Arya Behzadi

Background: Indirect inguinal hernia is a common condition that often requires surgical intervention. This study compares two surgical approaches for hernia repair: tissue reinforcement using the remaining sac and polypropylene mesh repair. Methods: A randomised, controlled, double‐blind clinical trial was conducted on 132 patients aged 18–82 diagnosed with indirect inguinal hernia. Participants were randomly assigned to two intervention groups: one undergoing polypropylene mesh repair and the other using tissue reinforcement with the remaining sac. Key outcomes, including recurrence rates, postoperative complications, pain intensity, recovery time and hospital stay, were assessed at multiple intervals. Results: Both techniques demonstrated comparable safety and efficacy. Recurrence rates were low in both groups (1.5% in the mesh group vs. 3% in the tissue reinforcement group, at one‐year follow‐up, p = 0.56). Postoperative complications, including seroma and haematoma, were identical (3% in both groups). Pain intensity (mean VAS score: 5.7 vs. 5.6, p = 0.847) and recovery time (6.7 days vs. 6.6 days, p = 0.960) were similar between the two approaches. Conclusion: Both polypropylene mesh and tissue reinforcement techniques are effective and safe for indirect inguinal hernia repair, with minimal differences in outcomes. Surgical decisions should be tailored to individual patient needs and clinical scenarios. These findings provide evidence supporting the flexibility of surgical approaches in managing indirect inguinal hernias. Trial Registration: IRCT20230410057871N3

Ovarian leiomyomas are rare, benign tumors accounting for 0.5%–1% of all benign ovarian neoplasms, typically presenting asymptomatically or with nonspecific symptoms such as abdominal pain. Neurological symptoms, such as lower limb weakness and paresis, are exceptionally rare and have not been previously reported as primary manifestations of ovarian leiomyoma. A 64‐year‐old postmenopausal woman presented with progressive lower limb weakness, paresis, and urinary incontinence over 3 months, initially suspected to be a recurrent stroke. Neurological examination and carotid Doppler were normal, ruling out stroke. Abdominopelvic imaging revealed a 49 × 34 × 14 cm mass originating from the left ovary, causing lumbosacral nerve root compression. Laparotomy with total abdominal hysterectomy and bilateral salpingo‐oophorectomy was performed. Histopathology confirmed a benign ovarian leiomyoma. Postoperative complications, including renal failure and bilateral pleural effusions, led to the patient's demise on day 6. This case represents the first reported instance of a giant ovarian leiomyoma presenting with neurological symptoms due to lumbosacral nerve compression. Clinicians should consider ovarian leiomyomas in the differential diagnosis of pelvic masses with atypical neurological presentations and pursue MRI or lumbosacral imaging for accurate characterization.

Background: Cell‐free fat extract (CEFFE), an adipose‐derived biologic, offers a potent alternative to cell‐based therapies by delivering a complex milieu of growth factors (e.g., VEGF, EGF, and BDNF) and regulatory proteins without the tumorigenic, immunogenic, or ethical challenges associated with stem cell applications. Objective: The objective of this study is to systematically evaluate CEFFE′s regenerative efficacy across diverse tissue systems—including musculoskeletal, neural, reproductive, dermal, ocular, and systemic applications—while synthesizing its underlying molecular mechanisms, clinical outcomes, and translational challenges. Methods: A comprehensive literature review was conducted utilizing databases such as PubMed, Scopus, and Web of Science, focusing on preclinical and clinical studies published from January 2018 to May 2026. Over 55 articles were analyzed to evaluate CEFFE′s efficacy, dosage–response patterns, and molecular pathways. Results: CEFFE accelerates tissue repair through three conserved mechanistic axes: antiapoptotic survival (e.g., PI3K–Akt/mTOR activation and NRF2‐mediated antiferroptosis), context‐specific immunomodulation (e.g., Annexin A5–mediated M2 macrophage polarization and NLRP3 inflammasome disruption), and extracellular matrix remodeling alongside angiogenesis (e.g., TGF‐ β /Smad signaling). Emerging evidence highlights CEFFE′s efficacy in novel domains such as intervertebral disc degeneration, corneal neurodegeneration, systemic sepsis, and as an IVF culture media supplement. Clinical trials confirm its safety and efficacy in dermatological applications (e.g., infraorbital aging and hyperpigmentation) and demonstrate superiority over standard treatments, such as hyaluronic acid, for early‐to‐mid‐stage osteoarthritis. Conclusions: CEFFE represents a highly versatile and precise cell‐free biologic capable of driving multitissue regeneration. To fully realize its clinical and commercial potential, future research must address donor variability by establishing standardized dosing protocols, implementing key‐molecule quantification for batch consistency, and conducting large‐scale, multicenter randomized controlled trials.

Tendon injuries constitute a significant challenge to musculoskeletal health, comprising approximately 50% of all related injuries in the United States and resulting in considerable treatment expenditures. Conventional conservative and surgical interventions frequently do not succeed in mitigating peritendinous adhesions, resulting in compromised functionality, pain, and an increased risk of re-rupture. This analysis investigates the underlying mechanisms of adhesion formation in the context of tendon healing, highlighting the disparity between intrinsic and extrinsic factors throughout the phases of inflammation, proliferation, and remodeling. The restoration of tendon gliding and mobility underscores the significance of adhesion prevention. This review concentrates on anti-adhesive compounds, encompassing physical barriers such as collagen and chitosan, as well as pharmacological agents including 5-fluorouracil and platelet-rich plasma. The analysis covers their mechanisms of action and preclinical efficacy demonstrated in vitro and in animal models, along with their diverse bioactivities, which include anti-inflammatory and antibacterial effects. The principal findings indicate significant reductions in adhesions; however, they also highlight challenges such as inconsistent degradation rates, potential toxicity, and a paucity of clinical evidence. Future directions encompass the implementation of randomized controlled trials, the establishment of standardized protocols, and the development of multifunctional biomaterials aimed at addressing research gaps and improving patient outcomes in the field of orthopedic surgery.

