Platelet-rich plasma therapy or arthroscopic surgery on repair of anterior cruciate ligament rupture.

The Anterior Cruciate Ligament (ACL) rupture reduces knee stability. In old patients with ACL rupture, surgery is not recommended due to the person's low level of activity and knee osteoarthritis. Platelet-rich plasma (PRP) is a good treatment option in inflammatory cases in orthopedics. Hence, the aim of this study was to assess and comparison of the effect of PRP and arthroscopic surgery on anterior cruciate ligament rupture. This is a clinical trial that was performed in 2020-2021 in Tehran. 100 patients were randomly divided into two groups. The first group of patients underwent ACL tendon repair surgery by arthroscopy and tendon graft. The second group were treated by PRP injection. Both groups of patients were visited from 3 months to 14 months after surgery or PRP treatments. The pain was assessed by Visual Analogue Scale (VAS), we also used Knee Score by the Oxford Score Knee Outcome Scale (OKS) to assess patient's functions. The mean VAS score was 3.05 ± 2.47 in patients in surgery group and mean VAS score was 4.39± 2.66 in patients in the PRP group (p = 0.03). These data showed significant improvements in VAS score in both groups with higher improvements in surgical group. After procedures, the ROM was 120.33 ± 19.60º in surgery group and 109.31 ± 17.22º in PRP group (p = 0.03). Patients in both groups had significantly decreased pain severity after 14 months, but the patients in the surgical treatment group had significantly lower pain and higher ROM compared to PRP group.

Comparison of surgical complications following hip hemiarthroplasty between the posterolateral and lateral approaches.

INTRODUCTION: Femur neck fractures are common fractures among the elderly. Hemiarthroplasty is a surgical choice for femur neck fractures in patients older than 70 years. This surgery is performed using two main methods: Posterolateral and Direct lateral. Here in this study, we aimed to evaluate and compare surgical and post-surgical complications of these two methods. MATERIALS AND METHODS: This retrospective study was performed on 154 patients with femur neck fractures between 2017-2021. All patients with femur neck fractures who had been under hemiarthroplasty entered this study. Data regarding complications such as dislocation, mortality, cause of mortality, repeated surgery and incidence of deep vein thrombosis (DVT) in both Posterolateral and Direct lateral surgical approaches were collected and analyzed. RESULTS: We indicated that there is no significant difference between the two surgical approaches regarding dislocation (P=0.06), mortality (P=0.598) and repeated operation (P=0.550). CONCLUSION: Taken together there are no significant differences between the two surgical approaches and we suggest that clinicians could decide based on their experiences and the clinical condition of patients.

Evaluation of femoral malrotation after intramedullary nailing.

BACKGROUND: Intramedullary nailing and closed reduction are one of the most important treatment strategies for femoral shaft fractures. Malrotation in the femoral shaft is a complication that requires exact investigations. Here we aimed to evaluate and report the outcomes of malrotation of femur in patients with femoral shaft fractures following antegrade intramedullary nailing. METHODS: In this cross-sectional study, 140 patients who had referred to Shahid-Beheshti Hospital in Abadan, Iran and had undergone antegrade intramedullary fixation for isolated femoral shaft fracture during a 6-year period from 2015 to 2021 were enrolled. Demographic information and disease-related information were collected. During operation, the patients were assessed clinically for malrotation of femur with 90° of the knee flection and with the hip in 0° flexion and then in the postoperative follow-up period, the patient was examined again and a computed tomography scan requested to identify the degree of malrotation of femur and the observers were unaware of the CT scan result at the time of the clinical examination. We also measured the amount of internal and external rotation while the patient in the lying supine position with 90° flexion in the knee and hip joint and lying prone position with hip extension. In CT imaging to determine the amount of malrotation of femur, the angle between a line drawn across the two femoral condyles in the posterior aspect and the femoral neck shows the amount of rotation. RESULTS: Degree of rotational deformity, less than 5°, 5 to 10° and 10 to 15° was less than 8.6%, 75.7% and 15.7% respectively and did not relate to age, sex, fracture location and activity of the patients (P>0.05). There was a strong linear correlation with the average predictive power between clinically detected torsional deformity in comparison with the CT detected torsional deformity (r=0.333 and P=0.005), which was stronger in women than men (r=0.336 in men and r=0.659 in women) (P<0.05). There was a strong linear correlation with the average predictive power between clinically detected torsional deformity in comparison with the CT detected torsional deformity was observed only in external malrotation of femur (r=0.541 and P=0.001). A poor inverse linear relationship was observed between clinically detected and CT detected torsional deformity with the age of the patients which the correlation of clinically detected was more than the CT detected (r in clinical examination =-0.285 and r in CT measurement =-0.246) (P<0.05). CONCLUSION: In this study, there was no femoral malrotation over 15° that was associated with clinical symptoms. However, a CT scan should be performed for accurate diagnosis and necessary measures but it does not seem necessary to perform in all patients.

