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Background: Salivary gland tumors form nearly 3% of head and neck tumors. Due to their large histological variety and vicinity to facial nerves, pre-operative diagnosis and differentiation of benign and malignant parotid tumors are a major challenge for radiologists. Objective: The majority of these tumors are benign; however, sometimes they tend to transform into a malignant form. Functional MRI techniques, namely dynamic contrast enhanced (DCE-) MRI and diffusion-weighted MRI (DWI) can indicate the characteristics of tumor tissue. Methods: DCE-MRI analysis is based on the parameters of time intensity curve (TIC) before and after contrast agent injection. This method has the potential to identify the angiogenesis of tumors. DWI analysis is performed according to diffusion of water molecules in a tissue for determination of the cellularity of tumors. Conclusion: According to the literature, these methods cannot be used individually to differentiate benign from malignant salivary gland tumors. An effective approach could be to combine the aforementioned methods to increase the accuracy of discrimination between different tumor types. The main objective of this study is to explore the application of DCE-MRI and DWI for assessment of salivary gland tumor types.

Background: Salivary gland tumors form nearly 3% of head and neck tumors. Due to their large histological variety and vicinity to facial nerves, pre-operative diagnosis and differentiation of benign and malignant parotid tumors are a major challenge for radiologists. Objective: The majority of these tumors are benign; however, sometimes they tend to transform into a malignant form. Functional MRI techniques, namely dynamic contrast enhanced (DCE-) MRI and diffusion-weighted MRI (DWI) can indicate the characteristics of tumor tissue. Methods: DCE-MRI analysis is based on the parameters of time intensity curve (TIC) before and after contrast agent injection. This method has the potential to identify the angiogenesis of tumors. DWI analysis is performed according to diffusion of water molecules in a tissue for determination of the cellularity of tumors. Conclusion: According to the literature, these methods cannot be used individually to differentiate benign from malignant salivary gland tumors. An effective approach could be to combine the aforementioned methods to increase the accuracy of discrimination between different tumor types. The main objective of this study is to explore the application of DCE-MRI and DWI for assessment of salivary gland tumor types. [ABSTRACT FROM AUTHOR]

Background: This study was conducted to determine the frequency of abnormal discal findings in lumbar MRI in patients with non traumatic non surgical low back pain who referred to Imam-Khomeini hospital Materials and methods: This study was conducted as a descriptive -- analytical cross-sectional prospective survey among 280 consecutive patients who referred to Imam-Khomeini hospital in 2008 - 2009. The data were collected by check list and analysis was done by SPSS 10 Results: The mean age of the patients was 40.98. 56.1% were female Abnormal MRI was seen in 83.2% and 72.9% had disc involvement including 40.7% central, 21.1% right and 36.3% left involvements, 25.75% had bulging, 62.85% protrusion, 11.05% extrusion and finally 0.35% had sequestration. Conclusion: It may be concluded that disc protrusion and bulging are the most common findings in MRI and according to excellent ability of MRI in diagnosis of herniation, MRI is recommended in patients with non surgical non traumatic low back pain. [ABSTRACT FROM AUTHOR]

A quiz is presented regarding the case of a 59-year-old woman with generalized abdominal pain, nausea, and vomiting after colonoscopy.

A quiz concerning the diagnosis of a 48-year-old woman with right hip pain for 20 days is presented.

The article presents a case study of a 15-year old female with painless abdominal distention. She showed mild discomfort of the bowel habit and found a complete distention of the upper abdomen and mild distention of the lower abdomen during her physical examination. The girl had a family history of hydatid disease in her father and brother. The article discusses ovarian mucinous cystadenomas which are cystic masses that contains serous, mucinous and hemorrhagic components.

The article discusses the synovial sarcoma, a malignant tumor of the soft tissues. It states that the condition can spread to the other areas of the body including lungs, regional lymph nodes, bone, and bone marrows. The condition can be detected through radiography or computed tomography (CT) scan. It also presents the case of a 40-year-old woman with rapid enlargement of the right buttock and upon CT scan, sclerosis of the right iliac wing was detected.

A quiz concerning the diagnosis for a 37-year-old woman with painless mass in the right posterior neck is presented.

Abstract Introduction A thyroglossal duct cyst is the most common congenital anomaly of the thyroid gland and midline masses in childhood (70% abnormality in childhood, 7% in adult). Carcinomas arising from a thyroglossal duct cyst are rare (only 1% of thyroglossal duct cyst cases) and characterized by relatively non-aggressive behavior and rare lymphatic spread. They are also diagnosed mostly during the third and fourth decades of life. About 85% to 92% of all thyroglossal duct cyst carcinomas are papillary carcinomas. Case presentation We present the case of a 44-year-old Iranian woman with Cacausian ethnicity with a painless anterior neck mass that appeared gradually over three months. She had a history of frequent painful swelling of the anterior part of her neck, which subsided with antibiotic therapy. Thyroid functional tests were normal and a thyroid scinitigraphy showed a cold nodule in the left lobe of her thyroid. A computed tomography scan revealed a large, heterogeneous enhancing soft tissue mass with cystic components in the midline of the anterior neck space. This extended from the base of the tongue,(completely separated from its muscles, to the inferior aspect of the thyroid gland and showed the destruction of the hyoid bone and the thyroid cartilage. The diagnosis of a thyroglossal duct cyst with malignant transformation was maintained. A fine needle aspiration revealed papillary carcinoma. Conclusion This patient's case is presented because of its rare, aggressive, and invasive nature and rare and unusual manifestation, as well as its rapid increase in size, the destruction of the hyoid bone, chondrolysis of the thyroid cartilage, lymph adenopathy and the existence of a cold nodule in the thyroid gland.

