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Arash Babaei-Ghazani,1 Bijan Forogh,1 Gholam Reza Raissi,1 Tannaz Ahadi,1 Bina Eftekharsadat,2 Naseh Yousefi,1 Shahram Rahimi-Dehgolan,3 Katayoun Moradi1 1Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, Iran University of Medical Sciences (IUMS), Tehran, Iran; 2Physical Medicine and Rehabilitation Research Center, Department of Physical Medicine and Rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran; 3Physical Medicine and Rehabilitation Department, IKHC Center, Tehran University of Medical Sciences (TUMS), Tehran, IranCorrespondence: Shahram Rahimi-DehgolanPhysical Medicine and Rehabilitation Department, IKHC Center, Tehran University of Medical Sciences (TUMS), Tehran, IranEmail shahram.rahimi.dehgolan@gmail.comKatayoun MoradiNeuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, Iran University of Medical Sciences (IUMS), Tehran, IranEmail katayoun-moradi69@gmail.comPurpose: To compare two common approaches for ultrasonography (US)-guided injection.Patients and Methods: Sixty patients with mild-to-moderate CTS were included in this double-blind randomized controlled trial (RCT). They received a single shot of corticosteroid injection through either the US-guided in-plane approach: radial or ulnar side. Participants were evaluated using Boston Carpal Tunnel Questionnaire (BCTQ) and visual analogue scale (VAS) for pain, as well as electrodiagnosis (EDX) and US parameters before the intervention, and within 12 weeks of follow-up.Results: In both groups, all outcomes, except for the electrodiagnostic measures, significantly improved within the follow-up. Pain-VAS and both subscales of BCTQ questionnaire, as our main subjective outcomes, revealed dramatic improvement, with the largest amount of changes in VAS (70%; comparing to baseline value), and about 37% for both of BQSS and BQFS scales, all indicating superiority of radial to ulnar in-plane approach. During the first follow-up, we did not detect any remarkable preference between the groups in either subjective or electrodiagnostic variables. However, there was a significant difference at next follow-up time-points in terms of VAS for pain and BQFS favoring radial approach (Table 3). Furthermore, US-measured parameters including nerve-circumference and CSA improved only in the radial in-plane group.Conclusion: The current data proved that radial in-plane approach for CTS injection could be at least as effective as the more common ulnar in-plane method. Even the pain-relief effect was longer for the radial in-plane approach. Also, patients’ functional status and objective variables all revealed better outcomes via the new approach.Keywords: electromyography, corticosteroid injection, Boston Carpal Tunnel Questionnaire, BCTQ, carpal tunnel syndrome, CTS

Background and Objectives: Heavy metals have an important role on organism life and their high concentration may be a great threat for humans and other organisms’ lives. Up to now, various methods have been used for the removal of these metals, which include the adsorption process. The aim of this study was the recovery of municipal disposals, and using as absorbent for lead & cadmium removal from aqueous solutions.Methods: Adsorption of lead & cadmium on dry activated sludge was investigated. Activated sludge was obtained from diary industry (Tehran). All experiments were performed in batch system on 202 synthetic samples to investigate the effects of pH, contact time initial concentration lead & cadmium and adsorbent dose. The most conventional adsorption and kinetic models were applied to describe metal adsorption and dynamic reaction.Results: The results showed that with increasing of adsorbent doses, contact time and pH solution, lead & cadmium removal efficiency increased. The maximum lead & cadmium adsorption was obtained at pH: 6 and an equivalent time of 180 min. With increasing initial concentration of lead & cadmium, removal efficiency decreased. The obtained results in this study were matched with langmuir 2 isotherm (R2>0.99) and interparticle diffusion kinetic (R2>0.94). Maximum adsorption capacity of lead & cadmium on dry activated sludge was obtained to be 2.66 and 1.66mg/g, respectively. Maximum constant rate of lead & cadmium was 0.045 and 0.041mg/g.min0.5, respectively.Conclusion: According to the results, dry activated sludge is recommended as a low cost and available adsorbent to remove lead & cadmium from aqueous solutions.

