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Background: Limb lengthening procedures are performed for various indications, including limb length discrepancies (LLDs) and short stature. This systematic review and meta-analysis compares the efficacy and safety of the newer motorized intramedullary lengthening nails (MILNs) with the traditional alternative techniques (ATs) for femoral limb lengthening., Methods: We conducted a comprehensive literature search in the Medline, Embase, Cochrane, Web of Science, and Scopus databases, inclusive of all dates through July 1, 2023, and without language restrictions. Factors mediating outcomes included problems, obstacles, complications, total adverse events, healing/consolidation index, time to full weight-bearing, lengthening accuracy, percentage of lengthening goal achieved, and duration of hospital stay. Effect sizes were quantified using STATA 17.0. Statistical algorithms employed were random effects model standardized mean differences (SMDs) for continuous outcomes and log risk ratios (RRs) for dichotomous outcomes, both with 95% confidence intervals (CIs)., Results: Our meta-analysis included 10 studies comparing MILN with AT: 180 femurs in the MILN group and 160 femurs in the AT group. This was exclusively comprised of retrospective cohort studies. When compared with AT, limb lengthening procedures utilizing MILNs had significantly lower problems (log RR, -1.35; 95% CI, -1.93 to -0.77; p < 0.001), complications (log RR, -0.56; 95% CI, -0.90 to -0.22; p = 0.001), and total adverse events (log RR, -0.69; 95% CI, -1.17 to -0.21; p = 0.005), as well as a superior bone healing index (SMD, -0.80; 95% CI, -1.32 to -0.28; p = 0.003). However, no significant differences were found in obstacles, percentage of lengthening goal achieved, lengthening accuracy, time to full weight-bearing, and duration of hospital stay., Conclusion: Limb lengthening with MILNs vs. AT may offer more favorable patient outcomes, lowering risk for problems, complications, and total adverse events, while optimizing the bone healing/consolidation index. However, the limitation of nonrandomized retrospective studies and high heterogeneity should be acknowledged., Level of Evidence: Level II (meta-analysis of cohort studies). See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/B160)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Background and Aim: Social factors play a crucial role in the quality of life of + 50 adults. This study aimed to investigate the association between social support, depression, and loneliness and the health-related quality of life in + 50 adults of Ardakan., Methods: This was a cross-sectional study from the first phase of Ardakan Cohort Study on Aging (ACSA) in 2019. Health-Related Quality of Life (HRQoL, SF-16), Duke Social Support Index (DSSI), and Center for Epidemiologic Studies Depression Scale (CES-D10) were used to assess the variables of interest. Multivariable linear regression was used to model the associated factors with the score of the SF-16 tool in two dimensions; physical (PCS) and mental (MCS)., Findings: A total of 5197 over 50 years individuals included in this study; The mean age was 62.2 ± 7.3 years old, and 52% were male. The mean score for PCS and MCS subscales was 45.6 (95% CI 45.4 to 45.9) and 49.3 (95% CI 49.0 to 49.5), respectively. Adjusted for other variables, having less feeling level of loneliness, and not having depressive symptoms were related to better PCS and MCS scores., Conclusion: The HRQoL for the mental aspect of HRQoL was better than the physical in elder populations. Also, much more focus should be paid to older adults who experience inadequate social support, higher levels of loneliness, and depressive symptoms.

Chronic pain remains a treatment challenge. Curcumin, a natural plant product found in the Curcuma genus, has been shown to possess anti-inflammatory, antioxidant, and neuroprotective properties. In this systematic review and meta-analysis, we aimed to evaluate the efficacy of curcumin and nano-curcumin for treating chronic pain in clinical and preclinical studies. A systematic search was performed through PubMed, SCOPUS, Web of Science Core Collection, Cochrane, and Google Scholar up to April 1, 2023, using relevant keywords. Trials that met the inclusion criteria were included in this study. We applied the mean difference (MD) or standardized mean difference (SMD) in random or fixed-effects models to analyze the impact of combined trials. We also evaluated the potential risk of bias using the Higgins method for clinical studies and the SYRCLE Risk of Bias tool for animal studies. Our meta-analysis included 59 studies, comprising 29 animal studies and 30 clinical studies. Curcumin strongly reduced pain in preclinical studies, and both the intraperitoneal (SMD = 1.48; 95% CI, 0.81 to 2.14; p < 0.001, and I 2  = 77.9%) and oral (SMD = 1.27; 95% CI, 1.01 to 1.55; p < 0.001, and I 2  = 0.0%) administration method of curcumin had pain-relieving effects. However, the subcutaneous method (SMD = 0.24; 95% CI, - 0.89 to 1.38; p = 0.67) had no effect. The drug's efficacy within the 100-250 mg range (SMD = 1.46; 95% CI, 0.76 to 2.15; p < 0.001; and I 2  = 73.4%) surpassed that observed above 250 mg (SMD = 1.23; 95% CI, 0.89 to 1.57; p < 0.001; and I 2  = 0.0%). In clinical studies, nano-curcumin had a powerful effect on pain reduction compared to placebo (MD =  - 1.197; CI 95% (- 1.94 to - 0.45); p = 0.002; and I 2  = 80.9%), and the effects of NSAIDs on pain were not significantly altered when used in combination with Curcuma longa extract (MD =  - 0.23; CI 95% (- 0.99 to 0.53); p = 0.554; and I 2  = 92%). In addition, the effect of increased bioavailability of curcumin (MD =  - 1.54; CI 95% (- 2.06 to - 1.02); p < 0.001; and I 2  = 89.6%), curcumin (MD =  - 1.35; CI 95% (- 2.451 to - 0.252); p = 0.016; and I 2  = 90.8%), and nano-curcumin was greater than placebo. Our meta-analysis suggests that curcumin and nano-curcumin are effective in reducing chronic pain. These findings have important implications for pharmaceutical science and may lead to the development of new treatments for chronic pain. However, further research is needed to confirm these findings., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Cardiovascular disease (CVD) is the leading cause of morbidity globally, with chronic inflammation as a key modifiable risk factor. Toll-like receptors (TLRs), pivotal components of the innate immune system, including TLR-3, -7, -8, and -9 within endosomes, trigger intracellular cascades, leading to inflammatory cytokine production by various cell types, contributing to systemic inflammation and atherosclerosis. Recent research highlights the role of endosomal TLRs in recognizing self-derived nucleic acids during sterile inflammation, implicated in autoimmune conditions like myocarditis., Areas Covered: This review explores the impact of endosomal TLRs on viral infections, autoimmunity, and inflammatory responses, shedding light on their intricate involvement in cardiovascular health and disease by examining literature on TLR-mediated mechanisms and their roles in CVD pathophysiology., Expert Opinion: Removal of endosomal TLRs mitigates myocardial damage and immune reactions, applicable in myocardial injury. Targeting TLRs with agonists enhances innate immunity against fatal viruses, lowering viral loads and mortality. Prophylactic TLR agonist administration upregulates TLRs, protecting against fatal viruses and improving survival. TLRs play a complex role in CVDs like atherosclerosis and myocarditis, with therapeutic potential in modulating TLR reactions for cardiovascular health.

