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To evaluate the association of laser photocoagulation of placental anastomoses (LPA) prior to 18 weeks' gestation (early LPA) with very preterm delivery and neonatal survival in pregnancies with twin-twin transfusion syndrome (TTTS).This was a retrospective cohort study of monochorionic diamniotic twin pregnancies with TTTS undergoing LPA between 2002 and 2018 at two institutions. The rates of delivery 28, 30 and 32 weeks' gestation, preterm prelabor rupture of membranes (PPROM) and 30-day survival of one or both infants were compared between pregnancies undergoing early LPA and those undergoing LPA ≥ 18 weeks' gestation. Regression analysis was performed to determine the association of early LPA with very preterm delivery and 30-day survival, adjusted for Quintero stage, study phase, selective fetal growth restriction, gestational age at delivery, maternal age ≥ 35 years, body mass index 35 kg/mA total of 414 TTTS pregnancies were included in the study, of which 68 (16.4%) underwent early LPA. In the total cohort, the incidence of delivery at 28, 30 and 32 weeks' gestation was 22.7%, 39.6% and 53.4%, respectively. Survival of both twins and survival of at least one twin at 30 days were 67.5% and 90.8%, respectively. No significant difference was noted between pregnancies that underwent early LPA and those that had LPA ≥ 18 weeks in the rate of delivery 28 weeks (19.1% vs 23.4%; P = 0.4), 30 weeks (38.2% vs 39.9%; P = 0.8) and 32 weeks (44.1% vs 55.2%; P = 0.1) and PPROM (29.0% vs 24.1%; P = 0.4), or in the incidence of double-twin survival (63.9% vs 68.1%; P = 0.5) and survival of at least one infant (91.8% vs 90.6%; P = 0.7) at 30 days. Early LPA was not associated with very preterm delivery or neonatal survival in the regression analyses. Early LPA was associated with a longer LPA-to-delivery interval compared with LPA performed ≥ 18 weeks (median, 106.9 days (range, 2-164 days) vs median, 69.3 days (range, 0-146 days); P 0.001) when adjusted for confounding variables (hazard ratio, 2.56 (95% CI, 1.76-3.73); P 0.001).Laser surgery before 18 weeks is not associated with an increased rate of very preterm delivery and PPROM or with reduced neonatal survival when compared with LPA after 18 weeks. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Psychological distress (including depression and anxiety) is common in the first years of cancer diagnosis but can differ by country and region. The aim of the present paper was to review the prevalence of psychological distress among cancer patients in the Southeast Asia (SEA) region. A systematic literature search was carried out using several databases (i.e., PubMed, PsychARTICLES, Embase, CINAHI, Web of Sciences, Plus, Scopus, and AHMED). Papers originally published in English language were taken into consideration if they (i) were published from 2010 to 2021 and (ii) reported the prevalence of psychological distress among patients with different types of cancer. A total of 23 studies met the inclusion criteria. The most frequently employed psychometric instrument for anxiety and depression screening was the Hospital Anxiety and Depression Scale (HADS). The prevalence of anxiety (ranging from 7% to 88%) was wider than that of depression (ranging from 3% to 65.5%) among patients with different types of cancer and living in various countries in the SEA region. The overall prevalence rate of psychological distress among cancer patients from the SEA region was not fundamentally very different from that of general populations. These findings provide useful information for health professionals and cancer patients to understand the negative role of psychological distress in quality of life and health. The research findings demonstrate the importance of counselling for psychological distress among cancer patients as means of effectively resolving their psychological problems and ultimately improving the quality of oncology medical care. Clinical recommendations for cancer management should incorporate the early identification of (and therapy for) psychological distress, as well as their monitoring during treatment.

Introduction and objectives Problematic internet use (PIU) has become public health concern, particularly among adolescents and emerging adults. There is growing interest concerning the potential impacts of early maladaptive schemas (EMSs) on PIU and its most severe manifestation internet addiction (IA). However, a deeper understanding of these relationships is needed regarding of effects of schemas on IA. The purpose of the present study was to explore the role of EMSs among adults. Methods The sample comprised 714 Iranian participants who completed a self-report survey comprising sociodemographic variables, the Internet Addiction Test (IAT), and the Young Schema Questionnaire-Short Form (YSQ-SF). The data were analysed using partial least squares structural equation modelling (PLS-SEM). Results Findings indicated that there was a positive and significant relationship between EMS domains and IA. The results confirmed that disconnection/rejection schema domains and impaired autonomy/performance schema domains were significantly related with IA. The results of the analysis of convergent validity and discriminant validity were acceptable among the nine reflective constructs. Conclusion Findings of the present study indicated that existence of underlying EMSs may be a vulnerability factor for developing IA and adds to the growing body of cyberpsychology literature that has examined the relationships between the EMSs and IA.

