Reconstruction of Chest Wall Using a Two-Layer Prolene Mesh and Bone Cement Sandwich

Wide surgical resection is the most effective treatment for the vast majority of chest wall tumors. This study evaluated the clinical success of chest wall reconstruction using a Prolene mesh and bone cement prosthetic sandwich. The records of all patients undergoing chest wall resection and reconstruction were reviewed. Surgical indications, the location and size of the chest wall defect, diaphragm resection, pulmonary performance, postoperative complications, and survival of each patient were recorded. From 1998 to 2008, 43 patients (27 male, 16 female; mean age of 48 years) underwent surgery in our department to treat malignant chest wall tumors: chondrosarcoma (23), osteosarcoma (8), spindle cell sarcoma (6), Ewing''s sarcoma (2), and others (4). Nine sternectomies and 34 antero-lateral and postero-lateral chest wall resections were performed. Postoperatively, nine patients experienced respiratory complications, and one patient died because of respiratory failure. The overall 4-year survival rate was 60 %. Chest wall reconstruction using a Prolene mesh and bone cement prosthetic sandwich is a safe and effective surgical procedure for major chest wall defects.     

Lithium decreased endothelium‐mediated,but not nonadrenergic noncholinergic,relaxation of guinea pig corpus cavernosum in vitro: a role for nitrergic system

Lithium causes erectile dysfunction in patients but its mechanism is yet unknown. The aim of our study was to verify the effect of acute lithium administration on the nonadrenergic noncholinergic (NANC)‐ and endothelium‐mediated relaxation of guinea pig isolated corpus cavernosum. Although lithium (0.5, 1, and 5 mm ) had no effect on the neurogenic relaxations, it significantly (P < 0.001) attenuated the relaxant responses to acetylcholine in a concentration‐dependent manner. Combination of low concentration of lithium (0.5 mm ) with either 0.1 or 1 μm l ‐NAME significantly (P < 0.001) reduced the endothelium‐mediated relaxation. Although the Nitric oxide (NO) precursor l ‐arginine at 1 mm did not alter the relaxant responses to acetylcholine in control strips, it improved the inhibition by lithium (1 mm ) of relaxant responses to acetylcholine. Sodium nitroprusside (SNP; 10 nm –1 mm ) produced similar concentration‐dependent relaxations in both groups. Our experiments indicated that lithium can result in impairment of the NO‐mediated endothelium‐dependent but not NANC relaxation of guinea pig corpus cavernosum.     

Long-term fatigue after perimesencephalic subarachnoid haemorrhage in relation to cognitive functioning,mood and comorbidity

Purpose: To study relationships between fatigue and objective and subjective cognitive functioning, mood and comorbidity in the long term after perimesencephalic subarachnoid haemorrhage (PM-SAH).

Methods: Cross-sectional study. Objective cognitive functioning was measured with: Trail Making Test; Symbol Substitution; D2; Verbal and Semantic Fluency; Tower Test; Digit Span; 15-Words Test; Rey Complex Figure. Subjective cognitive functioning: Cognitive Failure Questionnaire. Fatigue: Fatigue Severity Scale. Mood: Hospital Anxiety and Depression Scale.

Results: Forty-six patients, mean age 50.4 (SD?=?9.4), mean time after PM-SAH 4.7 (SD?=?1.6) years participated. Patients with fatigue (33%) had significantly lower scores than patients without fatigue on most objective cognitive functioning tests (p?Conclusions: This study supports our previous findings that a third of patients with PM-SAH experience fatigue and problems of cognitive functioning, also in the long term. Future research should investigate whether these patients would benefit from long-term follow-up and/or cognitive rehabilitation programmes.

• Implications for Rehabilitation

• Consequences for patients with PM-SAH are underestimated.

• One in every three patients suffered from fatigue in the long term after onset of PM-SAH.

• Patients with PM-SAH should be screened for problems of cognitive functioning, fatigue and mood in outpatient clinic just as patients with aneurysmal SAH.

     

Clinical features of epilepsy at 2 referral hospitals in Northern Iran

Objective:

To investigate the demographic and clinical characteristics of epilepsy in 2 referral hospitals in northern Iran.

Methods:

In this cross-sectional study, we evaluated 300 patients with the confirmed diagnosis of epilepsy referred to the Neurology clinics of 22-Bahman, and 17-Shahrivar Hospitals, Mashad, Iran, from April 2011 to December 2012. We collected and analyzed demographic and disease information.