Background and Aims: This study set out to examine the stiffness of the gastrocnemius medialis (GM) and Achilles tendon across postmenopausal women with osteosarcopenia (OS), osteoporosis (OP), and normal bone mineral density. Furthermore, we explored the relationship between muscle-tendon stiffness and postural sway during a curve-tracking task in both sagittal (AP) and frontal (ML) planes., Methods: Seventy-three women volunteered to participate in this study. The participants were classified into OS (T-score ≤ - 2.5 and muscle mass below 5.5 kg/m 2 ), OP (T-score ≤ - 2.5), and healthy (T-score >-1) groups. The shear wave elastography was used to determine GM and Achilles tendon stiffness during rest and activation. The postural sway was recorded using a force plate during the performance-based curve tracking (CT) task., Results: The stiffness of the GM and Achilles tendon was found to be significantly lower in the OS group compared to the OP and healthy groups (P < 0.05). In the CT task, the OS group exhibited a significant decrease in the mean absolute (P = 0.011) and RMS error (P = 0.022) in the ML direction compared to the OP group. Additionally, a positive correlation was found between the ML mean absolute error and both GM and Achilles's stiffness during rest and activation (P < 0.05)., Discussion and Conclusion: The OS group exhibited the lowest muscle-tendon stiffness. The GM and Achilles stiffness was positively correlated with poor performance-based balance, particularly in the ML direction. This may increase the risk of falls and subsequent hip fractures during simple daily weight- shifting activities in women with osteosarcopenia., Competing Interests: Declarations. Ethical approval: This protocol was approved by the ethics committee of the Tarbiat Modares University (IR.MODARES.REC.1402.038) in accordance with the Declaration of Helsinki’s later amendments. Consent to participate: Participants provided written informed consent to use their data for this study. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Botulinum toxin (BTX) injection can be an effective treatment for persistent pain and functional impairment associated with hypertrophy of the first dorsal interosseous muscle. It offers a non-surgical and minimally invasive alternative for those who have failed conservative treatment, showcasing the therapeutic promise of BTX for addressing similar musculoskeletal conditions., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

The rare disorder known as Neutral Lipid Storage Disease with Myopathy presents with a variety of clinical manifestations, including myopathy, cardiac dysfunction, and other organ complications. Early diagnosis is crucial due to the increased risk of cardiomyopathy. We describe the clinical, histopathological, muscle imaging, and genetic findings of nine neutral lipid storage myopathy patients. Proximal weakness and asymmetric involvement may suggest lipid storage myopathy. While skeletal muscle weakness was the main manifestation in our patients, one case presented only with hyperCKemia. Additionally, three patients had fertility issues, two suffered from diabetes mellitus, two had cardiomyopathy, and one had a history of hypothyroidism. Muscle histopathology revealed lipid depositions and rimmed vacuoles, prompting peripheral blood smears to detect Jordan Anomalies. All muscle biopsies and peripheral blood smear showed lipid droplets, rimmed vacuoles, and Jordan anomaly. Identifying PNPLA2 gene mutations is important for diagnosing neutral lipid storage myopathy; our cases showed some novel mutations. This study highlights the importance of early diagnosis and comprehensive evaluation in managing neutral lipid storage myopathy cases., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Osteonecrosis is a major cause of morbidity for patients with systemic lupus erythematosus (SLE). Although core decompression is an approved and trusted technique to prevent further joint deterioration, this surgical method seems to be less beneficial for SLE patients. We aimed to evaluate the outcomes of core decompression in SLE patients with primary stages of femoral head osteonecrosis., Methods: In this study, 23 patients (39 affected hip joints) with osteonecrosis of the femoral head with stage II of the disease, based on the Ficat-Arlet classification system, underwent core decompression. Also, patients demographic characteristics, clinical data, medication history, comorbidities, immunological findings, hip plain radiographs, history of total hip arthroplasty after core decompression, and patients satisfaction with joint function according to the Oxford hip score questionnaire were obtained., Results: In the study, 53.8% of affected joints showed signs of radiographic deterioration in follow-up imaging. Sixty-one and a half percent (61.5%) of patients had unsatisfactory joint performance. A third (33.3%) of affected hip joints underwent total hip arthroplasty up to 5 years from core decompression. SLE patients with a history of receiving bisphosphonate were 83.2% less dissatisfied with their joint function than patients without a history of bisphosphonate use (P < 0.02). Of the 23 studied cases, the mean cumulative dose of prednisolone before and after core decompression surgery was 46.41 mg and 14.74 mg respectively. Besides, one case (2.6%) that had a high anti-phospholipid antibodies level during follow-up did not have any radiographic deterioration, and 9 cases (23.1%) had some degrees of radiographic deterioration., Conclusions: The patients group that used bis-phosphonate, had a higher level of satisfaction with joint function after core decompression. Patients with high-level anti-phospholipid antibodies are related to a poor prognosis after core decompression., (© 2023. The Author(s).)

Objectives: Primary idiopathic frozen shoulder (FS) causes pain and stiffness in the shoulder joint. Over time, this disease causes restriction of shoulder motion. We undertook this study to evaluate possible correlation of MRI findings with outcome of conservative management in FS., Methods: A total of 65 cases participated in prospective cohort study. The correlation of MRI findings obtained before commencing the treatment with outcome of non-operative management (Mean of ROM, VAS, SST and OSS) was evaluated., Results: Anterior extracapsular edema significantly correlated with FF, EXR, VAS (a) and OSS. The effusion in humeral side of axillary recess significantly correlated with ROM restriction in ABD, EXR. Capsular thickness of glenoid portion showed good significance with FF, ABD, VAS (a) and OSS. Increased thickness of CHL showed negative correlation with improvement of EXR (P=0.049) (r=-0.617). Thickening of IGHL showed negative correlation with improvement of ABD (p=0.005 r=-0.862) and FF (p=0.007 r=-0.831). Mean Height of Axillary recess (HAR) was 7.2mm (3.5-11mm). HAR showed negative correlation with VAS pain scale (P=0.036) (r=-0.682) and OSS (P=0.038) (r=-0.668)., Conclusion: Thickness of the joint capsule and effusion at the axillary fold are important factors for refractory frozen shoulder. We can recommend MRI for refractive cases and low threshold of expectation can be set for conservative management in patients with above findings., Competing Interests: None, (2024 © BY THE ARCHIVES OF BONE AND JOINT SURGERY.)

