Teleexercise for geriatric patients with failed back surgery syndrome

IntroductionFailed back surgery syndrome (FBSS) is defined as back pain which either persists after attempted surgical intervention or originates after a spine surgery. There is a high risk of perioperative morbidity and a high likelihood of extensive revision surgery in geriatric patients with FBSS or post-laminectomy foraminal stenosis.MethodsThere is a need for less invasive methodologies for the treatment of FBSS, such as patient-tailored exercise training, with attention to the cost and special needs of the geriatric patients with FBSS. This commentary will provide some background regarding teleexercise (utilizing an internet-based platform for the provision of exercise-related care) for FBSS and will propose three exercises which are easy to administer over online-based platforms and can be the subject of future investigation.ResultsGiven the documented benefits of regular rehabilitative exercises for patients with FBSS, the high cost of face-to-face services, and the need for infection mitigation in the wake of the COVID-19 Pandemic, teleexercise may be a practical and cost-beneficial method of exercise delivery, especially for geriatric patients with limitations in mobility and access to care. It should be noted that, prescription of these exercises should be done after face-to-face evaluation by the physician and careful evaluation for any “red flag” symptoms.ConclusionIn this commentary, we will suggest three practical exercise training methodologies and discuss the benefits of teleexercise for geriatric patients with FBSS. Future research should aim to assess the efficacy of these exercises, especially when administered through telehealth platforms

A Survey of Medical Students’ Points of Views about the Outcomes of Immediate Feedback Assessment Tool in Team-Based Learning™ at Tehran University of Medical Sciences, Iran

Background & Objective: Utilizing the immediate feedback assessment to Technique (IF-AT) in team-based learning is a controversial issue due to its high cost. The aim of this study was to investigate medical students’ views about the outcomes of using IF-AT regarding the cooperation rate and method of students in team-based learning activates. Methods: This descriptive study was conducted in 2016 at the School of Medicine, Tehran University of Medical Sciences, Iran. The study population consisted of medical students who had experienced both team-based learning methods (with and without IF-AT). Convenience sampling was performed based on the willingness of students to complete a researcher-made, valid, and reliable questionnaire. Data were analyzed using SPSS software. Results: The IF-AT is designed for use in multi-response questions. Based on pre-determined patterns, the answer was hidden under a surface which was scratched off by students after discussing the answer. Of the 139 participants, 55.5% stated that utilizing IF-AT caused an increase in the time of discussion, and 38.8% believed that it had small or very small effect on the participation of students who would not previously take part in the discussion. In addition, 84.2% noted that the use of this tool increased the accuracy of answers. 85 (61.1%) believed that IF-AT made team discussion more exciting. Moreover, 53.2% noted that it enhanced the depth of the discussion, and 60.4% stated that discussions became more serious. However, the majority of students (50.3%) believed that it had little effect on the integration of knowledge of other subjects in answering questions. The students’ views in the open question, in addition to approving the quantitative results, showed that students may wait for other teams to reveal the answer before using their form. Conclusion: The students believed that the use of the IF-AT has positive effects on participation in team work. Although it may be a costly method, due to its positive effects from the perspective of students, the cost associated with buying or producing of the tool seems to be economical. In order to prevent the creation of a competitive educational environment, it is recommended that students be made effectively aware of the goals and rationales of using this tool. Student orientations should be done in multiple time intervals and must be taken into consideration on other related circumstance, such as professional code of conduct training. Key Words: Team-based learning, Active learning, Immediate feedback assessment Technique, Medical student

Effects of FK506 on Hippocampal CA1 Cells Following Transient Global Ischemia/Reperfusion in Wistar Rat

Transient global cerebral ischemia causes loss of pyramidal cells in CA1 region of hippocampus. In this study, we investigated the neurotrophic effect of the immunosuppressant agent FK506 in rat after global cerebral ischemia. Both common carotid arteries were occluded for 20 minutes followed by reperfusion. In experimental group 1, FK506 (6 mg/kg) was given as a single dose exactly at the time of reperfusion. In the second group, FK506 was administered at the beginning of reperfusion, followed by its administration intraperitoneally (IP) 6, 24, 48, and 72 hours after reperfusion. FK506 failed to show neurotrophic effects on CA1 region when applied as a single dose of 6 mg/kg. The cell number and size of the CA1 pyramidal cells were increased, also the number of cell death decreased in this region when FK506 was administrated 48 h after reperfusion. This work supports the possible use of FK506 in treatment of ischemic brain damage

