined for the presence of C. trachomatis isolates by microscopic valuation. Out of 167 samples, 19 (11.3%) viable C. trachomatis organisms were isolated in cell culture. Eighteen isolates were successfully genotyped by MLVA-ompA analysis. RESULTS: The most prevalent ompA genotypes were E, D, F and G, comprising 42%, 26.3% and 21% and 10.5% of isolates, respectively. Other genotypes were not detected from any of the samples. Out of the 18 fully genotyped isolates, 10 different MLVA-ompA genotypes were obtained. The most prevalent MLVA-ompA genotypes were 8.6.1-E (33.3%) and 8.5.2-D (16.6%). Genotype 8.6.1-E was common in both females and males. CONCLUSIONS: Our results showed that MLVA-ompA analysis was more discriminatory than ompA typing alone and, therefore, a suitable complement to ompA. Using this method, dominant genotypes in the community and transmission patterns in sexual networks could be identified. The high diversity of C. trachomatis strains in Tehran may be due to the low level of public health and awareness, and future studies are needed.

Recent advances in isolation and detection of exosomal microRNAs related to Alzheimer's disease.

Alzheimer's disease, a progressive neurological condition, is associated with various internal and external risk factors in the disease's early stages. Early diagnosis of Alzheimer's disease is essential for treatment management. Circulating exosomal microRNAs could be a new class of valuable biomarkers for early Alzheimer's disease diagnosis. Different kinds of biosensors have been introduced in recent years for the detection of these valuable biomarkers. Isolation of the exosomes is a crucial step in the detection process which is traditionally carried out by multi-step ultrafiltration. Microfluidics has improved the efficiency and costs of exosome isolation by implementing various effects and forces on the nano and microparticles in the microchannels. This paper reviews recent advancements in detecting Alzheimer's disease related exosomal microRNAs based on methods such as electrochemical, fluorescent, and SPR. The presented devices' pros and cons and their efficiencies compared with the gold standard methods are reported. Moreover, the application of microfluidic devices to detect Alzheimer's disease related biomarkers is summarized and presented. Finally, some challenges with the performance of novel technologies for isolating and detecting exosomal microRNAs are addressed.

Robotic digital microfluidics: a droplet-based total analysis system.

Developing automated platforms for point-of-need testing is a crucial global demand. Digital microfluidics is a promising solution for expanding integrated testing devices featuring ultimate control over the chemical and biological reactions in micro/nanoliter droplets. In this study, robotic digital microfluidics (RDMF) is introduced for the mechanical manipulation of the droplets precisely and inexpensively. A controllable and multifunctional arm equipped with several actuators is responsible for dispensing and manipulating droplets on a disposable superhydrophobic cartridge. The platform has been demonstrated with diverse functions, including droplet dispensing, transport, mixing, aliquoting, and splitting. Moreover, incorporating magnetic and heating modules into the system can realize particle manipulation and droplet heating. The liquid handling operations are investigated from both experimental and modeling perspectives. Handling a wide range of droplet sizes without needing high-voltage electric sources, integrability with different detection techniques, and ease of manufacturing are the main advantages of the RDMF platform compared to conventional digital microfluidic systems. The availability of a complete fluidic toolbox and multiple detection choices make RDMF promising for droplet-based total analysis technology. The system was applied for a urinalysis test to show its versatility in handling complex biochemical assays. The results entirely matched those obtained based on laboratory gold standard techniques.

Ex-Vivo and In-Vivo Expansion of Spermatogonial Stem Cells Using Cell-Seeded Microfluidic Testis Scaffolds and Animal Model.

AIMS: This study was designed to provide both ex-vivo and in-vivo methods for the extraction and expansion of spermatogonial stem cells (SSCs). METHODS: For in-vivo experiments, azoospermic mouse model was performed with Busulfan. Isolation, culture, and characterization of neonate mouse SSC were also achieved. We performed an in-vivo injection of labeled SSCs to the testes with azoospermia. In ex-vivo experiments, extracted SSCs were seeded on the fabricated scaffold consisting of hyaluronic acid (HA) and decellularized testis tissues (DTT). Immunofluorescence staining with PLZF, TP1, and Tekt 1 was performed for SSCs differentiation and proliferation. RESULTS: Several studies demonstrated efficient spermatogenic arrest in seminiferous tubules and proved the absence of spermatogenesis. Transplanted SSCs moved and settled in the basement covering the seminiferous tubules. Most of the cells were positive for Dil, after 4 weeks. An epithelium containing spermatogonia-like cells with Sertoli-like, and Leydig cells were evident in the seminiferous tubules of biopsies, and the IHC staining was significantly positive, 4 weeks after injection of SSCs. The results of the ex-vivo experiments showed positive staining for all markers, which was significantly enhanced in scaffolds of ex-vivo experiments compared with in-vitro seeded scaffolds. CONCLUSION: Ex-vivo SSC differentiation and proliferation using cell-seeded microfluidic testis scaffolds maybe effective for treatment of the azoospermia.

