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OBJECTIVE: Relapse of epileptic spasms after initial treatment of infantile epileptic spasms syndrome (IESS) is common. However, past studies of small cohorts have inconsistently linked relapse risk to etiology, treatment modality, and EEG features upon response. Using a large single-center IESS cohort, we set out to quantify the risk of epileptic spasms relapse and identify specific risk factors. METHODS: We identified all children with epileptic spasms at our center using a clinical EEG database. Using the electronic medical record, we confirmed IESS syndrome classification and ascertained treatment, response, time to relapse, etiology, EEG features, and other demographic factors. Relapse-free survival analysis was carried out using Cox proportional hazards regression. RESULTS: Among 599 children with IESS, 197 specifically responded to hormonal therapy and/or vigabatrin (as opposed to surgery or other second-line treatments). In this study, 41 (21%) subjects exhibited relapse of epileptic spasms within 12 months of response. Longer duration of IESS prior to response (>3 months) was strongly associated with shorter latency to relapse (hazard ratio = 3.11; 95% CI 1.59-6.10; p = 0.001). Relapse was not associated with etiology, developmental status, or any post-treatment EEG feature. SIGNIFICANCE: This study suggests that long duration of IESS before response is the single largest clinical predictor of relapse risk, and therefore underscores the importance of prompt and successful initial treatment. Further study is needed to evaluate candidate biomarkers of epileptic spasms relapse and identify treatments to mitigate this risk. PLAIN LANGUAGE SUMMARY: Relapse of infantile spasms is common after initially successful treatment. With study of a large group of children with infantile spasms, we determined that relapse is linked to long duration of infantile spasms. In contrast, relapse was not associated with the cause of infantile spasms, developmental measures, or EEG features at the time of initial response. Further study is needed to identify tools to predict impending relapse of infantile spasms.

Abstract Accurate solute solubility measuring and modeling in supercritical carbon dioxide (ScCO2) would address the best working conditions and thermodynamic boundaries for material processing with this type of fluid. Theory- and data-driven methods are two general modeling approaches. Using theory-driven methods, the solubility is estimated based on the principles of thermodynamics, while data-driven methods are developed by training the algorithms. Despite acceptance of each of these methods, more experimental solubility data are still needed to promote modeling performances. In this study, for the first time, solubility of morphine sulfate is determined and modeled by a set of 13 semi-empirical (theory-driven) and random forest (data-driven) models. Using a laboratory system with an ultraviolet-visible (UV-Vis) spectroscopy, the experimental solubilities including 48 data points were obtained at different temperatures (308–338 K) and pressures (12–27 MPa). The minimum (0.806 × 10−5) and maximum (5.902 × 10−5) equilibrium mole fractions were observed at working pressures of 12 and 27 MPa, respectively, both at the same temperature of 338 K. It was indicated that random forest model (with AARD% of 1.29%) had an excellent predictive performance against semi-empirical models (with AARD% from 9.33 to 19.76%). The results showed that solute molecular weight had the highest effect on random forest modeling. Using modeling results from Chrastil and Bartle models, total and vaporization enthalpies of dissolution of morphine sulfate in ScCO2 were found to be 35.12 and 59.04 kJ/mole, respectively.

Background: Guillain-Barre Syndrome (GBS) is the most prevalent acute peripheral polyneuropathy disorder. The disparities between populations and variations in the major risk factors highlight the importance of country-specific studies. This study aimed to report clinical characteristics and outcomes of ICU-admitted patients with GBS in an academic medical center in Iran. Methods: The data were collected retrospectively from all patients with GBS admitted to Namazi Hospital, affiliated with Shiraz University of Medical Sciences, (Shiraz, Iran), between March 2016 to March 2021. Specialized neurological information and the Acute Physiology and Chronic Health Evaluation (APACHE II) score were recorded. The SPSS software was used to analyze the data. The analyzed data were reported as numbers and percentages, or mean±SD, or median(Interquartile) Results: The study included 132 GBS patients, with an average age of 47.87±15.4 years and a male-to-female ratio of 1.69:1. More than half of the patients (58.5%) were classified as having an axonal disease. In patients with axonal illness, 51.4% of patients had lower limb powers

Abstract Ion gradients across cell membranes generate voltage potentials that are involved in a wide range of biological processes. According to the membrane hypothesis of aging, aging is inextricably linked to a decrease in resting membrane potential (Vmem). Alterations in ion channel activity and membrane fluidity caused by aging disrupt bioelectric homeostasis, increase intracellular calcium and potassium concentrations, induce abnormal mechanistic target of rapamycin (MTOR)‐ and AMPK‐regulated metabolism and energy dissipation, and decrease proliferation and regeneration. Failure to maintain ion channel activity and membrane potential leads to cell senescence or death. There is evidence that by manipulating ion channel activities, a cryptic memory can be recalled to restore lost proliferative or regenerative abilities. Reversal or prevention of senescence, aging phenotypes, and longevity may be achieved by fine‐tuning mitochondrial membrane polarization. Therefore, there is optimism that deciphering the bioelectric codes that govern cell functions will lead to the development of new gero‐electroceuticals that restore cell function and prevent tissue loss during aging.

