Lateral Ankle sprain is a common sports injury with a high incidence rate after muscle fatigue. Health specialists are searching for the best conservative approach to reduce the complications of this injury and decrease the incidence rate after fatigue. This systematic review and meta-analysis aimed to assess the effectiveness of external ankle support on balance in patients with ankle instability following muscle fatigue. We conducted a systematic search of PubMed, Scopus, and Web of Science up to April 29, 2024, to find articles involving populations with ankle instability, interventions using external ankle support (taping or ankle orthoses), and outcomes related to balance assessed during muscle fatigue. The Risk of Bias 2 tool was used for risk of bias assessment. Data on patients, interventions, fatigue protocols, and outcomes were extracted and analysed. A meta-analysis was performed using Review Manager 5.3 software, calculating standardized mean differences with 95% confidence intervals (CI) for each outcome. Nine crossover studies involving 230 subjects were included. The narrative synthesis shows that external ankle supports improve the single leg hop test [Mean difference=7.84, P=0.01], center of pressure range and velocity, and ankle inversion. The meta-analysis results indicate that compared to the control group, external ankle supports after muscle fatigue significantly change Y balance clinical test-posterolateral [MD=1.22, 95% CI (0.16, 2.28), p=0.03], Y balance clinical test-posteromedial [Mean difference=2.60, 95% CI (0.42, 4.79), p=0.03], center of pressure time to stabilization-mediolateral [Mean difference=-0.68, 95% CI (-1.29, -0.07), p=0.04], center of pressure time to stabilization-vertical [Mean difference=-0.62, 95% CI (-0.94, -0.30), p=0.01], and vertical ground reaction force [Mean difference=0.58, 95% CI (0.21, 0.96), p=0.02]. External ankle supports are an effective conservative intervention for improving specific aspects of balance in patients with ankle instability, particularly following muscle fatigue. Significant improvements were observed in the Y Balance Test, center of pressure measures, vertical ground reaction force, and single-leg hop performance. Healthcare professionals are encouraged to incorporate external ankle supports into rehabilitation programs for individuals with ankle instability. These supports can enhance balance, improve functional outcomes, and help mitigate the negative effects of muscle fatigue on postural stability.

We retrospectively reviewed the outcome of triple nerve transfer, including reinnervation of brachioradialis and double nerve transfer surgery in C5–C6 traumatic brachial plexus injuries.

Bacterial gastroenteritis is a significant public health concern, capable of causing severe infections. Among the various pathogens involved, those belonging to the Enterobacteriaceae family are the most frequently isolated and associated with gastrointestinal disorders. This study aimed to investigate the prevalence of common diarrheagenic Enterobacteriaceae in Iran over the past two decades, from 2000 to 2023. A comprehensive systematic search was conducted across multiple databases, including EMBASE, HINARI, MEDLINE, PubMed, Google Scholar, and the Cochrane Library. The focus was on observational published studies reporting the prevalence of diarrheagenic Enterobacteriaceae in Iran during 2000 and 2023. The criteria did not restrict patient demographics such as age, gender, health conditions, or occupation. This meta-analysis employed a 95% confidence interval (CI) for analysis. Evidence of heterogeneity was determined using an I² value greater than 50%. To explore potential sources of heterogeneity, subgroup analysis and meta-regression analysis were performed. Statistical analyses were executed using R version 4.3.2 along with the meta package. A p-value less than 0.05 was considered statistically significant. Out of 3,701 papers reviewed, 56 studies met the inclusion criteria and were analyzed. The overall pooled prevalence of diarrheagenic Enterobacteriaceae species from 2000 to 2023 was 14.0% (95% CI: 0.11–0.17). Subgroup analysis revealed Shigella spp. had the highest prevalence at 18.0% (95% CI: 0.13–0.24; I²=99%), followed by diarrheagenic Escherichia coli at 11.0% (95% CI: 0.09–0.15; I²=97%), Salmonella spp. at 9.0% (95% CI: 0.05–0.17; I²=99%), and Yersinia spp. at 2.0% (95% CI: 0.00-0.10; I²=94%). Prevalence trends showed Shigella spp. increasing from 4% (95% CI: 0.03–0.08) in 2000–2004 to 36% (95% CI: 0.20–0.55) in 2021–2023. Diarrheagenic E. coli (DEC) showed no clear pattern, ranging from 5% (95% CI: 0.01–0.24) to 17% (95% CI: 0.07–0.36). Salmonella spp. exhibited more significant fluctuations, rising from 6% (95% CI) in both 2000–2004 and 2005–2008 periods to 20% (95% CI: 0.03–0.66) in 2009–2012 and 30% (95% CI: 0.11–0.60) in 2017–2020. Yersinia spp. was only determined in 2000–2004 with a pool prevalence of 12% (95% CI: 0.00-0.91). Sub-species analysis revealed Shigella sonnei was the most prevalent species among Shigella spp. in Iran, accounting for 42% of cases (95% CI: 0.33–0.52). Regarding DEC species, Enteroaggregative E. coli (EAEC) and Enterotpathogenic E. coli (EPEC) had the highest rate at 15% (95% CI). Furthermore, a pool prevalence of 2% (95% CI: 0.00-0.89) was reported for Yersinia enterocolitica among diarrheagenic Enterobacteriaceae in Iran. This meta-analysis provides valuable insights into the prevalence of diarrheagenic Enterobacteriaceae in Iran over the past two decades. The findings highlight the significant impact of these pathogens on public health, with Shigella spp. showing the highest prevalence and increasing trends. Further research should investigate the factors contributing to the prevalence of diarrheagenic Enterobacteriaceae, including genetic diversity of diarrheagenic Enterobacteriaceae isolates, molecular mechanisms underlying the virulence of these pathogens, or antibiotic resistance patterns.