Some studies suggest that childhood can affect some later outcomes. This cross-sectional study of the first phase of the Ardakan Cohort Study on Aging (ACSA) on 5,197 individuals examined the effects of childhood socioeconomic and health on aging well. Childhood socioeconomic status (SES) was measured using parents' education and self-expressed family's financial status. Quality of Life (SF-12), Satisfaction with Life Scale (SWLS), WHO well-being scale, and self-reported health questionnaire were used. All data, including childhood experiences, was collected at a single time point. Poor childhood health was associated with lower well-being, life satisfaction, and mental quality of life (OR: .53, p = .032, OR: 0.49, p = .019, and β: -3.51, p = .008, respectively). The family's financial status during childhood was associated with the mental and physical quality of life, satisfaction, well-being, and health (all p < .05). Fathers and mothers who had some level of education increased the odds of being healthy by 1.20 and 1.49 times, respectively. Childhood circumstances affect older adults' health and social conditions. Policies to improve childhood health and SES should be prioritized., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: The rise in the elderly population has brought attention to mild cognitive impairment (MCI). Sleep disorders also affect many older adults, indicating an important area of research for disturbed sleep and faster brain aging. This population-based study aimed to investigate the association of several sleep indicators with cognitive performance., Methods: This cross-sectional study focused on adults over 50 in the Ardakan Cohort Study on Aging (ACSA). MCI was evaluated using the Mini-Mental State Examination (MMSE) and the Abbreviated Mental Test score (AMTS) in literate and illiterate individuals. Sleep characteristics were collected using the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, and Berlin questionnaire. The logistic regression models were used to analyze the data., Results: Overall, 3,380 literate and 1,558 illiterate individuals were included. In both groups, participants with MCI had a significantly higher PSQI global score ( p < 0.05). Also, among the literate individuals, a significantly higher risk of having sleep-disordered breathing and poor sleep quality was observed in participants with MCI ( p < 0.05). In illiterate individuals, higher sleep latency than 15 min increased odds of MCI ( p < 0.05). However, after adjusting for all variables, only literate individuals with a sleep duration of more than 8 h had 66 percent increased odds of having MCI ( p = 0.033)., Conclusion: Sleep duration might be associated with cognitive function in the older Iranian population. Our findings underscore the importance of considering sleep patterns in relation to cognitive health., Competing Interests: The authors have no conflicts of interest to declare., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Background and Aims: Electrocardiography (ECG) is a widely accessible, noninvasive, and cost-effective diagnostic instrument used to evaluate patients with suspected heart failure (HF). The aim of this study is to investigate electrocardiographic changes in patients with different stages of HF in a random population of Yazd city., Methods: This prospective cross-sectional study included 319 individuals, randomly selected, aged 40 years and more, registered in the Yazd Health Study was conducted from March 2022 to May 2023 at Afshar Hospitals. In accordance with the AHA/ACC guidelines, HF was classified into four stages (A, B, C, and D)., Results: The 159 individuals were classified in the stage 0 group, 77 were in Stage A, 65 were in Stage B, and 18 were in Stage C of HF. In the Stage 0, the PR interval (PRi) was 130.5 ± 18.1 ms, while in Stage C, it was 143.3 ± 21.9 ms, with a significant difference ( p  = 0.047). Similarly, the QRS interval (QRSi) increased with HF staging ( p  = 0.001). The frequency of diabetes mellitus (DM), hypertension (HTN), hyperlipidemia (HLP), chronic heart disease, alcoholism, and PRi, QRSi, QT interval levels were independent predictors of HF stage in multivariate regression analysis., Conclusion: The prevalence of HF stages, as classified by the AHA/ACC guidelines, was observed, with significant correlations between ECG parameters and HF progression. abnormal rhythms, left bundle branch block, ischemia, hypertrophy, and left atrial enlargement increased with higher HF stages. Major risk factors like DM and HTN exhibited a heightened prevalence in advanced HF stages, accentuating their pivotal role in the progression of HF., Competing Interests: The authors state that they have no conflicts of interest that might have influenced the outcome of this research., (© 2024 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Background: Kinesio taping (KT) has been shown to be clinically effective in a wide range of musculoskeletal disorders. Despite evidence supporting KT, there still needs to be more certainty regarding its clinical worthiness in managing postoperative conditions. This study aims to assess the effect of postoperative KT on knee edema, pain, and range of motion (ROM) when added to routine physiotherapy after knee surgery., Methods: In this systematic review and meta-analysis, MEDLINE, Embase, Scopus, Web of Science, and CENTRAL databases were searched from their inception to July 2023. Randomized controlled trials (RCTs) comparing routine physiotherapy with and without KT were included. Random-effect models were used to calculate the standardized mean difference (SMD), confidence interval, and heterogeneity (I2)., Results: Sixteen RCTs on 842 operated knees were included. KT reduced knee edema in first week (SMD, -0.59, p < 0.001), 14th postoperative day (POD) (SMD, -0.78, p < 0.001), and 28 to 42 days postop (SMD, -0.66, p < 0.001). The KT demonstrated significant pain improvement in second week (SMD, -0.87, p < 0.001) and the fourth week (SMD, -0.53, p < 0.001). The KT groups demonstrated ROM improvement within second week (SMD, 0.69, p = 0.010) and in the 28th POD (SMD, 0.89, p = 0.009). Subgroup analysis demonstrated minimal heterogeneity in anterior cruciate ligament reconstruction (ACLR) cases. However, it did not show significant superiority regarding ankle, calf, or thigh edema and Lysholm scale., Conclusion: This study suggests that adding KT to routine postoperative physiotherapy reduces pain and knee edema after total knee arthroplasty or ACLR. Low to very low certainty of evidence for all outcomes and the limited number of studies emphasize the need for more high-quality primary studies to explore the optimal method of KT application and its effectiveness in specific knee surgeries., Level of Evidence: Level I. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/B69)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Background and Purpose: Radiotherapy (RT) is an essential treatment modality against cancer and becoming even more in demand due to the anticipated increase in cancer incidence. Due to the rapid development of RT technologies amid financial challenges, we aimed to assess the available RT facilities and the issues with achieving health equity based on current equipment compared to the previous reports from Iran., Materials and Methods: A survey arranged by the Iran Cancer Institute's Radiation Oncology Research Center (RORC) was sent to all of the country's radiotherapy centers in 2022. Four components were retrieved: the reimbursement type, equipment, human resources, and patient load. To calculate the radiotherapy utilization rate (RUR), the Lancet Commission was used. The findings were compared with the previous national data., Results: Seventy-six active radiotherapy centers with 123 Linear accelerators (LINACs) were identified. The centers have been directed in three ways. 10 (20 LINACs), 36 (50 LINACs), and 30 centers (53 LINACs) were charity-, private-, and public-based, respectively. Four provinces had no centers. There was no active intraoperative radiotherapy machine despite its availability in 4 centers. One orthovoltage X-ray machine was active and 14 brachytherapy devices were treating patients. There were 344, 252, and 419 active radiation oncologists, medical physicists, and radiation therapy technologists, respectively. The ratio of LINAC and radiation oncologists to one million populations was 1.68 and 4.10, respectively. Since 2017, 35±5 radiation oncology residents have been trained each year., Conclusion: There has been a notable growth in RT facilities since the previous reports and Iran's situation is currently acceptable among LMICs. However, there is an urgent need to improve the distribution of the RT infrastructure and provide more facilities that can deliver advanced techniques., (© 2024. The Author(s).)

