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Abstract Background Spontaneous coronary artery dissection is a rare disease with a more prevalence in women, mostly in the postpartum state, which was first described by Peretti in 1931. Case presentation This report describes a previously healthy woman who had a spontaneous coronary artery dissection. This case is related to the early postpartum period with a successful outcome. In addition, the diagnostic and therapeutic approaches of this unique clinical entity are discussed and reviewed. Conclusions Because these kinds of cases are so rare, reporting these cases and the management and treatment approaches can guide other clinicians worldwide, and maybe a guideline for choosing the best approach around different situations could be published.

This study presents a sizing methodology in the frame of the multidisciplinary design of interior permanent magnet synchronous machines. The proposed approach targets at obtaining an initial electromagnetic design of the machine, including diameters, axial length, rotor barrier shape, stator slot geometry as well as the winding layout. The analytical design workflow consists of an iterative sizing procedure based on a robust geometric model, consistent equations, and no correction factors. The process is carried out starting from very basic design parameters such as rated voltage, torque, and magnetic material properties. The modular structure of the proposed design algorithm can be easily integrated with optimization routines obtaining a final optimized design, which contemplates various multiobjective constraints.

Abstract Background Enzyme combinations, particularly phytase (PHY) with various carbohydrases and proteases, are utilized in commercial broiler production to enhance nutrient and energy bioavailability. Objective A feeding study was undertaken to determine whether the efficiency of an Escherichia coli–derived PHY and a feed enzyme complex (FEC) derived from Bacillus spp. containing carbohydrase and protease as main activities in broiler chickens is dependent on diet quality. A total of 900 male one‐day‐old broiler chickens (Ross 308) were assigned to a 2 × 3 factorial arrangement of the treatments with 2 different nutrient density diets, standard nutrient diet (SN diet) and a low‐nutrient diet (LN diet; −100 kcal/kg for AMEn and −5% for crude protein [CP] and limiting amino acids), and 3 enzyme treatments (control [no enzymes], PHY and PHY + FEC). Each treatment group was composed of 6 replicates of 25 birds each. Results The LN diet caused a decrease in performance index, tibia length and diameter, tibia calcium content and jejunal villus surface area (VSA). The interaction effects between diet and enzyme supplementation were observed (p

Introduction: The outcome of orthodontic treatment depends on the malocclusion and the ratio of the size of the upper and lower teeth. The aim of this study was to evaluate the discrepancy of tooth crown size in different groups of malocclusions. Materials & Methods: In this cross-sectional study, 165 patients referred to the Orthodontic Department of Babol School of Dentistry were randomly selected. The samples were divided into three skeletal malocclusion groups (55 in each group) according to the ANB angle. The level of anterior and total Bolton ratio in the cases was calculated, and the deviation from normal value of anterior and posterior Bolton was calculated. The results were analyzed using the ANOVA and chi-square test. The significance level was set at p

Abstract The association between uric acid (UA) and cardio‐metabolic conditions has been recognized for a long time. However, recently, a body of evidence has highlighted the independent role of UA in a series of conditions, including renal and cardiovascular diseases. In this light, data regarding the prognostic role of UA in acute coronary syndrome (ACS) is scarce. A total number of 100 patients, 59 males and 41 females, diagnosed with ACS were recruited in this study. At the time of admission to the hospital, the serum level of UA was measured. In addition, the HEART score was calculated based on each patients' profile. Participants were on average 61.37 ± 12.08 years old. The most prevalent risk factors were hypertension (48%), a history of coronary artery disease (40%), and diabetes mellitus (33%). The average serum level of UA was 5.81 ± 1.81 mg/dl, and the calculated HEART score had a median of six (minimum of two and maximum of ten). A positive yet statistically insignificant correlation was found between the measured UA level and the calculated HEART score (R = 0.375, p = 0.090). However, further studies with larger sample size are required to assess the direct association of UA level with major adverse cardiac events in patients with cardiovascular disease.

Abstract Unroofed coronary sinus (UCS) is an uncommon congenital heart anomaly and the most unusual type of atrial septal defect. This report presents a 71‐year‐old female with palpitation and dyspnea following an emotional stress, who was referred for ablation of typical atrial flutter. Finally diagnosed with a partially unroofed CS causing a bidirectional shunt.