Abstract Objective Relapse of epileptic spasms after initial treatment of infantile epileptic spasms syndrome (IESS) is common. However, past studies of small cohorts have inconsistently linked relapse risk to etiology, treatment modality, and EEG features upon response. Using a large single‐center IESS cohort, we set out to quantify the risk of epileptic spasms relapse and identify specific risk factors. Methods We identified all children with epileptic spasms at our center using a clinical EEG database. Using the electronic medical record, we confirmed IESS syndrome classification and ascertained treatment, response, time to relapse, etiology, EEG features, and other demographic factors. Relapse‐free survival analysis was carried out using Cox proportional hazards regression. Results Among 599 children with IESS, 197 specifically responded to hormonal therapy and/or vigabatrin (as opposed to surgery or other second‐line treatments). In this study, 41 (21%) subjects exhibited relapse of epileptic spasms within 12 months of response. Longer duration of IESS prior to response (>3 months) was strongly associated with shorter latency to relapse (hazard ratio = 3.11; 95% CI 1.59–6.10; p = 0.001). Relapse was not associated with etiology, developmental status, or any post‐treatment EEG feature. Significance This study suggests that long duration of IESS before response is the single largest clinical predictor of relapse risk, and therefore underscores the importance of prompt and successful initial treatment. Further study is needed to evaluate candidate biomarkers of epileptic spasms relapse and identify treatments to mitigate this risk. Plain Language Summary Relapse of infantile spasms is common after initially successful treatment. With study of a large group of children with infantile spasms, we determined that relapse is linked to long duration of infantile spasms. In contrast, relapse was not associated with the cause of infantile spasms, developmental measures, or EEG features at the time of initial response. Further study is needed to identify tools to predict impending relapse of infantile spasms.

Vascular endothelial growth factor (VEGF), brain-derived neurotrophic factor (BDNF), and insulin-like growth factor-1 (IGF-1) may help the brain resist both functional and structural neurodegeneration, which is critical for maintaining cognitive and neurological health in older adults. This meta-analysis and meta-regression seek to elucidate the impact of physical activity on these biomarker levels in healthy seniors, as well as to examine the influence of several moderator factors, including age, sex, period length, and time, for the first time. The standardized mean effect metric was used to assess the influence of weights, which reflected each group's relative importance in comparison to baseline data. The study looked at potential moderating factors including age, gender, and physical activity levels. The analysis of 11 studies indicated no significant effect of physical activity on VEGF levels [0.328, CI 95 % (−0.871 to 1.52); I2 = 0.00; p = 0.592; Q = 4.14]. Physical activity had a substantial impact on brain-derived neurotrophic factor (0.827, 95 % confidence interval: 0.487 to 1.16; I2 = 0.00; p = 0.00; Q = 78.46), with females showing particularly notable effects (Tau2 = 0.327, Tau = 0.571, I2 = 80.90 %, Q = 68.05, df = 15, p = 0.00). Physical activity also had a substantial effect on insulin-like growth factor 1 (0.276, 95 % confidence interval: 0.065 to 0.487; I2 = 0.00; p = 0.10; Q = 8.35), indicating that it positively influences IGF-1 levels. Overall, while physical exercise has a significant effect on BDNF and IGF-1, more research is needed to fully understand its impact on vascular endothelial growth factor and to investigate how individual characteristics may influence exercise outcomes.

Background: The World Health Organization (WHO) has not identified a definitive cure for COVID-19, recommending supportive treatment or antimicrobial therapy based on individual patient needs. This study explores the processes and challenges emergency physicians at Rasul Akram Hospital in Tehran face when prescribing medications with insufficient evidence during the COVID-19 pandemic. Methods: A qualitative study using conventional content analysis. Purposeful sampling with maximum variation was employed until data saturation was achieved. Seventeen participants (5 women, 12 men) aged 32 to 55 underwent individual in-depth interviews. Results: Analysis of the data from the interviews revealed three main categories, 11 subcategories, and 20 themes. Patient-related factors, including mental conditions, fear, and reliance on rumors, significantly influence healthcare decision-making. Financial, cultural, and social challenges faced by patients also impact treatment choices. Factors related to hospitals and companies, such as economic advertising and restrictions, can affect patient care. Physician-related factors, such as adherence to protocols and consideration of traditional medicine, play a key role in treatment decisions. Conclusion: Patient-related, hospital-related, and physician-related factors are essential in shaping treatment decisions in healthcare settings. Understanding and addressing these diverse influences are crucial for providing effective and personalized healthcare. The complexity of decision-making in healthcare, especially during the pandemic, underscores the importance of considering and navigating these various factors to deliver optimal care tailored to patients' needs and preferences.

