dr. mohammad jafar emami

 Today, the incidence of septic arthritis by Staphylococcus aureus has increased due to intra-articular injections, prosthetic joints, and underlying conditions such as rheumatoid arthritis and immunosuppression. Pistacia atlantica has significant antioxidant, anti-inflammatory, and antibacterial activities.

 Considering S. aureus as the most important etiology of septic arthritis, this experimental study aimed to evaluate the effects of P. atlantica on septic arthritis.

 Septic arthritis was induced by intra-articular injection of S. aureus suspension in left stifles of rats, which were divided randomly into eight groups, containing ten per group, including normal: no intervention; control: septic arthritis was induced but not treated; Oral Placebo (OP): 14 days daily P.O.; Local Injected Placebo (LIP): a single dose intra-articular (IA injection) of normal saline; Oral P. atlantica (OPa): 14 days daily P.O. P. atlantica extract; Local Injected P.atlantica (LIPa): a single-dose IA injection of P. atlantica extract; Prophylactic Oral P. atlantica (ProOPa): prophylactic P.O. P. atlantica extract daily one week before the induction for 21 days; Prophylactic Local Injected P. atlantica (ProLIPa): a prophylactic single-dose IA injection of P. atlantica extract one week before the induction. For further evaluations, blood and histopathological samples were obtained.

 Pistacia atlantica oral medication reduced the physical symptoms of inflammation. Although hematological analysis showed a fall in the control group compared to the normal group, all medicated groups increased. The OPa group showed the closest WBC count (9.46 ± 4.12 × 109/L) to the normal group (P = 0.073). All histopathological parameters had significantly higher scores in the control group compared to the normal group. Although the scores increased in the groups that received P. atlantica, they decreased in the groups that received placebo, except for synovitis degree. The OPa group demonstrated a lower degree of synovitis (1.40 ± 0.51) than the control group; however, it was not significant (P = 0.690). Local injections revealed higher erosion scores (2.80 ± 0.63 for the LIPa group and 2.70 ± 0.48 for the ProLIPa group) than the control group (P < 0.05).

 Oral administration of P. atlantica alleviated the clinical symptoms. Cellular immunity activation and systemic benefits of oral P. atlantica were assessed. Histopathology confirmed the immune system involvement and antibacterial activity of P. atlantica. More erosion may be due to more bacterial debris with arthritogenic properties. Meanwhile, the probability of the stimulatory effect of P. atlantica extract for synovial content should not be ignored.

The purpose of this study was to investigate the effects of the combination of vitex agnus castus extract, as a source of phytoestrogens, plus magnesium supplementation on osteogenic and angiogenic factors and callus formation in women with long bone fracture. In a double-blind randomized placebo controlled trial, 64 women with long bone fracture,20-45 years old, were randomly allocated to receive 1) one Agnugol tablet (4 mg dried fruit extract of vitex agnus castus) plus 250 mg magnesium oxide (VAC + Mg group (n = 10)), 2) one Agnugol tablet plus placebo (VAC group (n = 15)), 3) placebo plus 250mg magnesium oxide (Mg group (n = 12)), or 4) placebo plus placebo (placebo group (n = 14)) per day for 8 weeks. At baseline and endpoint of the trial, serum alkaline phosphatase, osteocalcin, and vascular endothelial growth factor (VEGF) were measured together with radiological bone assessment. There were no significant differences in the characteristic aspects of concern between the four groups at baseline. Despite the increased level of alkaline phosphatase in the VAC group (188.33 ± 16.27 to 240.40± 21.49, P = 0.05), administration of VAC + Mg could not increase alkaline phosphatase activity. However, treatment with VAC + Mg significantly enhanced the osteocalcin level. The serum concentration of VEGF was increased in the VAC group (269.04 ± 116.63 to 640.03 ± 240.16, P < 0.05). Callus formation in the VAC + Mg group was higher than the other groups but the differences between the four groups were not significant (P = 0.39). No relevant side effect was observed in patients in each group. Our results suggest that administration of vitex agnus castus plus magnesium may promote fracture healing. However, more studies need to further explore the roles of vitex agnus castus in fracture repair processes.