This paper presents the concept of efficiency mapping for large synchronous hydrogenerators, which are useful for evaluating hydropower generation performance vis-à-vis interconnected intermittent generation to machine efficiency-oriented design. Tests for loss segregation at rated conditions are needed, and models for loss variation along all operational areas are presented. The weighted average efficiency is obtained as the summation of all operating load point efficiencies times related weights, defined according to criteria or from a 2D-histogram of machine operation. The proposed methodology is applied and compared for two machine designs and to an existent machine under operation.

The concept of mizaj corresponds to the idea of personalized medicine and is the main diagnostic principle of Persian medicine (PM). This study aims to investigate diagnostic tools for the detection of mizaj in PM. In this systematic review of articles published before September 2022, articles were searched for in the Web of Science, PubMed, Scopus, Google Scholar, SID databases, and gray literature. The titles of the articles were screened by researchers and relevant articles were selected. Abstracts were reviewed by two reviewers to select final articles. Subsequently, the articles found were critically evaluated by two reviewers according to the CEBM method. Finally, article data were extracted. Of the 1812 articles found, 54 were included in the final evaluation. Of these, 47 articles were related to the diagnosis of whole body mizaj (WBM). WBM was diagnosed in 37 studies using questionnaires and 10 using expert panels. In addition, six articles examined the mizaj of organs. Only four of these questionnaires were found with reported reliability and validity. There were two questionnaires for assessing WBM, but neither had sufficient reliability and validity. Questionnaires that assess organs had weak designs and lacked sufficient reliability and validity.

Background: Remote ischemic preconditioning (RIPC) is a simple non-invasive method by using cycles of ischemia and reperfusion on a remote organ. Objective: To determine the effect of RIPC outcomes in patients with ST-segment-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Methods: This double blind randomized clinical trial was conducted in two teaching and reference hospitals in Mashhad, Iran. Sixty patients with acute STEMI were enrolled from October 2018 to January 2019. The patients were allocated into two groups, by using sealed envelope randomization i.e., a study group of patients who had undergone RIPC intervention and a control group of patients who had not undergone RIPC. Half an hour before PPCI, a sphygmomanometer cuff was placed around the left upper arm and inflated up to 200mmHg for five minutes; then the cuff was deflated for another five minutes, and this cycle was repeated 3 times before or during PPCI. Corrected Thrombolysis in Myocardial Infarction (TIMI) frame count, ST-segment resolution, reperfusion arrhythmias and contrast induced nephropathy (CIN) were evaluated in both groups after PPCI. Study data was analyzed by SPSS version 16. Results: A total number of 26 males and 14 females were studied in study groups (n=20 for each). Both groups were homogenous according to their baseline characteristics. Both TIMI grade and Corrected Thrombolysis in Myocardial Infarction Frame Count CTFC significantly improved after RIPC (p=0.001 and p

Coordinative chain transfer polymerization (CCTP) has opened a new path for the development of novel products like olefin block copolymers and chain-end functional polyolefins. However, conflicting results are frequently reported on the catalyst performance including activity and comonomer selectivity under CCTP conditions. Here we have selected two catalysts including rac-ethylenebis(1-η5-indenyl)zirconocene and bis(imino) pyridine iron, with drastically different comonomer affinities. The effect of diethyl zinc as the chain transfer agent (CTA) on their individual performances is evaluated at different 1–hexene concentrations, in copolymerization with ethylene. Combined thermal fractionation and GPC results confirm that not all chains experience the reversible transfer reaction. Nevertheless, the metallocene catalyst shows twice activity and about 30% lower comonomer incorporation in the presence of CTA. Conversely, the late transition metal catalyst demonstrates lower activity and remains comonomer irresponsive. It could be concluded that, in addition to establishing a reversible transfer reaction, CTA affects the nature of active centers. This finding can help designing olefin copolymers with a more defined chemical composition based on CCTP reaction.

Background: SARS-CoV virus infection results in a dysbalanced and severe inflammatory response with hypercytokinemia and immunodepression. Viral infection triggers systemic inflammation and the virus itself can potentially cause vascular damage, including blood–brain barrier (BBB) disruption and alterations in the coagulation system, which may result in cardiovascular and neurovascular events. Here, we review the literature and present a case of COVID-19 infection leading to an aneurysmal subarachnoid haemorrhage (aSAH). Case Description: A 61-year-old woman presented with dyspnea, cough, and fever. She had a history of hypertension and was overweight with a body mass-index of 34. There was no history of subarachnoid hemorrhage in the family. Due to low oxygen saturation (89%) she was admitted into ICU. A chest CT showed a typical picture of COVID-19 pneumonia. The PCR-based test of an oropharyngeal swab was COVID-19-positive. In addition to oxygen support she was prescribed with favipiravir and hydroxychloroquine. She experienced a sudden headache and lost consciousness on the second day. Computer tomography (CT) with CT-angiography revealed a subarachnoid haemorrhage in the basal cisterns from a ruptured anterior communicating artery aneurysm. The aneurysm was clipped microsurgically through a left-sided standard pterional approach and the patient was admitted again to the intensive care unit for further intensive medical treatment. Post-operatively, the patient showed slight motor dysphasia. No other neurological deficits. Conclusion: Systemic inflammation and ventilator support-associated blood pressure fluctuations may trigger aneurysmal subarachnoid haemorrhage secondary to COVID-19 infection. COVID-19 infection could be considered as one of the possible risk factors leading to instability and rupture of intracranial aneurysm.