Background and Aims: Data on mild cognitive impairment (MCI) in low- to middle-income countries are still being determined, despite the fact that most future older adults are expected to reside in these regions. This study aimed to investigate the prevalence and associated factors of MCI in Iran., Methods: A cross-sectional study was conducted on 4938 community-dwelling subjects aged 50 years or above in the first wave of the Ardakan Cohort Study on Aging. MCI was evaluated using the Mini-Mental State Examination (MMSE) and the Abbreviated Mental Test Score (AMTS) in literate and illiterate individuals. The relationship between factors associated with the odds of MCI was assessed through logistic regression., Results: The prevalence of MCI among all participants, the literates and illiterates, was 15.8%, 6.3%, and 36.4%, respectively. It was found that failure to accomplish any of the MMSE or AMTS items was significantly related to MCI ( p  < 0.001). Age ([odds ratio (OR): 1.05; p  < 0.001 in the literates], [OR: 1.06; p  < 0.001 in the illiterates]), sex (OR: 0.13; p  < 0.001 in the illiterates), history of stroke ([OR: 2.86; p  = 0.006 in the literates], [OR: 2.04; p  = 0.045 in the illiterates]), and depression ([OR: 1.87; p  < 0.001 in the literates], [OR: 1.41; p  = 0.008 in the illiterates]) were significantly associated with MCI., Conclusion: This study highlights the significant associations between age, education, depression, stroke, and MCI in Iranian participants. These findings emphasize the need for targeted interventions in low-literacy populations, mental health screening, and stroke prevention strategies to mitigate the burden of MCI and enhance cognitive health., Competing Interests: The authors declare no conflict of interest., (© 2024 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Introduction: The objective of this study was to assess the prevalence of falls, fear of falling (FOF), complications arising from falls, and identify possible sociodemographic and health-related factors associated with these outcomes among older adults., Methods: This cross-sectional study was based on the first wave of the Ardakan Cohort Study on Aging (ACSA), which includes participants over 50 years of age residing in Ardakan, Iran. Fall history, number of fall events, FOF, hospitalizations, and fractures in the past 12 months were assessed through a face-to-face interview. Health-related factors were recorded on a self-expressed basis. Associations were assessed using multiple logistic regression., Results: Among the 4,990 participants, fall history in the past 12 months was prevalent in 19.9%, with 10.1% reporting more than two fall events. Women (p < 0.001) and older participants (p< 0.001) had a higher prevalence. In females, 28.8% reported moderate to severe FOF, while 21% experienced disruptions in their daily activities as a result of this fear. The prevalence of fractures following falls was 5.1% in males and 8.6% in females. After adjusting for confounding factors, FOF (OR: 1.59, 95% CI: 1.33-1.91, p<0.001), imbalance (OR: 2.45, 95% CI: 1.68-3.58, p<0.001), urinary incontinence (OR: 1.44, 95% CI: 1.04-1.9, p=0.025), cognitive impairment (OR: 1.21, 95% CI: 1.01-1.46, p=0.049), vertigo or dizziness (OR: 1.39, 95% CI: 1.15-1.68, p<0.001), osteoporosis (OR: 1.24, 95% CI: 1.03-1.50, p=0.023), osteoarthritis (OR: 1.33, 95% CI: 1.13-1.56, p=0.001), depression (OR: 1.30, 95% CI: 1.06-1.60, p=0.010), and Central Nervous System (CNS)-affecting diseases (OR: 1.99, 95% CI: 1.33-2.97, p=0.001) were found to have positive associations with falls., Conclusion: This study showed that about one-fifth of those over 50 in Iran have experienced at least one fall within a year. Self-expressed imbalance, FOF, and urinary incontinence were the most prominent risk factors. Due to resulting in hospitalization and fractures, falls also lead to fear of falling and the associated limitation of activities., Competing Interests: The authors declare no conflict of interest.

Antibiotics are one of the most widely used drug groups. The presence of antibiotics in urban water sources and sewage creates many environmental and medical risks for humans and other living organisms. In this study, the potential of zinc oxide (ZnO) coated on almond shell activated carbon (ACA-ZnO) in removing ciprofloxacin (CIP) from aqueous solutions was investigated. Almond shell was used to make activated carbon. Zinc oxide nanoparticles were prepared by the sol-gel method, and finally, ZnO nanoparticles were bonded to activated carbon. The effect of independent parameters pH, contact time, adsorbent dose, and initial CIP concentration on CIP removal efficiency using ACA-ZnO was investigated by response surface methodology. Optimal removal was obtained at pH = 5.4, CIP initial concentration = 7.4 mg/L, adsorbent dose = 0.82 g/L, and reaction time = 67.3 min. This study followed a quadratic model (R 2 = 0.958). The best model of adsorption isotherm fits with the Freundlich model (R 2 = 0.9972) and the maximum capacity was 251.42 mg/g adsorption kinetics, and pseudo-second-order kinetic model (R 2 = 0.959). The results of this study showed that ACA-ZnO as an adsorbent is very efficient, without environmental side effect and cost-benefit., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Objectives: The purpose of this study was to investigate the analgesic effects of duloxetine, specifically on postoperative pain, opioid consumption, and related side effects following total hip or knee arthroplasty., Methods: In this systematic review and meta-analysis, Medline, Cochrane, EMBASE, Scopus, and Web of Science were searched until November 2022 for studies which compared duloxetine with placebo when added to routine pain management protocols. Individual study risk of bias assessment was conducted based on Cochrane risk of bias tool 2. Random effect model meta-analysis was done on mean differences, to evaluate the outcomes., Results: Nine randomized clinical trials (RCT) were included in the final analysis, totaling 806 patients. Duloxetine reduced opioid consumption (oral morphine milligram equivalents) on postoperative days (POD) 2 (mean difference (MD): -14.35, P  = .02), POD 3 (MD: -13.6, P < .001), POD 7 (MD: -7.81, P < .001), and POD 14 (MD: -12.72, P < .001). Duloxetine decreased pain with activity on POD 1, 3, 7, 14, 90 (All P < .05), and pain at rest on POD 2, 3, 7, 14, and 90 (all P < .05). There was no significant difference in the prevalence of the side effects, except for increased risk of somnolence/drowsiness (risk ratio: 1.87, P = .007)., Conclusion: Current evidence shows low to moderate opioid sparing effects of perioperative duloxetine and a statistically but not clinically significant reduction in pain scores. Patients treated with duloxetine had an increased risk for somnolence and drowsiness., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: There has been growing interest in the potential role of adjunctive magnesium sulfate in improving pain management. This systematic review and meta-analysis aimed to assess the effect of intra-operative adjunctive magnesium sulfate on pain management and opioid consumption in total knee arthroplasty (TKA)., Methods: A comprehensive search was conducted in Medline, Embase, Scopus, Web of Science, and Cochrane Library databases, covering studies up to April 2023. The extracted data included pain management outcomes, opioid consumption, and adverse effects from the selected studies. Standardized mean differences (SMDs) were calculated for continuous outcomes, while risk ratios (RRs) were calculated for dichotomous outcomes. Meta-analysis was conducted employing random-effects models in STATA 17., Results: In this meta-analysis of 8 randomized controlled trials involving 536 patients, adjunctive magnesium sulfate in TKA was found to significantly reduce opioid consumption during the first 24 hours after operation (SMD: -1.88, 95% confidence interval (CI): [-3.66 to -0.10]; p = 0.038). It also resulted in lower pain scores at rest 24 hours after surgery (SMD: -1.53, 95% CI: [-2.70 to -0.37]; p = 0.010). There were no significant differences in time to first rescue analgesic and adverse effects between the groups. The included studies were assessed to have low to high levels of risk of bias., Conclusion: This study presents evidence at low to moderate levels supporting the use of intra-operative adjunctive magnesium sulfate in TKA for improved pain management and reduced opioid consumption. However, further research is needed to address the heterogeneity and to explore optimal dosing regimens and routes of administration to maximize the benefits of magnesium sulfate in TKA., Competing Interests: The authors declare that they have no conflict of interest.