Background: Epidural hematoma (EDH) and subdural hematoma (SDH) are common complications after traumatic brain injury. Intracranial hematomas can be without complications or associated with life-threatening conditions, including midline shift, cerebral edema, intracerebral ischemia, and increased intracranial pressure. This study aimed to investigate the prevalence of EDH and SDH in patients with head trauma attending the emergency department. Materials and Methods: This descriptive cross-sectional study included 146 patients with head trauma referred to the Emergency Department of Shahid Mohammadi Hospital, Bandar Abbas, in 2021. Patients’ data, including age, gender, Glasgow Coma Scale (GCS) on admission, mechanism of trauma, type of hematoma, length of intensive care unit (ICU) stay, outcome (recovery/death), and neurosurgery requirements were extracted from their medical files. Results: The mean age of the participants was 20.97±15.05 years, of whom 114 (78.1%) were male. EDH and SDH were observed in 7.5% and 11% of patients, respectively. The most common mechanism of trauma was traffic accidents (39%), followed by falls (28.1%) and assaults (13%). Moreover, 11% of the patients needed neurosurgical intervention. Most patients recovered (95.9%), and 4.1% died. The mean GCS on admission was 13.47±2.34. Furthermore, SDH was significantly higher in the patients who died (P=0.001) and those aged≥18 years (P=0.028). Conclusion: The results of the current study showed a higher prevalence of SDH compared to that of EDH. Both hematoma types appeared to correlate with the mechanism of trauma, ICU admission, GCS on admission, and neurosurgery requirement, while SDH was associated with age and death.

Abstract Background Chronic hepatitis B (CHB) virus is the most common risk factor for developing liver malignancy. Autophagy is an essential element in human cell maintenance. Several studies have demonstrated that autophagy plays a vital role in liver cancer at different stages. In this systematic review, we intend to investigate the role of polymorphism and mutations of autophagy‐related genes (ATGs) in the pathogenesis and carcinogenesis of the hepatitis B virus (HBV). Materials and Methods The search was conducted in online databases (Web of Science, PubMed, and Scopus) using Viruses, Infections, Polymorphism, Autophagy, and ATG. The study was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses criteria. Results The primary search results led to 422 studies. By screening and eligibility evaluation, only four studies were relevant. The most important polymorphisms in hepatocellular carcinoma were rs2241880 in ATG16L1, rs77859116, rs510432, and rs548234 in ATG5. Furthermore, some polymorphisms are associated with an increased risk of HBV infection including, rs2241880 in ATG16L1 and rs6568431 in ATG5. Conclusion The current study highlights the importance of rs2241880 in ATG16L1 and rs77859116, rs510432, and rs548234 in ATG5 for HBV‐induced HCC. Additionally, some mutations in ATG16L1 and ATG5 were important in risk of HBV infection. The study highlights the gap of knowledge in the field of ATG polymorphisms in HBV infection and HBV‐induced HCC.

Background and purpose: Acute ischemic stroke is one of the main causes of death and long-term disability worldwide. Prehospital emergency diagnosis and subsequent transfer of stroke patients to the nearest stroke center for starting an appropriate treatment are critical steps in stroke rescue chain. In Iran, emergency medical technicians implement the SAMA code, following the diagnosis of acute stroke using FAST protocol, to manage the patients. Materials and methods: This retrospective cross-sectional study was conducted on patients who were referred to the prehospital emergency department of Hazrat Rasool Akram Hospital with the announcement of the SAMA code in 2019. The aim of this study was to evaluate the positive predictive value of the prehospital emergency technicians in the announcement of the SAMA code. Results: Of the 95 patients referred with the SAMA code, 19 patients diagnosed with hemorrhagic stroke (based on brain CT-scan) were excluded from the study. In 17.1% of the remaining 76 patients, diagnoses other than acute ischemic stroke were proposed. Ultimately, diagnosis of acute ischemic stroke was confirmed in 63 patients, and 25% of them were eligible for intravenous thrombolytic therapy, however, merely 5.26% of the eligible patients received the treatment. The positive predictive value of prehospital emergency service in referring patients diagnosed with acute ischemic stroke was determined to be 86.3%. Additionally, the positive predictive value for identifying acute cerebral stroke patients eligible for intravenous thrombolytic therapy was calculated to be 25%. Conclusion: This study revealed that prehospital emergency's positive predictive value for acute ischemic stroke identification was adequate. However, activating the SAMA code with greater diagnostic accuracy can save time and costs.

