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Background: Neonatal cholestasis is an important disease of the liver and biliary ducts in infancy. In neglected cases, the disease has irreversible complications. Idiopathic neonatal hepatitis, biliary atresia, TORCH infections and choledochal cyst are important causes of neonatal cholestasis. The aim of this study was to determine the causes of cholestasis among neonates admitted to the Children’s Medical Center of Tehran University. Methods: This is a descriptive, retrospective study including 109 patients diagnosed with obstructive icterus, from 1994 to 2001. With data collected from hospital records, the inclusion criteria consisted of cholestasis with a conjugated bilirubin of up to 2 mg/dl from at least two laboratory samples (20% of total bilirubin). The definitive diagnosis of cholestasis included the laboratory investigations, which were in the patients’ hospital records and documented by their physicians. Results: Our patients (63 males and 46 females) had a mean age of 40±6 days. The most common clinical findings were icterus, acholic stool and hepatosplenomegaly. The most common cause of cholestasis was idiopathic neonatal hepatitis followed by biliary atresia, which together caused 75% of all the cases in this study. Conclusions: In our general population, the most common causes of neonatal cholestasis are hepatitis and biliary atresia. In other investigations, the etiology of neonatal cholestasis was different than that of this study. Because the number of different disorders presenting with cholestasis may be greater during the neonatal stage than at any other time of life, early diagnosis and treatment is very important for improved prognosis.

Background: The aim of this study was to review the frequency, histopathology and outcome in children with tumors of the liver. Methods: Included in this retrospective/descriptive study were 30 children treated for liver tumors from 1375-1384 (ca. 1996-2005), at Children’s Hospital Medical Center, Tehran, Iran. We included the clinical, radiologic, and pathologic data of our patients, focusing on the frequency, etiology and outcome. Results: Patient ages ranged from three months to 12 years (median 3.8 years), with 18 males (60%) and 12 females (40%). Of these, 17 patients had hepatoblastoma (55.66%), including 13 males and four females, with an age range of six months to five years. Four cases (13.33%) had neuroblastoma. Hepatocellular carcinoma (HCC) was found in three cases (10%), all of whom were carriers of hepatitis B. Two cases (6.66%) were diagnosed with mesenchymal hamartoma, two cases (6.66%) with hemangioendothelioma and two cases (6.66%) with rhabdomyosarcoma and leiomyosarcoma of the biliary tract. Abdominal swelling and hepatomegaly were seen in all of patients. Jaundice was observed in two cases. Serum alpha-fetoprotein levels greater than 500 ng/ml were seen in 17 cases (56.66%). All patients were receiving specific treatment. The three-year survival rate was 65% for hepatoblastoma and 2% for HCC Conclusion: With the introduction of specific treatment, the survival rate for children with tumors of the liver has significantly increased. Further improvement can be achieved using diagnostic biopsy for hepatoblastoma, although it may result in complications, and preoperative chemotherapy followed by complete surgical excision (per International Society of Pediatric Oncology guidelines), yielding an outstanding survival rate of 80%.

Introduction: Iron deposition in liver is a major finding in thalassemic patients. Histologic grading of iron deposition is widely used in many institutions and various grading systems have been introduced. The aim of this study was to introduce a new histologic scoring system (Markaze Tebbi Koodakan: MTK 1, 2 and 3) which considers size and density of iron granules as well as zone of iron deposition and verify this system with atomic absorption spectrometry (AAS method). Materials and methods: Liver biopsies from 63 patients were evaluated, 40 (63.5%) were male and 20 (36.5%) were female. The mean age of the patients was 8.01±3.7 and the age range was from 1.8 to 15 years. Iron scoring was performed according to Sindram & Marx and MTK 1-3 scoring systems.Paraffin blocks were processed for AAS and the results of the iron analysis (HIC: hepatic iron concentration) were reported as µmol/g dry liver weight. The statistical analysis was performed using SPSS, version 16 (SPSS Inc., Chicago, IL, USA). Results: The mean (SD) of hepatic iron concentration was 230.9 (121.2) µmol/g dry weight. The relationship between the variables HIC, HII (hepatic iron index) and all histological grading of iron (S&M and MTK1-3) was very strong. Significant differences were identified between the mean HIC in scores 1 & 2 of all histological iron scorings (S&M and MTK 1-3), but no significant differences identified in other adjacent scores in all histological iron scorings (S&M and MTK 1, 2 and 3). Discussion and conclusion: New scoring system introduced by us in this study was very much the same as simple Sindram and Marx classification. So it is concluded that although size of iron granules is important in lower scores, but in higher scores it is not as much important as the zone in which iron granules are deposited.

