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Background: Computed tomography (CT) is a routine procedure for diagnosing using ionization radiation which has hazardous effects especially on sensitive organs. Objective: The aim of this study was to quantify the dose reduction effect of lead apron shielding on the testicular region during routine chest CT scans. Material and Methods: In this measurement study, the routine chest CT examinations were performed for 30 male patients with common lead aprons folded and positioned in testis regions. The patient’s mean body mass index (BMI) was 26.2 ± 4.6 kg/m2. To calculate the doses at testis region, three thermoluminescent dosimeters (TLD-100) were attached at the top surface of the apron as an indicator of the doses without shielding, and three TLDs under the apron for doses with shielding. The TLD readouts were compared using SPSS software (Wilcoxon test) version 16. Results: The radiation dose in the testicular regions was reduced from 0.46 ± 0.04 to 0.20 ± 0.04 mGy in the presence of lead apron shielding (p < 0.001), the reduction was equal to 56%. Furthermore, the heritable risk probability was obtained at 2.0 ×10-5 % and 4.6 ×10-5 % for the patients using the lead apron shield versus without shield, respectively. Conclusion: Applying common lead aprons as shielding in the testis regions of male patients undergoing chest CT scans can reduce the radiation doses significantly. Therefore, this shield can be recommended for routine chest CT examinations.

Background and Objective:Social support is generally accepted to act as a protective factor against stressful situations. However, the extent of its effect on the depression and lifestyle of myocardial infarction (MI) patients is not known. Therefore, the present study aimed to examine the role of perceived social support in predicting major depressive disorder and lifestyle components in MI patients. Materials and Methods:This quasi-experimental study was conducted in 2019 on 176 MI patients chosen through the purposive and convenience sampling methods from the Heart Center Hospital of Mazandaran, Iran. The required information was collected by three standard questionnaires, including the social supportappraisals (SS-A)scale by Phillips, the Beck Depression Inventory (BDI-II), and Health-Promoting LifestyleProfile (HPLP-II). Pearson correlation coefficient and canonical correlation coefficient were performed. The significance level in this study was considered as P-value Results:The findings of the present study indicated that social support could predict depression by 48% and a significant negative correlation was found between social support and depression (r=-0.47,P=0.01). Moreover, social support had a significant impact on lifestyle components and was shown to predict health accountability (R2=0.691, β=0.289), spiritual growth (R2=0.672, β=0.256), stress management (R2=0.285, β=0.122), and interpersonal behavior (R2=0.586, β=0.175). In addition, it affected these factors significantly. Conclusion:Providing opportunities for further social support for MI patients paves the way for enhancing health-promoting behaviors and reducing depression in this group of patients. Keywords:Depression,Lifestyle,Myocardial Infarction (MI),Perceived social support

Background The aim of this study was to investigate the diagnostic accuracy of microcalcification, as well as its associated sonographic features, for prediction of thyroid nodule malignancy. We prospectively assessed the patients with thyroid nodule, who underwent ultrasound-guided fine-needle aspiration during 2017–2020 in Babol, northern Iran. The ultrasonographic characteristics of the nodules, as well as their cytological results, were recorded. We used regression analysis to evaluate the relation between sonographic findings and nodule malignancy. A receiver operator characteristics (ROC) analysis was also used to estimate the ability of ultrasound to predict the characteristic features of malignancy, as estimated by the area under the curve (AUC). Results Overall, 1129 thyroid nodules were finally included in the study, of which 452 (40%) had microcalcification. A significant positive association was found between nodule malignancy and microcalcification in both univariate (OR=3.626, 95% CI 2.258–5.822) and multivariable regression analyses (OR=1.878, 95% CI 1.095–3.219). In the nodules with microcalcification, significant positive relations were seen between malignancy and hypoechogenicity (OR=3.833, 95% CI 1.032–14.238), >5 microcalcification number (OR=3.045, 95% CI 1.328–6.982), irregular margin (OR=3.341, 95% CI 1.078–10.352), and lobulated margin (OR=5.727, 95% CI 1.934–16.959). The ROC analysis indicated that AUC for hypoechogenicity, >5 microcalcification number, irregular margin, and lobulated margin were 60%, 62%, 55%, and 60%, respectively, in predicting malignant thyroid nodules. Conclusion The findings indicated that microcalcification can be a potential predictor of thyroid nodule malignancy. Also, the presence of irregular or lobulated margins, multiple intranodular microcalcification (>5 microcalcifications), and/or hypoechogenicity can improve the ability of microcalcification in distinguishing malignant from benign nodules.