Abstract The influenza virus hemagglutinin is an important part of the virus attachment to the host cells. The hemagglutinin proteins are one of the genetic regions of the virus with a high potential for mutations. Due to the importance of predicting mutations in producing effective and low-cost vaccines, solutions that attempt to approach this problem have recently gained significant attention. A historical record of mutations has been used to train predictive models in such solutions. However, the imbalance between mutations and preserved proteins is a big challenge for the development of such models that need to be addressed. Here, we propose to tackle this challenge through anomaly detection (AD). AD is a well-established field in Machine Learning (ML) that tries to distinguish unseen anomalies from normal patterns using only normal training samples. By considering mutations as anomalous behavior, we could benefit existing rich solutions in this field that have emerged recently. Such methods also fit the problem setup of extreme imbalance between the number of unmutated vs. mutated training samples. Motivated by this formulation, our method tries to find a compact representation for unmutated samples while forcing anomalies to be separated from the normal ones. This helps the model to learn a shared unique representation between normal training samples as much as possible, which improves the discernibility and detectability of mutated samples from the unmutated ones at the test time. We conduct a large number of experiments on four publicly available datasets, consisting of three different hemagglutinin protein datasets, and one SARS-CoV-2 dataset, and show the effectiveness of our method through different standard criteria.

Abstract The inter-arm blood pressure difference has been advocated to be associated with cardiovascular mortality and morbidity. Our study aimed to investigate the association between Inter-arm systolic and diastolic blood pressure differences and Cardio Vascular Disease (CVD). A total of 10,126 participants aged 35–70 years old were enrolled in a prospective Fasa Persian Adult Cohort. In this cross-sectional study, the cutoff values for inter-arm blood pressure difference were less than 5, greater than 5, greater than 10, and greater than 15 mm Hg. Descriptive statistics and logistic regression were used to analyze the data. Based on the results the prevalence of ≥ 15 mmHg inter-arm systolic and diastole blood pressure difference (inter-arm SBPD and inter-arm DBPD) were 8.08% and 2.61%. The results of logistic regression analysis showed that inter-arm SBPD ≥ 15 and (OR

Carbonate solution is used for the alkaline leaching of uranium from solid waste. Time, temperature, stirring speed (independent parameters) and total carbonate concentration, carbonate to bicarbonate ratio, and the ratio of liquid eluent volume to solid waste weight (L/S) (dependent parameters) are effective parameters in the leaching process. Independent parameters were optimized using the one variant at time (OVAT) method and the dependent parameters were evaluated simultaneously with the use of MINITAB software and using the face central composite design (FCCD) method. The solid waste powder was analyzed by EDAX, SEM, and XRD, and elemental analysis of samples was performed by ICP-OES after complete dissolution. Duration time of 0.5 hours, the stirrer rotation speed of 150 rpm, room temperature, concentrations of 0.09, 0.01, and 0.1 M for sodium carbonate, bicarbonate, and total carbonate, respectively, with a ratio of 9.1 and 20 for the ratio of sodium carbonate to sodium bicarbonate and L/S, respectively, were optimal conditions. Reproducibility of solid waste leaching was obtained by performing 4 experiments and the values of 94.2±2 and 4.15±1.6 were obtained for the average percentage of leach and solid residue, respectively. The average uranium grade was 2.09±0.02.

Abstract A supercritical fluid, such as supercritical carbon dioxide (scCO2) is increasingly used for the micronization of pharmaceuticals in the recent past. The role of scCO2 as a green solvent in supercritical fluid (SCF) process is decided by the solubility information of the pharmaceutical compound in scCO2. The commonly used SCF processes are the rapid expansion of supercritical solution (RESS) and supercritical antisolvent precipitation (SAS). To implement micronization process, solubility of pharmaceuticals in scCO2 is required. Present study is aimed at both measuring and modeling of solubilities of hydroxychloroquine sulfate (HCQS) in scCO2. Experiments were conducted at various conditions (P = 12 to 27 MPa and T = 308 to 338 K), for the first time. The measured solubilities were found to be ranging between (0.0304 × 10–4 and 0.1459 × 10–4) at 308 K, (0.0627 × 10–4 and 0.3158 × 10–4) at 318 K, (0.0982 × 10–4 and 0.4351 × 10–4) at 328 K, (0.1398 × 10–4 and 0.5515 × 10–4) at 338 K. To expand the usage of the data, various models were tested. For the modelling task existing models (Chrastil, reformulated Chrastil, Méndez-Santiago and Teja (MST), Bartle et al., Reddy-Garlapati, Sodeifian et al., models) and new set of solvate complex models were considered. Among the all models investigated Reddy-Garlapati and new solvate complex models are able to fit the data with the least error. Finally, the total and solvation enthalpies of HCQS in scCO2 were calculated with the help of model constants obtained from Chrastil, reformulated Chrastil and Bartle et al., models.

Key clinical message Oto‐tricho is associated with the symptoms of gag reflex and non‐neuropathic tinnitus, which can be treated by removing the hair and its follicle. Abstract Oto‐tricho refers to a disorder of hair growth in the tympanic membrane (TM). In its early stages, it can manifest as symptoms such as tinnitus, chronic pain, cough, and nausea. If left untreated, it can potentially lead to tympanosclerosis, TM micro‐perforation, and hearing loss. In this report, we present a case study of a 33‐year‐old male with hair and follicle growth observed on the left TM. Over the course of the past year, the patient experienced various symptoms including tinnitus, dry cough, and chronic pain. An examination with an otoscope revealed the presence of oto‐tricho‐tussia/tinnitus. To address the issue, the hair and hair follicles were surgically removed using direct visual guidance. Subsequent follow‐up was conducted over a period of 5 months, during which no pain or infection was observed at the site of the TM. The patient's previous symptoms were successfully resolved. Furthermore, further observation of the TM revealed no evidence of hair follicles or hair regrowth.