We performed a meta-analysis to investigate the effects of high-intensity interval exercise (HIIE) as compared to moderate-intensity exercise (MIE) and a control condition (CON) on postprandial glucose (PPG) and insulin (PPI) responses. PubMed, Web of Science, and Scopus were comprehensively searched to identify relevant studies until October 2021. Separate analyses were conducted for HIIE versus MIE and HIIE versus CON. A total of 30 studies comprising 36 intervention arms and involving 467 participants (350 adults) were included in the meta-analysis. HIIE reduced PPG and PPI when compared with CON. Based on subgroup analyses, reductions in PPG and PPI were significant for both children and adult participants, as well as for healthy participants and participants with metabolic disorders, with larger effects in those with metabolic disorders. There were no significant differences between HIIE and MIE for PPG or PPI. However, when comparing studies matched for total work performed, HIIE was more effective for decreasing PPG as compared with MIE. HIIE is effective for reducing PPG and PPI in both children and adult participants, particularly in those with metabolic disorders. In addition, HIIE has superior effects for reducing PPG as compared with MIE, when equivalent work was performed at both intensity levels.

Objective This study investigated the prevalence of feeding and eating disorders, and identified their correlates and comorbidities among children and adolescents. Method We used the nationally representative sample of the Iranian Children and Adolescents' Psychiatric disorders (IRCAP) survey, with 30,532 participants randomly selected by a multistage cluster sampling method. We employed the kiddie schedule for affective disorders and schizophrenia-present and lifetime version (K-SADS-PL) semi-structured face-to-face interview to screen for any psychiatric disorders, including feeding and eating disorders, and associated factors. We used multivariate binary logistic regression to analyze the data. Results Valid data from 27,111 participants were analyzed. The total prevalence of feeding and eating disorders among children and adolescents was 0.89 (0.81-1.10). In all types of feeding and eating disorders, the adjusted odds ratio was higher among girls (except binge-eating disorder) and older adolescents but was lower among rural residents. The most common psychiatric comorbidities observed in children and adolescents with feeding and eating disorders were obsessive-compulsive disorder (20.2%), agoraphobia (20.2%), depressive disorder (16.4%), social phobia (10.1%), oppositional defiant disorder (10.1%), generalized anxiety disorder (9.4%), attention deficit hyperactivity disorder (7.5%), and conduct disorder (5.7%), which were significantly more common compared to their peers without feeding and eating disorders. Discussion Older age, female gender and living in an urban area are predisposing factors in feeding and eating disorders (in binge-eating disorder, the male gender is a positive correlate). We suggest that future works pay attention to the role of gender, comorbidities and predisposing factors.

Extracorporeal circulation (ECC) is an integral part of cardiac surgery. Yet, the contact with artificial surfaces, mechanical stress, shear, and suction forces within the ECC pose a pronounced risk for damaging the corpuscular components of the blood. These suction forces may be reduced by a repositioning of the roller pumps employed below the reservoir. Furthermore, the repeated compression of the involved silicone tubing is likely to cause degradation. We present our observations regarding changes in the ECC performance following this degradation process. In vitro experiments were performed in a standard as well as a simplified ECC setup and included measurements of pressure, effective flow, and tubing restoring force over a time frame of 12 hours with two different pump positions utilizing transit time flow measurement. Suction forces within the tubing could be significantly reduced by shifting the pump position below the reservoir. Regardless of the setup, the tubing showed significant loss of restoring force as well as effective flow over time. A shift of the pump position within the ECC setup can be recommended to prevent blood damaging negative pressures. Further research is necessary to evaluate the exact cause of the reduction of restoring force overtime as well as its risks for the patients. Finally, our results underline the importance of transit time flow measurements to collect reliable flow data.