Chronic Liver diseases in children is the result of many different diseases including: metabolic, genetic, infectious, toxic and idiopathic causes. This was a case series study on 133 infants and children with age range 6 month to 12 years old, who presented clinically with manifestation of chronic liver disease and were admitted to Children Hospital Medical Center from year 1999 to 2000. In this study, 32 (24.5 percent) patients had autoimmune chronic hepatitis, 15 (11.3 percent) Glycogen storage diseases, 12 (9 percent) extrahepatic biliary atresia, 11 (8.2 percent) willson disease, 10 (7.5 percent) cryptogenic cirrhosis, 6 (4.5 percent) chronic hepatitis C, 5 (3.8 percen) chronic hepatitic B, 5 (3.8 percent) galactosemia 3 (2.25 percent) congenital hepatic fibrosis, 3 (3.8 percent) histiocytosis X, 3 (2.25 percent) sclerosing cholangitis, 2 (1.5 percent) byler’s disease 2 (1.5 percent) primary tuberculosis, 1 (0.75 percent) choledocalcyst, 1 (0.75 percent) Alagyle syndrome. According to our data, chronic liver disease should be considered in infants and children. In our study, the most common causes are found to be: metabolic and genetic diseases (37.5 percent), chronic autoimmune hepatitis (24 percent) and biliary disorders (14 percent), that encompass 86 percent of the patients.

Computer model of the patellofemoral joint was developed and the effects on the anterior displacement of the tibial tuberosity were investigated. The input geometrical and verification data for the model were obtained form an experimental study on a cadaver knee, mounted in an instron machine. The computer program found the configuration of the patellofemoral joint which satified both the geometrical and force equilibrium conditions, simultaneously, using a trial graphical approach.verification of the model was achieved by determining the patellar sagittal plane motion and patellofemoral contact locations and comparing the results with the experimental results of the same specimen and published data. Simulation of the anterior displacement of the tibial tuberosity by the model showed that the location of contact area migrates distally on the femur and proximally on the patella following operation. The contact force of the patellofemoral joint decreased significantly by 70% at full extension, 30% at 30 degrees flexion and around 15% at higher flexion angles for a 1 cm anterior displacement of the tibial tuberosity and nearly doubled for a 2cm anterior displacement. The change of the effective moment are of the quadriceps was not considerable. The results suggest that the major effect of the Maquet operation on the contact force appears in extension and mid-flexion rather than deep flexion amgles. Further displacement of the tuberosity enhances the reduction of the contact force, however, the total reduction is less than what was predicted by Maquet. The change of the contact location relieves pain in short term but causes hyperpressure in the proximal retropatellar surface which might be detrimental in long term

The coupled problem of estimating the temperature rise due to the winding and core loss in a vertically oriented magnetic component is considered. The principle contributions in this paper are two-fold: 1) the coupling between the losses and thermal problems for the component is addressed accounting for the effects of nearby barriers and 2) the complication that the convection coefficient is not known accurately is overcome by means of solving a coupled electrothermal--air flow problem in order to characterize heat transfer to the ambient surroundings. It is shown that the coupling between the loss and temperature in the magnetic material has negligible effects on the temperature since the deviation in temperature is not more than 13% at worst if the loss is considered constant for different barrier-to-core distances. The convection coefficients of the core's top and side surfaces are shown not to be significantly influenced by the boundary condition imposed on the barrier. The boundary conditions substantially affect the temperature by introducing an additional path for heat transfer. Additionally, the contribution of radiation is found to be roughly 50% of the total loss regardless of the barrier height and distance and its boundary condition. Index Terms--Convection, heat transfer, loss-temperature coupling, radiation.