FIZZ1 and Ym as Tools to Discriminate between Differentially Activated Macrophages

Although it is well-established that macrophages can occur in distinct activation states, the molecular characteristics of differentially activated macrophages, and particularly those of alternatively activated macrophages (aaMφ), are still poorly unraveled. Recently, we demonstrated that the expression of FIZZ1 and Ym is induced in aaMφ as compared with classically activated macrophages (caMφ), elicited in vitro or developed in vivo during infection with Trypanosoma brucei brucei. In the present study, we analyzed the expression of FIZZ1 and Ym in caMφ and aaMφ elicited during Trypanosoma congolense infection and show that the use of FIZZ1 and Ym for the identification of aaMφ is not limited to T. b. brucei infection and is independent of the organ sources from which macrophages are obtained. We also demonstrate that FIZZ1 can be used to discriminate between different populations of aaMφ. Furthermore, we studied the effects of various stimuli, and combinations thereof, on the expression of FIZZ1 and Ym in macrophages from different mouse strains and demonstrate that regulation of the expression of FIZZ1 and Ym in macrophages is not dependent on the mouse strain. Finally, we show that these genes can be used to monitor the macrophage activation status without the need to obtain pure macrophage populations

Correlation of Horizontal Cephalic Index and Cranial Parameters in Iranian Medical Students

Cranial parameters and cephalic indices are used to evaluate the racial and gender differences. The aim of this study was to assess the cephalic indices, to classify the type of cranium and to determine the relationship between the horizontal cephalic index and cranial parameters among Iranian medical students. This study was done on 200 medical students (100 males and 100 females) with an age range of 18-30-year-old. Head length, head breadth, and auricular height were measured by using a standard spreading caliper. Then cephalic indices were calculated for the classification of cranial type. The linear regression was used for examining the relationship between the horizontal cephalic index and head length, head breadth and auricular height. The results of this study showed that the mean of the horizontal, vertical, and transverse cephalic index in total students were 83.51±6.85, 85.58±5.85 and 102.77±6.35 cm, respectively. According to this result, the predominant head shapes in total students were brachycephalic, hypsicephalic and acrocephalic types. In this study, there was a strongly negative correlation between horizontal cephalic index with head length (r=-0.744, P=0.000), moderate positive correlation between horizontal cephalic index with head breadth (r=0.512, P=0.000) and weakly negative correlation between horizontal cephalic index with auricular height (r=-0.205, P=0.004). The data of the present study can be beneficial in craniofacial reconstruction, clinical diagnosis, and forensic applications

Wharton’s jelly mesenchymal stem cells attenuate global hypoxia-induced learning and memory impairment via preventing blood-brain barrier breakdown

Objective(s): Intracerebroventricular (ICV) injections of mesenchymal stem cells (MSCs) may improve the function and structure of blood-brain barrier (BBB), possibly by preserving the BBB integrity. This study examined the impact of Wharton’s jelly (WJ)-MSCs on cognitive dysfunction and BBB disruption following a protracted hypoxic state.Materials and Methods: Twenty-four male Wistar rats were randomly studied in four groups: Control (Co): Healthy animals, Sham (Sh): Rats were placed in the cage without hypoxia induction and with ICV injection of vehicle, Hypoxic (Hx)+vehicle: Hypoxic rats with ICV injection of vehicle (5 μl of PBS), and Hx+MSCs: Hypoxic rats with ICV injection of MSCs. Spatial learning and memory were evaluated one week after WJ-MSCs injection, and then animals were sacrificed for molecular research.Results: Hypoxia increased latency and lowered the time and distance required reaching the target quarter, according to the findings. Furthermore, hypoxic rats had lower gene expression and protein levels of hippocampus vascular endothelial (VE)-cadherin, claudin 5, and tricellulin gene expression than Co and Sh animals (P<0.05). Finally, administering WJ-MSCs after long-term hypoxia effectively reversed the cognitive deficits and prevented the BBB breakdown via the upregulation of VE-cadherin, claudin 5, and tricellulin genes (P<0.05).Conclusion: These findings suggest that prolonged hypoxia induces spatial learning and memory dysfunction and increases BBB disruption, the potential mechanism of which might be via reducing VE-cadherin, claudin 5, and tricellulin genes. Hence, appropriate treatment with WJ-MSCs could reverse ischemia adverse effects and protect the BBB integrity following prolonged hypoxia