Various industrial activities contribute heavy metals to the soil environment directly or indirectly through the release of solid wastes, waste gases, and wastewater. Phytoremediation can be potentially used to remedy metal-contaminated sites. A major step towards the development of phytoremediation of heavy metal-impacted soils is the discovery of the heavy metal hyperaccumulation in plants. This study evaluated the potential of 7 species growing on a contaminated site in an industrial area. Several established criteria to define a hyperaccumulator plant were applied. The case study was represented by an industrial town in the Hamedan province in the central-western part of Iran. This study showed that most of the sampled species were able to grow in heavily metal-contaminated soils and were also able to accumulate extraordinarily high concentrations of some metals such as Pb, Fe, Mn, Cu and Zn. Based on the obtained results and using the most common criteria, Camphorosma monospeliacum for Pb and Fe, and Salsola soda and Circium arvense for Pb can be classified as hyperaccumulators and, therefore, they have suitable potential for the phytoremediation of contaminated soils.

Background: Recent studies have raised the issue of an increased incidence of polycystic ovaries (PCO) and menstrual disturbances in women with epilepsy treated with valproate (VPA). It seems that antiepileptic drugs, especially valproate, may have a functional role in altering the endocrine system of child-bearing women with epilepsy. We conducted this study to investigate the association of VPA and ovarian structural/menstrual disorders in epileptic women.Methods: In this cross-sectional study, we compared a total of 64 epileptic patients, aged 16-45 years, 32 of whom had been taking VPA alone and 32 were on other antiepileptic drugs for a minimum duration of six months. Ovarian sonography was performed and body mass index (BMI) calculated for all subjects. We also recorded the presence of menstrual disturbances in both groups.Results: Fifteen (46%) of the VPA subjects had PCO compared to 7 (21.9%) of the other group. In the VPA group, four (12.5%) had oligomenorrhea, one (3.1%) amenorrhea and 13 (40.6%) had irregular menstrual cycles. However, from the other group, two (6.3%) subjects had oligomenorrhea and seven (21.9%) had irregular menstrual cycles; amenorrhea was not present in the non-VPA treated patients. Mean BMI was 22.5 kg/m2 among the VPA subjects and 20.1 kg/m2 in the non-VPA subjects.Conclusions: This study supports the association of PCO and high BMI with VPA treatment. The frequency of menstrual disturbances did not differ significantly between the two groups.

Background: Creutzfeldt-Jakob disease (C-JD) is a rare disorder characterized with rapidly progressive mental decline, myoclonic jerk and finally death. The transmissible pathogen for this disease is a proteinaceous infectious particle termed prion. The prion protein is encoded by a gene (designated as PRNP) on the short arm chromosome 20.This disorder is diagnosed based on clinical findings, course of disease, EEG, MRI and confirmed with brain biopsy. Case report: A 56- year- old woman presented with confusion, disorientation, hyper somnolence, psychiatric problems such as hallucination, progressive mental deterioration and myoclonic jerks. She had history of several times phlebotomy with traditional and non sterile methods in two past years. She had no past history of other disease. Her illness was diagnosed based on clinical findings, course of her illness, typical MRI, EEG and rule out other dementing disease. She died after one month. Conclusion: in any patients with psychiatric disorders, rapidly progressive mental deterioration and myoclonic jerks C-JD should be considered as an important diagnosis. Treatable dementing disease should be considered and ruled out at first. The significance of phlebotomy in C-JD has yet to be determined.