Background: Previous studies has shown that nucleotide-binding and oligomerization domain-containing protein 2 (NOD2) is expressed in Fibroblast-like synoviocytes (FLSs) of rheumatoid arthritis (RA) patients which is stimulated by muramyl dipeptide (MDP) present in the joint environment and induces inflammation via the NF-κB pathway. Also, other studies have shown that curcumin inhibits proliferation, migration, invasion, and Inflammation and on the other hand increases the apoptosis of RA FLSs. In this study, we aim to evaluate the effect of curcumin, a natural anti-inflammatory micronutrient, on the expression of NOD2 and inflammatory cytokines., Methods: Synovial membranes were collected from ten patients diagnosed with RA and ten individuals with traumatic injuries scheduled for knee surgery. The FLSs were isolated and treated with 40 μM curcumin alone or in combination with 20.3 μM MDP for 24 h. mRNA was extracted, and real-time PCR was performed to quantitatively measure gene expression levels of NOD2, p65, IL-6, TNF-α, and IL-1β., Results: The study findings indicate that administering MDP alone can significantly increase the mRNA expression levels of IL-6 and IL-1β in the trauma group and TNF-α in the RA group. Conversely, administering curcumin alone or in combination whit MDP can significantly reduce mRNA expression levels of P65 and IL-6 in FLSs of both groups. Moreover, in FLSs of RA patients, a single curcumin treatment leads to a significant reduction in NOD2 gene expression., Conclusion: This study provides preliminary in vitro evidence of the potential benefits of curcumin as a nutritional supplement for RA patients. Despite the limitations of the study being an investigation of the FLSs of RA patients, the results demonstrate that curcumin has an anti-inflammatory effect on NOD2 and NF-κB genes. These findings suggest that curcumin could be a promising approach to relieve symptoms of RA., (© 2023. The Author(s).)

Background: Characterization of parotid tumors before surgery using multi-parametric magnetic resonance imaging (MRI) scans can support clinical decision making about the best-suited therapeutic strategy for each patient., Objective: This study aims to differentiate benign from malignant parotid tumors through radiomics analysis of multi-parametric MR images, incorporating T2-w images with ADC-map and parametric maps generated from Dynamic Contrast Enhanced MRI (DCE-MRI)., Material and Methods: MRI scans of 31 patients with histopathologically-confirmed parotid gland tumors (23 benign, 8 malignant) were included in this retrospective study. For DCE-MRI, semi-quantitative analysis, Tofts pharmacokinetic (PK) modeling, and five-parameter sigmoid modeling were performed and parametric maps were generated. For each patient, borders of the tumors were delineated on whole tumor slices of T2-w image, ADC-map, and the late-enhancement dynamic series of DCE-MRI, creating regions-of-interest (ROIs). Radiomic analysis was performed for the specified ROIs., Results: Among the DCE-MRI-derived parametric maps, wash-in rate (WIR) and PK-derived K trans parameters surpassed the accuracy of other parameters based on support vector machine (SVM) classifier. Radiomics analysis of ADC-map outperformed the T2-w and DCE-MRI techniques using the simpler classifier, suggestive of its inherently high sensitivity and specificity. Radiomics analysis of the combination of T2-w image, ADC-map, and DCE-MRI parametric maps resulted in accuracy of 100% with both classifiers with fewer numbers of selected texture features than individual images., Conclusion: In conclusion, radiomics analysis is a reliable quantitative approach for discrimination of parotid tumors and can be employed as a computer-aided approach for pre-operative diagnosis and treatment planning of the patients., Competing Interests: None, (Copyright: © Journal of Biomedical Physics and Engineering.)

Background: Recently, attention has been focused on mesenchymal stem cells (MSC) because of their unique ability to suppress inflammation induced by cytokine storms caused by COVID-19. Several patients have been successfully treated in this manner. After one year of treatment with Wharton's jelly-derived MSC injections, this study evaluated the safety and efficacy of injecting MSCs intravenously in patients with COVID-19., Methods: This study treated four patients with severe COVID-19 with Wharton's jelly-derived mesenchymal stem cells. In this study, patients were followed up for routine tests, tumor markers, and whole-body imaging (spiral neck CT scan (with contrast), spiral chest CT scan (with & without contrast), and spiral abdominopelvic CT scan (with IV & Oral contrast)) one year after cell therapy., Results: The results indicated that lymphocyte; lymph count significantly increased, and neutrophil, ESR, ferritin, and CRP significantly decreased. LDH showed a non-significant decrease ( P -value<0.05). One year after the WJ-MSC injection, the tumor markers were normal, and no tumors were observed in patients after one year. Also, the CT scan result was normal., Conclusions: In patients, no serious complications were observed after a one-year follow-up. After monitoring the patient via laboratory tests, tumor markers, and whole-body imaging, we concluded that the Wharton jelly-derived mesenchymal stem cells did not cause severe complications, including tumor formation, in severe COVID19 patients within a year. More clinical trials with higher sample sizes need to be performed on cell therapy with Wharton jelly-derived mesenchymal stem cells in the future., Competing Interests: The authors declare that they have no competing interests., (© 2022 Published by Elsevier Inc.)