Evaluation of the Effect of Anterior Teeth Torque Values on the Space Occupied by Six Anterior Teeth: a Finite Element Analysis.

Statement of the Problem: Various factors have been introduced to achieve normal occlusion. One of them is anterior teeth torque that has a significant effect on orthodontic treatment outcomes. Purpose: The aim of this study was to investigate the effect of changes in anterior teeth torque on changes in the space occupied by six anterior teeth by using computer-aided three-dimensional interactive application (CATIA). Materials and Method: In this experimental finite element study, acrylic teeth with pre-adjusted MBT braces were aligned and three-dimensional (3D) scans were made by 3Dscaner. In the CATIA software program, upper incisors' torque was changed to -2, -4, -6, +2, +4 and+6 degrees and in the lower incisors to -1, - 3, -5, +3 and+5 degrees; the space was measured at 3 heights of maxillary incisor crowns and at incisal edges of mandibular incisors. Then maxillary incisors were then tapered and the measurements were made again. To evaluate the effect of tooth size, these procedures were carried out on teeth with +17% and -17% magnifications. Results: The results showed that by increasing anterior torque from 14.7 to 20.7 degrees in maxillary incisors, the space occupied by anterior teeth increased. Maximum changes were at cingulum height with 1.421mm. Reduction in anterior torque from 14.7 to 8.7 degrees resulted in a decrease in this space and maximum changes were observed in the cingulum height with 1.824mm. In the mandibular arch, a 10-degree change in anterior torque resulted in an -.752mm change in the space. Changes in the space occupied by anterior teeth was not significant in tapered and normal teeth in +6 and -6-degree torque (p Value= 0.78 and p Value=0.83). Conclusion: By increasing or decreasing the incisors' torque, the space occupied by anterior teeth increased and decreased, respectively. These changes were less in tapered teeth. Size variations had no significant effect on the results.

The effects of Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum loads on semen quality: Detection and quantitative analysis.

BACKGROUND: The loads of Chlamydia trachomatis (CT), Mycoplasma hominis (MH), and Ureaplasma urealyticum (UU) may impact infertility, as well as cause risk of transmission. The quality and quantity of semen demonstrate male reproductive health. This study aimed to investigate the semen quality affected by CT, MH, and UU loads. MATERIALS AND METHODS: 130 semen samples, including infertile and fertile cases, were collected and analyzed. The whole genomic DNA was extracted, and the desired genes' plasmids were constructed. The CT, MH, and UU loads were quantified by real-time PCR. The data were analyzed using SPSS version 24. RESULTS: The average age of participants was 35.2 ± 6.8 years. CT, MH, and UU frequency were 9.2% vs. 3.1%, 15.4% vs. 3.1%, and 15.4 vs. 3.1% in infertile and fertile men, respectively. The mean loads of CT, MH, and UU in infertile men were 6.44 log10 copies/ml (range 5.31-7), 4.24 log10 copies/ml (range 3.37-4.7), and 6.94 log10 copies/ml (range 5.08-8.69) respectively, which was significantly higher than fertile men. The findings revealed a significant correlation between CT and UU loads and semen parameters, whereas the load of MH displayed significant effects just on sperm motility, morphology, and the number of leukocytes. CONCLUSION: The absence of clinical manifestations may not indicate the quality of semen. The pathogens' loads may significantly influence the quality and properties of male reproductive health.

Successful treatment of plasmapheresis followed by interferon beta-1a in a child with severe COVID-19.

COVID-19 outbreak has become a global health concern due to challenges in treatment and high mortality rate; therefore, its therapeutic approaches play an important role in reducing the mortality rate and resolving this concern. Different therapies have been introduced, including interferon beta-1a and purification methods, for instance, plasmapheresis. In this article, we reported a child with severe COVID-19 who fully recovered after receiving plasmapheresis and interferon beta-1a.