Distyly, a floral dimorphism that promotes outcrossing, is controlled by a hemizygous genomic region known as the S‐locus. Disruptions of genes within the S‐locus are responsible for the loss of distyly and the emergence of homostyly, a floral monomorphism that favors selfing. Using whole‐genome resequencing data of distylous and homostylous individuals from populations of Primula vulgaris and leveraging high‐quality reference genomes of Primula we tested, for the first time, predictions about the evolutionary consequences of transitions to selfing on S‐genes. Our results reveal a previously undetected structural rearrangement in CYPᵀ associated with the shift to homostyly and confirm previously reported, homostyle‐specific, loss‐of‐function mutations in the exons of the S‐gene CYPᵀ. We also discovered that the promoter and intronic regions of CYPᵀ in distylous and homostylous individuals are conserved, suggesting that down‐regulation of CYPᵀ via mutations in its promoter and intronic regions is not a cause of the shift to homostyly. Furthermore, we found that hemizygosity is associated with reduced genetic diversity in S‐genes compared with their paralogs outside the S‐locus. Additionally, the shift to homostyly lowers genetic diversity in both the S‐genes and their paralogs, as expected in primarily selfing plants. Finally, we tested, for the first time, long‐standing theoretical models of changes in S‐locus genotypes during early stages of the transition to homostyly, supporting the assumption that two copies of the S‐locus might reduce homostyle fitness. Here, we focus the transition from distyly to homostyly in the common primroses to study the causes and consequences of mating‐system transitions. Using whole‐genome resequencing data, we find that loss‐of‐functions mutations in the CYPT gene is associated with multiple independent transitions to homostyly and that this transitions has consequences in the so‐called distyly S‐locus. Finally, we tested, for the first time, long‐standing theoretical models of changes in S‐locus genotypes during early stages of the transition to homostyly. [ABSTRACT FROM AUTHOR]

Anaerobic decomposition of organic compounds in landfills is responsible for generation of greenhouse gases. The present study aimed to determine the total gas and methane emission from a landfill located in Hamedan (west of Iran) from 2011 to 2030. LandGEM 3.02 model was used to estimate the gas emission with the volumetric methane percent of 60%, production potential of 107, and methane generation rate of 0.2. Spatial distribution of annual methane and total landfill gas emission rate in the study area at three decades were provided through ArcGIS software. The results showed that organic and food wastes had the maximum amounts in the solid waste stream (over 75%). The results showed that 4.371×108 m3 methane would be produced after 20 years, mostly (4.053×106m3) in the first year. In addition, methane production capacity in Hamedan landfill site was 107 m3/Mg. According to the results, the maximum and minimum gas generation rates are in summer (the hottest season) and winter (the coldest season) respectively. The results of the LandGEM model represented that the total gas and methane generation rates will be significant in the first 10 years. The potential of rapidly degradable organic compounds for gas emission will be higher than that of slowly degradable organic compounds. The results obtained in the present study can be beneficially used in planning for energy production and other applications in landfill sites. [ABSTRACT FROM AUTHOR]

The aim of this study was to optimize the conditions of the Basic Blue 41 (BB41) adsorption on NaOH-modified rice husk (NaOH–RH) using response surface methodology based on Box–Behnken design. The three-level factors considered were pH (4, 7, and 10), initial concentration of BB41 (50, 75, and 100 mg L−1), and adsorbent dose (0.025, 0.0875, and 0.15 g L−1). Statistical analysis of result has shown that the predicted values for BB41 adsorption were close to the experimental values and were in a good agreement, on the other hand, theF-value (40.48),p-value (0.0004), andR2(0.9865) indicated that the regression is able to give a good prediction of response for the adsorption process in the range studied. According to the results, when the response was set in maximize and all the three factors were set in a range, the optimized values for BB41 adsorption were predicted as follows: pH value of 8.47, and BB41 initial concentration of 67.9 mg L−1and adsorbent dose of 0.12 g L−1for removal efficiency of 97.65%. [ABSTRACT FROM AUTHOR]

This study proposes an efficient computer simulation approach for estimation and optimization of performance measures in a polling system. A single server polling system operating under exhaustive, gated, and mixed service disciplines is developed. In this system, the arrival process is a Poisson process and service and setup times are exponentially distributed. The polling model is solved through two different methods: an exact method that requires the complete characterization of the system, and a computer simulation-based solution that reduces the solving time and the complexity of the model. A set of numerical experiments are presented in which it is shown that the computer simulation model outperforms the exact method in terms of estimating a system’s performance measures. Moreover, it is shown that the optimizer simulation model is capable of handling general distributions and several queuing systems, whereas the exact method requires the complete characterization of the system through a Markov chain, which is a time-consuming and inefficient approach. In addition, the efficient computer simulation-based solution could be easily applied to polling systems with different numbers of queues and service disciplines. [ABSTRACT FROM PUBLISHER]