Purpose: To identify pre-surgical imaging predictive value and factors associated with the clinicopathologic discrepancy for implication of definitive pelvic radiotherapy in clinically node-negative bladder cancer., Method: The documented data of bladder cancer patients who underwent radical cystectomy plus pelvic lymphadenectomy were collected retrospectively. Patients' characteristics, last imaging, pathology reports, disease-specific survival and overall survival were retrieved., Results: From 142 patients, pre-surgical imaging had a sensitivity of 76.4%, specificity of 73.7%, positive predictive value (PPV) of 94.9%, and negative predictive value (NPV) of 32.6% (p value < 0.0001) for detection of muscle invasion. Also, for detection of positive lymph nodes, imaging had a sensitivity of 31.8%, specificity of 85.7%, PPV of 50%, and NPV of 73.7% (p value: 0.022). 44.4% of study population were upstaged after surgery (24.6% associated with N-upstaging) and 18.3% were downstaged (12% associated with N-downstaging). Receipt of neoadjuvant chemotherapy and T-stage were not correlated with N-upstaging. On multivariate analysis, lymphovascular invasion (LVI) maintained its significance for independent prediction of upstaging (OR 3.3, 95% CI 1.5-7.5, p value: 0.004) and inversely with downstaging (OR 0.34, 95% CI 0.12-0.96, p value: 0.04). Older age (OR 1.03, 95% CI 1.0-1.05, p value 0.047), positive margins (OR 2.1, 95% CI 1.2-3.8, p value 0.011), presence of LVI (OR 2.5, 95% CI 1.4-4.7, p value 0.003), perineural invasion (OR 2.0, 95% CI 1.2-3.4, p value 0.013), and lymph node ratio (OR 1.011, 95% CI 1.001-1.021, p value 0.03) were associated with worse survival. Also, N-upstaging independently predicted a worse survival after controlling for surgical pathology stage (OR 2.3, 95% CI 1.2-4.5, p value 0.011)., Conclusions: The optimal target volume in definitive chemoradiotherapy of node-negative bladder cancer patients remains to be established. Since then, customizing the treatment is considered especially for positive LVI in TURBT specimen., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The application of the coagulation/flocculation process is very important due to its simplicity in removing turbidity. Due to the disadvantages of using chemical coagulants in water and the lack of sufficient effect of natural materials alone in removing turbidity for proper performance, the simultaneous use of chemical and natural coagulants is the best way to reduce the harmful effects of chemical coagulants in water. In this study, the application of poly aluminum chloride (PAC) as a chemical coagulant and rice starch as a natural coagulant aid to remove turbidity from aqueous solutions was investigated. Effects of the above coagulants on the four main factors, coagulant dose (0-10 mg/L), coagulant adjuvant dose (0-0.1 mg/L), pH (5-9), turbidity (NTU 0-50), and each five levels were assessed using a central composite design (CCD). Under the optimized conditions, the maximum turbidity elimination efficiency was found to be 96.6%. The validity and adequacy of the proposed model (quadratic model) were confirmed by the corresponding statistics (i.e., F-value of 23.3, p-values of 0.0001, and lack of fit of 0.877 for the model, respectively, R 2  = 0.88, R 2 adj . = 0.84, R 2 pred  = 0.79, AP = 22.04)., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Soft tissue filler injection is the second most common nonsurgical cosmetic procedure. Despite the safety of fillers, as use has grown, so has the number of patients affected by adverse events. Ophthalmoplegia following cosmetic filler injection is a rare complication, mostly occurring after injection to the glabella, nasolabial fold, periorbital, and lateral nasal site. In all cases where ophthalmoplegia has been reported following fillers, patients have simultaneously experienced vision loss and other ocular symptoms. We report a case of isolated acute ophthalmoplegia following hyaluronic acid injection solely in the temple region. A 40-year-old woman, 3 hours after the procedure, presented to our hospital with left eye ophthalmoplegia, ptosis, and hypotropia. Treatment started with hyaluronidase, steroids, and anticoagulants. After 4 weeks, left eye ophthalmoplegia remained unchanged, and through a 10-week follow-up, all left ocular movements improved, and only mild hypotropia and ptosis persisted. This case report shows that ophthalmoplegia may also happen with temple region filler injections. We also review available prevention techniques and treatments to avoid such complications when performing soft tissue fillers for gaunt appearance correction., Competing Interests: Conflict of Interest None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).)

Introduction:  Despite the increasing vaccination coverage, COVID-19 is still a concern. With the limited health care capacity, early risk stratification is crucial to identify patients who should be prioritized for optimal management. The present study investigates whether on-admission lactate dehydrogenase to albumin ratio (LAR) can be used to predict COVID-19 outcomes., Methods: This retrospective cross-sectional study evaluated hospitalized COVID-19 patients in an academic referral center in Iran from May 2020 to October 2020. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the value of LAR in the prediction of mortality. The Yuden index was used to find the optimal cut-off of LAR to distinguish severity. Patients were classified into three groups (LAR tertiles), first: LAR<101.46, second: 101.46≤LAR< 148.78, and third group: LAR≥148.78. Logistic regression analysis was used to identify the association between tertiles of LAR, as well as the relationship between each one-unit increase in LAR with mortality and ICU admission in three models, based on potential confounding variables., Results: A total of 477 patients were included. Among all patients, 100 patients (21%) died, and 121 patients (25.4%) were admitted to intensive care unit (ICU). In the third group, the risk of mortality and ICU admission increased 7.78 times (OR=7.78, CI: 3.95-15.26; p <0.0001) and 4.49 times (OR=4.49, CI: 2.01-9.04; p <0.0001), respectively, compared to the first group. The AUC of LAR for prediction of mortality was 0.768 (95% CI 0.69- 0.81). LAR ≥ 136, with the sensitivity and specificity of 72% (95%CI: 62.1-80.5) and 70% (95%CI: 64.9-74.4), respectively, was the optimal cut-off value for predicting mortality., Conclusion: High LAR was associated with higher odds of COVID-19 mortality, ICU admission, and length of hospitalization. On-admission LAR levels might help health care workers identify critical patients early on., Competing Interests: The authors have no conflicts of interest to declare for this study.

Background: Cervical cancer, the most common gynecological cancer, is a matter of concern, especially in developing countries. The present study investigates survival rates, associated factors, and post-treatment follow-up status in cervical cancer patients., Study Design: A retrospective cohort study., Methods: This study was conducted on 187 patients referred to an academic referral cancer center in Iran from 2014-2020. Overall survival (OS) and event-free survival (EFS) were evaluated using Kaplan Meyer analysis. The event was defined as recurrence, metastasis, or death., Results: The patients came for post-treatment visits for a median of 36 months (interquartile range [IQR]: 18-51). The median OS and EFS were 24 and 18 months, respectively. The 1- and 3- year OS rates were 90% and 72%, respectively. The 1- and 3- year EFS rates were 76% and 61%, respectively. Stage ≥ III (hazard ratio [HR]: 3.1, 95% confidence interval [CI]: 1.5, 6.5, P &lt; 0.001) and tumor size &gt; 4 cm (HR: 2.5, 95% CI: 1.2, 4.9, P = 0.006) predicted lower OS. The most common histopathology was squamous cell carcinoma (SCC) (71.1%) with non-significant higher 3- year OS (HR: 0.62, 95% CI: 0.33, 1.16, P = 0.13). No significant difference in OS was found between adjuvant and definitive radiotherapy in both early and advance-staged patients (Log-rank = 0.7 P = 0.4, log-rank = 1.6, P = 0.2, respectively)., Conclusion: As evidenced by the obtained results, the survival of patients was lower compared to that in developed countries. Higher stage and tumor size led to shorter survival. The histopathology and type of treatment in comparable stages did not have any significant impact on survival.

The dentin matrix is a collagenous scaffold structurally involved in anchoring resin-based materials to the tooth. Time-dependent degradation of this scaffold at the resin-dentin interface remains a core problem in adhesive dentistry, limiting the service life of dental fillings. This study explored the use of emergent materials termed metal-organic frameworks (MOFs)─formed by the self-assembly of metal ions and organic building blocks─to safeguard the collagen integrity in the functional dentin matrix. We demonstrate that collagen fibrils (from demineralized human dentin) can induce the biomimetic growth of MOF crystals as protective coatings to strengthen and stabilize the fibrils. Zeolitic imidazolate framework-8 (ZIF-8), a zinc-based microporous MOF, was used to fabricate the MOF composites via a "one-pot" reaction in water. The ZIF-modified dentin matrix presented superior mechanical strength and resistance to proteolysis, which can positively affect the longevity of collagen as an anchoring substrate. This work identifies a potential biomedical application of biomimetically synthesized MOFs in repairing dental tissues critical to restorative therapies.