The COVID-19 pandemic expedited the growing rate of reliance on telehealth, as it provided a safer option for patients to seek the care they need and avoid potential negative consequences of being exposed to the COVID-19 virus. The aim of this study is to develop a series of Human-Computer Interaction (HCI)-based leading indicators to proactively analyze and evaluate the user interface in telehealth and virtual visits. Building on Nielsen's usability heuristics and mapping them to the six aspects of quality of care introduced by the Institute of Medicine, we identified the design features that had the highest impact on the quality of care and developed a list of leading indicators for each feature. Further, we developed corresponding checklists for each leading indicator to evaluate the features of the user. Beyond the benefits of telehealth for both patients and healthcare providers during atypical circumstances, the changes prompted by the COVID-19 public health emergency have possibly altered the position of telehealth to the point that communicating through video and audio has become the new normal. Therefore, the importance of designing an interface to facilitate user interaction with the system and consequently with one another is of utmost importance.

Facial rejuvenation and augmentation with autologous fat injection are common and effective techniques worldwide. This procedure has few complications and is usually used for soft-tissue augmentation. Although this procedure is considered safe, many patients have experienced different complications such as visual loss, stroke, or skin necrosis after these procedures. Herein, a case of embolic stroke along with blindness and facial necrosis due to facial filler injection is described. In this case, a patient developed decreased level of consciousness, left hemiparesis, and blindness that was finally diagnosed based on imaging as embolic stroke following facial autologous fat injection. The symptoms improved partially and gradually by conservative treatment and the patient was discharged with some sequels.

Abstract Palbociclib is a poorly water-soluble medicine which acts against metastatic breast cancer cells. Among various techniques to improve the solubility of this medicine, applying supercritical technologies to produce micro- and nano-sized particles is a possible option. For this purpose, extraction of solubility data is required. In this research, the solubility of palbociclib in supercritical carbon dioxide (ScCO2) at different equilibrium conditions was measured at temperatures between 308 and 338 K and pressures within 12–27 MPa, for the first time. The minimum and maximum solubility data were found to be 8.1 × 10–7 (at 338 K and 12 MPa) and 2.03 × 10–5 (at 338 K and 27 MPa), respectively. Thereafter, two sets of models, including ten semi-empirical equations and three Peng–Robinson (PR) based integrated models were used to correlate the experimental solubility data. Bian’s model and PR equation of state using van der Waals mixing rules (PR + vdW) showed better accuracy among the examined semi-empirical and integrated models, respectively. Furthermore, the self-consistency of the obtained data was confirmed using two distinct semi-empirical models. At last, the total and vaporization enthalpies of palbociclib solubility in ScCO2 were calculated from correlation results of semi-empirical equations and estimated to be 40.41 and 52.67 kJ/mol, respectively.

This study investigates multiple intelligences in relation to online video experiences, age, gender, and mode of learning from a rural Australian university. The inter-relationships between learners' different intelligences and their motivations and learning experience with the supplementary online videos utilised in their subjects are investigated. These videos were accessed by students using a variety of digital devices, including mobile devices and in lecture theatres. Quantitative responses using online surveys were collected from 111 students. Measures included McKenzie's Multiple Intelligences Inventory and the Online Video Experience Inventory. The Online Video Experience Inventory resulted in two sub-scales, namely, motivation and learning experience. Overall multiple intelligences was significantly positively correlated with learning experience but not student motivation. Although the findings revealed a significant difference between the MI profiles of respondents and their age category, it was revealed that all students are lower in Existential intelligence. Further analyses between gender and the MI subscales also indicated significant differences between gender and Logical-Mathematical and Intrapersonal intelligences. However, a negligible significant relationship was found between the two sub-scales of the Learning Experience Inventory and age of the participants.

Nowadays, supercritical fluids (SCFs) technologies present a processing option for obtaining new products with noteworthy characteristics. Access to reliable solubility data of pharmaceutical compounds in SCFs is considered as the first step for recrystallizing, separating, and producing nano particles via processes based on this type of technique. In this study, high-pressure solubility of buprenorphine hydrochloride, a strong pain reliever, in supercritical carbon dioxide (scCO2) was measured at temperature and pressure conditions of 308–338 K and 120–270 bar, for the first time. The minimum and maximum solubility values, in terms of equilibrium mole fractions, were found to be 0.131 × 10-4 (at 338 K and 120 bar) and 4.752 × 10-4 (at 338 K and 270 bar), respectively. Thereafter, the obtained data were correlated using two different approaches, namely Peng-Robinson (PR) equation of state (EoS) and a set of semi-empirical models. Results from applying statistical criteria indicated that Jouyban and Sodeifian models are suitable choices for predicting solubility data. Furthermore, using the obtained correlation results, the total and vaporization enthalpies of buprenorphine hydrochloride dissolution in scCO2 were estimated to be 65.59 and 85.60 kJ/mole, respectively.