Background and Aim: The common mechanism for lateral ankle sprain is inversion, plantar flexion, or the combination of both, if untreated successfully can lead to chronic ankle instability. It seems that the foot position, while touching the ground, has an effective role to cause ankle sprain. Thus it is possible to prevent ankle sprain through limiting foot position. Therefore the aim of this research is to study the effect of plantar flexion and eversion on mediolateral ground reaction force while landing in individuals who suffering from functional ankle instability. Materials and Methods: In this case-control research study 32 subjects (17 subjects with unilateral functional ankle instability (FAI) and 15 control subjects), aged from 18 to 35 years, were tested. All subjects in instability group were selected by the orthopedic physician, then the anterior drawer and talar tilt tests were performed for diagnosis of functional ankle instability and other physical examinations. Control group were matched with instability group by age, weight, height, gender and body mass index. The subjects standing with single leg on a 40 cm high platform in 25 cm front of a force-plate while the test leg relaxed and non-weight bearing. The subject landed on the test leg on the center of the force-plate. The subjects landed according to four types of position: A: neutral position of ankle and lateral foot wedge, B: neutral position of ankle, C: positive heel and lateral foot wedge and D: positive heel. Results: Among control group, medial ground reaction force increased in the "C" position relative to "B" position (p=0.007) and "C" position relative to "D" position (p=0.018). In FAI group, lateral ground reaction force increased in "C" position relative to "B" position (p=0.001) and "C" position relative to "A" position (p=0.002). Also in FAI group medial ground reaction force decreased in "D" position relative to "A" position (p=0.014). Conclusion: According to the findings, applying lateral foot wedge, while the ankle is in plantar flexion, increases the mediolateral ground reaction forces. Based on the results, position of plantar flexion is more possibly effective than inversion in ankle sprain. According to the study, the lateral foot wedge in ankle plantar flexion position may be more effective than in neutral one to change mediolateral ground reaction forces. [ABSTRACT FROM AUTHOR]

There are various techniques for removal of water hardness each with its own special advantages and disadvantages. Electrochemical or electrocoagulation method due to its simplicity has gained a great attention and is used for removal of various ions and organic matters. The aim of the present study was to investigate the efficiency of this technique in removal of water hardness under different conditions. This experimental study was performed using a pilot plant. The applied pilot was comprised of a reservoir containing aluminum sheet electrodes. The electrodes were connected as monopolar and a power supply was used for supplying direct electrical current. Drinking water of Kerman (southeast of Iran) was used in the experiments. The efficiency of the system in three different pH, voltages and time intervals were determined. Results showed the efficiency of 95.6% for electrocoagulation technique in hardness removal. pH and electrical potential had direct effect on hardness removal in a way that the highest efficiency rate was obtained in pH=10.1, potential difference of 20 volt and detention time of 60 minutes. Considering the obtained efficiency in the present study, electrocoagulation technique may be suggested as an effective alternative technique in hardness removal. [ABSTRACT FROM AUTHOR]

As healthcare spending on diabetes and its complications continues to rise, the optimization of prescribed insulin regimens is becoming increasingly important from both clinical and economic perspectives. Not only the prevalence of diabetes is high in Iran, but also the rate of diabetes complications is relatively high due to uncontrolled glucose level. Direct medical costs including pharmacy, complication, adverse events, and patient management costs were calculated in local currency Iranian Rial (IRR) and sensitivity analyses were performed. [Extracted from the article]

Background Carbapenemes are a good choice for treatment of infections caused by multidrug resistant Pseudomonads aeruginosa. The emergence of carbapenem resistance has become a major problem in treatment of this organism especially among immunocompromised patients including burn patients. Objectives The aim of this study was to investigate carbapenem-resistance mechanisms among burn patients in Tehran, Iran, during 2014 - 2015. Methods The antibiotic resistance phenotypic test was accomplished by the Kirby Bauer disk diffusion method. The phenotypic investigation of metallo-beta-lactamase (MBL) producers was evaluated by the combined disk diffusion test (CDDT) method. The prevalence of MBL genes, including blaIMP-1 and blaVIM-1 was evaluated by polymerase chain reaction (PCR) and sequencing methods. Amplification of oprD was performed by PCR and the results of sequencing were aligned with wild-type P. aeruginosa strain PAO1. Results A total of 100 P. aeruginosa were investigated, of which, 95 were resistance to imipenem. Out Of 95 imipenem resistant isolates,, 81 (85.2%) were MBL producers. Among all isolates, 13 strains carried the blaIMP-1 gene, whereas all of the strains were negative for the blaVIM-1 gene. Amplification of OprD porin was performed for all 100 P. aeruginosa strains. Two insertion sequences (ISs) including ISPpu21 and ISPa1328 were detected in PCR products of OprD gene, that were larger than expected. Conclusions The prevalence of β-lactamase-producing isolates and their isolation from life-threatening infections in burn patients is increasing at an alarming rate worldwide. Also, we have identified two novel IS elements, ISPa1328 and ISPpu21, in P. aeruginosa isolates from hospitals in Tehran, Iran. In most of the isolates, insertional inactivation of oprD by ISPa1328 and ISPpu21 were associated with carbapenem resistance.