Background: Dobutamine stress echocardiography (DSE) is a non-invasive technique to detect coronary artery diseases (CAD). There are limited studies on evaluation of the right ventricular function by stress echocardiography. The appropriate evaluation of RV function and early diagnosis of its failure can help to improve outcomes for the patients undergoing cardiac surgery. Objective: To determine right ventricular dysfunction in patients with three-vessel CAD by using DSE. Methods: This cross-sectional study was among 13 patients who were candidates for coronary artery bypass grafting (CABG) referred to Ghaem Hospital, Mashhad, Iran; from September 2015 to May 2016. After a physical examination and initial measures, DSE was performed and echocardiographic parameters were recorded by a cardiologist. Paired-samples t-test was performed using SPSS Software v.16.0 for data analysis. Results: The study included 13 patients (9 males) with a mean age of 65.4±7.6 years. The mean of TAPS was 16.9±4.5 mm and 15.7±2.9 mm before and after stress echocardiography, respectively (p=0.69). Systolic right ventricular (SRV) peak increased from before DSE compared with after DSE (8.0±2.2 vs. 13.7±4.2 mm/s, p

In this article, we measured the levels of fluoride in groundwater. The samples were taken from groundwater in Bushehr's province, Iran. After the collection of samples, the concentration levels of fluoride were determined by the standard SPADNS method using spectrometer. The mean concentration levels of fluoride in water of all stations were higher than the WHO drinking water guideline. Microsoft Office Excel 2016 was used for calculation of mean values. The mean concentration level of fluoride instatement were in the range of 1.52 to 3.64 mg l-1. Keywords: Bushehr, Drinking water, Fluoride, Groundwater, Spectrometer

BACKGROUND: The interventricular septal hematoma (IVSH) is a rare and potentially lethal finding. There are variously reported etiologies including instrumental damages during cardiac interventions. Although there are not enough studies available, conservative management is considered as a preferable approach in stable patients.CASE REPORT: A 45-year man smoker with the previous history of percutaneous coronary intervention (PCI), admitted with unstable angina in present visit. Coronary angiography showed significant in-stent restenosis (ISR) of the left anterior descending (LAD) artery stent. During our intervention for treatment of the ISR, the wire movement caused a diffuse dissection without any runoff, in the distal portion of the LAD. Therefore two stents were deployed in the dissected segment with a short overlapping segment. Unfortunately, the overlapping segment of these stents was located in the myocardial bridge segment. Therefore the contraction of the interventricular septum (IVS) caused a scissor-like movement of the stents, and they ruptured the LAD into the septum. Therefore, the contrast agent was accumulated in the IVS. Immediately, a graft stent was deployed in the overlapping segment of stents and perforation became sealed. In echocardiography, the IVS diameter increased to 30 mm. Since the patient was hemodynamically and electrically stable, he underwent conservative approach and after two months the septum returned to the normal size.CONCLUSION: During PCI on the LAD artery, the implantation of stents in the septal course with a short overlapping segment can result in coronary perforation, and therefore IVS hematoma by the scissor effect. Septal hematoma may cause life-threatening arrhythmias or ventricular septal rupture, but if it is asymptomatic or uncomplicated. Conservative management is the best strategy.