During the transportal technique of anterior cruciate ligament (ACL) reconstruction, tunnel outlet location can be varied depending on certain anatomical and technical characteristics. Therefore, we aimed to find out the acceptable zone of endobutton location by introducing several radiographic values. Postoperative lateral radiographs of 72 patients were assessed to measure the distances from the centre of the button to the posterior femoral cortex (D1) and to the most distal point of the lateral condyle (D2). Furthermore, based on the anteroposterior (AP) radiographs, the distances from the centre of the button to the lateral femoral cortex (D3) and from the centre of the button to the line connecting the most distal points of the medial and lateral femoral condyles (D4) were assessed. To measure the sensitivity and specificity of each radiographic value (D1, D2, D3 and D4), the area under the receiver operating characteristic curve was calculated. The alpha angle and femoral tunnel length values were considered as gold standards. Analyses showed that the mean values for D1, D2, D3 and D4 were 13.20 ± 0.54, 39.44 ± 0.31, 1.65 ± 0.15 and 42.66 ± 0.47 mm, respectively. The mean angle was found to be 38.6 ± 0.3°, and the mean femoral tunnel length was 38.6 ± 0.2 mm. Age was significantly related to D2 and the diameter of the femur in AP X-ray, while body mass index had a significant relation with D3 (p < 0.05). In this study, a new method was proposed to evaluate the accuracy of anatomical tunnel placement in ACL reconstruction surgery postoperatively. The statistical analysis of the measured variables showed that the mean ratios were 21.79 ± 0.87 for D1, 65.65 ± 0.63 for D2 and 51.90 ± 0.73 for D4. The results indicated that if the tunnel exit location and endobutton placement in the postoperative radiological images fall within the suggested areas, it can be meaningfully concluded that the tunnel is correctly positioned intraarticularly and the ligament reconstruction is anatomical.

The aim of this study was to investigate the efficacy of our modified cementing technique in reducing the rate of aseptic tibial loosening focusing on its relationship with keel length. Every participant who underwent primary total knee arthroplasty (TKA) between August 2014 and September 2022 with a minimum of 4-year follow-up using 1 of 3 implants were included: Persona + conventional cementing technique; Persona + modified cementing technique; and NexGen LPS-Flex. The modifications applied include better preparation of the bone surfaces and the cancellous bone cavities, pressurizing the cement and interstitial fluid suction at the same time, applying a layer of cement on the surfaces of the tibia and implant, and immobilizing the limb. Kaplan-Meier analyses were performed to estimate survivorship. A total of 988 of 1039 primary TKAs (95.1%) were included with follow-up of 89.26 ± 7.32 months. Twenty eight (2.83%) TKA required revisions due to aseptic tibial loosening; 3 (1.1%) in the NexGen group, 21 (6.9%) in the conventionally cemented Persona group, and 4 (0.9%) within the modified cemented Persona group. Aseptic loosening occurred at a mean of 69.00 ± 2.65, 34.57 ± 22.90, and 68.50 ± 3.42, respectively. Survivorship for aseptic loosening was 98.9%, 93.1%, and 99.1% at 8 years, respectively. The revision rate for early (during the first 24 months) aseptic loosening was 4.6% in the conventionally cemented Persona group. No early aseptic loosening reported in other 2 groups. In conclusion, meticulous cementing techniques can reduce the rate of tibial loosening in shorter keel designs.