Diurnal volume changes is one of the main factors influencing socket fit in transtibial prosthesis and causing pressure problem issues. Embedded bladder liners have been recently a potential approach to deal with this problem. The aim of this technical note was to introduce a new transtibial silicone liner designed based on hybrid socket theory. To make expandability in the liner, an integrated wax structure was constructed over the selected areas of the positive model and then removed after lamination process. In addition, a mechanical system with manual control was designed to fit the liner with the residual limb volume by pumping the water in or out of the liner through connective tubes. The results showed that this new design had high reliability in maintaining identical surface pressures after volume changes in laboratory trials. Therefore, it seems that selective expandability of this liner would accommodate residual limb volume fluctuations without disturbing effect on preliminary pressure pattern. [ABSTRACT FROM AUTHOR]

Assistive device equipment can improve the performance of sit-to-stand (STS), standing, and walking of people with lower limb disability. The motorized assistive device is usually expensive and the use of another assistive device also makes an excessive force in the upper and lower extremity during (STS) transfer, which is not desirable for patients. In addition, only a few number of the non-motorized assistive devices that support all three phases; namely, sit-to-stand, standing, and walking are available. Consequently, improving and creating the new technology seems essential in this case. In this paper, the design procedure of saddle-assistive device is described in order to make use of the linear actuator in (STS) transfer and walk. Experimental results orientation of the shoulder during (STS) was recorded in the lab. Then, based on this analysis and simulation, saddle-assistive devices(S-AD) were designed and prototyped. Function prototype of the (S-AD) was done in the lab on a healthy person in (STS) and walking and then was compared with (STS) in normal mode. It is proposed due to the integration of the three phases in one device. Other advantages are force reduction on lower limbs, creating conditions of stability, and independence for patients with lower limb disability. [ABSTRACT FROM AUTHOR]

Realistic simulation of tool-tissue interactions can help to develop more effective surgical training systems and simulators. This study uses a finite element and meshless modeling approach to simulate the grasping procedure of a large intra-abdominal organ, i.e. a kidney, during laparoscopic surgery. Results indicate that the accuracy of the meshless method is comparable with that of the finite element method, with root mean square errors in the range of 0.8 to 2.3 mm in different directions. For the model presented in this study, the computational cost of the meshless method was much less than that of the finite element model. [ABSTRACT FROM AUTHOR]

Considering the loss of direct visual and tactile information, surgeons require special training programs to obtain sufficient proficiency for laparoscopic surgery. Surgical training simulation systems provide an effective alternative to animal models for repetitive training practices. The purpose of this study was to develop a biomechanical model of large soft organs for simulation of the interactions of a surgical grasper and spleen in real-time. The mechanical behavior of the spleen was molded in detail, including its nonlinear hyper viscoelastic properties using a mass-spring-damper model. A novel collision detection algorithm was used to determine the tool-tissue contact zones. Forcebased and geometry-based boundary conditions were imposed at the contact nodes, respectively, to represent slippage-included and slippage-free grasping conditions. The model's predictions were validated against the experimental results on a synthetic test sample. Results of simulation of interactions between the grasping tool and the spleen organ indicated that the non-linear rate dependent and stress relaxation behaviors of the tissue was well depicted by the model. Also, the model was capable of reflecting the effect of tool-tissue friction coefficient on the slippage-free or slippage-included grasping behaviors. [ABSTRACT FROM AUTHOR]

