فهرست مطالب vaccaro

Zarrin Mafic dikes, which outcrop in the Western Yazd block, Central Iran, trending NW–SE, emplaced into the Zarrin granitoid. They are sub-alkaline gabbro; characterized by intergranular and mylonitic foliated texture. Geochemical data reveal the Zarrin mafic dikes are from the partial melting lithospheric mantle, a spinel-peridotitic source. Furthermore, they are characterized by 87Sr/86Sr ratio of (0.7044-0.7028) and 144Nd/143Nd ratio of (0.5123- 0.5122), that consistent with the derivation from a lithospheric mantle. Their primitive mantle normalized trace elemental patterns display enrichment in LILEs compared to HFSEs, and positive Rb, Ba, and U but negative Ta, Nb, Th, and Zr anomalies, carrying characteristics subduction-related magmatism and metasomatism by subduction-related fluids. The petrogenesis of the Zarrin mafic dikes are related to melting of the lithospheric mantle, and upwelling asthenospheric mantle in the extensional basin which was associated with the subduction.

To estimate the summation of mortality rate and the contributing factors in patients with traumatic thoracolumbar spinal cord injuries (TLSCI).
A systematic search of observational studies that evaluated the mortality associated with TLSCI in MEDLINE and EMBASE was conducted. The study quality was evaluated using a modified quality assessment tool previously designed for observational studies.
Twenty-four observational studies involving 11,205 patients were included, published between January 1, 1997, and February 6, 2016. Ten studies were of high quality, thirteen were of moderate quality, and one study was of low quality. Seventeen reports described risk factors for mortality and eleven of these studies used a multiple regression models to adjust for confounders.The reported mortality rate ranged from 0 to 37.7% overall and between 0 and 10.4% in-hospital. The sum of mortality for in-hospital, 6-month, and 12-month were 5.2%, 26.12%, 4.3%, respectively. The mortality at 7.7 years follow-up was 10.07% and for 14 years follow-up reports ranged from 13.47% to 21.46%. Associated data such as age at injury, male to female ratio, pre-existing comorbidities, concomitant injuries, duration of follow-up, and cause of death have been underreported in studies investigating the mortality rate after TLSCI.
Currently no study has accurately assessed mortality in the thoracolumbar spine, while there is general agreement that traumatic thoracolumbar spinal cord injuries are important.

It has been suggested, although not proven, that presence of concomitant psychiatric disorders may increase the inpatient costs for patients undergoing elective surgery. This study was designed to test the hypothesis that elective lumbar fusion surgery is more costly in patients with under treatment for depression.
This is a retrospective case-control study of 142 patients who underwent elective lumbar fusion. Of those 142 patients, 41 patients were chronically using an antidepressant medication that considered as a "study group", and 101 patients were not taking an antidepressant medication that considered as a "control group". Data was collected for this cohort regarding antidepressant usage patient demographics, length of stay (LOS), age-adjusted Charlson comorbidity index scores and cost. Costs were compared between those with a concomitant antidepressant usage and those without antidepressant usage using multivariate analysis.
Patients using antidepressants and those with no history of antidepressant usage were similar in terms of gender, age and number of operative levels. The LOS demonstrated a non-significant trend towards longer stays in those using anti-depressants. Total charges, payments, variable costs and fixed costs were all higher in the antidepressant group but none of the differences reached statistical significance. Using Total Charges as the dependent variable, gender and having psychiatric comorbidities were retained independent variables. Use of an antidepressant was independently predictive of a 36% increase in Total Charges . Antidepressant usage as an independent variable also conferred a 22% increase in cost and predictive of a 19% increase in Fixed Cost . Male gender was predictive of a 30% increase in Total Charges .
This study suggests use of antidepressant in patients who undergo elective spine fusion compared with control group is associated with increasing total cost and length of hospitalization, although none of the differences reached statistical significance.

Blacks have a higher incidence of diabetes and its related complications. Self-rated health (SRH) and perceived stress indicators are associated with chronic diseases. The aim of this study was to examine the associations between SRH, perceived stress and diabetes status among two Black ethnicities. The cross-sectional study included 258 Haitian Americans and 249 African Americans with (n = 240) and without type 2 diabetes (n = 267) (N = 507). Recruitment was performed by community outreach. Haitian-Americans were less likely to report ‘fair to poor’ health as compared to African Americans [OR=0.58 (95% CI: 0.35, 0.95), P = 0.032]; yet, Haitian Americans had greater perceived stress than African Americans (P = 0.002). Having diabetes was associated with ‘fair to poor’ SRH [OR=3.14 (95% CI: 2.09, 4.72), P < 0.001] but not perceived stress (P = 0.072). Haitian-Americans (P = 0.023), females (P = 0.003) and those participants having ‘poor or fair’ SRH (P < 0.001) were positively associated with perceived stress (Nagelkerke R2=0.151). Perceived stress associated with ‘poor or fair’ SRH suggests that screening for perceived stress should be considered part of routine medical care; albeit, further studies are required to confirm our results. The findings support the need for treatment plans that are patient-centered and culturally relevant and that address psychosocial issues.

Spinal cord injured (SCI) patients have sexual disorders including erectile dysfunction (ED), impotence, priapism, ejaculatory dysfunction and infertility. Treatments for erectile dysfunction include four steps. Step 1 involves smoking cessation, weight loss, and increasing physical activity. Step 2 is phosphodiesterase type 5 inhibitors (PDE5I) such as Sildenafil (Viagra), intracavernous injections of Papaverine or prostaglandins, and vacuum constriction devices. Step 3 is a penile prosthesis, and Step 4 is sacral neuromodulation (SNM). Priapism can be resolved spontaneously if there is no ischemia found on blood gas measurement or by Phenylephrine. For anejaculatory dysfunction, massage, vibrator, electrical stimulation and direct surgical biopsy can be used to obtain sperm which can then be used for intra-uterine or in-vitro fertilization. Infertility treatment in male SCI patients involves a combination of the above treatments for erectile and anejaculatory dysfunctions. The basic approach to and management of sexual dysfunction in female SCI patients are similar as for men but do not require treatment for erectile or ejaculatory problems.

An assessment of nonoperative and operative intervention inregards to neurological improvement following traumatic closed cervical spinal cord injury (CSCI). A retrospective evaluation of a cohort of patients with a CSCI from C3 to T1 was reviewed. The analysis included a total of 13 eligible patients. The neurologic and functional outcomes were recorded from the acute hospital admission to the most recent follow-up. Data included patients'' age; level of injury, neurologic exam according to the Frankel grading system, the performance of surgery, the mechanism and timing of the CSCI decompression, and motor index score (MIS). Ninety-two percent of the patients were male with the mean age of 28.2 ± 11.5. Before treatment, 10/13 patients (77.0%) had functionally complete neurological deficits below the level of injury. The median interval from injury to surgery was 16 days. Eight patients underwent surgical intervention and five were treated nonoperatively. The median length of follow-up was 14 months after surgery (Range: 7 - 93 months). Spinal cord functional improvement was observed in 2/8 (25%) of the surgically managed patients and in 4/5 (80%) of the patients treated nonoperatively. Root recovery was observed in 6/8 (75%) of the patients who were treated surgically and 4/5 (80%) of the patients treated nonoperatively. Some degree of motor score improvement occurs following a closed cervical spinal cord injury with or without operative surgery in the follow up period.