A simple and selective method for the preconcentration of Fe(III) and Zn ions prior to flame atomic absorption spectrometric (FAAS) determinations using a column packed with nano graphene oxide (GO) as a solid-phase extractant has been presented in this manuscript. The method is based on the sorption of mentioned ions on synthesized GO with use of Methyl-2-(4-methoxy-benzoyl)-3- (4-methoxyphenyl)-3-oxopropanoylcarbamate) as chelating agent. Some effective parameters on the extraction and complex formation were selected and optimized. Under the optimized conditions (pH 9, flow rate 9 mL min−1), metal ions were retained on the column, then quantitatively eluted by 5 mL 3.0 mol L−1 HNO3 solution. The preconcentration factor was calculated as 240. The detection limits for the understudy analyte ions were found in the range of 0.22 ng mL-1 to 0.28 ng mL-1 (for Fe3+ and Zn2+, respectively). The column packed with GO was good enough for metal ions separation in matrixes containing alkali, alkaline earth, transition and heavy metal ions. This method was also used to determine the recovery rate of the studied ions in real samples.

Summary: Background: Urinary biomarkers may improve the prediction of chronic kidney disease (CKD) progression. Yet, data reporting the applicability of most commercial biomarker assays to the detection of their target analyte in urine together with an evaluation of their predictive performance are scarce. Methods: 30 commercial assays (ELISA) were tested for their ability to quantify the target analyte in urine using strict (FDA-approved) validation criteria. In an exploratory analysis, LASSO (Least Absolute Shrinkage and Selection Operator) logistic regression analysis was used to identify potentially complementary biomarkers predicting fast CKD progression, determined as the 51CrEDTA clearance-based measured glomerular filtration rate (mGFR) decline (>10% per year) in a subsample of 229 CKD patients (mean age, 61 years; 66% men; baseline mGFR, 38 mL/min) from the NephroTest prospective cohort. Findings: Among the 30 assays, directed against 24 candidate biomarkers, encompassing different pathophysiological mechanisms of CKD progression, 16 assays fulfilled the FDA-approved criteria. LASSO logistic regressions identified a combination of five biomarkers including CCL2, EGF, KIM1, NGAL, and TGF-α that improved the prediction of fast mGFR decline compared to the kidney failure risk equation variables alone: age, gender, mGFR, and albuminuria. Mean area under the curves (AUC) estimated from 100 re-samples was higher in the model with than without these biomarkers, 0.722 (95% confidence interval 0.652–0.795) vs. 0.682 (0.614–0.748), respectively. Fully-adjusted odds-ratios (95% confidence interval) for fast progression were 1.87 (1.22, 2.98), 1.86 (1.23, 2.89), 0.43 (0.25, 0.70), 1.10 (0.71, 1.83), 0.55 (0.33, 0.89), and 2.99 (1.89, 5.01) for albumin, CCL2, EGF, KIM1, NGAL, and TGF-α, respectively. Interpretation: This study provides a rigorous validation of multiple assays for relevant urinary biomarkers of CKD progression which combination may improve the prediction of CKD progression. Funding: This work was supported by Institut National de la Santé et de la Recherche Médicale, Université de Paris, Assistance Publique Hôpitaux de Paris, Agence Nationale de la Recherche, MSDAVENIR, Pharma Research and Early Development Roche Laboratories (Basel, Switzerland), and Institut Roche de Recherche et Médecine Translationnelle (Paris, France).

Background and Aim: Cancer is associated with psychological pressure and negative emotions. Therefore, identification and application of psychological therapies can be effective in the prevention and improvement of psychological pressure and problems in the patients with cancer. The aim of this study was to determine the effectiveness of emotional schema therapy on cancer-related fatigue and self-care behaviors in patients with breast cancer. Materials and Methods: This was a pre-test-post-test quasi-experimental study with a control group, and its statistical population included all women with breast cancer referring to nongovernmental oncology center of Urmia in 2020. 30 women with breast cancer (15 in the experimental group - 15 in the control group) were selected by convenient sampling method. Our inclusion criteria included female patients with breast cancer, , minimum age 40 and maximum age 60 years, in the phase 1 and 2 of the disease, undergoing chemotherapy, and disease duration of at least 6 months and having diploma as minimum certificate in education. The patients randomly assigned to experimental and control groups. Okoyama Cancer Fatigue Questionnaire (2000) and researcher-made self-care behaviors questionnaire were used to collect data. The experimental group received 12 sessions of Leahy's emotional schema therapy (2002). Every session lasted 90 minutes. Data analysis was performed using multivariate covariance test. Results: The mean age of the participants was (56.36) with standard deviation (8.09). The results of multivariate covariance analysis showed that the mean scores of cancer-related fatigue and self-care behaviors after implementation of emotional schema therapy were significantly different in the experimental group compared to those in the control group. This means that emotional schema therapy reduced cancer-related fatigue and improved self-care behaviors. Conclusion: According to the results of this study, emotional schema therapy is effective in reducing cancer-related fatigue and improvement of self-care behaviors in the women with breast cancer.