Study design:A feasibility study on the effect of a new reciprocating orthosis on specific gait parameters for use by people with spinal cord injury.Objectives:The aim of this study was to design and develop a new medial linkage orthosis (MLO) mechanism incorporating a reciprocating motion and to determine its efficacy in improving specific spatiotemporal, kinematic and kinetic parameters while ambulating when worn by healthy subjects. This was achieved via the use of a lower limb paralysis simulator (LLPS).Methods:A reciprocating joint with a remote center of motion was designed for use as an MLO. A prototype was fabricated and incorporated into an orthosis and equipped with a saddle to make the reciprocating motion possible. The efficacy of the orthosis was evaluated on four able-bodied healthy subjects who were trained to walk with the MLO attached to the LLPS.Results:Mean walking speed, stride length, stride time and cadence was 0.09±0.007 m s−1, 0.42±0.01 m, 4.89±0.45 s and 29.54±4.32 steps min−1, respectively, when healthy subjects walked with the new orthosis. The mean hip joint torque produced was 0.36±0.13 Nm.Conclusion:In this study a new MLO was designed and fabricated that provided a reciprocating mechanism using a four-bar mechanism to set the virtual axis of the mechanism in a more proximal position than hinge-type joints. Further investigation is currently underway to assess its effect on gait parameters and energy expenditure in paraplegic patients. [ABSTRACT FROM AUTHOR]

Background: Niemann-Pick disease and β-thalassemia are distinct conditions with specific clinical and morphological manifestations. β-thalassemia is the most common inherited blood disorder in Iran whereas Niemann-Pick disease, a lysosomal storage disorder, is rarely found in this country. Case Presentation: This 5-month old girl, a known case of β-thalassemia major was hospitalized for failure to thrive and hepathosplenomegaly. Because of unusual splenomegaly and liver enzymes disturbance that was not compatible with the first diagnosis, further evaluation revealed cherry red spot and high lipid profile suggestive of lysosomal storage disease. Foamy cells in the bone marrow and low activity of the specific enzyme led to the diagnosis of Niemann-Pick disease. Conclusion: This unique case illustrates the importance of looking for a second pathological condition in a patient whose clinical profile does not support the first diagnosis in its entirety [ABSTRACT FROM AUTHOR]

Objective: Reinfection rate of Helicobacter pylori after successful eradication is low in developed countries. This study was performed to determine the reinfection rate of H. pylori during a follow up period of 12 months in Iranian children. Methods: In this prospective study, children with H. pylori infection were treated with triple omeprazole based regimen. Patients with negative 13C urea breath test (UBT) performed after 8 weeks of therapy, were followed up by the same test after 1 year. Findings: Thirty seven patients, aged 5 to 17 years, were studied. Among them 25 (67.5%) were boys. After eradication therapy of H. pylori, 34 patients had negative 13C UBT. Reinfection occurred in 5 (14.7%) patients. Reappearance or continuing symptoms after treatment were associated with higher rate of recurrence (P=0.042). Conclusion: Recurrence rate of H. pylori was high in our children. Successful eradication significantly decreased complaints and further symptoms. Follow up and reevaluation of patients is necessary especially when there are symptoms after eradication. [ABSTRACT FROM AUTHOR]

Semiconductor heterojunctions are ubiquitous components of modern electronics. Their properties depend crucially on the band alignment at the interface, which may exhibit straddling gap (type-I), staggered gap (type-II) or broken gap (type-III). The distinct characteristics and applications associated with each alignment make it highly desirable to switch between them within a single material. Here we demonstrate an electrically tunable transition between type-I and type-II band alignments in MoSe 2 /WS 2 heterobilayers by investigating their luminescence and photocurrent characteristics. In their intrinsic state, these heterobilayers exhibit a type-I band alignment, resulting in the dominant intralayer exciton luminescence from MoSe 2 . However, the application of a strong interlayer electric field induces a transition to a type-II band alignment, leading to pronounced interlayer exciton luminescence. Furthermore, the formation of the interlayer exciton state traps free carriers at the interface, leading to the suppression of interlayer photocurrent and highly nonlinear photocurrent-voltage characteristics. This breakthrough in electrical band alignment control, interlayer exciton manipulation, and carrier trapping heralds a new era of versatile optical and (opto)electronic devices composed of van der Waals heterostructures., (© 2024. The Author(s).)

