فهرست مطالب amir azarhomayoun

Object: 

Indocyanine green (ICG) angiography has become the standard of practice in many centers managing cerebrovascular diseases. Though, 3D stereoscopic recording of the surgeries has received widespread attention, there is need for a technology to display and record real time 3D ICG angiographies. In this study, we designed and constructed an ICG angiography camera to display real time 3D ICG angiographies.

Our project had three phases. In phase I, a handmade ICG camera was designed and constructed in our laboratory. Second phase included creating a 3D camera to display real time images in 3D anaglyph format. In the last phase, we developed a 3D ICG camera to demonstrate 3D ICG angiographies in real time.

We successfully completed all three phases of the project and could display real time 3D ICG angiography of a mouse mesenteric arteries, record it, and take pictures.

We proposed a method and proved its feasibility for producing a 3D ICG angiography camera to be mounted on the next generation of neurosurgical microscopes.

The National Traumatic Spinal Cord Injury Registry in Iran (NSCIR-IR), was implemented initially in three hospitals as a pilot phase from 11 Oct 2015 to 19 Jun 2016 and has been active in eight centers from 19 Jun 2016. Poursina Hospital, a trauma care referral center in Rasht, Guilan Province of Iran is one of the registry sites, and has been involved in registering eligible patients since 1 Jan 2016. This study aimed to identify the challenges and solutions for sustaining the NSCIR-IR in a regional center.

This was a mixed-methods study. For the quantitative analysis, a retrospective observational design was used to measure case capture or case identification rate, mapping cases in the registry against those eligible for registry inclusion amongst the register of hospital admissions. For the qualitative component, data was collected using focus group discussions and semi-structured interviews, followed by thematic analysis.

From 19 Jun 2016 to 24 Jan 2018, the proportion of case capture (case identification rate) was 17%. The median time between case identification and data entry to the system was 30.5 d (range: 2 to 193 d). Thematic analysis identified a lack of trained human resources as the most important cause of low case identification rate and delay in data completion.

Recruitment and education to increase trained human resources are needed to improve case capture, the timeliness of data input and registry sustainability in a regional participating site.

To estimate the summation of mortality rate and the contributing factors in patients with traumatic thoracolumbar spinal cord injuries (TLSCI).
A systematic search of observational studies that evaluated the mortality associated with TLSCI in MEDLINE and EMBASE was conducted. The study quality was evaluated using a modified quality assessment tool previously designed for observational studies.
Twenty-four observational studies involving 11,205 patients were included, published between January 1, 1997, and February 6, 2016. Ten studies were of high quality, thirteen were of moderate quality, and one study was of low quality. Seventeen reports described risk factors for mortality and eleven of these studies used a multiple regression models to adjust for confounders.The reported mortality rate ranged from 0 to 37.7% overall and between 0 and 10.4% in-hospital. The sum of mortality for in-hospital, 6-month, and 12-month were 5.2%, 26.12%, 4.3%, respectively. The mortality at 7.7 years follow-up was 10.07% and for 14 years follow-up reports ranged from 13.47% to 21.46%. Associated data such as age at injury, male to female ratio, pre-existing comorbidities, concomitant injuries, duration of follow-up, and cause of death have been underreported in studies investigating the mortality rate after TLSCI.
Currently no study has accurately assessed mortality in the thoracolumbar spine, while there is general agreement that traumatic thoracolumbar spinal cord injuries are important.

Vascular imaging during surgical procedures is very important and has many applications. There are several methods for intraoperative vascular assessment such as intraoperative angiography, Doppler, and fluorescence-based techniques. The latter group and specially the Indocyanine Green (ICG) Video Angiography (VA) is commonly used for vascular surgery and sentinel node biopsy. However, the cost of these microscope mounted cameras limit their availability in the developing countries. Considering this limitation, we designed and constructed a simplified low-cost camera for real-time ICG angiography. In this article, we describe the device structure and give a preliminary report on its usage in an animal model. Methods and Materials/ Patients: ICG-VA camera was designed and constructed in our laboratory. The device consists of optic filters, light sources, and cameras. After inducing anesthesia and exposing mesenteric vessels in a mouse, ICG-VA of these vessels were taken and recorded. Considering the very low cost of the device and its acceptable image quality, it can be utilized in operation theatres and or laboratories for research purposes.

Traumatic brain injury is one of the leading causes of mortality and disability in young adults. Epigallocatechin-3-gallate, the antioxidant compound of green tea, has been proposed to have antioxidant and anti-inflammatory properties. This study evaluates the potential effects of epigallocatechin-3-gallate on the early clinical outcome and serum S100B levels (biomarker for brain tissue damage severity) in patients with moderate to severe traumatic brain injury.
Methods and Materials/Patients: Thirty patients with moderate to severe traumatic brain injury admitted to the intensive care unit were enrolled. The patients were randomly allocated to treatment with either a daily oral dose of 400 mg epigallocatechin-3-gallate or placebo (distilled water) for seven days. The main outcome measures were duration of mechanical ventilation and ICU stay, Glasgow Coma Scale, and S100B protein level.
The results revealed a significant improvement in consciousness level after seven days in the epigallocatechin-3-gallate group (2.93±3.9 unit improvement in GCS versus 0.14±3.05 reduction in GCS, p-value:0.033). There was also a significantly shorter duration of mechanical ventilation in the epigallocatechin-3-gallate compared to the control group (5.1 days versus 9.8 days, p-value:0.02). Reduction of the serum S100B level was slightly higher in the epigallocatechin-3-gallate group (23.96 versus 18.6 pg/ml) but the difference was not statistically significant.
Epigallocatechin-3-gallate supplementation had beneficial effects on consciousness level of the patients with moderate to severe traumatic brain injury in the acute phase.

Intra-cranial bleeding takes place in about 15% of patients with mild traumatic brain injury (mTBI). The risk factors for progression and expansion of hematoma and their natural course is not well known. This study was designed to elucidate the natural course, risk factors, and time interval for progression or regression of the post-mTBI intra-cranial hemorrhages (ICH). Eighty two patients with mTBI suffering intra-cranial hematoma on their initial brain CT scan were prospectively enrolled in a cohort study and data including accident characteristics, past medical history, and physical examination on their arrival were registered. They all underwent initial and repeat brain CT scans according to the protocol in our institute. Natural course of hematoma was demonstrated and data analysis of the patients’ characteristics and their CT scan findings was performed to elucidate risk factors associated with hematoma progression or the need for intervention. Age, sex, anti-coagulants, diabetes, associated trauma, type of the accident, transportation time, hemodynamic parameters, initial GCS, signs of skull base trauma, para-clinical measures, and primary size of hematoma were not associated with increased risk of hematoma progression (p>0.05). Sub-arachnoid and subdural hemorrhages resorbed after 6 days while epidural hematoma resorbed after 16 days from the accident. In this study, in accordance with previous studies, hematoma progression was preceded by clinical decline in all cases. It may be safe to discharge patients with normal sensorium after 24 h who do not show evidence of hematoma progression on repeat brain CT scan. However, further studies to externally validate these findings are warranted.