The coagulopathy of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is well documented in adults, with increases in D-dimer and prothrombin time found to be strong predictors of mortality, and anticoagulation shown to decrease this mortality. Viscoelastic parameters such as elevations in maximum clot firmness (MCF) on rotational thromboelastometry (ROTEM) have correlated with a hypercoagulable state in adults with SARS-CoV-2. We report our experience in children infected with SARS-CoV-2, with noted elevations in D-dimer and MCF on ROTEM (indicating hypercoagulability). Exploration of viscoelastic testing to provide additional laboratory-based evidence for pediatric-specific risk assessment for thromboprophylaxis in SARS-CoV-2 is warranted.

Background Asthma is recognized as a major public health concern in the world. The aim of this investigation was to evaluate the prevalence of asthma by using the Global Allergy and Asthma Network of Excellence (GA2LEN) questionnaire and examine its association with chronic rhinosinusitis, in the province of Bushehr, Southwestern of Iran. Methods In a cross-sectional, population-based study, a total of 5420 invited individuals, aged 15–65, were selected through a multi-stage, stratified, cluster random sampling and from which 5201 completed the GA2LEN questionnaire (response rate = 95.9%). The prevalence of asthma, current, and physician-diagnosed asthma were analyzed by using sex and age groups and the association of asthma and chronic rhinosinusitis (CRS) was investigated using a multiple logistic regression model. Results Based on the information from the GA2LEN questionnaire, the overall prevalence of asthma in the population under study was 10.0% (95% CI 9.2–10.8). Moreover, the prevalence of current asthma was 8.9% (95% CI 8.1–9.7). Further, the prevalence of current early, late-onset and physician-diagnosed asthma within the asthma group was 51.1% (95% CI 46.5–55.7), 48.9% (95% CI 44.3–53.5) and 3.9% (95% CI 2.1–2.5), respectively. Additionally, CRS was more frequent among the participants with asthma [(57.3%, OR = 2.3; 95% CI 2.1–2.5)], and there was a significant association between CRS and current, early and late-onset of asthma (P

Human epidermal growth factor receptor-2 is an important and prognostic factors and one of the most targeted proteins in breast cancer's therapy. There is no globally accepted method for determining its status. Here, we aimed to evaluate the immunohistochemistry method validity in predicting HER-2 status by Fluorescence in situ hybridization method and investigate some clinicopathological variables association with HER-2 amplification. A total of 190 HER-2 2+ and 3+ by immunohistochemistry (IHC) invasive breast cancer cases were enrolled in this study. Fluorescence in situ hybridization (FISH) was performed for these cases using FDA criteria and the association between clinicopathological variables and HER-2 status evaluated. Study consisted of 190 invasive breast cancer patients (160 HER-2 2+ and 30 HER-2 3+). HER-2 FISH amplification according to FDA criteria was found 27.5% (44/160 patients) in HER-2 2+ patients and 83.3% (25/30 patients) in HER-2 3+ patients. Tumors with HER-2 amplification were more likely to be ER-negative (51.0% vs 31.2%, p = 0.013) and PR-negative (52.9% vs 27.0%, p < 0.001). This study showed that immunohistochemistry is not a good method for evaluating HER-2 status and decision-making about trastuzumab therapy even with 3+ score patients. However, this result may not be too strong for IHC 3+ cases due to the limited number of these patients in this study.

The Iranian Registry of Clinical Trials (IRCT) was established as a primary registry on December 4 2008 and has registered over 1350 trials by June 2011. Many researchers are still unaware of the need for registration of trials before recruiting the first patient and the proportion of retrospectively registered trials is likely to grow until this awareness increases. We sought to investigate the timing of the registrations in IRCT and to explore strategies to overcome this. We used all data in the IRCT database and extracted the date of registration, as well as the dates for the start and the end of recruitment. We categorized trials into 4 groups: those registered before the start of patient enrolment, within 30 days of enrolment, after 30 days but before the end of recruitment, and after the end of recruitment. The proportion of trials in each category was calculated by calendar year. The number of registered trials increased from 26 in the 3 months leading to 2009 to 181 in 2009, 772 in 2010 and 376 in the first 5 months of 2011 (estimate by end of year = 947). The proportions of trials registered after the end of patient recruitment were 55%, 58% and 62% in 2009, 2010 and 2011 respectively. On average, 6.4% of trials were registered within 30 days from the start of patient recruitment and 27% in the time between then and the end of recruitment. The rapid increase in the number of registered trials is an indication of strong implementation of the registration policy. This comes partly at the expense of an increased proportion of retrospective registrations. While this may be understandable at the beginning, it is clearly not acceptable and measures should be adopted to increase the proportion of prospectively registered trials and to make trial registration an integral part of the research culture.