Introduction Cortical venous thrombosis is a rare and underrepresented etiology for atypical cortical intracerebral hemorrhages (ICH). Cortical venous thrombosis poses a diagnostic challenge compared to dural venous sinus thrombosis. Venogram studies may show a dural sinus filling defect in cases but may not demonstrate thrombosed cortical veins, especially given their variable anatomy. Our aim was to identify cases of atypical cortical ICH in the absence of other secondary ICH risk factors that may have been associated with cortical venous thrombosis. Methods Retrospective chart review of cases of nonaneurysmal ICH over a 3‐year period at our comprehensive stroke center were reviewed. Imaging study and clinical data were reviewed to include only atypical cortical hemorrhages. All subjects were required to have computed tomography (CT) with thin 0.625 mm slices, CT angiogram (CTA) that included venous phases, diagnostic cerebral angiograms without identifiable vascular etiologies, and MR imaging. Atypical ICH was defined as cortical hemorrhage in the absence of vascular malformation, hematological disorders, suspected amyloid angiopathy, hypertension, trauma, dural venous sinus thrombosis, and other secondary etiologies. Social science statistics software was used for data analysis. Results From April 2019 to July 2022, out of 344 total ICH cases, 10 cases were deemed idiopathic despite rigorous investigation, including evaluation for venous sinus thrombosis. Six subjects were male. Mean age was 46.5 (95% CI 35.99, 57.02), and median NIHSS was 7 (95% CI 1.86, 12.54). Two of the ten patients were identified to have ICH‐adjacent hyperdense cortical vein on CT indicating thrombosis. On MRI brain, both patients had susceptibility weighted imaging (SWI) blooming within an adjacent cortical vein as well as hyperintense filling defect of veins on T2 sequence. Conclusions In our study population of atypical intracerebral hemorrhages, cortical venous thrombosis was identified in 20% of subjects. Cortical venous thrombosis may not represent a rare etiology in this unique patient population. Multimodal neuroimaging may be required to identify this underdiagnosed pathology.

Introduction As IV tenecteplase (TNK) is becoming an alternative to IV alteplase in acute ischemic stroke (AIS), establishing the incidence of intracranial hemorrhage (ICH) complications is important. Given the higher fibrin specificity of TNK as compared to alteplase, our aim was to distinguish hemorrhage within the stroke burden versus spontaneous ICH in patients with AIS with TNK‐associated ICH. Methods Retrospective chart review of patients presenting from February 2020 to January 2022 with anterior circulation AIS to our comprehensive stroke center who received TNK was performed to evaluate for associated ICH. ECASS‐3 criteria was used to define hemorrhagic transformation and ICH score was used for primary, spontaneous ICH. Fisher exact test statistic was used to evaluate for significant differences in ASPECTS score, medium versus versus large vessel occlusion, angiographic recanalization, IV eptifibatide use, pre‐morbid antiplatelet use, and association with symptomatic versus asymptomatic hemorrhage. A benchmark less than 5% symptomatic ICH incidence was set based on historical alteplase rates within our network. Social science statistics software was used for data analysis. Results Out of 77 subjects who received TNK, 20.7% (n = 16) developed ICH, 9.1% (n = 7) of which were symptomatic ICH with a temporally‐related increase in NIHSS of at least 4 or greater. Seven subjects (43.75%) were male. Mean age was 73.38 (95% CI 65.92, 80.83). Median initial NIHSS was 16, 95% CI [11.74, 21.51]. Median ASPECTS was 9, 95% CI [8.74, 9.89]. Two subjects developed spontaneous, primary ICH (n = 1 symptomatic ICH, n = 1 non‐symptomatic ICH) in the absence of hemorrhagic transformation of ischemic stroke. No significant difference between subjects with asymptomatic hemorrhage versus symptomatic hemorrhage was found when comparing ASPECTS > = 7 versus < 7 (Fisher value = 1), angiographic recanalization (Fisher value = 1), use of IV eptifibatide (Fisher value = 1), pre‐morbid antiplatelet use (Fisher value = 0.13), or medium vessel occlusion (Fisher value = ‐0.63). Conclusions Expected rates of hemorrhagic transformation were higher in tenecteplase than our historical benchmark rate for alteplase. Spontaneous hemorrhage unrelated to ischemic stroke area were seen in 2 subjects without known hematological disorders. Larger, prospective studies are needed to validate safety of tenecteplase in real world settings.