Results:

The mean age of patients was 31.5 ± 15.3 years. The diagnosis of disease had been made approximately 10 months after the onset of symptoms, and the treatment gap was 28%. The most widely used anticonvulsants were sodium valproate, carbamazepine, and phenobarbital. Generalized seizure was seen in 78%, partial seizure in 22%, and a combination of them in 11% of patients. Tonic-colonic seizure (72%) was the most common type of generalized epilepsy, and secondarily generalized seizure was the most frequent type of partial epilepsy.

Conclusion:

The epidemiological features of epilepsy in our region with regard to age and gender are the same as other parts of the world. The generalized type is the most common form of epilepsy, with tonic-colonic seizures being the most frequent type in our area.Epilepsy is a common and chronic neurological disorder that affects individuals of all ages and is characterized by recurrent (2 or more) unprovoked epileptic seizures.1 Seizure is an episode of involuntary movement, which may involve a part of the body or the entire body (generalized) and may be accompanied by loss of consciousness and control of bowel or bladder function. Seizure episodes are caused by abnormal electrical discharge in a group of brain cells. The age-adjusted prevalence and incidence of epilepsy in the general population are approximately 5 per 1000 person-years, and 50 per 100,000 person-years.2 The lifetime prevalence rate of epilepsy in developed countries is 3.5 to 10.7 per 1,000 person-years.3,4 Epilepsy affects 50 million people worldwide.5 The prevalence and incidence of epilepsy and consequently its burden is higher in developing countries than in developed countries.6 Approximately 80% of patients with epilepsy live in developing countries and so 80% of the disease burden is attributed to developing countries.6 Detailed classification of seizures and epilepsy is essential to understanding its nature, with a rational plan of investigation and decision making regarding the timing and duration of treatment and choice of antiepileptic drug. As our country is a developing country, better understanding of epilepsy features could provide better management and control of disease, and so decrease the burden of it. As the epidemiological and clinical characteristics of epilepsy are not yet completely understood in Iran, this study aimed to investigate the demographic and clinical features of epilepsy in 2 referral hospitals in our region.     

The Epworth Sleepiness Scale: translation and validation study of the Iranian version

Purpose

The main purpose of this study was to assess the reliability and validity of the Iranian version of the Epworth Sleepiness Scale (ESS-IR).

Methods

This was a cross-sectional study of 507 suspicious patients either to obstructive sleep apnea (n?=?466) or narcolepsy (n?=?41) in order to carry out a psychometric evaluation of the ESS-IR by performing reliability, validity, and responsiveness analyses. Reliability of the ESS-IR was assessed by internal consistency and test–retest reliability. Validity of the instrument was assessed using several statistical approaches including construct validity (exploratory factor analysis), discriminant validity, and criterion validity. Responsiveness of the ESS-IR was assessed by comparing the ESS-IR total score before and after 6–9 months of continues positive airway pressure (CPAP) treatment in 16 patients with obstructive sleep apnea (OSA).

Results

The ESS-IR had an acceptable internal consistency and test–retest reliability. Factor analysis in both groups showed a two-factor solution for the ESS-IR, but the first factor showed statistically significant loads in all items. In addition, the ESS-IR discriminated well between patients with and without OSA. There is a fair correlation between the ESS-IR total score and multiple sleep latency test results that is not significant at all. Finally, the ESS-IR was found to be responsive to change where the total score was significantly decreased after CPAP treatment (P?<?0.001).

Conclusion

The findings suggest that the ESS-IR is a reliable and valid measure for evaluating daytime sleepiness and now can be used in research and clinical settings in Iran.     

Effect of Heparin on Post-Operative Adhesion in Flexor Tendon Surgery of the Hand

Flexor tendon laceration is a common hand injury. Timely and correct diagnosis of this defect is an important factor for restoring hand function. Post-operative adhesion is a frequent problem after tendon repair and its prevention is difficult in some types of tendon lacerations. There have been some controversial studies on the positive effect of some materials and substances on prevention of these adhesions. This study aims to evaluate effects of the Heparin in postoperative tendon adhesions. In this clinical trial, 100 patients with laceration of flexor tendons in zone II of the hand were enrolled. The patients were randomly divided into two groups. In the first group, 0.5 cc Heparin (5000 IU/cc) was injected into each tendon ends before tendon repair. In the control group, repair was carried out without any heparin injection. After 3 months the total active range of motion (TAROM), mean extension gap (MEG) and mean flexion gap (MFG) were measured and compared between these two groups. The TAROM and MEGs were not significantly different between two groups; but MFGs were significantly better in Heparin treated group (P < 0.02). However rupture rate was significantly higher in heparin treated group (P = 0.003). Heparin may improve the tendons function and reduce the postoperative adhesions in zone II of the hand; however there is a significant risk of tendon rupture.     