Introduction: Novel coronavirus (COVID-19) and tuberculosis (TB) are the newest and one of the oldest global threats, respectively. In the COVID-19 era, due to the health system's focus on the COVID-19 epidemic, the national TB control program received less attention, leading to a worsening of the global TB epidemic. In this study, we will review the characteristics of TB patients coinfected with COVID-19. Material and Methods: Using Scopus, PubMed/Medline, Embase, and Web of Science databases, a systematic search was performed. Case reports and case series on TB/COVID-19 coinfection published from January 1, 2019 to February 24, 2021 were collected. There were no limitations regarding publication language. Results: Eleven case series and 20 case reports were identified from 18 countries, with the majority them being from India ( N = 6) and China ( N = 4). Overall, 146 patients (114 men and 32 women) coinfected with TB and COVID-19 enrolled. Smoking (15.1%), diabetes (14.4%), and hypertension (8.9%) were the most frequent comorbidities among these patients. The COVID-19 patients with TB mainly suffered fever (78.8%), cough (63.7%), and respiratory distress (22.6%). Hydroxychloroquine (64.0%) and lopinavir/ritonavir (39.5%) were the most common treatments for them. The mortality rate was 13.0% and the rate of discharged patients was 87.0%. Conclusion: Global prevalence of COVID-19-related deaths is 6.6%. Our results showed that 13.0% of patients with TB/COVID-19 died. Thus, this study indicated that coinfection of TB and COVID-19 can increase the mortality. The respiratory symptoms of TB and COVID-19 are very similar, and this causes them to be misdiagnosed. In addition, TB is sometimes diagnosed later than COVID-19 and the severity of the disease worsens, especially in patients with underlying conditions. Therefore, patients with TB should be screened regularly in the COVID-19 era to prevent the spread of the TB/COVID-19 coinfection., 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., (Copyright © 2021 Koupaei, Naimi, Moafi, Mohammadi, Tabatabaei, Ghazizadeh, Heidary and Khoshnood.)

Pressure-assisted coating (PAC) is introduced to coat 3D-printed polymeric scaffolds with β-tricalcium phosphate (β-TCP) for tissue engineering applications. The method consists of four steps: infiltration of ceramic particles into the porous structure of the polymeric scaffold, dehydration of the slurry, compaction of ceramic particles around the scaffold, and heat treatment. The optimal coating is obtained at an infiltration speed of 400 mm/min followed by complete dehydration, compaction under ca. 8 MPa pressure, and subsequent heat treatment at 65 °C. The outcome is a uniformly coated scaffold with no deformation or structural defects, as confirmed by micro-CT analysis and laser and scanning electron microscopy. Scaffolds coated using the PAC method present superior interface bonding strength compared to those coated with a biomimetic approach. The contact angle decreased from 75.2 ± 1.4° for the uncoated scaffold to 39.6 ± 9.6° for the PAC specimen. PAC also increased the surface roughness from 0.66 ± 0.08 to 6.89 ± 0.26 μm and doubled the number of attached cells on the 3 rd day of culture. The described method is applicable to different structures, object sizes, pore sizes, and shapes. For instance, in-depth coating of a 10 mm × 10 mm ( D × H ) cone with a 58 ± 4 μm-thick layer of β-TCP can be achieved using PAC. The method can be used to coat other polymers, such as poly(lactic- co -glycolic acid) (PLGA). Successful coating of β-TCP on 3D-printed PLGA scaffolds is also presented as a proof of concept.

Background: Remaining pharmaceutical compounds cause environmental pollution. Therefore, refining these compounds has become a major challenge. In this study, the function of eliminating Cefixime (CFX) using rice starch was evaluated under controlled conditions., Methods: Response Surface Methodology (RSM) was used to design, analyze, and optimize experiments, and the interaction between four variables including pH (3-9), rice starch dose (0-300 mg/L ), CFX initial concentration (0-16 mg/L ) and time (20-120 min ) was investigated on CFX removal., Results: The optimum pH, starch dose, initial concentration and time were 4.5, 225 mg/L , 7.9 mg/L and 95 min , respectively. The maximum efficiency of CFX removal was 70.22%. According to RSM, this study follows a quadratic model (R 2 =0.954)., Conclusion: Rice starch has been successful in removing CFX from the aqueous solution. Therefore, it is recommended to utilize this process to remove CFX from aqueous solutions., (Copyright© 2020 Avicenna Research Institute.)

The purpose of this study was to produce and characterize Hydroxyapatite/Zinc Oxide/Palladium (HA/0.05 wt% ZnO/0.1 wt% Pd) nanocomposite scaffolds and study their mechanical and antibacterial properties, biocompatibility and bioactivity. The initial materials were developed using sol-gel and precipitation methods. Scaffolds were characterized using atomic absorption analysis (AA), scanning electron microcopy (SEM), energy dispersive spectroscopy (EDS) and transmission electron microscopy (TEM), atomic force microscopy (AFM) and Brunauer-EmmeS-Teller (BET) method. Furthermore, the bioactivity of scaffolds in simulated body fluid (SBF) and the interaction of dental pulp stem cells (DPSCs) with the nanocomposite scaffolds were assessed. Our results showed that the HA/ZnO/Pd (H1), HA/ZnO/Pd coated by 0.125 g chitosan (H2) and HA/ZnO/Pd coated by 0.25 g chitosan (H3) scaffolds possess higher compressive strength and toughness and lower microhardness and density compared to the pure HA (H0) scaffolds. Immersion of samples in SBF showed the deposition of apatite on the surface of the scaffolds. The biocompatibility assay indicated lower cell proliferation on the H1, H2 and H3 in comparison to the H0. The antibacterial results obtained show a significant impact by loading Pd/ZnO on HA in the deactivation of microorganisms in vitro.

Purpose: In this work, the effects of sodium chloride (NaCl) on gene expression of planktonic Streptococcus mutans cells are investigated. Also assessed are the effects of NaCl on zeta potential of sound and demineralized dentin., Methods: The relative level of glucosyltransferase B ( gtfB ), gtfC and gtfD transcription of S. mutans in the presence of NaCl was evaluated by quantitative polymerase chain reaction (qPCR). The osmolality of varying salt (NaCl) concentrations and their influence on the zeta potential of sound and demineralized dentin was investigated as well., Results: NaCl significantly reduced the expression of gtfB and C genes in planktonic S. mutans ; whereas, gtf D gene expression significantly increased in the presence of NaCl (P < 0.05). NaCl at concentrations of 37.5 mg/ml reduced zeta potential of demineralized dentin, while no significant decrease of zeta potential was found when sound dentin was exposed to this concentration., Conclusion: NaCl reduces the expression of some gtfs in S. mutans and increases negative potential charge of demineralized dentin.

3D dual porosity protein-based scaffolds have been developed using the combination of foaming and freeze-drying. The suggested approach leads to the production of large, highly porous scaffolds with negligible shrinkage and deformation compared to the conventional freeze-drying method. Scanning electron microscopy, standard histological processing and mercury intrusion porosimetry confirmed the formation of a dual network in the form of big primary pores (243 ± 14 µm) embracing smaller secondary pores (42 ± 3 µm) opened onto their surface, resembling a vascular network. High interconnectivity of the pores, confirmed by micro-CT, is shown to improve diffusion kinetics and support a relatively uniform distribution of isolated human dental pulp stem cells within the scaffold compared to conventional scaffolds. Dual network scaffolds indicate more than three times as high cell proliferation capability as conventional scaffolds in 14 days.

