Rehabilitation Strategies in patients with Spinal Cord Injuries

ABSTRACTThe setting of rehabilitation for patients with spinal cord injured is promising environment. Attending the new strategies is useful to promote the treatment and the patient's ability. This method has a huge challenge for patients encountered with cognitive impairment. Patient education and skills at the rehabilitation center can be a challenging endeavor. By rehabilitation, patients suddenly evolve and they have to enhance the cognitive capacity to survive environmental changes face dramatic. These proceedings help the independence, self-esteem of the patients and help them cope with illness and life

The Synergistic Effect of Co-delivery of Anticancer Drugs Into Astrocytes Isolated From Human Glioblastoma Multiforme

Background: Chemotherapy drugs are not effective in the treatment of primary brain tumors due to the low efficacy of these drugs and drug transfer from the blood-brain barrier (BBB) toward the tumor site. Our purpose in this study was to assess the co-delivery of anticancer drugs to increase drug permeability from BBB.Methods: In this study, two chemotherapy drugs, namely methotrexate (MTX) and paclitaxel (PTX), were inserted into polyvinyl alcohol and poloxamer188-conjugated nanoparticles (NPs). Astrocytes were treated with different concentrations of 0-50 μg/ml from MTX, PTX, the MTX-PTX mixture, PTX-loaded NPs, MTX-loaded NPs, and PTX-MTX co-loaded NPs for 48 hours. The tumoricidal effect was assessed using the survival rate, Hoechst staining, and western blotting.Results: The results indicated significant reduction of the survival rate in astrocytes treated with PTX-MTX co-loaded NPs. In addition, apoptosis hallmarks consisting of fragmented DNA, overexpression of Bax, and expression reduction of Bcl-2 were in the cultured astrocytes.Conclusions: Our study proposes that the PTX-MTX co-delivery to NPs could be used as a possible approach for anti-cancer drug delivery to glioblastoma multiforme

The Role of Medical Ethics In Comprehensive Healthcare System

Daily development of the human knowledge, promotion of biomedical technologies and improvement of physicians' ability in diagnosis and treatment of different types of diseases have always accompanied plenty of discussions and challengeable subjects, especially from the view point of ethical issues.Obtaining deep and accurate recognition of these subjects, the attention of the physicians and the scholars of different fields, especially of the ethics has been drawn to medical ethics as a new solution in the comprehensive Healthcare System. Despite the great changes in medical technologies, there are still some concerns about the physicians' abilities in decision makings that may directly or indirectly affect the health or life of the people.Therefore these concerns have leaded to the appearance of new movements all calling for the patients' rights and the rights of society to participate in medical decision-makings. On the other hand we should notice about some other cases that play effective roles in policy makings of the comprehensive healthcare system. Fore instance, the required resources will vary following the changes in technology; the population especially of the elderly is increasing; moreover the time needed for the new work forces to be entered into the labor market has typically increased. Consequently, a higher number of people are waiting to benefit from the recourses and lower number of them is involved in producing the recourses.Thus, to work on the important topics like the requirements of human societies, ethical considerations of biotechnology and medical researches, Allocation of limited and immense resources, important ethical criteria of decision makings, representation of fundamental solutions and medical ethics trainings is considered as one of the most basic necessities of comprehensive healthcare system among others

Entanglement Of The Rights Of The Child, Well-Being And Justice: A Conceptual Framework For Child Protection And Well-Being

Background: Human Rights (HRs) framework supports improving human health status and the reduction of health inequalities through action on Social Determinants of Health (SDH). Given the shortcoming of HRs to protect the children, the question is, how can we ensure child protection and well-being rather than just child health?Methods: In this conceptual analysis study, first, we explain the fundamental rights of the child and the steering role of them in moving towards health equity through action on SDH; second, meanwhile argue the shortcoming of rights-based protection, provide a list of the core capabilities and corresponding rights of the child; and third, we represent a conceptual framework for child protection and well-being using both HRs norms and moral entitlements based on recent ethical theories of justice, with a preventive approach.Results: According to the framework, HRs instruments should lead to the protection of the child and the development of core capabilities through addressing social determinants and providing equal opportunities, of which the ability to live a healthy life is just one. In addition, actualizing these capabilities depends on the context. Since achieving well-being rather than just the health, in addition to acquiring the core capabilities as states of beings, implies their function as doings, that requires considering the socioecological context to provide means necessary to meet the essential dimensions of well-being at the level of adequacy.Conclusion: Implementing the suggested framework requires that each country create a national action framework and determine the role and duties of the responsible organizations

A Predictive Model for Assessment of Successful Outcome in Posterior Spinal Fusion Surgery