Prognostic role of the Donor Risk Index,the Eurotransplant Donor Risk Index,and the Balance of Risk score on graft loss after liver transplantation

This study aimed to identify cutoff values for donor risk index (DRI), Eurotransplant (ET)-DRI, and balance of risk (BAR) scores that predict the risk of liver graft loss. MEDLINE and Web of Science databases were searched systematically and unrestrictedly. Graft loss odds ratios and 95% confidence intervals were assessed by meta-analyses using Mantel–Haenszel tests with a random-effects model. Cutoff values for predicting graft loss at 3 months, 1 year, and 3 years were analyzed for each of the scores. Measures of calibration and discrimination used in studies validating the DRI and the ET-DRI were summarized. DRI ≥ 1.4 (six studies, n = 35 580 patients) and ET-DRI ≥ 1.4 (four studies, n = 11 666 patients) were associated with the highest risk of graft loss at all time points. BAR > 18 was associated with the highest risk of 3-month and 1-year graft loss (n = 6499 patients). A DRI cutoff of 1.8 and an ET-DRI cutoff of 1.7 were estimated using a summary receiver operator characteristic curve, but the sensitivity and specificity of these cutoff values were low. A DRI and ET-DRI score ≥ 1.4 and a BAR score > 18 have a negative influence on graft survival, but these cutoff values are not well suited for predicting graft loss.     

Subtrochanteric Fractures: Comparison of Proximal Femur Locking Plate and Intramedullary Locking Nail Fixation Outcome

Fixation of subtrochanteric fracture, even for experienced surgeons, is a challenge. This fracture is most difficult to treat, and the incidence of complications in this type of fracture is higher. This study compared surgical results of two methods, proximal femur locking compression plate and intramedullary locking nail. This is an analytic study, performed on all patients with subtrochanteric fracture who were referred to the hospital during 3 years. They were treated with proximal femur locking plate or intramedullary locking nail. The postoperative complications were evaluated and recorded. Finally, the data were analyzed by SPSS software. Complications were studied in both groups. Neither treatment has statistically significant difference in complications, onset of complications incidence, and time of full-weight bearing. Although the Harris Hip Score among patients improved in both methods of treatment, there is no significant difference between the two groups. The results of subtrochanteric fracture fixation by intramedullary or locking plate were similar and had the same outcome.     

Immobilized copper nanoparticles on nitrogen-rich porous activated carbon from egg white biomass: a robust hydrophilic–hydrophobic balance catalyst for click reaction

Biomass conversion to carbonaceous materials and their use in various applications, such as capacitors, catalyst supports, and adsorbents, have attracted considerable attention from the viewpoint of green chemistry. In this regard, chicken egg white is one of the most important biomass, which can act as an in situ nitrogen doping source. In this paper, nitrogen-rich porous carbon material was synthesized from egg white biomass via pyrolysis at 600 °C under nitrogen atmosphere, followed by chemical activation with KOH at 500 °C. The results showed that the as-synthesized porous carbon material has a high content of nitrogen and high surface area, on which nitrogen can tune the surface hydrophobicity–hydrophilicity through interaction with water molecules. Then, the copper nanoparticles were immobilized on the surface of nitrogen-rich activated carbon by a chemical reduction method. Nanocatalyst structure was characterized by elemental analysis, TEM, AFM, Raman, FT-IR, porosimetry and atomic adsorption techniques. Finally, catalytic activity was evaluated for the one-pot synthesis of triazole in aqueous medium. The nanocatalyst offers some advantages such as excellent activity, low loading of catalyst, good yields of products and short reaction times.

Nitrogen-rich porous carbon (NAC) material was synthesized from egg white biomass via pyrolysis, followed by chemical activation with KOH. Then, the copper nanoparticles were immobilized on the surface of the NAC by chemical reduction method.