Objectives: It is essential to know the normal extrusion measures in order to detect pathological ones. In this study, we aimed to define some normal reference values for meniscal extrusion in the normal knees during different ranges of motion., Methods: The amount of anterior and posterior portion of meniscal extrusion among 21 asymptomatic volunteers (42 knees) were tracked in 0, 45, and 90° of knee flexion using an ultrasound machine. The repeated measures analysis of variance (ANOVA) was used to show the interaction between the amounts of meniscal extrusion and the different degrees of knee flexion., Results: The anterior portion of the lateral menisci at full knee extension (0.59 ± 1.40) and the posterior portion of the medial menisci during 90° flexion (3.06 ± 2.36) showed the smallest and the highest mean amount of extrusion, respectively. The normal average amounts of anterior extrusion were 1.12 ± 1.17 and 0.99 ± 1.34 mm for medial and lateral menisci, respectively. The posterior meniscal normal extrusions were significantly increasing in both medial and lateral menisci during the survey (F = 20.250 and 11.298; both P values <.001) as they were measured 2.37 ± 2.16 and 1.53 ± 2.18 mm in order., Conclusions: The medial meniscus can extrude 1.74 ± 1.84 mm normally while this amount was 1.26 ± 1.82 mm for the lateral meniscus. These measures commonly increased with the rising of knee flexion motion. Likewise, the posterior portion showed more extrusion than the anterior portion on both sides. These measures commonly increased with higher knee flexion., (© 2022 American Institute of Ultrasound in Medicine.)

Background: Since 2019, coronavirus disease 2019 (COVID-19) has been the leading cause of mortality worldwide., Aims: To determine independent predictors of mortality in COVID-19, and identify any associations between pulmonary disease severity and cardiac involvement., Methods: Clinical, laboratory, electrocardiography and computed tomography (CT) imaging data were collected from 389 consecutive patients with COVID-19. Patients were divided into alive and deceased groups. Independent predictors of mortality were identified. Kaplan-Meier analysis was performed, based on patients having a troponin concentration>99th percentile (cardiac injury) and a CT severity score ≥18., Results: The mortality rate was 29.3%. Cardiac injury (odds ratio [OR] 2.19, 95% confidence interval [CI] 1.14-4.18; P=0.018), CT score ≥18 (OR 2.24, 95% CI 1.15-4.34; P=0.017), localized ST depression (OR 3.77, 95% CI 1.33-10.67; P=0.012), hemiblocks (OR 3.09, 95% CI 1.47-6.48; P=0.003) and history of leukaemia/lymphoma (OR 3.76, 95% CI 1.37-10.29; P=0.010) were identified as independent predictors of mortality. Additionally, patients with cardiac injury and CT score ≥ 18 were identified to have a significantly shorter survival time (mean 14.21 days, 95% CI 10.45-17.98 days) than all other subgroups. There were no associations between CT severity score and electrocardiogram or cardiac injury in our results., Conclusions: Our findings suggest that using CT imaging and electrocardiogram characteristics together can provide a better means of predicting mortality in patients with COVID-19. We identified cardiac injury, CT score ≥18, presence of left or right hemiblocks on initial electrocardiogram, localized ST depression and history of haematological malignancies as independent predictors of mortality in patients with COVID-19., (Copyright © 2022. Published by Elsevier Masson SAS.)

Since 1952, when Langenskiöld introduced his six-stage classification on roentgenographic morphologies of tibia vara, this method has been used extensively in Orthopaedic studies. Different studies have tried to determine the reliability of this method. Although there are scarce reports of major variability in using Langenskiöld classification, but the question still remains, as to whether using expert subspecialists and MRI would improve its reliability. The aim of this study is to evaluate inter-rater reliability of Langenskiöld classification using simple radiograph and MRI, by expert raters. This is a cross-sectional multicenter study, involving patients from 4 tertiary pediatric orthopedic centers in France and Iran. Radiograph and MRI (T1, T2, fat saturation) of the affected knees were independently classified by 12 academy members from France and Iran: six pediatric fellowship orthopedic surgeons and six musculoskeletal radiologists. All data were analyzed afterwards by an independent researcher. Mean weighted kappa for agreement based on radiograph and MRI was 0.47 and 0.45, respectively. Mean percent of total agreement was 46.6 and 40.8% in the same order. Kappa statistics for the new grouping were 0.53 and 0.46 for roentgenograms and MRIs, respectively. The new regrouping was proposed so that each group would need a different treatment strategy. Fleiss kappa statistics for group B (stages 2 and 3), rose from (0.33 and 0.09) to 0.44. These values for group C (stages 4 and 5) rose from (0.42 and 0.11) to 0.54. This study concludes that Langenskiöld's classification when used by experts, still has a moderate inter-rater reliability at best. This variability is most at stages 2, 3, and 4; and can cause different treatment approaches. Use of MRI does not have a significant effect on its reliability. Regrouping the stages improved the inter-rater reliability. Level of evidence: III., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

It has been more than a year since the outbreak of COVID-19, and it is still the most critical issue of the healthcare system. Discovering effective strategies to treat infected patients is necessary to decrease the mortality rate. This study aimed to determine the effects of nanocurcumin on the severity of symptoms and length of hospital stay (LOS) in COVID-19 patients. Forty-eight COVID-19 patients were randomly assigned into nanocurcumin (n = 24) and placebo (n = 24) groups receiving 160 mg/day nanocurcumin or placebo capsules for 6 days. Mean differences of O 2 saturation were significantly higher in patients who received nanocurcumin supplements (p = 0.02). Also, nanocurcumin treatment significantly reduced the scores of domains 3 and 4 and the total score of Wisconsin Upper Respiratory System Survey (WURSS-24), indicating milder symptoms in the treatment group (p = 0.01, 0.03, and 0.01 respectively). Besides, the LOS in curcumin groups was lower than in the placebo group, although the difference was not statistically significant (6.31 ± 5.26 vs. 8.87 ± 8.12 days; p = 0.416). CBC/differentiate, hs-CRP level and the pulmonary involvement in CT scan were not different between the two groups. As nanocurcumin can be effective in increasing O 2 saturation and reducing the severity of symptoms in COVID-19 patients, it could probably be used as a complementary agent to accelerate the recovery of patients., (© 2022 John Wiley & Sons Ltd.)