Background:Motivational factors are generally regarded as an important ingredient for change in therapy. However, there is currently a lack of available instruments that can measure clients’ readiness for change in therapy.Aim:The objective of this paper was to create an instrument, the Readiness for Therapy Questionnaire (RTQ), which could measure clients’ readiness for change.Method:The RTQ was created by researchers following analysis of themes drawn from a review of the literature and interviews with patients at the end of therapy. This included both people who completed therapy and those who dropped out. As part of the standard assessment process, the RTQ was administered to 349 participants (69.6% female and 30.4% male; mean age 37.1 years; 90.5% Caucasian) who were patients at a psychological therapy service for common mental health difficulties.Result:An initial 12-item scale was reduced to 6 items. This scale significantly correlated with post-therapy PHQ-9 and GAD-7 scores and changes in these scores across therapy. After controlling for baseline scores and demographic variables, a logistic regression showed that scores on this 6-item measure pre-therapy significantly predicted three outcome variables: completing therapy, being recovered on both PHQ-9 and GAD-7 post-therapy, and having a reliable change in both the PHQ-9 and GAD-7 post-therapy. However, receiver operating characteristic (ROC) curve analysis showed the measure had poor sensitivity and specificity. Symptom severity did not have a significant impact on motivation to change.Conclusion:The RTQ is potentially a valid measure with useful clinical applications in treatment of common mental health difficulties.

Objective: Holmium laser has demonstrated high efficacy in urethral disobstruction. Venous air embolism (VAE) is a rare complication of prostate surgery. Only two cases of venous air embolism (VAE) in patients submitted to HoLEP, have been described. In this paper we show a third case of not fatal VAE after HoLEP. Materials and methods: A case of VAE occurred in holmium laser enucleation (HoLEP) due to obstructive lower urinary tract symptoms (LUTS) in a 70 years old patient. After the procedure, patient’s end tidal carbon dioxide (ETCO2) levels dramatically decreased at 17 mmHg, with pressure airway (PAW)16 mmHg; oxygen saturation level was at 75%, without any loss in the ventilation circuit and with arterial blood pressure of 94/54 mmHg. Due to the negativity for other suspicions, the suspect of VAE was postulated. Result: The immediate switching from laryngeal mask to Oro Tracheal Intubation increased the oxygen level. A cardiac transthoracic ultrasound was negative for air bubbles inside cardiac cavities, without any alteration in the cardiac kinetics. Arterial blood sample turned negative for any alteration compatible with VAE and catheter continuous vesical irrigation was started to obtain clear washing fluid without blood cloths. The extubated patient showed no neurological defects. Conclusions: An invasive monitoring system is the key to rapidly and correctly identify any embolic episode during this kind of surgery.

Background Reported effects of obesity on the extent of angiographic coronary artery disease(CAD) have been inconsistent. The present study aimed to investigate the relationships between the indices of obesity and other anthropometric markers with the extent of CAD. Methods This study was conducted on 1008 consecutive patients who underwent coronary angiography. Body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) were separately calculated for each patient. Extent, severity, and complexity of CAD were determined by the Gensini and SYNTAX scores. Results According to the results, there was a significant inverse correlation between the SYNTAX score with BMI (r = − 0.110; P P = 0.018), and WHtR (r = − 0.089; P = 0.005). Furthermore, a significant inverse correlation was observed between the Gensini score with BMI (r = − 0.090; P = 0.004) and WHtR (r = − 0.065; P = 0.041). However, the results of multivariate linear regression analysis did not show any association between the SYNTAX and Gensini scores with the indices of obesity and overweight. On the other hand, the patients with an unhealthy WC had a higher prevalence of diabetes mellitus (DM) (P = 0.004) and hypertension (HTN) (P P = 0.002 and P = 0.032, respectively). Conclusion It seems that the anthropometric indices of obesity are not the predictors of the angiographic severity of CAD. However, they are associated with an increased risk of cardiovascular risk factors and higher risk profile.

