pouya tabatabaei irani

Total knee arthroplasty (TKA) has been known as a definitive treatment for advanced knee osteoarthritis. Both intramedullary (IM) and extramedullary (EM) tibial guides have been used to restore the desired extremity alignment. However, controversy exists regarding the superiority of either technique We aimed to compare the functional outcomes and accuracy of IM and EM tibial guides in providing neutral alignment after TKA. In a randomized, double-blinded clinical trial, we studied 98 patients undergoing primary TKA in two groups of IM and EM. We measured the medial proximal tibial angle (MPTA), varus angle (VA), and joint-line convergence angle with normal ranges of 90°±3°, 0-2°, and 0±3°, respectively, on a three-joint alignment view after three months. We also assessed the functional outcomes at the last follow-up. Finally, we compared these outcomes between the two groups.  Eighty-four patients (IM=42, EM=42) were included in the final analysis (16 males, 68 females, mean age: 63.9±8.6 years, mean follow-up: 13±2.9 months). The mean postoperative (post-op) alignment angles showed no significant difference, although MPTA outliers were significantly more frequent in the EM group (26.2% vs. 9.5% in IM, P=0.04). None of the functional outcomes showed a significant difference between the two groups. However, the mean increase in knee range of motion (ROM) was significantly higher in the knees with VAs within ±3° of neutral than those outside this range (30.8 vs. 27.4, respectively, P=0.039). We conclude that both techniques were not different regarding the mean alignment angles and functional outcomes. However, fewer MPTA outliers can be seen with the IM technique. A post-op mechanical axis within ±3° of neutral can result in a more ROM increase after one year.  Level of evidence: I

This study aimed to present a rare case of a failed dynamic hip screw (DHS) used for fixation of intertrochanteric fracture sliding into the pelvis and to review the most common causes of DHS failure in order to prevent this from happening in the future.

 A 68-year-old woman was referred to the orthopedics clinic with left hip pain and limping from 6 months ago. In our evaluation, she had DHS failure and intrapelvic protrusion.

There have been several  aspects  of the previously described  DHS failure. We performed a two-stage total hip arthroplasty (THA) for the patient with a good one-year follow-up in the present case.

Trigger wrist is a rare disease with few reported cases in the literature. This condition presents with painful sensation and a clicking sound during finger or wrist movements.

In this report, we present a 32-year-old man suffering from trigger wrist along with carpal tunnel syndrome caused by muscle belly hypertrophy and extension to the carpal tunnel. The diagnostic approach and surgical techniques are explained.

In cases of trigger wrist associated with carpal tunnel syndrome (CTS), there may be an underlying cause covering both the trigger wrist and CTS at the volar side of the wrist. Therefore, a precise clinical examination is recommended to avoid unnecessary surgery, releasing of A1 pulley, or steroid injection.

 Glioblastoma (GBM) is the most common and invasive form of primary malignant brain tumors, with a survival rate of about 1 year. Transforming growth factor-beta1 (TGF- beta 1) plays a very important role in tissue homeostasis and cancers. It seems that polymorphism of T29C (L10P, rs1982073, or rs1800470), which has been studied in various cancers such as breast and colon, creates the significant differences plays an important role in GBM prognosis and treatment. In this study, we evaluated the effect of T29C (rs1982073) polymorphism of TGF-beta1 gene in GBM.   This study was conducted on 100 cases of GBM including 47 paraffin-embedded brain tissue samples and 53 blood samples from another 53 GBM patients, who was under therapy, and 150 were controls. The TGF-beta rs1982073 single-nucleotide polymorphism (SNP) was identified by the NCBI and genotyping was performed by high-resolution melt (HRM) assay. Melt curves from HRM which suspected to SNP were selected and subjected to direct sequencing. Finally, the collected data were entered into the SPSS software (Version. 20) and mean ± standard deviation or n (%) was used to show the data.   The mean age in GBM group was 51.63 ± 13.27 years. Accordingly, the two groups were matched in terms of age and gender (P > 0.05). The frequency of GG genotype was significantly higher in GBM patients. In contrast, although the frequency of AG genotype was higher in GBM group, it was not statistically significant. Furthermore, the presence of G allele was significantly more frequent than A allele in GBM patients.   Findings of the present study supports that the Pro10Leu, rs1982073, or rs1800470 SNP in TGF- beta 1 is found to be expressed significantly more in GBM patients as it was found in breast cancer.

The kB family of nuclear factor (NF-κB) is a series of transcription factors that plays a key role in regulation of immunity, cell growth, and apoptosis and is considered as the main downstream component of epidermal growth factor receptor for which there are evidence of excessive activity in most cases of glioblastoma multiform (GBM). Thus, the current information has gained evidence on NF-κBIA tumor suppressor role in GMB. SNP rs1957106 was diagnosed as a new polymorphism which affected the expression of NF-κBI and causes activation of NF-κB in GBM patients.

This study was conducted on 100 cases of GBM including 47 paraffin-embedded brain tissue samples and 53 blood samples from another 53 GBM patients and 150 controls. The NF-κBI rs1957106 SNP was identified by the NCBI, and genotyping was performed by high-resolution melt (HRM) assay. Melt curves from HRM which suspected to single-nucleotide polymorphism (SNP) were selected and subjected to direct sequencing.

The distribution of allele A of NF-κβ gene in patients with GBM with 31% was not significantly different from healthy participants (27.3%) (P = 0.375). Furthermore, the distribution of AG and GG genotypes in comparison with AA genotypes did not show a significant correlation with GBM incidence (P > 0.05).

Findings of the present study provide evidence that the rs1957106 SNP in NF-κBIA is found more in GBM patients, but it was not statistically significant. As there are conflicting studies showing significant higher rate of this SNP in GBM, further study is suggested.