Background: There is a growing need for information regarding the recent coronavirus disease of 2019 (COVID-19). We present a comprehensive report of COVID-19 patients in Iran., Materials and Methods: One hundred hospitalized patients with COVID-19 were studied. Data on potential source of exposure, demographic, clinical, and paraclinical features, therapy outcome, and postdischarge follow-up were analyzed., Results: The median age of the patients was 58 years, and the majority of the patients (72.7%) were above 50 years of age. Fever was present in 45.2% of the patients on admission. The most common clinical symptoms were shortness of breath (74%) and cough (68%). Most patients had elevated C-reactive protein (92.3%), elevated erythrocyte sedimentation rate (82.9%), and lymphocytopenia (74.2%) on admission. Lower lobes of the lung were most commonly involved, and ground-glass opacity (81.8%) was the most frequent finding in computed tomography scans. The administration of hydroxychloroquine improved the clinical outcome of the patients. Lopinavir/ritonavir was efficacious at younger ages. Of the 70 discharged patients, 40% had symptom aggravation, 8.6% were readmitted to the hospital, and three patients (4.3%) died., Conclusion: This report demonstrates a heterogeneous nature of clinical manifestations in patients affected with COVID19. The most common presenting symptoms are nonspecific, so attention should be made on broader testing, especially in age groups with the greatest risk and younger individuals who can serve as carriers of the disease. Hydroxychloroquine and lopinavir/ritonavir (in younger age group) can be potential treatment options. Finally, patients discharged from the hospital should be followed up because of potential symptom aggravation., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Research in Medical Sciences.)

Background: Mesenchymal stem cells (MSCs) have received particular attention because of their ability to modulate the immune system and inhibit inflammation caused by cytokine storms due to SARS-CoV-2. New alternative therapies may reduce mortality rates in patients with COVID19. This study aimed to assess the safety and efficacy of injecting intravenous Wharton's jelly-derived MSCs in patients with COVID-19 as a treatment., Methods: In this study, five patients with severe COVID-19 were treated with Wharton's jelly-derived mesenchymal stem cells (150 × 106 cells per injection). These patients were subject to three intravenous injections 3 days apart, and monitoring was done on days 0, 3, 6, and 14 in routine tests, inflammatory cytokines, and flow cytometry of CD4 and CD8 markers. A lung CT scan was performed on base and days 14 and 28. In addition, IgM and IgG antibodies against SARS-CoV-2 were measured before and after treatment., Results: The results showed that IL-10 and SDF-1 increased after cell therapy, but VEGF, TGF-β, IFN-γ, IL-6, and TNFα decreased. Routine hematology tests, myocardial enzyme tests, biochemical tests, and inflammation tests were performed for all patients before and after cell therapy on base and days 3, 6, and 14, which indicated the improvement of test results over time. COVID-19 antibody tests rose in 14 days after WJ-MSC injection. The total score of zonal involvement in both lungs was improved., Conclusions: In patients, the trend of tests was generally improving, and we experienced a reduction in inflammation. No serious complications were observed in patients except the headache in one of them, which was resolved without medication. In this study, we found that patients with severe COVID-19 in the inflammatory phase respond better to cell therapy. More extensive clinical trials should be performed in this regard., Trial Registration: IRCT, IRCT20190717044241N2 . Registered April 22, 2020., (© 2021. The Author(s).)

Background: Glomus tumor is an uncommon soft tissue tumor. However, as the tumor causes significant disability, its early diagnosis is essential. It involves subungual areas of fingers and toes in most cases, and its extra-digital involvement is rarely seen. To the best of the authors' knowledge, only a few chest wall involvement cases have been reported in the literature., Case Presentation: In this paper, we describe a 63-year-old patient with a chest wall glomus tumor presenting with axillary paroxysmal pain and limitation in his shoulder range of motion that had been missed for nearly 15 years. His symptoms were relieved immediately following surgical excision., Conclusion: Glomus tumors may involve any part of the human body. It is curable with surgical excision in most cases. Therefore, a correct early diagnosis has paramount importance. A high index of suspicion is needed for early diagnosis, especially when the tumor involves uncommon anatomic areas.