Value relevance studies have thus far provided mixed evidence. Studies also found that fair value reporting has a significant impact on the value relevance of other comprehensive income. Additionally, most studies on value relevance of other comprehensive income focused on developed countries where the capital market is more efficient. In these settings due to the existence of active market, fair valuation of assets may not pose a major problem. In Malaysia the mandatory reporting of comprehensive income by all listed firms based on the requirement of FRS101, coincides with the adoption of FRS139 the standard for financial instrument and could be an interesting setting to investigate. This study hypothesized that other comprehensive income and its components are associated with share price. The results indicate that other comprehensive income and its components are value relevant. The results indicate that the move towards a more comprehensive income reporting through the preparation of the Statement of Comprehensive Income results in more informative financial reporting.

Abstract Background Mental health has been integrated in the primary health care program in small cities and villages of Iran in a national level since the late 1980s. We performed a systematic review of literature to investigate the effect of education on change in attitude and knowledge of mental health care providers and the population covered in the program during the recent two decades in Iran. Methods Electronic bibliographic databases including Pubmed, PsycINFO and EMBase as well as the main Iranian databases (Scientific Information Database, IranMedex, IranPsych, and IranDoc) were searched. Additionally, hand searching, personal contacts and tracking of reference lists were performed. All of the studies which compared the attitude and knowledge of the related population before and after an educational intervention were recruited. Results Six articles met the inclusion criteria and entered the review. All of these studies showed an improvement in the attitude and knowledge of the studied population. Although the studies were different in many respects, a meta-analysis on the two more similar studies showed a significant effect of training on long term improvement of the knowledge and attitude of the population. Conclusion A short term training improved knowledge and attitude of the population and health personnel immediately after the intervention. There is also evidence for a long term change in the attitude and knowledge of general population after short term training.

In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Segebladh B, Borgström A, Nyberg S, et al. Evaluation of different add-back estradiol and progesterone treatments to gonadotropin-releasing hormone agonist treatment in patients with premenstrual dysphoric disorder. Am J Obstet Gynecol 2009;201:139.e1-8. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this study was to recover industrial waste (spent bleaching earth (SBE)) and use it as an adsorbent in fluoride removal from aqueous solution. Waste SBE was obtained from the oil industry, and acid and alkaline were used to recover it. Experiments were carried out in a batch system, and the effects of parameters including pH, adsorbent doses, fluoride initial concentration and contact time on the adsorption of fluoride using regenerated spent bleaching earth (RSBE) were examined. In addition, the optimum conditions obtained in this study were tested on Kuhbonan water. The results revealed that as the adsorbent dose, contact time and pH increased, the fluoride removal efficiency increased as well. The maximum fluoride adsorption was obtained at pH=7 and an equivalent time of 180min. Furthermore, when the fluoride initial concentration in water increased, fluoride removal efficiency decreased. The maximum adsorption capacity of RSBE was 0.6mg/g fluoride (2.5–8mg F−/L, 10g RSBE/L and pH=7). The kinetics analysis showed that the rate of fluoride adsorption on RSBE was 0.64mg/g·min0.5. In addition, the results showed that when 10g RSBE/L was added to Kuhbonan water, fluoride residual can reach levels allowable by WHO guidelines. [Copyright &y& Elsevier]