Gastric phytobezoars as a very unusual cause of gastric outlet obstruction.

Bezoars are collections of indigestible foreign material found in the gastrointestinal tract. Phytobezoars are the most common among the types of bezoars. Treatment of phytobezoars is categorized into four types: chemical dissolution, endoscopic removal, adjuvant prokinetics, and surgery. Complications from phytobezoars can include gastric outlet obstruction (GOO), ileus, ulcerations, gastrointestinal bleeding, and perforation. Herein, we present an 86-year-old woman with refractory postprandial vomiting. Then, exploratory laparotomy was performed and the diagnosis was gastric phytobezoar. Phytobezoars-induced GOO is rare and its diagnosis is still a challenge.

Nonspecific orbital inflammation and thyroid eye disease, a rare comorbidity: report of two cases and review of literature.

BACKGROUND: To present the very rare comorbidity of developing non-specific orbital inflammation (NSOI) in two patients with histories of definite thyroid eye disease (TED). CASE PRESENTATION: Both patients complained of new-onset progressive proptosis although their thyroid disease was controlled and computed tomography scan revealed an intraorbital inflammatory mass. The pathological assessment indicated that both patients had developed fibrosing NSOI. Therefore, intravenous corticosteroids were administered. The mass regressed and the amount of proptosis was decreased in both patients. CONCLUSIONS: We reviewed all related cases in the literature and extracted their clinical and radiological characteristics for this paper. Ophthalmologists should consider TED and NSOI in patients with a new-onset complaint of proptosis. Despite rare comorbidity of TED and NSOI, it should be considered especially in patients with refractory proptosis, and lead to its further evaluation and prompt management.

The Possible Role of Pathogenic and Non-Pathogenic Bacteria in Initiation and Exacerbation of Celiac Disease; A Comprehensive Review.

Celiac Disease (CD) is an immune-mediated enteropathy, generally of the proximal intestine, that occurs in genetically susceptible individuals triggered by the ingestion of gluten. The incidence and frequency of CD are increasing, and it is predicted that CD affects approximately 1% of the people worldwide. The common clinical manifestations of CD are divided in two sections, including classic and non-classic symptoms that can be created in childhood and adulthood. The relationship between pathogenic and non-pathogenic bacteria with CD is complex and multidirectional. In previous published studies, results demonstrated the triggering impact of bacteria, viruses, and parasites on initiation and development of Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS). Different studies revealed the inducing effect of pathogenic and non-pathogenic bacteria on CD. However, increasing evidence proposes that some of these microorganisms can also play several positive roles in CD process. Although information of the pathogenesis of the CD is quickly expanding, the possible role of bacteria needs further examination. In conclusion, with respect to the possible correlation between different bacteria in CD, the current review-based study aims to discuss the possible relationship between CD and pathogenic and non-pathogenic bacteria and to show various and significant aspects of mechanisms involved in the CD process.

Are Viruses and Parasites Linked to Celiac Disease? A Question that Still has no Definite Answer.

Celiac Disease (CD) is a complex autoimmune enteropathy of the small intestine that commonly occurs in genetically predisposed individuals due to intake of gluten and related proteins. Gluten consumption, duration of breast-feeding, various infections, especially frequent intestinal infections, vaccinations and use of antibiotics can be linked to CD. It is predicted that it affects 1% of the global population and its incidence rate is increasing. Most of the people with the HLA-DQ2 or HLADQ8 are at a higher risk of developing this disease. The link between infections and autoimmune diseases has been very much considered in recent years. In several studies, we explained that pathogenic and non-pathogenic microorganisms might have multiple roles in initiation, exacerbation, and development of Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD). In various studies, the relationship between infections caused by viruses, such as Epstein-Barr Virus (EBV), Rotavirus, Hepatitis C (HCV), Hepatitis B virus (HBV), Cytomegalovirus (CMV), and Influenza virus, and parasites including Giardia spp. and Toxoplasma gondii with CD has been raised. However, increasing evidence proposes that some of these microorganisms, especially helminths, can also have protective and even therapeutic roles in the CD process. Therefore, in order to determine the role of microorganisms in the process of this disease, we attempted to summarize the evidence suggesting the role of viral and parasitic agents in pathogenesis of CD.