Background: Nowadays, health-care companies use different antimicrobial agents in toothpastes to reduce oral microorganisms. The aim of this study was to investigate the antimicrobial effects of one Iranian herbal toothpaste in different concentrations compared with the chemical type on oral microorganisms in vitro ., Materials and Methods: In this experimental study, the antimicrobial effect of one Iranian herbal toothpaste in comparison with its chemical type at three concentrations of 1, 1:1, and 1:3 on Streptococcus mutans (SM), Lactobacillus (LB), and Candida albicans (CA), respectively, were studied by agar disc diffusion method. The microorganisms were cultured on 21 plates. Then, four sterile paper discs were placed on each plate and the extracts were placed on them in prepared concentrations and incubated at 37°C ± 0°C for 24 h. The diameter of the inhibition zone around the discs was then measured in millimeters and recorded two-way ANOVA, one-way ANOVA tests, and regarding the difference variances, Tamhane supplementary tests were used at the significance level of P < 0.05., Results: According to the results of this study, the full concentration of Iranian herbal toothpaste on SM, LB, and CA microorganisms had higher antimicrobial effect than the other two concentrations. This difference was statistically significant ( P < 0.05). Furthermore, all the three toothpastes at full concentration had the same antimicrobial activity ( P < 0.05). The antimicrobial effect of herbal toothpaste decreased significantly compared with the chemical toothpaste while the concentration decreased ( P < 0.05)., Conclusion: At full concentration, herbal and chemical toothpastes have the same antimicrobial effect, but by reducing the concentration, the antimicrobial effect of herbal toothpaste is reduced compared with the chemical one., Competing Interests: The authors of this manuscript declare that they have no conflicts of interest, real or perceived, financial or nonfinancial in this article.

Hard tissues including teeth, bone and cartilage have inability or poor capacity to self-renew, especially in large defects. Therefore, repair of damages in these tissues represents a huge challenge in the medical field today. Hard tissue engineering commonly utilizes different stem cell sources as a promising strategy for treating bone, cartilages and tooth defects or disorders. Decades ago, researchers successfully isolated and identified endometrial mesenchymal stem/stromal cells (EnSCs) and discovered their multidifferentiation potential. Current studies suggest that EnSCs have significant advantages compared with stem cells derived from other tissues. In this review article, we summarize the current in vitro and in vivo studies that utilize EnSCs or menstrual blood-derived stem cells for differentiation to osteoblasts, odontoblasts or chondroblasts in an effort to realize the potential of these cells in hard tissues regeneration.

There are numerous functions for laser in modern implant dentistry including surface treatment, surface coating, and implant manufacturing. As laser application may potentially improve osseointegration of dental implants, we systematically reviewed the literature for in vitro biological responses to laser-modified or processed titanium dental implants. The literature was searched in PubMed, ISI Web, and Scopus, using keywords "titanium dental implants," "laser," "biocompatibility," and their synonyms. After screening the 136 references obtained, 28 articles met the inclusion criteria. We found that Nd:YAG laser was the most commonly used lasers in the treatment or processing of titanium dental implants. Most of the experiments used cell attachment and cell proliferation to investigate bioresponses of the implants. The most commonly used cells in these assays were osteoblast-like cells. Only one study was conducted in stem cells. These in vitro studies reported higher biocompatibility in laser-modified titanium implants. It seems that laser radiation plays a vital role in cell response to dental implants; however, it is necessary to accomplish more studies using different laser types and parameters on various cells to offer a more conclusive result.

Stem-cell-based therapies were introduced aiming to overcome the limitations of the existing procedures for regeneration of mineralized tissues. Stem cells isolated from the endometrial tissue and dental pulp have the capacity to differentiate into various functional cells including osteoblasts. However, studies comparing their ability to regenerate mineralized tissue are lacking. The purpose of this study was to compare the proliferation and osteogenic differentiation potential of endometrial stem cells (EnSCs) and dental pulp stem cells (DPSCs) using in vitro cell culture technique. The DPSCs and EnSCs were isolated from human dental pulp and endometrium, respectively. Their proliferation and osteogenic potential were compared in the same osteogenic medium (OM) after 3, 5, 7 and 10 days using the methyl thiazol tetrazolium assay, alizarin red staining, and real-time quantitative reverse transcription polymerase chain reaction (Real-Time qRT-PCR). The EnSCs showed higher proliferation rate compared to DPSCs. Regarding osteogenesis, alizarin red-positive colonies appeared earlier and in greater amounts in DPSCs group. The real-time qRT-PCR demonstrated significantly greater osteogenic potential of DPSCs compared to EnSCs. Our findings revealed significant differences in stem cell properties based on the tissue source. The EnSCs had greater proliferation rate than DPSCs, while DPSCs showed greater osteogenic potential compared to EnSCs in the same OM.

Aim: In the present study, we aimed to fabricate poly-lactic-co-glycolic acid (PLGA) microspheres containing a mixture of three antibiotics-minocycline, metronidazole, and ciprofloxacin (MMC)-to assess their efficacy and properties., Methods: MMC were loaded onto PLGA biopolymer microspheres at a 1:1:1 ratio using the double emulsion technique. The morphology of microspheres was observed by a (SEM). The controlled release of antibiotics was evaluated over an 18-day period. The antibacterial efficacy of released antibiotics against Aggregatibacter actinomycetemcomitans was evaluated by measuring the diameter of the growth-inhibition zone. The cytotoxicity of MMC-containing microspheres was also evaluated and compared using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. One-way anova was used for the data analysis., Results: SEM micrographs confirmed the spherical shape and smooth surface of microspheres. The adequate release of antibiotics was observed from the microspheres within the desired time period of 16-18 days. The MMC-containing microspheres showed antibacterial activity for 11 days. Moreover, MMC-containing microspheres showed superior cell biocompatibility compared to the free mixture of the three antibiotics (P < 0.05)., Conclusion: Microspheres containing triple antibiotics showed good release, antibacterial activity for 11 days, and similar cell biocompatibility compared to the empty microspheres., (© 2016 John Wiley & Sons Australia, Ltd.)

Introduction: Elimination of pathological microflora of root canal systems is a major goal in endodontic treatment. This study aimed to compare the antimicrobial efficacy of calcium hydroxide as an intracanal medication and antibacterial photodynamic therapy (aPDT) against Enterococcus faecalis and Candida albicans in teeth with periapical (PA) lesions. Methods: This in vivo study was conducted on 20 patients with single-rooted mandibular premolar with previously failed endodontic treatment. This study was performed as a clinical trial (IRCTID: IRCT2016090429686N1). After conventional chemo-mechanical root canal preparation (hand and rotary instruments and 2.5% NaOCl), microbiological samples were obtained using sterile paper points, then stored in thioglycolate solution and transferred to a microbiology laboratory. Group 1 (n = 10) specimens underwent aPDT (diode laser 808 nm + 50 mg/mL methylene blue), while creamy calcium hydroxide paste was used in group 2 for a duration of 1 week. A control sample was taken with sterile paper points and F3 Protaper rotary file. The samples were dispersed in transport medium, serially diluted, and cultured on selective mediums to determine the number of colony forming units (CFUs). Data were analyzed by Mann-Whitney U test at 5% significance level. The significance level for all analyses was set at P < 0.05. Results: Number of CFU significantly decreased in both groups after the interventions ( P < 0.001); however, there was no significant difference in the colony count between the 2 groups. Conclusion: aPDT and calcium hydroxide therapy showed the same antimicrobial efficacy on E. faecalis and C. albicans.

Background: Reconstruction of bone defects is often performed using bone autografts. However, limitations associated with the use of autografts led to the use of bone substitute materials., Objectives: The purpose of this study was to compare the surface characteristics of three commercially available grafts namely allografts, xenografts and alloplasts., Methods: This in vitro study was conducted on beta-tricalcium phosphate (β-TCP) alloplast, a mixture of demineralized bone matrix and mineralized bone allograft (DBM&MBA) and natural bovine bone mineral (NBBM) xenograft. Presence of apatite groups on the surface of samples was assessed by X-ray diffraction (XRD) while the presence of functional groups was evaluated using Fourier transform infrared spectroscopy (FTIR). Also, dental pulp stem cells (DPSCs) were cultured on the surface of samples and their adhesion was evaluated under a scanning electron microscope (SEM)., Results: The FTIR showed a relatively similar pattern for NBBM and TCP samples and a different pattern in DBM&MBA. The results of XRD analysis also showed similarities between NBBM and TCP with sharper peaks than the DBM&MBA sample. The SEM micrographs showed that at 24 hours, no cell was detectable on the surface of NBBM sample; whereas, elongated cells were noted on the surface of TCP and DBM&MBA samples., Conclusions: The patterns of β-TCP and NBBM samples in XRD and FTIR spectroscopy showed high resemblance but they had different behaviors with respect to cell adhesion.