Introduction In patients presenting with acute ischemic stroke (AIS), non‐contrast CT (NCCT) and CT angiography (CTA) are used to determine large vessel occlusions (LVO). Using thin‐cut NCCT, hyperdense signs represent thrombus. NCCT provides information on thrombus characteristics such as length and morphology that is not evidenced by CTA. The aim of this study is to determine if hyperdense signs identified on thin‐cut NCCT are a valid tool in periprocedural planning for endovascular thrombectomy (EVT). Methods At our comprehensive stroke center, patients presenting with AIS who had thin‐cut NCCT defined as 0.625mm per slice followed by EVT and subsequent High Resolution Photographs (HRPs) of post‐EVT thrombus were identified. High‐resolution photographs were taken by operating physician with adjacent ruler for accurate measurement. Thin‐cut NCCT and associated fully extracted thrombus HRPs were reviewed by two board certified vascular neurologists to determine agreement. Cohen’s K was used to determine kappa inter‐rater agreement. Wilcoxon signed‐rank test was used to determine if significant difference existed between thrombus length and independently measured hyperdense sign. Social science statistics software was used for data analysis. Results From January 2019 to December 2021, out of 87 cases where thrombus was extracted after EVT, 57 met inclusion criteria and had associated initial CT head. Mean age was 68.22 (95% CI 64.26, 72.18), and 49% were female (n = 28). Mean thrombus length was 12.49mm (95% CI 10.19, 14.80). Mean hyperdense sign length measured by Interpreter 1 was 12.86mm (95% CI 10.54, 15.18). Mean hyperdense sign length measured by Interpreter 2 was 12.61mm (95% CI 10.40, 14.83). Kappa score was 1. There was no significant difference in thrombus length and Interpreter 1 hyperdense sign (z = 0.99; p‐value 0.317) or Interpreter 2 hyperdense sign (z = ‐0.92; p‐value = 0.36). Conclusions Our study suggests that in acute ischemic stroke patients, hyperdense sign on thin‐cut NCCT may be a valid reliable marker of thrombus length and morphology that assists in peri‐procedural planning for mechanical thrombectomy. Larger, prospective studies are needed to validate our results.

Introduction Heterogeneity of collateralization in patients with acute ischemic stroke (AIS) is a marker of fast versus slow progression of penumbral consumption and infarct expansion. Our aim was to evaluate the relationship between time‐dependent stroke progression and incidence of intracranial hemorrhage (ICH) and acute neurological deficits. Methods Retrospective chart review of patients presenting with anterior circulation large vessel occlusion (LVO)‐associated AIS at our comprehensive stroke center with 24 hours last known normal (LKN) who underwent endovascular thrombectomy (EVT) without intra‐arterial thrombolytics or non‐thrombolytics were included. We used Alberta Stroke Program Early CT Score (ASPECTS) on initial non‐contrast CT to identify slow versus fast progressors. ASPECTS 7 and

Introduction Intravenous tenecteplase (TNK) is currently being used as a thrombolytic agent in acute ischemic stroke (AIS) and has has been shown to be non‐inferior to intravenous alteplase according to recent studies. Intracranial hemorrhage (ICH) as a complication of alteplase is approximately at 6%. The aim of our study was to determine the rate of significant ICH in patients receiving TNK indicated for AIS in a real world setting. Methods A network‐wide (3 CSCs, 6 PSCs), multicenter retrospective chart review of patients receiving TNK from February 2020 to January 2022 was performed using the Get With The Guidelines database. TNK bolus dose of 0.25mg/kg was used according to a network‐wide policy. ICH was categorized using ECASS‐3 criteria. Fisher exact test statistic was used to determine if a significant association existed between the presence of ICH and baseline ASPECTS score, endovascular treatment (EVT), and IV eptifibatide use. A benchmark less than 2% PH‐2 incidence was set based on historical alteplase related PH‐2 rates within our network. Social science statistics software was used for data analysis. Results Out of 180 patients who received TNK, 25 subjects (13.89%) developed hemorrhagic transformation. Mean age was 71.88 (95% CI 65.54, 78.22). Forty‐eight percent of subjects were female. Median ASPECTS score was 8 (95% CI 7.54, 8.78). Median 90 day mRS was 3 (95% CI 2.1, 3.9). Hemorrhagic transformation was classified as HI‐1 in 5% (n = 9), HI‐2 in 1.7% (n = 3), PH‐1 in 3.8% (n = 7), and PH‐2 in 3.3% (n = 6) subjects. No significant difference between subjects with other subtypes versus PH‐2 was identified when adjusting for ASPECTS score > = 7 versus < 7 (Fisher value = 1), EVT versus no EVT (Fisher value = 0.65), or use of IV eptifibatide (Fisher value = 0.06). Conclusions Tenecteplase is associated with higher rates of PH‐2 intracranial hemorrhage when compared with our benchmark rates of alteplase‐related PH‐2. This study is significantly limited by small sample size, retrospective nature, and uncontrolled variables. Larger, prospective studies are needed to validate our results.