Comparison of two different stems for total hip arthroplasty.

BACKGROUND: Total hip arthroplasty (THA) is the golden standard in treating severe osteoarthritis, which has not responded to conservative treatment. This study aimed to evaluate and compare the therapeutic results of THA using Short-stem and Standard-stem prostheses. METHODS: The study was a randomized clinical trial without a control group that was performed in 2020. A total number of 156 patients were recruited over three years. Patients were divided into two groups. The first group was treated with a Short-stem prosthesis and the second group was treated with a Standard-stem prosthesis. Patients were visited according to a schedule. At each visit, a control graph was prepared and the condition of the bone prosthesis and its position were examined. Also, the status of cane use and weightlifting were evaluated. Clinical signs such as pain, lameness, and the ability to climb stairs were assessed and recorded based on the Harris scale. Patients were also evaluated for surgical complications such as infection or limb length discrepancy. RESULTS: Data of 140 patients were analyzed. The mean age of patients was 60.2 ± 6.38 years. The amount of bleeding in the short-stem group was significantly lower than the standard-stem group (380.17 ml versus 430.13 ml, P = 0.001). In both groups, there was a significant increase in Harris score after the end of the study compared to before the operations. Furthermore, Harris's mean score was higher in the short-stem group compared to standard-stem group. However, these significant differences were observed only in the sixth week (P < 0.0001) and the third month (P < 0.0001). CONCLUSION: The use of Short-stem prosthesis in the short term can play a role in improving patient performance but in the long term evaluations, there is no apparent difference with the use of Standard-stem prostheses.

Outcomes of acromioclavicular joint dislocation using tightrope arthroscopy.

BACKGROUND: Based on different treatment outcomes and different treatment methods for acromioclavicular dislocation, we decided to evaluate the treatment outcomes of acromioclavicular joint dislocation using tightrope arthroscopy. METHODS: This retrospective cross-sectional study was performed on patients with acromioclavicular joint dislocation referred to Alzahra Hospital in Isfahan and Abadan-Iran from 2015 to 2017. Information that was assessed included age, sex, type of dislocation (Figure 1), duration of injury, cause of injury, complications such as osteoarthritis, changes in the distance between the joints, as well as the American Shoulder and Elbow Surgeons Shoulder Score (ASES) were collected after 6 months of surgery. RESULTS: There was a significant relationship between horizontal change instability and type of injury that 9 cases (60%) of type 5 of injury and 0 of type 3 had horizontal change instability (P=0.01). There was a reverse significant correlation between ASES score and duration of injury (r=-0.58, P=0.01). CONCLUSION: Acromioclavicular joint dislocations could successfully be treated with the TightRope system. We also showed that patient's pain and functions are diversely correlated with injury durations.

Outcomes of patients with humerus fracture under treatment with PHILOS plate.

BACKGROUND: Based on the contradictory results about the effect of an intramedullary nail in the treatment of humeral shaft fracture, in this study, we aim to evaluate the outcomes of patients with humeral fracture treated with PHILOS plaque. METHODS: In this cross-sectional study, which was performed to evaluate the recovery rate of patients with humeral fracture treated with PHILOS plaque referred to Shahid Beheshti Hospital in Abadan-Iran during 2015-2019. Constant Shoulder Score was evaluated six months and one year after the operation. RESULTS: The mean constant shoulder score was increased significantly after 1 year compared to 6 months (P<0.001). The means of constant shoulder score 6 months in type 4 of fracture was significantly higher than type 3 of fracture (P=0.03) but there was no significant relationship between the means of constant shoulder score 1 year after surgery and type of fracture. CONCLUSION: We suggest that orthopedic surgeons should pay more attention to the usage of PHILOS plate in patients with humerus fractures especially the type 4 fracture.

Modified Camitz versus BRAND Procedures for the Treatment of Severe Carpal Tunnel Syndrome: A Comparative Trial Study.