Different degrees of clinical success have been reported for synthetic, allograft, and xenograft bone substitutes in human trials. Although these substitutes have been clinically investigated, their in vitro effects on cell differentiation remain unclear. Proliferation, differentiation, and attachment of dental pulp stem cells (DPSCs) to β-tricalcium phosphate (β-TCP), freeze-dried bone allograft (FDBA), and deproteinized bovine bone mineral (DBBM) were compared in this study. MTT assay, measurement of total DNA, and reverse transcriptase polymerase chain reaction were performed. β-TCP had the highest potential for DPSC attachment and proliferation, while FDBA induced osteoblastic differentiation of DPSCs. Further in vivo investigations are necessary to select a clinically appropriate scaffold.

Bone autografts are often used for reconstruction of bone defects; however, due to the limitations of autografts, researchers have been in search of bone substitutes. Dentin is of particular interest for this purpose due to high similarity to bone. This in vitro study sought to assess the surface characteristics and biological properties of dentin samples prepared with different treatments. This study was conducted on regular (RD), demineralized (DemD), and deproteinized (DepD) dentin samples. X-ray diffraction and Fourier transform infrared spectroscopy were used for surface characterization. Samples were immersed in simulated body fluid, and their bioactivity was evaluated under a scanning electron microscope. The methyl thiazol tetrazolium assay, scanning electron microscope analysis and quantitative real-time polymerase chain reaction were performed, respectively to assess viability/proliferation, adhesion/morphology and osteoblast differentiation of cultured human dental pulp stem cells on dentin powders. Of the three dentin samples, DepD showed the highest and RD showed the lowest rate of formation and deposition of hydroxyapatite crystals. Although, the difference in superficial apatite was not significant among samples, functional groups on the surface, however, were more distinct on DepD. At four weeks, hydroxyapatite deposits were noted as needle-shaped accumulations on DemD sample and numerous hexagonal HA deposit masses were seen, covering the surface of DepD. The methyl thiazol tetrazolium, scanning electron microscope, and quantitative real-time polymerase chain reaction analyses during the 10-day cell culture on dentin powders showed the highest cell adhesion and viability and rapid differentiation in DepD. Based on the parameters evaluated in this in vitro study, DepD showed high rate of formation/deposition of hydroxyapatite crystals and adhesion/viability/osteogenic differentiation of human dental pulp stem cells, which may support its osteoinductive/osteoconductive potential for bone regeneration.

Aim: The purpose of this study was to investigate the cytotoxicity of nanohybrid mineral trioxide aggregate (MTA) in comparison with calcium-enriched mixture (CEM) cement and MTA-Angelus, using human gingival fibroblasts (HGFs)., Materials and Methods: Nine disc-shaped specimens of each material (in 2 set stat: A, set for 24 h; B, set for 30 min; and C, fresh stat) were prepared. HGFs were exposed to tested materials' extracts or control media. Cytotoxicity testing was performed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazoliumbromide assay in two time intervals., Statistical Analysis: Results were evaluated by one-way ANOVA and t -test. Statistical significance was set at P < 0.05., Results: CEM cement demonstrated favorable cell viability values when completely set (24 h set MTA = 24 h set CEM) at both time intervals. Interestingly, 24 h after incubation, CEM in Groups B and C demonstrated higher cell viability values than MTA ( P < 0.05). However, after 72 h of incubation, these groups of CEM and MTA showed equal cell viability. All samples of nanohybrid MTA had slight cytotoxic effects after 24 h of incubation, and moderate cytotoxic effects after 72 h of incubation., Conclusion: Set CEM and set MTA-Angelus exerted similar, favorable effects on cell viability. However, within the limitations of this in vitro study, the results suggest that nanohybrid MTA could not be recommended as a material of choice for cervical root resorption., Competing Interests: There are no conflicts of interest.

Dentin has become an interesting potential biomaterial for tissue engineering of oral hard tissues. It can be used as a scaffold or as a source of growth factors in bone tissue engineering. Different forms of dentin have been studied for their potential use as bone substitutes. Here, we systematically review different methods of dentin preparation and the efficacy of processed dentin in bone tissue engineering. An electronic search was carried out in PubMed and Scopus databases for articles published from 2000 to 2016. Studies on dentin preparation for application in bone tissue engineering were selected. The initial search yielded a total of 1045 articles, of which 37 were finally selected. Review of studies showed that demineralization was the most commonly used dentin preparation process for use in tissue engineering. Dentin extract, dentin particles (tooth ash), freeze-dried dentin, and denatured dentin are others method of dentin preparation. Based on our literature review, we can conclude that preparation procedure and the size and shape of dentin particles play an important role in its osteoinductive and osteoconductive properties. Standardization of these methods is important to draw a conclusion in this regard. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2616-2627, 2016., (© 2016 Wiley Periodicals, Inc.)

Objectives: The dentin matrix servers as a reservoir of growth factors, sequestered during dentinogenesis. The aim of this study was to assess the viability and proliferation of dental pulp stem cells in the presence of dentin matrix-derived non-collagenous proteins and two growth factors; platelet-derived growth factor BB and transforming growth factor beta 1., Material and Methods: The dental pulp cells were isolated and cultured. The dentin proteins were extracted and purified. The MTT assay was performed for assessment of cell viability and proliferation in the presence of different concentrations of dentin proteins and growth factors during 24 - 72 h post-treatment., Results: The cells treated with 250 ng/mL dentin proteins had the best viability and proliferation ability in comparison with other concentrations (P < 0.05). The MTT assay demonstrated that cells cultured with 5 ng/mL platelet-derived growth factor BB had the highest viability at each time point as compared to other groups (P < 0.05). However, in presence of platelet-derived growth factor BB alone and in combination with transforming growth factor beta 1 and dentin proteins (10 ng/mL), significant higher viability was seen at all time points (P < 0.05). The least viability and proliferation at each growth factor concentration was seen in cells treated with combination of transforming growth factor beta 1 and dentin proteins at 72 h (P < 0.05)., Conclusions: The results indicated that the triple combination of growth factors and matrix-derived non-collagenous proteins (especially at 10 ng/mL concentration) has mitogenic effect on dental pulp stem cells.

Introduction: The aim of this study was to compare the antibacterial efficacy of diode laser 810nm and photodynamic therapy (PDT) in reducing bacterial microflora in endodontic retreatment of teeth with periradicular lesion., Methods: In this in vivo clinical trial, 20 patients who needed endodontic retreatment were selected. After conventional chemo mechanical preparation of root canals, microbiological samples were taken with sterile paper point (PP), held in thioglycollate broth, and then were transferred to the microbiological lab. In the first group, PDT with methylene blue (MB) and diode laser (810 nm, 0.2 W, 40 seconds) was performed and in the second group diode laser (810 nm, 1.2 W, 30 seconds) was irradiated. Then second samples were taken from all canals., Results: CFU/ml amounts showed statistically significant reduction in both groups (P < 0.001). CFU/ml amounts were compared between the two groups and there was no statistical difference., Conclusion: PDT and diode laser 810 nm irradiation are effective methods for root canal disinfection. PDT is a suitable alternative for diode laser 810 nm irradiation, because of lower thermal risk on root dentin.