Background: Data on the epidemiology of inflammatory bowel disease (IBD) in the Middle East are scarce. We aimed to describe the clinical phenotype, disease course, and medication usage of IBD cases from Iran in the Middle East., Methods: We conducted a cross-sectional study of registered IBD patients in the Iranian Registry of Crohn's and Colitis (IRCC) from 2017 until 2022. We collected information on demographic characteristics, past medical history, family history, disease extent and location, extra-intestinal manifestations, IBD medications, and activity using the IBD-control-8 questionnaire and the Manitoba IBD index, admissions history, history of colon cancer, and IBD-related surgeries., Results: In total, 9746 patients with ulcerative colitis (UC) (n=7793), and Crohn's disease (CD) (n=1953) were reported. The UC to CD ratio was 3.99. The median age at diagnosis was 29.2 (IQR: 22.6,37.6) and 27.6 (IQR: 20.6,37.6) for patients with UC and CD, respectively. The male-to-female ratio was 1.28 in CD patients. A positive family history was observed in 17.9% of UC patients. The majority of UC patients had pancolitis (47%). Ileocolonic involvement was the most common type of involvement in CD patients (43.7%), and the prevalence of stricturing behavior was 4.6%. A prevalence of 0.3% was observed for colorectal cancer among patients with UC. Moreover,15.2% of UC patients and 38.4% of CD patients had been treated with anti-tumor necrosis factor (anti-TNF)., Conclusion: In this national registry-based study, there are significant differences in some clinical phenotypes such as the prevalence of extra-intestinal manifestations and treatment strategies such as biological use in different geographical locations., (© 2024 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Purpose: This study examined the effects of a dynamic neoprene orthosis on kinematic variables of gait in children with spastic bilateral cerebral palsy (CP)., Methods: Five children (whose median age was 9.6 years and who ranged in age from six to 12) with spastic bilateral CP and flexed knee at levels I-III of the Gross Motor Function Classification System were examined using kinematic gait analysis in three different conditions: 1) with dynamic neoprene orthosis; 2) without dynamic neoprene orthosis (immediate effect); and 3) without orthosis after six weeks of intervention., Results: The comparison between condition one (with dynamic neoprene orthosis) and condition two (without dynamic neoprene orthosis) demonstrated the existence of improvements in minimum hip and knee flexion variables. Moreover, the results indicated that the improvements remained constant in several key gait variables after six weeks., Conclusion: The results varied from subject to subject, and there were signs of improvement in some of the subjects. Therefore, it was not possible to draw conclusions at a group level. Nonetheless, a number of individuals may benefit from this type of orthosis.