Objective: To develop prognostic models for survival (alive or deceased status) prediction of COVID-19 patients using clinical data (demographics and history, laboratory tests, visual scoring by radiologists) and lung/lesion radiomic features extracted from chest CT images., Methods: Overall, 152 patients were enrolled in this study protocol. These were divided into 106 training/validation and 46 test datasets (untouched during training), respectively. Radiomic features were extracted from the segmented lungs and infectious lesions separately from chest CT images. Clinical data, including patients' history and demographics, laboratory tests and radiological scores were also collected. Univariate analysis was first performed (q-value reported after false discovery rate (FDR) correction) to determine the most predictive features among all imaging and clinical data. Prognostic modeling of survival was performed using radiomic features and clinical data, separately or in combination. Maximum relevance minimum redundancy (MRMR) and XGBoost were used for feature selection and classification. The receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC), sensitivity, specificity, and accuracy were used to assess the prognostic performance of the models on the test datasets., Results: For clinical data, cancer comorbidity (q-value < 0.01), consciousness level (q-value < 0.05) and radiological score involved zone (q-value < 0.02) were found to have high correlated features with outcome. Oxygen saturation (AUC = 0.73, q-value < 0.01) and Blood Urea Nitrogen (AUC = 0.72, q-value = 0.72) were identified as high clinical features. For lung radiomic features, SAHGLE (AUC = 0.70) and HGLZE (AUC = 0.67) from GLSZM were identified as most prognostic features. Amongst lesion radiomic features, RLNU from GLRLM (AUC = 0.73), HGLZE from GLSZM (AUC = 0.73) had the highest performance. In multivariate analysis, combining lung, lesion and clinical features was determined to provide the most accurate prognostic model (AUC = 0.95 ± 0.029 (95%CI: 0.95-0.96), accuracy = 0.88 ± 0.046 (95% CI: 0.88-0.89), sensitivity = 0.88 ± 0.066 (95% CI = 0.87-0.9) and specificity = 0.89 ± 0.07 (95% CI = 0.87-0.9))., Conclusion: Combination of radiomic features and clinical data can effectively predict outcome in COVID-19 patients. The developed model has significant potential for improved management of COVID-19 patients., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Coronavirus disease 2019 (COVID-19) has transformed into a worldwide challenge, since its outbreak in December 2019. Generally, patients with underlying medical conditions are at a higher risk of complications and fatality of pneumonias. Whether patients with systemic autoimmune diseases or vasculitides, are at increased risk for serious complications associated with COVID-19, is not established yet. Computed tomography (CT) has been employed as a diagnostic tool in the evaluation of patients with clinical suspicion of severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection with a reported sensitivity of higher than reverse transcription polymerase chain reaction (RT-PCR) test. Multifocal bilateral ground-glass opacities (GGOs) with peripheral and posterior distribution and subsequent superimposition of consolidations are considered the main imaging features of the disease in chest CT. However, chest CT images of underlying rheumatologic or autoimmune diseases or vasculitides, such as systemic sclerosis, systemic lupus erythematosus, rheumatoid arthritis, Behçet disease, and granulomatosis with polyangiitis, especially those with extensive lung involvement can overshadow or obliterate features of COVID-19. In addition, CT findings of such diseases may resemble manifestations of COVID-19 (such as ground glass opacities with or without superimposed consolidation), making the diagnosis of viral infections, more challenging on imaging. Comparing the imaging findings with prior studies (if available) for any interval change is the most helpful approach. Otherwise, the diagnosis of COVID-19 in such patients must be cautiously made according to the clinical context and laboratory results, considering a very high clinical index of suspicion on imaging.

Background: Chest computed tomography (CT) scan is frequently used in the diagnosis of COVID-19 pneumonia., Objectives: This study investigates the predictive value of CT severity score (CSS) for length-of-stay (LOS) in hospital, initial disease severity, ICU admission, intubation, and mortality., Methods: In this retrospective study, initial CT scans of consecutively admitted patients with COVID-19 pneumonia were reviewed in a tertiary hospital. The association of CSS with the severity of disease upon admission and the final adverse outcomes was assessed using Pearson's correlation test and logistic regression, respectively., Results: Total of 121 patients (60±16 years), including 54 women and 67 men, with positive RT-PCR tests were enrolled. We found a significant but weak correlation between CSS and qSOFA, as a measure of disease severity (r: 0.261, p = 0.003). No significant association was demonstrated between CSS and LOS. Patients with CSS>8 had at least three-fold higher risk of ICU admission, intubation, and mortality., Conclusions: CSS in baseline CT scan of patients with COVID-19 pneumonia can predict adverse outcomes and is weakly correlated with initial disease severity., Competing Interests: Declarations of Competing Interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

As of April 17th, 2020, more than 2,190,010 COVID-19 cases with 147,010 deaths have been recorded worldwide. It has been suggested that a high mortality rate occurs in patients with severe disease and is associated with advanced age and underlying comorbidities, such as malignancies. To the best of our knowledge, no study has been conducted to evaluate chest CT features in patients with malignancy and concomitant COVID-19 infection. In fact, the imaging findings can be challenging and have not yet been fully understood in this setting. In this manuscript, we go over imaging findings in chest CT of patients with COVID-19 and known cancer. With the ongoing COVID-19 pandemic and exponentially increasing incidence throughout the world, in at-risk and vulnerable populations such as patients with known malignancies, infection with SARS-CoV-2 should be included in the differential considerations even with atypical image pictures. Detection of superimposed infection in patients with cancers who present with pulmonary infiltrations warrant correlation with clinical picture, contact history, and RT-PCR confirmatory testing., Competing Interests: Declaration of competing interest The author has no conflicts of interest relevant to this article to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

COVID-19 is principally a respiratory illness and pulmonary manifestations constitute main presentations of the disease. According to the reported studies, SARS-CoV-2 infection is not limited to the respiratory system and other organs can be also affected. Renal dysfunction, gastrointestinal complications, liver dysfunction, cardiac manifestations, mediastinal findings, neurological abnormalities, and hematological manifestations are among the reported extrapulmonary features. Considering the broad spectrum of clinical manifestations and the increasing worldwide burden of the disease, there is an urgent need to rapidly scale up the diagnostic capacity to detect COVID-19 and its complications. This paper focuses on the most common extrapulmonary manifestations in patients with COVID-19 pneumonia. Further studies are needed to elaborate and confirm the causative relationship between SARS-CoV-2 and the reported extrapulmonary manifestations of COVID-19., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: We evaluated the association between muscle ultrasound, number of motor units, and clinical parameters, and assessed their utility for distinguishing amyotrophic lateral scleorisis (ALS) patients from healthy individuals., Methods: Three muscle pairs (abductor pollicis brevis, abductor digiti minimi, and tibialis anterior) of 18 ALS patients and 18 controls underwent muscle ultrasound (echointensity and thickness) and assessment of motor unit number index (MUNIX). The clinical and functional status of participants were also assessed., Results: Mean age of the patients was 53.8 ± 12.1 years, and score on the ALS Functional Rating Scale-Revised was 38.9 ± 4.1. Echointensity of all tested muscles of ALS participants was significantly higher than that of controls, but there was no significant difference in muscle thickness. Muscle echointensity correlated significantly with clinical and electrophysiological parameters., Conclusion: Echointensity of muscles was highly associated with clinical scales and MUNIX, confirming its relevance as an ancillary diagnostic test in ALS patients., (© 2020 Wiley Periodicals LLC.)