BACKGROUND: Carpal tunnel syndrome (CTS) is characterized by complications such as pain, paresthesia, and numbness in the fingers. There are some surgical therapies for the management of severe carpal tunnel, but differences exist between the treatments available for creating the opposition. The current study was conducted to compare the effect of modified Camitz and BRAND techniques on thumb opposition in patients with severe CTS. METHODS: A total of 40 patients with severe CTS who were candidates for opponensplasty were enrolled in this clinical trial study at Alzahra and Kashani hospitals, Isfahan, Iran, from 2014 to 2018. The patients were divided into two groups of modified Camitz and BRAND. Quick DASH-9 and Kapandji scores as well as pulp and side pinch and pronation angle were assessed before and after the surgeries. RESULTS: Quick DASH-9 score, Kapandji score, pulp and side pinch and pronation angle significantly improved post-operatively (P=0.0XXX, P=0.0XXX, P=0.0XXX, P=0.0XXX, and P=0.0XXX, respectively). But, no significant differences were seen in the mentioned variables between both groups pre and post-operative (P>0.05, for all the studied variables). No postsurgical complications were seen in any of the groups. CONCLUSION: The findings of the present study demonstrated that, both Modified Camitz and BRAND techniques are effective and safe techniques, yielding high improvements, but no serious complications. Both techniques can be considered for treatment of patients with severe CTS.

Visual inspection results of ultrasound guided biopsy specimens and compared with open biopsy pathologic in patients with breast lesions.

BACKGROUND: Core needle biopsy (CNB) method is a common method and a gold standard for the diagnosis of breast lesions. The purpose of this study was to compare the results of visual inspection of ultrasound guided biopsy specimens with pathologic outcomes in patients with breast lesions. METHODS: This cross-sectional descriptive was conducted on 600 patients with breast lesions who were candidates for ultrasonography with CNB were entered into the study. Then, patients underwent sonography with needle biopsy, in a sample taken by The radiologist classifies the breast mass according to its consistency and shape based on observation to the malignant or benign, as well as the Breast Imaging Reporting and Data System or Mass BIRADs. visual inspection results were compared with the CNB pathology of patients. RESULTS: In this study, the sensitivity and specificity of the lesion were 97.48% and 94.10%, respectively, and positive and negative predictive values of this test were 85.64% and 99.05%, respectively. CONCLUSION: Given that the sensitivity and specificity of the biopsy lesions to detect the type of mass was higher than the pathology of the sample, it can be ensured that the biopsy of breast lesions, especially in sizes less than 10 mm in time Increased the biopsy and reduced the number of cores taken from the lesion.

Bile duct injury outcomes following cholecystectomy: a cross sectional study.

BACKGROUND: Considering the importance of the repairing time in patients with biliary duct injury, the aim of this study was to evaluate the outcomes of patents with bile duct injury following cholecystectomy. METHODS: In this cross sectional study that was conducted on 64 patients with bile duct injury following cholecystectomy was referred to Shafa hospital in Tehran-Iran during 2010-2019 due to repair of biliary duct. Then patients were divided into two groups based on early and late referring time after bile duct injury, the postoperative outcomes were evaluated in two groups. RESULTS: The alanine transaminase (ALT) and the aspartate aminotransferase (AST) in the late group were significantly higher than the early group. There were significant differences between the two groups based on the results of endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) (P < 0.05). The frequency of bile duct dilatation, cholangitis and itching in late group were significantly higher than early group, also the frequency of uncomplicated outcome in the early group were significantly more than late group (P < 0.05). CONCLUSION: The postoperative complication of biliary duct injury reduced, if patients diagnosed and referred at the same early stages (early referral).

Tidal amplification and salt intrusion in the Mekong Delta driven by anthropogenic sediment starvation.

Natural resources of the Mekong River are essential to livelihood of tens of millions of people. Previous studies highlighted that upstream hydro-infrastructure developments impact flow regime, sediment and nutrient transport, bed and bank stability, fish productivity, biodiversity and biology of the basin. Here, we show that tidal amplification and saline water intrusion in the Mekong Delta develop with alarming paces. While offshore M2 tidal amplitude increases by 1.2-2 mm yr-1 due to sea level rise, tidal amplitude within the delta is increasing by 2 cm yr-1 and salinity in the channels is increasing by 0.2-0.5 PSU yr-1. We relate these changes to 2-3 m bed level incisions in response to sediment starvation, caused by reduced upstream sediment supply and downstream sand mining, which seems to be four times more than previous estimates. The observed trends cannot be explained by deeper channels due to relative sea level rise; while climate change poses grave natural hazards in the coming decades, anthropogenic forces drive short-term trends that already outstrip climate change effects. Considering the detrimental trends identified, it is imperative that the Mekong basin governments converge to effective transboundary management of the natural resources, before irreversible damage is made to the Mekong and its population.