Breast cancer is the most frequently occurring cancer among women throughout the world. Natural compounds such as curcumin hold promise to treat a variety of cancers including breast cancer. However, curcumin's therapeutic application is limited, due to its rapid degradation and poor aqueous solubility. On the other hand, previous studies have stated that drug delivery using nanoparticles might improve the therapeutic response to anticancer drugs. Poly(N-isopropylacrylamide-co-methacrylic acid) (PNIPAAm-MAA) is one of the hydrogel copolymers utilized in the drug delivery system for cancer therapy. The aim of this study was to examine the cytotoxic potential of curcumin encapsulated within the NIPAAm-MAA nanoparticle, on the MCF-7 breast cancer cell line. In this work, polymeric nanoparticles were synthesized through the free radical mechanism, and curcumin was encapsulated into NIPAAm-MAA nanoparticles. Then, the cytotoxic effect of curcumin-loaded NIPAAm-MAA on the MCF-7 breast cancer cell line was measured by MTT assays. The evaluation of the results showed that curcumin-loaded NIPAAm-MAA has more cytotoxic effect on the MCF-7 cell line and efficiently inhibited the growth of the breast cancer cell population, compared with free curcumin. In conclusion, this study indicates that curcumin-loaded NIPAAm-MAA suppresses the growth of the MCF-7 cell line. Overall, it is concluded that encapsulating curcumin into the NIPAAm-MAA copolymer could open up new avenues for breast cancer treatment.

Mesenchymal stem cells (MSCs) are non-hematopoietic, multipotent progenitor cells which reside in bone marrow (BM), support homing of hematopoietic stem cells (HSCs) and self-renewal in the BM. These cells have the potential to differentiate into tissues of mesenchymal origin, such as fibroblasts, adipocytes, cardiomyocytes, and stromal cells. MSCs can express surface molecules like CD13, CD29, CD44, CD73, CD90, CD166, CXCL12 and toll-like receptors (TLRs). Different factors, such as TGF-β, IL-10, IDO, PGE-2, sHLA-G5, HO, and Galectin-3, secreted by MSCs, induce interaction in cell to cell immunomodulatory effects on innate and adaptive cells of the immune system. Furthermore, these cells can stimulate and increase the TH2 and regulatory T-cells through inhibitory effects on the immune system. MSCs originate from the BM and other tissues including the brain, adipose tissue, peripheral blood, cornea, thymus, spleen, fallopian tube, placenta, Wharton's jelly and umbilical cord blood. Many studies have focused on two significant features of MSC therapy: (I) MSCs can modulate T-cell-mediated immunological responses, and (II) systemically administered MSCs home in to sites of ischemia or injury. In this review, we describe the known mechanisms of immunomodulation and homing of MSCs. As a result, this review emphasizes the functional role of MSCs in modulating immune responses, their capability in homing to injured tissue, and their clinical therapeutic potential.

Objectives: Efficacy of an ideal antimicrobial agent depends on its ability to eliminate microorganisms while causing minimal toxicity to host cells. The purpose of this study was to assess the effect of ethanolic and water extracts of Salvadora persica (SP) on proliferation and viability of human dental pulp stem cells (hDPSCs)., Materials and Methods: In this in-vitro study, the effects of seven concentrations of ethanolic and water extracts of SP (ranging from 5.75 mg/ml to 0.08 mg/ml) on hDPSCs were evaluated using the 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide assay. The results were analyzed using one-way ANOVA and Tukey's post-hoc test. P < 0.05 was considered statistically significant., Results: Water extract of SP only had cytotoxic effect at 5.75 mg/ml concentration; and caused significant cell proliferation at 1.43-0.08 mg/ml concentrations at 24 h (P < 0.05). At 48 h, only 0.17 and 0.08 mg/ml concentrations caused significant cell proliferation (P < 0.05). Ethanolic extract of SP at 5.75-1.43 mg/ml concentrations showed severe cytotoxic effects at 24 and 48 h. Other concentrations had no significant effects on cells (P > 0.05)., Conclusion: The highest concentrations of both water and ethanolic extracts of SP had cytotoxic effects on hDPSCs. Water extract of SP has favorable effects on cell proliferation at specific concentrations in a time-dependent manner.

During orthodontic treatments, applied mechanical forces create strain and result in tooth movement through the alveolar bone. This response to mechanical strain is a fundamental biological reaction. The present study evaluated the effect of equiaxial strain within the range of orthodontic forces on the osteogenic differentiation of human dental pulp stem cells (hDPSCs). Following isolation and culture of hDPSCs, 3rd passage cells were transferred on a silicone membrane covered with collagen. Cell adhesion to the membrane was evaluated under scanning electron microscope (SEM). Cells were divided into three groups: the first group was placed in a conventional culture medium, transferred to an equiaxial stretching device (3% strain for 2 weeks). The positive control was placed in an osteogenic medium with no mechanical strain. The negative control group was placed in the conventional culture medium with no mechanical strain either. Study groups were evaluated for expression ofosteogenic markers (Alkaline phosphatase and Osteopontin) with immunofluorescence and real time PCR. SEM images revealed optimal adhesion of cells to the silicone membrane. Immunofluorescence study demonstrated that osteocalcin expression occurred after 2 weeks in the two groups under mechanical and chemical signals. After application of equiaxial strain, level of expression of osteogenic markers was significantly higher than in the negative and positive control groups. Based on the study results, static equiaxial strain which mimics the types of orthodontic forces can result in differentiation of hDPSCs to osteoblasts. The results obtained may be used in cell therapy and tissue engineering.

Introduction: This in vitro study compared the cytotoxic effects of three commercially available MTA formulations naming ProRoot MTA (PMTA), Angelus MTA (AMTA), and Root MTA (RMTA), with calcium-enriched mixture (CEM) cement and a new nanohybrid MTA (NMTA) on human dental pulp stem cells (DPSC)., Methods and Materials: Four disc-shaped specimens of each material were prepared. After completion of setting, 2 different (neat and 1/2) elutes of the test materials were made. Then in each cavity of a 96-well plate, 3000 cells were seeded and incubated in a humidified incubator with 5% CO2 and 95% air at 37(°)C for 24 h. After this period, the culture medium of each well was replaced with 200 μL of test material elutes. Plain culture medium was used as the negative control and distilled water as the positive control group. Cell viability was assessed using 2, 5-diphenyl-SH-tetrazelium bromide colorimetric assay, aka Mosmann's tetrazolium toxicity (MTT) assay, at three time intervals (24, 48, and 72 h after mixing). Data were analyzed using the ANOVA and Tukey's post hoc test (P=0.05)., Results: After 24 h, the viability of cells in neat concentration had no significant differences (P>0.05) except for the NMTA. However, CEM and AMTA, at 1/2 concentration exerted significant proliferative effects on cells. At 48 and 72-h intervals, significant proliferation of DPSCs was seen in all samples, except for the NMTA which exerted toxic effects on cells., Conclusion: All of the three commercial MTAs and CEM cement showed comparative biocompatibility. However, NMTA had cytotoxic effects on DPSCs at all the time intervals.

Objective: Human endometrium has enormous regenerative capacity due to the presence of endometrial stem cells. The present study sought to assess the possibility of differentiation of these cells into odontoblast-like cells by in vitro induction., Methods: Endometrial stem-like cells were obtained using enzymatic digestion of the biopsy samples of the endometrium after hysterectomy and cultured in Dulbecco's Modified Eagle's Medium (DMEM) which contained dentine non-collagenous proteins (dNCPs). The results were evaluated using the following assays: analysis of morphology, enzymatic assay for measuring alkaline phosphatase activity, Alizarin Red staining to detect in vitro formation of mineralized nodules, immunofluorescence for detection of dentine sialoprotein (DSP) and dentine-matrix protein (DMP1), and Western blotting for DMP1 expression., Results: Following induction, endometrial stem-like cells demonstrated high alkaline phosphatase activity, and expression of DSP and DMP1 confirmed the odontoblast phenotype. DMP1 level increased in samples treated with dNCPs., Conclusions: Study results indicated that odontoblastic differentiation of endometrial stem cells can be induced by extracellular matrix proteins (e.g. dNCPs). The capacity of endometrial stem-like cells to differentiate into odontoblast-like cells under specific conditions gives new insights into the mechanism of odontogenesis and highlights the potential of such approaches for further research on dental tissue regeneration., (Copyright © 2013 Elsevier Ltd. All rights reserved.)