Purpose: MRI is now the modality of choice for evaluating articular cartilage. Nevertheless, it has some general drawbacks. Some patients cannot undergo MRI, and in others US scan could be the first examination and cartilage should be evaluated. Ultrasound could be a useful method for detecting trochlear cartilage low-grade lesions. In this study, our goal was to evaluate the efficacy of ultrasonography in detecting these lesions., Methods: All patients referred to our hospital, from July 2018 to July 2019, who were arthroscopic candidates due to sport-related pathologies, underwent ultrasound scan 1 day prior to surgery. Ultrasound assessment was performed by an expert radiologist, with a 13-MHz probe, located transversely proximal to the patella in different degrees of knee flexion to assess trochlear lesion grade and thickness. Arthroscopic examination of all patients was performed by an experienced orthopedic knee surgeon (second author). Sensitivity and specificity of ultrasound were calculated., Results: A total of 48 patients were involved in the study with a mean age of 33.2 years (SD: 9.7), between 19 and 51 years of age. Patients were 81% male (39 patients). The sensitivity of ultrasound in grading of trochlear cartilage lesion was 100%, meanwhile its specificity was 88.2% (30 cases had normal cartilage while this figure was 34 in arthroscopy)., Conclusion: Sonography is a low-cost, accessible diagnostic tool with high sensitivity and specificity for early detection of trochlear cartilage pathologies. It can play an important role as an outpatient diagnostic workup in patients with anterior knee pain.

Purpose: To study the efficacy of shear wave elastography (SWE), using both qualitative and quantitative methods, alone and in conjunction with other B-mode features., Method: 117 patients with 123 nodules were studied both by conventional ultrasonography and SWE. Size, echogenicity, margins, internal calcification (micro- or macro-calcification), composition, shape and color Doppler were assessed for each nodule. The elasticity was assessed both qualitatively and quantitatively. Velocity in the ROI (Region of Interest) was calculated in the stiffest portions for 3 times, and maximum and mean velocity were obtained. ROC curve was analyzed to calculate the best cut-off value of the SWV (Shear Wave Velocity). Univariate logistic regression was used to examine the maximum and mean SWV as discrete variables and the results were compared to key variables of conventional US (Ultrasound) features., Result: 123 nodules in 117 patients were evaluated. Poor margins, hypoechogenicity, micro-calcification, color Doppler grades III and IV, color map grades IV and V, maximum and minimum velocity had significant correlation with malignancy. The highest Nagelkerke R2 belonged to maximum and mean velocity (R2 = 41.2 and 39 respectively) which propose them as the strongest predictors of malignancy. The best cut-off point for differentiation of benign from malignant nodules was 3.63 m/s for maximum velocity (sensitivity of 90 %, specificity of 78.2 %,) and 3.44 m/s for mean velocity (sensitivity of 90 %, specificity of 76.4 %)., Conclusion: The Real-time SWE is a promising test for the preoperative malignancy risk stratification of patients and maximum velocity has the strongest predictive value for both conventional and elastography variables., Competing Interests: Declaration of Competing Interest No potential conflicts of interest are disclosed., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Tibial tuberosity-trochlear groove distance (TT-TGD) measurements play a decisive role in evaluating patellofemoral joint disorders. However, the prevalence of pathological TT-TGD among patients with patellofemoral pain remains unclear. The purpose of this study was to compare the size of TT-TGD among patients with patellofemoral pain syndrome (PFPS) and those with no history of patellofemoral pain., Methods: A total of 100 cases participated in this case-control study, among whom 53 individuals were in the case group and 47 individuals were in the control group. TT-TGD was measured by magnetic resonance imaging., Results: The mean TT-TGD was 12.3±3.3 in patients and 9.3±2.4 in controls ( P<0.001 ). Among patients, we had totally 34 patients with TT-TG equal or lower than 13 (64.2%) and in 18 patients, it was higher than 13 (34%)., Conclusion: The mean TT-TGD in patients with PFPS was greater than that in the control group ( P=0.001 ). An increase in TT-TGD can be considered one of the factors behind the development of PFPS., (2019 © BY THE ARCHIVES OF BONE AND JOINT SURGERY.)

Objective: Magnetic resonance spectroscopy (MRS) is a powerful tool for structural studies of chemical compounds and biomolecules and also documented promising findings as a potential imaging technology in thyroid oncology. This prospective study was to ascertain the clinical significance of 3 Tesla MRS in the evaluation of patients with thyroid nodules (TNs) as an ancillary diagnostic technique for thyroid carcinoma., Materials and Methods: Magnetic resonance spectroscopy at 3T at echo- times (TEs) 136 and 270 ms was carried out on 15 patients with total number of 32 TNs larger than 1 cm3, which all were surgically resected. Choline (Chol) to creatine (Cr) ratio was assessed at 136 and 270 TEs on each nodule and a receiver operating characteristic (ROC) curve was used to determine optimal cut-off point. The findings were compared with histopathology of thyroid specimens., Results: There were 23 benign and 9 malignant lesions (7 papillary and 2 follicular thyroid carcinomas). The mean values of Chol/Cr at 136 and 270 TEs was 2.28 ± 3.65 and 1.52 ± 1.67 respectively and the difference between benign and malignant nodules was only significant at 136 TEs. The study revealed that Chol/ Cr ratio cut-off point of 2.5 best correlates with histopathology results (sensitivity = 75%; specificity = 100%; PPV = 100%; NPV= 92%)., Conclusion: This preliminary study showed that 3T magnetic resonance spectroscopy might be a specific modality for the evaluation of thyroid nodules in differentiation of benign from malignant thyroid tissue. However, a larger series would give much greater confidence that this state-of-the-art technology will worth pursuing in clinical practice.