Background: Low back pain is a common problem in many people. Neurosurgeons recommend posterior spinal fusion (PSF) surgery as one of the therapeutic strategies to the patients with low back pain. Due to the high risk of this type of surgery and the critical importance of making the right decision, accurate prediction of the surgical outcome is one of the main concerns for the neurosurgeons.Methods: In this study, 12 types of multi-layer perceptron (MLP) networks and 66 radial basis function (RBF) networks as the types of artificial neural network methods and a logistic regression (LR) model created and compared to predict the satisfaction with PSF surgery as one of the most well-known spinal surgeries.Results: The most important clinical and radiologic features as twenty-seven factors for 480 patients (150 males, 330 females; mean age 52.32 ± 8.39 years) were considered as the model inputs that included: age, sex, type of disorder, duration of symptoms, job, walking distance without pain (WDP), walking distance without sensory (WDS) disorders, visual analog scale (VAS) scores, Japanese Orthopaedic Association (JOA) score, diabetes, smoking, knee pain (KP), pelvic pain (PP), osteoporosis, spinal deformity and etc. The indexes such as receiver operating characteristic–area under curve (ROC-AUC), positive predictive value, negative predictive value and accuracy calculated to determine the best model. Postsurgical satisfaction was 77.5% at 6 months follow-up. The patients divided into the training, testing, and validation data sets.Conclusion: The findings showed that the MLP model performed better in comparison with RBF and LR models for prediction of PSF surgery.Keywords: Posterior spinal fusion surgery (PSF); Prediction, Surgical satisfaction; Multi-layer perceptron (MLP); Logistic regression (LR) (PDF) A Predictive Model for Assessment of Successful Outcome in Posterior Spinal Fusion Surgery. Available from: https://www.researchgate.net/publication/325679954_A_Predictive_Model_for_Assessment_of_Successful_Outcome_in_Posterior_Spinal_Fusion_Surgery [accessed Jul 11 2019].Peer reviewe

Neuroprotective Strategies in the Perioperative Period: A Systematic Review

Surgery and anesthetics may cause brain damage, and the resulting neurological defect can impair the patient's cognitive function. This disorder is one of the most common complications after surgery and causes disorders in several cognitive areas of the patient. The mechanism of this disorder is not fully understood, but Neuronal inflammation is one of the main causes of this disorder. The purpose of this systematic review study was to evaluate neuroprotective drug strategies for the treatment or prevention of surgical disorders associated with anesthesia. We searched the keywords "neuroprotective", "neuroprotection", "postoperative" and "perioperative" in the databases of web of science, Scopus, PubMed, science direct and Google Scholar with a 5-year time limit. At first, 492 articles were obtained and finally, after detailed survey based on exclusion and inclusion criteria, 31 studies were selected to extract data. Findings from studies show that medication and treatment strategies used in group of mice and rats under surgery with treatment can improve Neuronal inflammation and brain damage compared to mice and rats with surgery only and reduce the side effects of surgery and anesthetics

Cut-off Value for Stenosis Ratio and Zung Depression Scale in Successful Prediction of Posterior Spinal Fusion surgery

Background: The aim of this study was to investigate effect of some clinical attributes in prediction of satisfaction with posterior spinal fusion (PSF) surgery in patients with lumbar disc herniation (LDH) and lumbar spinal canal stenosis (LSCS) and determine a cut-off point for these attributes.Methods: The attributes such as stenosis ratio (SR) values (described by Lurencin), Japanese Orthopaedic Association (JOA), The Zung depression scale (ZDS), duration of symptoms (in months), were investigated for 329 patients with LSCS and 151 patients with LDH separately. Patient satisfaction was recorded based on the international standard questionnaire Swiss Spinal Stenosis Score (SSS). The sensitivity and specificity values and the optimal cut-off points were calculated for SR, JOA, ZDS and duration of symptoms using receiver operating characteristic (ROC) analysis.Results: One hundred fifty-one patients with LDH (39 male, 112 female; mean age 50.24 ± 9.21 years) and 329 patients with LSCS (111 male, 218 female; mean age 53.28 ±7.81 years) were followed–up for 6 months. Post-surgical satisfaction was 73.86% in patients with LSCS and 85.43% in patients with LDH. The cut-off point of SR for prediction of besting surgical outcome was estimated more than 0.46 with asymptotic significance less than 0.05, 60% sensitivity and 75% specificity in LSCS patients (AUC-0.705, 95% CI, 0.644–0.766; P < 0.001).Conclusion: The findings show that the SR with a cut off value of 0.46 cross sectional area, in patients with LSCS may be superior to JOA, duration of symptoms and ZDS for prediction of satisfaction with PSF surgery

Molecular and Cellular Basis of Misfolded Proteins in Neurodegenerative Diseases

Neurodegeneration is characterized by a progressive loss of nerve structure and function which lead to cognitive impairment such as dementia. Neurodegenerative diseases (NDs) are partially caused by neuronal cell death and glial homeostasis. NDs such as Alzheimer’s disease (AD) and Parkinson’s disease (PD) can develop with aging. As well, in Huntington’s disease (HD) and amyotrophic lateral sclerosis (ALS), genetic mutations can affect CNS cell function. NDs occur through important processes including, protein misfolding and aggregation of misfolded proteins. These processes cause neurofibrillary tangles and plaques that result in neuronal cytotoxicity. Here, our intention is to shed light on some of the key roles of protein misfolding and aggregation in NDs. This review focuses specifically on understanding the molecular and cell-based mechanisms of protein misfolding and aggregation involved in the development of NDs