This study evaluated the prevalence of P. aeruginosa in cystic fibrosis(CF) patients, assessed its resistance patterns to commonly used antibiotics with an emphasis on fosfomycin, and examined the presence of resistance genes (glpT, fosA3, blaCTX-M) in these isolates. A cross-sectional study was conducted at Shahid Beheshti University of Medical Sciences, Tehran, from January to June 2022. Sixty sputum samples from CF-confirmed patients were collected and cultured. Antibiotic susceptibility testing (AST) was performed using the Kirby–Bauer disk diffusion method according to CLSI guidelines. Minimum inhibitory concentrations (MICs) of fosfomycin were determined using E-test strips. PCR was employed to detect the presence of glpT, fosA3, and blaCTX-M resistance genes. Data were analyzed using SPSS version 21. P. aeruginosa was isolated from 71.6% (43/60) of samples. Based on AST, significant antibiotic resistance was observed, particularly against fosfomycin (77.2%), imipenem, and amikacin (53.5%). Using the combined disk diffusion test (CDDT), 46% of isolates were identified as ESBL producers. PCR analysis revealed the presence of glpT gene in all isolates, fosA3 gene in 39.5%, and blaCTX-M gene in 30.2%. The fosA3 gene showed a strong correlation with fosfomycin resistance, while blaCTX-M was associated with beta-lactam resistance. Molecular diagnostics targeting resistance genes such as glpT, fosA3, and blaCTX-M are essential for guiding antibiotic therapy. The resistance patterns observed, particularly against fosfomycin, highlight the need for innovative therapeutic approaches. This study reveals a high rate of multidrug resistance in P. aeruginosa isolates from CF patients, particularly to fosfomycin, imipenem, and amikacin. The presence of resistance genes suggests a genetic basis for these patterns, emphasizing the importance of developing new strategies to manage P. aeruginosa infections effectively. Future studies should focus on targeted inhibitors for these genes to overcome resistance and improve clinical outcomes.

Introduction: Schaaf-Yang syndrome (SYS) is a rare autosomal dominant disorder, first identified in 2013, resulting from mutations in the paternal allele of the MAGEL2 gene. Schaaf-Yang syndrome exhibits clinical features similar to those of Prader-Willi syndrome (PWS), including hypotonia, joint contractures, developmental delay, and intellectual disability. However, SYS is also characterized by unique manifestations, such as recurrent hyperthermia, feeding difficulties, respiratory distress, and seizures. This case report describes the first SYS case identified in Iran. Case Presentation: A one-year-old female, born to consanguineous parents, presented with recurrent episodes of hyperthermia, respiratory distress, and seizures since the neonatal period. Despite initial empirical treatment with broad-spectrum antibiotics for suspected infections, her symptoms persisted. Physical examination revealed hypotonia, camptodactyly, and hand contractures. Genetic testing confirmed SYS with a MAGEL2 gene mutation (c.1923dupC, p.V643Gfs*70) and probable pathogenic variants in ASPM and KIF7. The hyperthermia was attributed to hypothalamic dysfunction, a hallmark of SYS, rather than an infectious cause. The patient remains under follow-up without specific pharmacological intervention. Conclusions: This case emphasizes the importance of considering SYS in patients presenting with unexplained fever, seizures, and neurodevelopmental delays. Early genetic testing is crucial for diagnosing SYS and differentiating it from conditions such as PWS or infection-related disorders. Timely diagnosis can improve management strategies and help reduce the risk of lasting neurological impairments associated with this genetic disorder.

The objective of this study was to evaluate inflammatory markers as predictors of fertility after varicocelectomy and to develop a prediction model. This prospective cohort was conducted on patients with varicoceles who were presented to the clinic of Imam Reza hospital of Tehran during 2019-2020. Semen analysis, complete blood count (CBC), and scrotal ultrasonography was requested. Patients with abnormalities of semen analysis were chosen as candidates for varicocelectomy. 6 months after the operation, semen analysis was repeated. Hematologic and semen analysis parameters were recorded at baseline and follow-up visits. Treatment success was defined as 50% increase in total motile sperm count (TMSC) in cases with preoperative TMSC> 5 million/cc or 100% increase in TMSC in cases with preoperative TMSC< 5 million/cc. Patients were then categorized into two groups based on treatment success and statistical analysis was performed on these two groups. 124 infertile patients with varicocele were evaluated in our study. 52 patients (41.93%) showed improvements in semen analysis after varicocelectomy. After univariate and multivariate analysis three parameters were used in our predictive model as body mass index (BMI)>23.70 kg/m2 (4 scores), neutrophil-lymphocyte ratio (NLR) >1.80 (3 scores), and TMSC<14.69 million (2 scores). A cut-off value of 5 was associated with an 87.5% sensitivity and an 84.6% specificity for the prediction of failure of varicocelectomy. Varicocelectomy can improve semen analysis parameters in almost all infertile men with varicocele. Using BMI, NLR, and baseline TMSC as the suggested scoring system can predict the success of varicocelectomy for improving fertility and determine the appropriate infertile candidates for surgery.