Mirabegron is a new agent served as the treatment for patients with overactive bladder (OAB). In the absence of head-to-head trials, we evaluated comparative cost-effectiveness of mirabegron versus solifenacin in OAB patients from national health system (NHS) perspective in Iran. Cost-effectiveness ratios and quality-adjusted life years (QALYs) were computed for the agents. [Extracted from the article]

Peripheral artery disease manifests as intermittent claudication in 4 to 12% people between 55 to 70 and 20% of people over 70 years old. The purpose of this study is to estimate the cost-effectiveness (CE) of cilostazol versus pentoxifylline in the treatment of intermittent claudication. A markov model was developed to assess the cost and efficacy of treatments in patients with intermittent claudication who are 40 years or above. [Extracted from the article]

The objective of this study was to compare the cost-effectiveness of tiotropium + olodaterol (TIO/OLO) 5/5 g versus aclidinium + formoterol (ACL/FOR) 400/12 g for patients with chronic obstructive pulmonary disease (COPD) in the Iranian health care setting using a newly developed patient-level Markov model that reflects the current understanding of the disease. An individual-level Markov model was adapted to simulate 1000 patients with moderate-to-severe COPD using TreeAge pro 2018 software over a 5-year time horizon from the perspective of the Iranian National Health Service. TIO/OLO can be considered a cost-effective bronchodilator compared with ACL/FOR in patients with moderate-to-severe COPD for the Iranian health care system. [Extracted from the article]

Chronic lung infection with Pseudomonas aeruginosa occurs in approximately 50% of patients with cystic fibrosis (CF) which compromises lung function, and significantly contributes to the increased healthcare costs. Hence, this analysis aimed to evaluate the cost-effectiveness of Inhaled tobramycin versus nebulized dornase alfa for the management of patients with CF from the perspective of the Iranian National Health Service (NHS). [Extracted from the article]

So far, there is no anti-tumor therapy available in Iran for patients with metastatic castration resistant prostate cancer (mCRPC) who progressed after receiving chemotherapy with docetaxel. This research aims to evaluate the cost-utility of Abiraterone in the treatment of docetaxel-refractory mCRPC patients compared to best supportive care (BSC), including prednisolone and palliative care, from the Iranian payer perspective. [Extracted from the article]

"nBackground: Hyperglycemia after acute stroke is a common finding that has been associated with an increased risk of death. For the last several years, it was believed that post-stroke hyperglycemia may worsen brain infarction in animal models. According to previous studies, the anti-inflammatory effect of insulin has a protective role on ischemic tissues. Glucose-insulin-potassium (GIK) infusions can be safely administered to acute stroke patients with mild to moderate hyperglycemia producing a physiological but attenuated glucose response to acute stroke, the effectiveness of which remains to be elucidated. In this study, we compared the effects of GIK infusion vs. placebo in ischemic stroke patients."n"nMethods: In this double blind randomized controlled trial, the intervention group consisted of 48 patients who received GIK infusion for 24 hours and the control group included 50 patients who received normal saline infusion for 24 hours. All patients had been admitted to Shariati Hospital during the first 24 hours after the onset of ischemic stroke. At one and three months after the treatment, patients were examined for morbidity and mortality using the Bethel and Modified- Rankin-Scale (MRS) questionnaires."n"nResults: GIK infusions significantly reduced plasma glucose concentrations. Statistically significant differences between the two groups were observed for disability and mortality. However, in spite of the protective effects of insulin and adverse effect of hyperglycemia in ischemic tissues, we observed no significant therapeutic effect from the GIK solution on patient outcome."n"nConclusions: Although hyperglycemia following acute stroke has been associated with subsequent mortality and impaired neurological recovery, the maintenance of euglycemia in the acute phase has not been shown to improve prognosis. According to this study, GIK infusion has no significant clinical benefit on the outcome of stroke patients. Thus, we cannot recommend routine use of GIK infusion in post-stroke hyperglycemia as an adjuvant treatment for ischemic stroke."n"n

Endocrine therapy continues to be the optimal systemic treatment for metastatic ER+/HER2- advanced breast cancer. PAL+FUL can be considered cost-effective compared to EVE+EXE for the treatment of patients with HR+/HER2- metastatic breast cancer patients failing initial therapy with NSAIs in the Iranian healthcare system. [Extracted from the article]