Rheumatic fever (RF) is a prevalent healthcare problem in the developing countries. Recurrence of this disorder is often observed in childhood and adolescence. RF can mimic the presentations of infective endocarditis, and clinicians are not really familiar with this issue. Herein, we present a case of recurrent acute rheumatic fever in a patient suspicious of acute bacterial endocarditis due to her previous RF. Finally, she was definitively diagnosed and underwent valvular replacement surgery and received prophylaxis antibiotics besides regular follow-up

BACKGROUND: Trans-radial coronary intervention is a popular technique due to patient comfort and lower complication rate. The main complications of this method are artery spasm, vessel perforation, and formation of pseudo-aneurysm.CASE REPORT: In this report, an unusual complication of radial access angiography was encountered. Shortly after the procedure, the patient’s right arm began to swell and a pulsating mass grew over the medial aspect of the arm. Right brachial artery angiography was performed immediately for rolling out brachial artery perforation. There was no evidence of extravasation in brachial angiography. Surprisingly, the mass began to disappear after some active flexion and extension at elbow joint. The same problem occurred again after percutaneous coronary intervention (PCI) on left anterior descending artery (LAD) in this case 2 days later and was resolved by the same maneuver.CONCLUSION: It can be conculded that the brachial artery path was shifted and became entrapped after the procedure due to low soft tissue support.

Background: Reducing patients’ pain is one of the main goals of providing clinical services, which requires nursing skill. As a simple technique, increasing the duration of subcutaneous heparin injection may affect the intensity of pain and bruising. Objective: The aim of this study was to assess the effect of increasing the heparin injection time on pain intensity and bruising associated with subcutaneous injection. Methods: The present quasi-experimental study consisted of 86 patients, admitted to our hospital, who were treated with subcutaneous heparin injection. A McGill pain intensity questionnaire was used to measure pain severity in a purposive sampling. All of the subjects received subcutaneous heparin twice for 10 seconds. They also were injected twice with heparin infusion, although it was for 30 seconds this time. The interval between the two injections was 24 h, and the intensity of the pain was measured after each injection. The Pearson correlation coefficient was measured, and analysis of variance (ANOVA) and the t-test were used to analyze the data. Results: Eighty patients received heparin. The body mass indexes were reported as 52 (60%) and 34 (40%) for subjects within the age range of 18.5-24.9 and 25-29.9, respectively. Regarding the mean of pain intensity, there was a significant difference between the 10 and 30 s injections (p ˂ 0.05). Additionally, there was a significant difference in bruising rates between the two methods 48 and 72 h after injection (p ˂ 0.05). The ANOVA test showed a significant association between gender and bruising (p = 0.001). Conclusion: According to the results, by elevating the duration of heparin injection, the severity of pain was reduced, and, therefore, the patients felt more comfortable. Trial Registration: The trial was registered at the Thai Clinical Trials Registry (TCTR) with the TCTR identification of TCTR20160221001. Funding: This research was supported by the research cluster grant (88186-25/01/89) from Mashhad University of Medical Sciences, Mashhad, Iran. The authors received no financial support for the authorship and/or publication of this article.

Ethylene / 1-butene copolymers at different comonomer levels were synthesized using Ziegler-Natta catalyst to evaluate the applicability of thermal fractionation methods in predicting chemical composition distribution (CCD). The continuous melting endotherms by DSC were converted to continuous CCD, and the average comonomer contents were compared with NMR results. DSC underestimated comonomer content specifically at higher levels and was more sensitive to the drawn baseline. The thermally fractionated melting endotherms by SSA method were deconvoluted and transformed into discrete CCDs. SSA method underestimated average comonomer content even more, however results were more reproducible. The main shortcoming of the thermal methods was the inability of short ethylene sequences in forming discernible lamella thicknesses at high comonomer levels. Calibration curves were created for converting the predicted comonomer contents into absolute values and used for studying industrial LLDPEs with different comonomer levels. It was shown that SSA provides more reliable results and correlates more reasonably to the measured densities.

BACKGROUND: Critical aortic stenosis (AS) is an unusual cardiac pathology in pregnancy, but has significant impact on the fetal and maternal outcomes of pregnancy. Pregnant patients with aortic stenosis and heart failure represent a major challenge for the heart team and anesthesiologist who should balance the risks and benefits of different treatment strategies and their effects on the mother and fetus.CASE REPORT: We present a 26-year-old parturient who underwent cesarean section at 30 weeks of gestation under general anesthesia in the presence of cardiac surgical team followed by deferred aortic valve replacement after two weeks.CONCLUSION: This report describes the importance of multidisciplinary preoperative evaluation, and careful surgical and anesthetic planning to avoid the deterioration of perioperative cardiac condition in such patients.

Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disease, which is caused by a multitude of mutations in genes encoding proteins of the cardiac sarcomere (1). Apical hypertrophic cardiomyopathy (AHCM) is an uncommon type of HCM. The sudden cardiac death is less likely to occur in the patients inflicted with AHCM (2). Herein, we presented the case of a 29-year-old man with AHCM, who had typical exertional chest pain without any cardiovascular risk factors, except for a sudden cardiac death in his older brother at the age of 28 years. After performing complete clinical and paraclinical evaluations, the patient underwent optimal medical treatment with beta-blocker agents without any symptoms.

Bis(2-R-ind)ZrCl2 (R: H or phenyl) was supported on different types of silica by in situ impregnation method and used for ethylene polymerization. In this method, the step of catalyst loading on support was eliminated and common alkyl aluminum (triisobutylaluminum, TiBA) cocatalyst was used instead of expensive methyl aluminiumoxane (MAO) cocatalyst in the polymerization. The effect of surface area of silica on the performance of the supported catalysts using three different types of silica including EP12 (390 m2/gr.), PQ3060 (570 m2/gr.) and MCM-41 (1100 m2/gr.) was investigated. The surface area had a more critical role relative to other characteristics of the support in the performance of catalysts. By using MCM-41 as support, the kinetic stability was enhanced. The activity of the supported catalysts was increased by increasing the surface area of silica in the order of MCM-41 > PQ3060 > EP12. The morphology of polymer particles was improved and reactor fouling was eliminated by supporting the catalyst.

The patient was a 19 year-old woman with the diagnosis of resistant hypertension, although she was under treatment of three classes of anti-hypertensive drugs (beta blocker, angiotensin receptor blocker, diuretic) for more than one year. In physical examination there was only a significant difference between the systolic blood pressure of upper and lower extremities (200 vs. 120 mmHg), without any other remarkable finding. Three different imaging modalities (echocardiography (Figure 1), CT angiography (Figure 2), conventional aortography (Figure 3) confirmed the aortic coarctation at 30 mm after left subclavian artery origin, with the 3.5-4 mm diameter of the narrowest segment. She underwent implantation of a self-expanding aortic stent and therefore the systolic pressure gradient decreased from 90 to 15 mmHg. After three months, her blood pressure was stable on 110/80 mmHg, while she received only metoprolol 25 mg twice daily and follow-up echocardiography showed 15-20 mmHg pressure gradient through the stent.

Background: Identifying the sources of variation in QTc measurementsis important for preventing arrhythmias during and afterhemodialysis. The present study was designed to determine thecorrelation between the type of hemodialysis buffer and thechanges in QTc interval in patients on chronic hemodialysis.Methods: Fifty-nine patients on chronic hemodialysis whoreferred in winter 2007 to hemodialysis centers of Ghaem andHashemi Nejad hospitals, in Mashhad, Iran, were divided intotwo groups according to their last dialysate buffer: acetate orbicarbonate. Electrocardiography, arterial blood gas parameters,serum K+, Na+, ionized calcium, and albumin levels weremeasured prior to and after hemodialysis in all patients.Results: All arterial blood gas parameters and serum electrolytesconcentrations were increased except K+ levels that weresignificantly decreased with hemodialysis. PCO2 and QTc intervalswere slightly increased in all patients, however thisincrease was not statistically significant. We found that thetype of dialysate affected the QTc interval, HCO3, base excess,base excess of extra cellular fluid, and base bufferchanges with no effect on ionized calcium, pH, PCO2, andserum albumin concentration. QTc interval was prolonged byusing bicarbonate and shortened by using acetate dialysatebuffer. We found no correlation between the variations of QTcinterval and serum electrolytes or arterial blood gas parametersin either group.Conclusion: Bicarbonate buffer use in hemodialysis prolongedQTc interval and acetate buffer shortened it. This effectis independent of serum electrolytes and pH changes duringhemodialysis. The effect of bicarbonate buffer is probablydue to more tolerability of ultra filtration, more effectiveedema reduction and augmented body electro-conductivity.

Objective: The aim of the present study was to compare the short-term and 6-month clinical outcome, and survival in patients older than 60 years with ST-elevation myocardial infarction randomized to either primary percutaneous coronary intervention (PPCI) or thrombolysis. Materials and Methods: 82 patients with STEMI older than 60 years were randomized to either primary PCI or thrombolysis from September 2006 to August 2008. Angiograms were reviewed by two interventionalists not involved in the study. Patients randomized to primary PCI received Aspirin and 600 mg Clopidogrel. Heparin was administered in conjunction with PCI. Patients randomized to thrombolysis received Aspirin followed by streptokinase infusion for one hour. Rescue PCI was considered if there was ongoing pain and ST-segment resolution was