Background: Preoperative differentiation of benign from malignant thyroid nodules remains a challenge. Aims: This study assessed the accuracy of diffusion-weighted imaging (DWI) for differentiation between benign and malignant thyroid nodules., Materials and Methods: Preoperative DWI was performed in patients with thyroid nodule by means of a 3-T scanner magnetic resonance imaging (MRI). Images were obtained at b value of 50, 500, and 1000 mm 2 /s to draw an ADC (apparent diffusion coefficient) map. Findings were compared with postoperative histopathologic results. Receiver operating characteristic curve was used to assess the accuracy of different cutoff points., Results: Forty-one thyroid nodules (26 benign and 15 malignant) were included in this study. None of static MRI parameters such as signal intensity, heterogeneity, and nodule border was useful to discriminate between benign and malignant lesions. Mean ADC value was (1.94 ± 0.54) × 10 -3 mm 2 /s and (0.89 ± 0.29) × 10 -3 mm 2 /s in benign and malignant nodules, respectively ( P -value < 0.005). ADC value cutoff of 1 × 10 -3 mm 2 /s yielded an accuracy, sensitivity, and specificity of 93%, 87%, and 96% to discriminate benign and malignant nodules., Conclusion: DWI is highly accurate for discrimination between benign and malignant thyroid nodules., Competing Interests: There are no conflicts of interest.

Objective: Gastroparesis is defined as delayed gastric emptying and is a common medical condition in diabetic patients. Scintigraphy is commonly used as a standard diagnostic procedure for the quantitative assessment of gastroparesis. The aims of this study were to determine an optimum imaging time for the diagnosis of gastroparesis, to assess the prevalence of gastroparesis, to evaluate the correlation between endoscopy and scintigraphy findings as well as the correlation between gastric emptying with patient genders, blood glucose concentration, and functional dyspepsia., Methods: Gastric emptying was assessed in 50 diabetic patients with a mean age of 50.16 years. For evaluation of gastric emptying, a test meal containing 2 pieces of toast, 120 cc non-labeled water and fried egg labeled with 1 mCi of 99m Tc was given to each patient. The scintigraphy was performed immediately after ingestion and was repeated at 1, 1.5, 2 and 4 hours after ingestion. In some patients, an additional 90-minute dynamic scan was also acquired., Results: The prevalence of gastroparesis in this study population was determined as 64%. Also, the results of this study revealed that a 4-hour scan after ingestion is more relevant than a 90-minute dynamic scan for the evaluation of delayed gastric emptying. There was no statistically significant difference between 1-hour and 2-hour scans, 1-hour and 90-minute scans, 2-hour and 90-minute scans, 2-hour and 4-hour scans. Likewise there was no significant correlation between blood glucose levels, gender and calculated values of gastric emptying time in all groups., Conclusion: According to our findings, it can be suggested that the prevalence of gastroparesis is higher than that mentioned in some previous studies. Also, this study indicates that a gastric emptying scintigraphy at 2 and 4 hours after meal ingestion might provide the anticipated clinical information in diabetic patients with dyspepsia without other evident reasons.

BACKGROUND Magnetic resonance enterography (MRE) has become the modality of choice in assessment of patients with Crohn's disease (CD). We aimed to present our experience on 300 patients with CD who underwent MRE during the first 30 months after setting up MRE for the first time in a referral center in Iran. METHODS Patients with a definite diagnosis of CD based on either ileocolonoscopy or histopathological studies were included in the final report and categorized into four phenotypes of inactive, active, stricturing, and penetrating disease. RESULTS This was a case series study on 300 patients with known CD out of 594 referred subjects. The most prevalent phenotype was inactive observed in 162 (54.0%) patients followed by stricturing in 44 (14.7%), active in 40 (13.3%), penetrating in 27(9%), and active on chronic in 27 (9%) cases. The number of referred patients increased from 51 cases in the first 6 months to 165 in the last 6 months. CONCLUSION This study presents the first report on the application of MRE in Iran as superb modality for management of CD. The growing number of referred patients indicates that MRE has been successful in addressing the most critical concerns of clinicians on determining the dominant disease phenotype.

Objectives: Pre-operative differentiation of salivary gland neoplasms is of great importance. This study was designed to evaluate the use of dynamic contrast-enhanced MRI (DCE-MRI) for differentiation between malignant, Warthin and benign non-Warthin (BNW) neoplasms of major salivary glands., Methods: 46 major salivary gland tumours (SGTs) underwent pre-operative DCE-MRI. Post-surgical histopathological evaluation showed 30 BNW, 6 Warthin and 10 malignant tumours. Time-signal intensity curves (TICs) were categorized as (a) Tpeak >43 s and washout ratio at 180 s (WR180) <4.6%; (b) Tpeak <43 s and WR >22%; (c) Tpeak >43 s and WR180 = 4.6-22.0%, Results: Accuracy of Tpeak was 98.9% for differentiation between BNW and Warthin tumours, 83.7% between BNW and malignant and 80% between malignant and Warthin tumours. All Warthin tumours showed Tpeak ≤43 s, while one BNW had Tpeak <43 s. A Tpeak <63.5 s differentiated 8/10 (80%) malignant tumours from BNW tumours, whereas 4/30 of BNW tumours had a Tpeak <63.5 s. Two malignant tumours had Tpeak <43 s. WR180 had an accuracy of 100% for differentiation between Warthin and BNW tumours, 87.3% between BNW and malignant, and 93.3% between Warthin and malignant tumours. 29 (96.7%) BNW tumours had a washout <4.60%, while 8 (80%) malignant tumours had a washout >4.60%. All Warthin tumours had a WR180 >22%, while two malignant tumours had a WR180 >22%. 29/30 of BNW tumours demonstrated TIC curve Type A and 1 tumour demonstrated Type C. 6/10 of malignant tumours had TIC Type C, 2 had TIC Type A and 2 Type B. All Warthin tumours were categorized as Type B., Conclusions: This study showed that DCE-MRI could be helpful in pre-operative differentiation of SGTs; especially for discrimination between Warthin and BNW tumours.