Combination therapy has been considered one of the most promising approaches for improving the therapeutic effects of anticancer drugs. This is the first study that uses two different antioxidants in full-characterized niosomal formulation and thoroughly evaluates their synergistic effects on breast cancer cells. In this study, in-silico studies of hydrophilic and hydrophobic drugs (ascorbic acid: Asc and curcumin: Cur) interactions and release were investigated and validated by a set of in vitro experiments to reveal the significant improvement in breast cancer therapy using a co-delivery approach by niosomal nanocarrier. The niosomal nanoparticles containing surfactants (Span 60 and Tween 60) and cholesterol at 2:1 M ratio were prepared through the film hydration method. A systematic evaluation of nanoniosomes was carried out. The release profile demonstrated two phases (initial burst followed by sustained release) and a pH-dependent release schedule over 72 h. The optimized niosomal preparation displayed superior storage stability for up to 2 months at 4 °C, exhibiting extremely minor changes in pharmaceutical encapsulation efficiency and size. Free dual drugs (Asc + Cur) and dual-drug loaded niosomes (Niosomal (Asc + Cur)) enhanced the apoptotic activity and cytotoxicity and inhibited cell migration which confirmed the synergistic effect of co-encapsulated drugs. Also, significant up-regulation of p53 and Bax genes was observed in cells treated with Asc + Cur and Niosomal (Asc + Cur), while the anti-apoptotic Bcl-2 gene was down-regulated. These results were in correlation with the increase in the enzyme activity of SOD, CAT, and caspase, and the levels of malondialdehyde (MDA) and reactive oxygen species (ROS) upon treatment with the mentioned drugs. Furthermore, these anti-cancer effects were higher when using Niosomal (Asc + Cur) than Asc + Cur. Histopathological examination also revealed that Niosomal (Asc + Cur) had a lower mitosis index, invasion, and pleomorphism than Asc + Cur. These findings indicated that niosomal formulation for co-delivery of Asc and Cur would offer a promising delivery system for an effective breast cancer treatment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: A novel titanium tilting suture anchor was designed and fabricated using additive manufacturing. The anchor enjoyed a nonsymmetrical structure to facilitate its insertion procedure through a weight-induced tilt, a saw-teeth penetrating edge to provide a strong initial fixation into cancellous bones of various densities, and an appropriate surface texture to enhance the longterm fixation strength through bone ingrowth., Methods: Biomechanical tests were performed on 10 ovine and 10 human cadaveric humeri to examine the insertion procedure and assess the initial fixation strength of the anchor, in comparison with a standard screw-type anchor as control., Results: This study indicated a simple yet reliable insertion procedure for the tilting anchor. All anchors survived after 400 cycles of cyclic loadings and failed in the load-to-failure step. There were no significant differences between the displacements and fixation stiffnesses of the anchors in either group. The ultimate failure load was significantly smaller (p<0.05) for tilting anchors in ovine group (273.7 ± 129.72 N vs. 375.6 ± 106.36 N), but not different in human group (311.8 ± 82.55 N vs. 281.9 ± 88.35). Also, a larger number of tilting anchors were pulled out in ovine group (6 vs. 3) but a smaller number in human group (4 vs. 6)., Conclusion: It was concluded that the biomechanical performance of the designed tilting anchor is comparable with that of the standard screw-type anchors., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Abedi, Pourghazi, Eslami, Nabian, Ali Mohammadi, Zanjani and Farahmand.)

Photocurrent in quantum materials is often collected at global contacts far away from the initial photoexcitation. This collection process is highly nonlocal. It involves an intricate spatial pattern of photocurrent flow (streamlines) away from its primary photoexcitation that depends sensitively on the configuration of current collecting contacts as well as the spatial nonuniformity and tensor structure of conductivity. Direct imaging to track photocurrent streamlines is challenging. Here, we demonstrate a microscopy method to image photocurrent streamlines through ultrathin heterostructure devices comprising platinum on yttrium iron garnet (YIG). We accomplish this by combining scanning photovoltage microscopy with a uniform rotating magnetic field. Here, local photocurrent is generated through a photo-Nernst type effect with its direction controlled by the external magnetic field. This enables the mapping of photocurrent streamlines in a variety of geometries that include conventional Hall bar-type devices, but also unconventional wing-shaped devices called electrofoils. In these, we find that photocurrent streamlines display contortion, compression, and expansion behavior depending on the shape and angle of attack of the electrofoil devices, much in the same way as tracers in a wind tunnel map the flow of air around an aerodynamic airfoil. This affords a powerful tool to visualize and characterize charge flow in optoelectronic devices.