Primary malignant bone tumors are heterogeneous groups of neoplasms, which affect mainly children and adolescents. The most common types are Osteosarcoma, Ewing sarcoma and chondrosarcoma. Elevation of sCD30 and sCD40L has been observed in lymphoma, leukemia and autoimmune disorders. To evaluate serum concentrations of sCD30 and sCD40L in patients with primary malignant bone tumors. Fifty-four cases (31 Osteosarcomas, 14 Ewing sarcomas, and 9 Chondrosarcomas) and 54 healthy controls enrolled in this study. Cases with the history of prior treatment (surgery, chemotherapy and radiotherapy) were excluded from the study. Serum levels of sCD30 and sCD40L were detected by an enzyme linked immunosorbent assay (ELISA). Mean serum concentration of sCD30 in Ewing sarcoma was significantly higher than that of the control groups (p=0.007), but mean serum concentrations of sCD30 in osteosarcoma and chondrosarcoma groups were not significantly different, compared to the controls (p=0.41 and p=0.11, respectively). Mean serum concentrations of sCD40L in osteosarcoma, Ewing sarcoma and chondrosarcoma groups were significantly higher than that of the control group (p<0.0001). In addition, the mean serum level of sCD4 Lin chondrosarcoma patients was higher than that of both Ewing sarcoma and osteosarcoma groups (p<0.001). sCD30 and sCD40L increase in primary bone tumors; however the significant of these findings for diagnosis or prognosis of these tumors needs further investigation.

Prevention of arthrofibrosis by different drugs and surgical techniques is an essential issue in modern orthopaedics. This study investigated the effect of bevacizumab on intra-articular fibrosis in a rabbit animal model. Arthrofibrosis was induced in right stifle joint of thirty male white rabbits by removing the cortical bone of femoral condyle in medial gutter under general anesthesia. The rabbits were randomly divided into three equal groups. The control group received intra-articular injection of saline; the «one-injection» group received a single dose of bevacizumab (2. 5 mg/kg)، and the «two-injection» group received two intra-articular injections on the day of operation and 14 days later. Forty five days after the surgery، the animals were sacrificed. The severity of fibrosis was assessed by range of motion of the stifles، macroscopic adhesion score، and histopathologic variables. Although no statistical difference was seen between the control group and the «one-injection» group in terms of range of motion and macroscopic evaluation، the histopathologic variables in prevention of arthrofibrosis، except for the granulation tissue، were significantly better in the «one-injection» group. The «two-injection» group in comparison to the «one-injection» group was better not only in range of motion evaluation (p=. 001) and visual adhesion score (p=. 012)، but also in most of the histopathologic variables، except for the cell count and granulation tissue. Two injections of bevacizumab for prevention of arthrofibrosis resulted in better outcome than single injection.

Phytoestrogens enhance bone integrity through prevention of bone loss and stimulation of bone formation، and also facilitation of bone healing. The aim of the present study was to evaluate the effect of vitex agnus castus extract، as a source of phytoestrogen on alkaline phosphatase and VEGF (vascular endothelial growth factor) and also callus formation in women with long bone fractures. In a double-blind randomized placebo controlled trial، 32 women with long bone fracture، age 20-45 years old، were randomly divided into the VAC (vitex agnus castus)، receiving 1 Agnugol tablet (containing 4 mg dried fruit extract of vitex agnus castus) -daily for 8 weeks or a placebo group. Serum alkaline phosphatase and VEGF were measured at the beginning and the end point، and also callus formation was checked at the end of study. Serum alkaline phosphatase was increased in both groups compared to the baseline. Although the elevation of ALP (Alkaline phosphatase) in placebo group was not significant، in treatment group، ALP was considerably increased (p=. 05). Comparison of the change of VEGF showed that، only in VAC group، VEGF level was significantly increased (p=. 01). The callus formation which revealed the fracture healing، in VAC and control groups was 71. 4% and 53. 8%، respectively. Treatment with vitex agnus castus extract for 2 months could enhance the VEGF level، however، further studies are need to show the effects of vitex agnus castus extract on alkaline phosphatase level and callus formation.