route to vinyl epoxides and vinyl aziridines via chiral sulfur ylides, we were keen to develop their potential in synthesis further. It had been reported that palladium-catalyzed reactions of vinyl epoxides and aziridines with doubly activated Michael acceptors gave tetrahydrofurans and pyrrolidines in good yield but usually with poor stereocontrol. However, related reactions with singly activated Michael acceptors were not effective. Nevertheless, we recognized that if we could find a way of coercing vinyl aziridines to react with singly activated enones/acrylates, and we were able to control stereochemistry in the annulation process, then we could potentially utilize this methodology in synthesis. Herein, we describe our success in simultaneously meeting these two significant challenges and also describe its application in a formal synthesis of ( )-a-kainic acid 1. Our initial efforts at promoting reaction between vinyl aziridine 2a and methyl vinyl ketone (MVK, A) using [Pd2(dba)3·CHCl3], (p-FC6H5)3P in THF (conditions employed by Yamamoto), however, were fruitless—we only observed decomposition. Using trimethylsilyl-substituted trans vinyl aziridine 2e, we now observed isomerization to a mixture of trans/cis aziridines (1:20). With this substrate, clearly the Pd was performing its role in generating the p-allyl palladium complex as this resulted in isomerization of the vinyl aziridine. However, the amide anion that was generated did not react with the enone. This result reinforced the observations by Yamamoto and Knight that doubly activated Michael acceptors were required to capture the relatively unreactive amide anion. We reasoned that ion pairing of the amide anion with the cationic Pd complex might compromise its reactivity, and that increased nucleophilicity should therefore be possible with an anionic Pd complex instead (Scheme 2).

SUMMARY —Samples of deboned meat from broiler necks and backs, whole fowl and turkey racks were obtained from commercial sources and examined for total aerobic counts, fecal coliforms, salmonellae, Clostridium perfringens, coagulase positive staphylococci and psychrotolerant microorganisms. The raw materials were either deboned immediately after birds were processed (conventional processing) or held in the plants at 3–5°C for 5 days prior to deboning (delayed processing). The storage studies were conducted by holding the deboned meat at 3°C for 0, 3, 6 and 12 days and at -15°C for periods of 3, 6 and 9 months. The total aerobic counts of delayed processed samples were shown to be higher than conventionally processed meat and remained the same throughout the storage period. In all instances, the total aerobic counts increased during the storage at 3°C. The MPN fecal coliforms were high for all samples and remained relatively the same throughout the storage period at 3°C. Freezing resulted in a significant reduction of fecal coliforms. Only six out of 54 samples were contaminated with salmonellae while four showed the presence of C. perfringens and none was contaminated with S. aureus. Pseudomonas, Achromobac-ter and Flavobacterium dominated the psychrotolerant genera isolated in this investigation.

Considering the effectiveness of tramadol in alleviating pain following major operations, trauma, labour and even chronic neuropathic pain, this study was designed to evaluate the efficacy of intraurethral administration of the drug in alleviating cystoscopy-related pain in men. Sixty male candidates of diagnostic cystoscopy, aged between 20 and 50 years, in ASA physical status I or II were included in the study. Patients were randomized into intervention [who received tramadol (100 mg) and lidocaine gel] or control group (in whom distilled water and lidocaine was administered) based on a permuted block randomization method. The severity of pain and the incidence of adverse effects were measured during and following the cystoscopy. The urologist' satisfaction was also assessed. Total pain score in the intervention group was significantly lower than the control group (P = 0·037). The urologist was more satisfied with the ease and convenience of performing the cystoscopy in the intervention group. No significant side effect was reported in either group. Adding 100 mg tramadol to lidocaine gel is more effective than using lidocaine gel alone in alleviating the pain associating with male rigid cystoscopy.