X-ray radiolytic labeling uses broadband X-rays for in situ hydroxyl radical labeling to map protein interactions and conformation. High flux density beams are essential to overcome radical scavengers. However, conventional sample delivery environments, such as capillary flow, limit the use of a fully unattenuated focused broadband beam. An alternative is to use a liquid jet, and we have previously demonstrated that use of this form of sample delivery can increase labeling by tenfold at an unfocused X-ray source. Here we report the first use of a liquid jet for automated inline quantitative fluorescence dosage characterization and sample exposure at a high flux density microfocused synchrotron beamline. Our approach enables exposure times in single-digit microseconds while retaining a high level of side-chain labeling. This development significantly boosts the method's overall effectiveness and efficiency, generates high-quality data, and opens up the arena for high throughput and ultrafast time-resolved in situ hydroxyl radical labeling., (© 2022. The Author(s).)

Background: The opening wedge high tibial osteotomy (HTO) fixation using the Tomofix system is at the risk of mechanical failure due to unstable fixation, lateral hinge fracture, and hardware breakage. This study aimed to investigate the effect of the level of anatomical fit (LOF) of the plate on the failure mechanisms of fixation., Methods: A finite element model of the HTO with a correction angle of 12 degrees was developed. The LOF of the TomoFix plate was changed parametrically by altering the curvature of the plate in the sagittal plane. The effect of the LOF on the fixation performance was studied in terms of the factor of safety (FOS) against failure mechanisms. The FOSs were found by 1) dividing the actual stiffness of the plate-bone construct by the minimum allowable one for unstable fixation, 2) dividing the compressive strength of the cortical bone by the actual maximum pressure at the lateral hinge for the lateral hinge fracture, and 3) the Soderberg criterion for fatigue fracture of the plate and screws., Results: The increase of the LOF by applying a larger bent to the plate changed the fixation stiffness slightly. However, it reduced the lateral hinge pressure substantially (from 182 MPa to 71 MPa) and increased the maximum equivalent stresses in screws considerably (from 187 MPa to 258 MPa). Based on the FOS-LOF diagram, a gap smaller than 2.3 mm was safe, with the highest biomechanical performance associated with a 0.5 mm gap size., Conclusion: Although a high LOF is necessary for the Tomofix plate fixation to avoid mechanical failure, a gap size of 0.5mm is favored biomechanically over complete anatomical fit., Competing Interests: The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Background: There is evidence of inconsistency in sequelae of exclusive enteral nutrition (EEN) as induction therapy in paediatric patients with Crohn's disease (CD)., Aim: To investigate the potential effects of EEN on paediatric Crohn's disease activity index (PCDAI), inflammation and biochemical parameters in paediatric patients with CD., Methods: We performed a comprehensive systematic search of PubMed/MEDLINE, Web of Science, SCOPUS and Embase until 8 January 2022 regardless of the time of publication or language. Random-effects model was applied to combine the datasets. The main outcomes were analysed through mean difference (MD) and its 95% confidence interval (CI)., Results: Forty six studies met eligibility criteria and were included in the meta-analysis. Pooled findings indicated that PCDAI score (MD of -27.24; 95% CI -31.84 to -22.64), calprotectin (MD of -842.83 mg/kg; CI -1018.24 to -667.42), CRP (pooled MD of -2.36 mg/dl; CI -2.68 to -2.03), and ESR (MD of -21.09 mm/h; CI -23.79 to -18.38), albumin (MD of 0.65 g/dl; CI 0.58 to 0.72), haemoglobin (MD of 1.12 g/dl; CI 0.87 to 1.37), weight (MD of 4.30 kg; CI 3.39 to 5.22), and height (MD of 0.98 cm; CI 0.35 to 1.62) improved significantly with EEN., Conclusions: Adherence to EEN can have significant, beneficial effects as induction therapy in paediatric patients with CD., (© 2022 John Wiley & Sons Ltd.)