Fingolimod and changes in hematocrit, hemoglobin and red blood cells of patients with multiple sclerosis.

INTRODUCTION: Fingolimod is the first oral drug approved by Food and Drug Administration (FDA) of United States for treating patients with relapsing-remitting multiple sclerosis (RRMS). Fingolimod acts by immunomodulation but there are still much remained about its different effects. OBJECTIVES: The aim of this study was to evaluate the changes in hematocrit (Hct), hemoglobin (Hb), and red blood cells (RBC) of patients with MS under treatments with fingolimod. METHODS: A total number of 66 MS patients were included to our study based on certain exclusion criteria and eligibility for fingolimod oral treatment. Hct, Hb, and RBC were measured for each patient before drug administrations. Patients were treated with Fingolimod. 5 mg daily and after three months of treatments, measurements of Hct, Hb, and RBC were performed. Data were analyzed using SPSS software version 24. RESULTS: Amounts of Hct, Hb, and RBC were significantly decreased in this patient cohort. Hematocrit was decreased in all patients. Hemoglobin levels were significantly decreased in the female cohorts. Such decreases for male patients were insignificant. Red blood cell counts were also significantly decreased in patients. CONCLUSION: Accumulating line of evidence had surveys on different side effects of fngolimod but here we indicated that fingolimod will also decrease amounts of Hct, Hb, and RBC which could result further problems in patients susceptible to other diseases.

Clinical presentation of carpal tunnel syndrome with different severity: a cross sectional study.

Background: Carpal tunnel syndrome is a common neuropathy in the hand which presented with pain and paresthesia in the hands and the wrists. The aim of our study was evaluated clinical symptoms of patients with different severity of CTS. Methods: This study is a cross-sectional study was performed on 40 patients referred to Emam khomeyni Hospital in Tehran from 2017 to late 2019 with symptoms of CTS and have been diagnosed with a definite diagnosis. Results: A positive significant correlation was between severity of CTS and age, and reverse significant correlation was between severity of CTS with duration of symptoms. There were significant relationships between severity of CTS and shaking or ringing the hands symptoms, weakness or atrophy of the flexion test and reverse phalen test (P < 0.05). Conclusion: Clinical symptoms of CTS can be diagnosing different severity of disease, so considering of symptoms can plays a predominant role in the diagnosis of the disease.

Effects of gamma oryzanol supplementation on anthropometric measurements & muscular strength in healthy males following chronic resistance training.

BACKGROUND & OBJECTIVES: Enhanced muscle strength is seen when resistance exercise is combined with the consumption of nutritional supplements. Although there is a limited number of studies available about the efficacy of gamma oryzanol supplementation with resistance exercise in humans, but its usage as a nutritional supplement for strength is common in athletes. The aim of this study was to determine the effects of gamma oryzanol supplementation during 9-week resistance training on muscular strength and anthropometric measurements of young healthy males. METHODS: In this double-blind clinical trial, changes of anthropometric measurements and muscular strength were studied after chronic resistance exercise and gamma oryzanol supplementation in 30 healthy volunteers (16 in supplement and 14 in placebo). Each day, gamma oryzanol supplement (600 mg) and placebo (the same amount of lactose) were consumed after training. The participants exercised with 80 per cent 1-Repetition Maximum (1-RM), for one hour and four days/week. Anthropometric measurements and subjects' 1-RM for muscular strength were determined at the commencement and end of the 9-week study. RESULTS: There was no significant difference between the baseline characteristics and target variables at baseline between the two groups. After gamma oryzanol supplementation, there was no significant difference in the means of anthropometric and skin fold measurements between the supplement and placebo groups. However, there were significant differences between the supplement and placebo groups for 1-RM of bench press and leg curl, which showed that gamma oryzanol improved muscle strength following resistance training. INTERPRETATION & CONCLUSIONS: Our findings indicated that 600 mg/day gamma oryzanol supplementation during the 9-week resistance training did not change anthropometric and body measurements, but it increased muscular strength in young healthy males. Further, studies need to be done in trained athletes, women, and in patients who suffer from muscular fatigue.