Benefit of magnesium-25 carrying porphyrin-fullerene nanoparticles in experimental diabetic neuropathy

Diabetic neuropathy (DN) is a debilitating disorder occurring in most diabetic patients without a viable treatment yet. The present work examined the protective effect of 25Mg-PMC16 nanoparticle (porphyrin adducts of cyclohexil fullerene-C60) in a rat model of streptozotocin (STZ)-induced DN. 25Mg-PMC16 (0.5 lethal dose50 [LD50]) was administered intravenously in two consecutive days before intraperitoneal injection of STZ (45 mg/kg). 24Mg-PMC16 and MgCl2 were used as controls. Blood 2,3-diphosphoglycerate (2,3-DPG), oxidative stress biomarkers, adenosine triphosphate (ATP) level in dorsal root ganglion (DRG) neurons were determined as biomarkers of DN. Results indicated that 2,3-DPG and ATP decreased whereas oxidative stress increased by induction of DN which all were improved in 25Mg-PMC16-treated animals. No significant changes were observed by administration of 24Mg-PMC16 or MgCl2 in DN rats. It is concluded that in DN, oxidative stress initiates injuries to DRG neurons that finally results in death of neurons whereas administration of 25Mg-PMC16 by release of Mg and increasing ATP acts protectively

Developing a Microanalytic Self-regulated Learning Assessment Protocol for Biomedical Science Learning

Background & Objective: Self-regulated learning (SRL) is highly task and context dependent. Microanalytic assessment method measures students’ SRL processes while performing a particular learning task. The present study aimed to design a microanalytic SRL assessment protocol for biomedical science learning. Methods: This mixed method study was conducted in Tehran University of Medical Sciences, Iran, in 2013. The data collection tool was a microanalytic SRL assessment protocol that was designed based on the literature review, expert opinion, and cognitive interview with medical students, and then, piloted. The participants consisted of 13 second year medical students. The subjects were interviewed while conducting a biomedical science learning task. Interviews were recorded, transcribed and coded based on a predetermined coding framework. Descriptive statistics were used to analyze the data. Results: The microanalytic SRL assessment protocol was developed in three parts; interview guide, coding framework, and biomedical science learning task. An interview guide was designed consisting of 6 open-ended questions aimed at assessing 5 SRL sub-processes of goal setting, strategic planning, meta-cognitive monitoring, causal attribution, and adaptive inferences and a close-ended question regarding self-efficacy. Based on the pilot study, most participants reported task-specific and task-general processes for the sub-processes of strategic planning (92%), metacognitive monitoring (77%), causal attribution (85%), and adaptive inferences (92%). Conclusion: The developed protocol could capture the fine-grained nature of the self-regulatory sub-processes of medical students for biomedical science learning. Therefore, it has the potential application of modifying SRL processes in early years of medical school. Key Words: Self-regulated learning, Microanalytic assessment method, Biomedical science learnin

A nanobody modulates the p53 transcriptional program without perturbing its functional architecture

The p53 transcription factor plays an important role in genome integrity. To perform this task, p53 regulates the transcription of genes promoting various cellular outcomes including cell cycle arrest, apoptosis or senescence. The precise regulation of this activity remains elusive as numerous mechanisms, e.g. posttranslational modifications of p53 and (non-)covalent p53 binding partners, influence the p53 transcriptional program. We developed a novel, non-invasive tool to manipulate endogenous p53. Nanobodies (Nb), raised against the DNA-binding domain of p53, allow us to distinctively target both wild type and mutant p53 with great specificity. Nb3 preferentially binds ‘structural’ mutant p53, i.e. R175H and R282W, while a second but distinct nanobody, Nb139, binds both mutant and wild type p53. The co-crystal structure of the p53 DNA-binding domain in complex with Nb139 (1.9 Å resolution) reveals that Nb139 binds opposite the DNA-binding surface. Furthermore, we demonstrate that Nb139 does not disturb the functional architecture of the p53 DNA-binding domain using conformation-specific p53 antibody immunoprecipitations, glutaraldehyde crosslinking assays and chromatin immunoprecipitation. Functionally, the binding of Nb139 to p53 allows us to perturb the transactivation of p53 target genes. We propose that reduced recruitment of transcriptional co-activators or modulation of selected post-transcriptional modifications account for these observations