Background: Knee osteoarthritis (KOA) may considerably change the gait parameters, including the gait variability patterns. Uncontrolled manifold (UCM) analysis has been used to evaluate the relationship between motor control and gait variability as a useful index for assessing the multi-segmental movements' coordination during walking. To our knowledge, no research has evaluated the alterations in the gait kinematic parameters during normal and narrow path walking in individuals with KOA as compared to asymptomatic people., Materials and Methods: In this cross-sectional study, individuals diagnosed with mild to moderate medial KOA and asymptomatic people will walk at their comfortable preferred speed on a treadmill. A motion capture system will be used to record at least 50 successful gait cycles. The kinematic variability of joints during gait will be analyzed using UCM, with the center of mass (COM) displacement considered as the performance variable. The primary outcome measure will be the lower limb synergy index. Variability of the COM displacement and changes in angles and angular velocities of lower extremity joints will be assessed as the secondary outcomes., Results: The results of this protocol study provide information on the lower limb kinematic synergy during gait on normal and narrow paths for individuals with KOA and asymptomatic controls., Conclusion: This information will help the researchers and clinicians understand KOA patients' gait variability characteristics more deeply. Moreover, it may lead to an enhanced evidence-based approach for clinical decision-making concerning improving gait stability and decreasing the falling risk in these people., Competing Interests: There are no conflict of interest., (Copyright: © 2022 Advanced Biomedical Research.)

Objectives: Non-invasive biomarkers, for the diagnosis of celiac disease, can reduce the need for biopsy, particularly in pediatric patients. The aim of this study was to investigate the levels tissue transglutaminase antibody (tTG) and plasma citrulline and its correlation with intestinal biopsy., Methods: In this cross-sectional descriptive study, Pediatric patients with celiac disease referred to (XXX)were included. The patients underwent tTG antibody test along with plasma citrulline measurements using HPLC ((high performance liquid chromatography). Biopsy was performed in all the patients and clinical and demographic findings were recorded in a patient form. The data were statistically analyzed using SPSSv22., Results: Of 118 patients with celiac disease, the mean level of citrulline in patients was 17.48 ± 6.92 and the mean tTG titer was 183.17 ± 41.25. The two variables were inversely correlated with each other, p < 0.01. With an increase in Marsh levels, a significant reduction in citrulline levels and an increase in plasma tTG levels were seen, p < 0.01, respectively. The mean citrulline and tTG titer was not associated with gender and the age of the patients., Conclusion: Our findings indicate that citrulline and tTG antibody titer are significant biomarkers for the diagnosis of celiac disease and the severity of intestinal atrophy among pediatric patients., Competing Interests: The authors deny any conflict of interest in any terms or by any means during the study., (© 2022 The Authors.)

Objective: Functional constipation (FC) and Gastroesophageal Reflux Disease (GERD) are common gastrointestinal disorders in children. The aim of this study is to investigate the correlation between functional constipation and GERD in children., Methods: In this cross-sectional study, a total of 82 children aged <16 years who referred to the pediatric gastroenterology clinic of (XXX) and were diagnosed with functional constipation according to ROME III criteria, and gastroesophageal reflux disease according to clinical history and DeMeester Score. Questionnaire was used to obtain the data regarding age, sex, cause of the visit, presence or absence of any symptom was noted, clinical examinations and difficulty in defecation., Results: Of the 82 children with FC and GERD, 45 were boys and 37 were girls. Among children with FC and GERD, FC was reported in 50 (61%) cases prior to the onset of GERD, whereas 32 (39%) of the children had reflux before FC. The mean age of participants presented with FC was 5.66 ± 3.52 and that of GERD was 5.24 ± 2.83. The difference in mean age was not statistically significant. Of the children with gastroesophageal reflux disease, there were 13 (40.6%) males and 19 females while 32 (64%) males and 18 females had FC and the gender-based difference was statistically significant between the 2 groups., Conclusion: The prevalence of functional constipation in children was higher than gastroesophageal reflux disease. Gastroesophageal reflux disease and functional constipation should be simultaneously considered for therapeutic interventions and patients with functional digestive diseases should be monitored and followed-up., Competing Interests: The authors deny any conflict of interest in any terms or by any means during the study. All the fees provided by research center fund and deployed accordingly., (© 2022 The Author(s).)