Background and aims: Hypertension is one of the most common and important risk factors of cardiovascular diseases. This phenomenon, if not cured, causes lots of problems in vital organs of the body like kidneys, brain, eyes, and heart. The aim of the current study was to identify factors which affect the time until myocardial infarction (MI) in hypertension patients using truncated Cox regression. Methods: This study was a population retrospective cohort and its statistical population included patients with hypertension symptoms, who had MI for the first time in Sari. A decision was made based on continuing the study as a nested case and control study because the number of MI incidents was low (7%) in the studied sample. In addition, the Cox’s model and truncated Cox were used for determining the factors affecting the patients’ survival. Results: The median and mean survival times in this sample were equal to 57 and 66.44 months, respectively. Considering time truncation, family history (HR=1.70) and the age at diagnosis (HR=0.99) were statistically significant in the Cox’s model (P< 0.05). Conclusion: Overall, using the Akaike criterion for comparing the survival time without the effect of truncation, the Cox’s model demonstrated better fitness by controlling the truncation effect. These results show the importance of controlling the truncation in those diseases in which it is impossible to distinguish the time of the appearance from the symptoms.

Background: Cerebral stroke, with ischemic stroke being its most common type, is the leading cause of chronic disability. The ketogenic diet has been used for treating seizures for centuries and has been considered to be a treatment for other neurologic diseases in recent years. The goal of this study is to evaluate the effects of ketogenic diet preconditioning on the early motor-behavior outcome of rats with induced cerebral ischemic stroke. Methods: Twenty-four rats were surveyed in 3 groups of Main, Control, and Sham. The Main group received a ketogenic diet plus medium chain triglyceride oil starting 3 days prior to stroke induction, while the other 2 groups took a normal diet. Subsequently, Endothelin-1 was injected stereotactically near the middle cerebral artery to induce an ischemic stroke in the Main and Control group. Normal saline was injected to the members of the Sham group with the same technique. The motor-behavior functions of the rats were compared between 3 groups using adjusting step, beam, and cylinder tests. Results: After stroke induction, rats on ketogenic diet were able to adjust their steps more efficiently, moved faster on the beam, and used their hands more symmetrically in the transparent cylinder in relation to the rats in the Control group. Conclusion: It seems that ketogenic diet preconditioning improves the early motor-behavioral outcome of ischemic stroke.

One of the main concerns in using commercial software for finite element analyses of dam-foundation-reservoir systems is that the simplifying assumptions of the massless foundation are unreliable. In this study, an appropriate direct finite element method is introduced for simulating the mass, radiation damping and wave propagation effect in foundations of dam-foundation-reservoir systems using commercial software ABAQUS. The free-field boundary condition is used for modeling the semi-infinite foundation and radiation damping, which is not a built-in boundary condition in most of the available commercial software for finite element analysis of structures such as ANSYS or ABAQUS and thus needs to be implemented differently. The different mechanism for modeling of the foundation, earthquake input and far-field boundary condition is described. Implementation of the free-field boundary condition in finite element software is verified by comparing it with analytical results. To investigation the feasibility of the proposed method in dam-foundation-reservoir system analysis, a series of analyses is accomplished in a variety of cases and the obtained results are compared with the substructure method by using the EAGD-84 program. Finally, the massed and massless foundation results are compared and it is concluded that the massless foundation approach leads to the overestimation of the displacements and stresses within the dam body.

Purpose: In all types of ischemic stroke, especially in the acute phase, excessive oxidative stress causes structural and functional damage to the brain. This may play a major role in the pathophysiology of the brain damage. Higher serum levels of bilirubin have therapeutic effects in oxidative stress-induced stroke. Nevertheless, role of increased serum levels of bilirubin in the acute phase of ischemic stroke is controversial. Methods: This study was a cross-sectional prospective descriptive study conducted in the Emergency Department (ED) of Imam Reza hospital, Tabriz University of Medical Sciences, Tabriz, Iran, throughout six months. 275 ischemic stroke patients were evaluated based on their brain CT scan infarct size, NIHSS, MRS, and serum levels of bilirubin. Later, data were analyzed using SPSS software. Results: Total, direct and indirect bilirubin levels were significantly higher in expired patients (p< 0.0001). Total (p< 0.0001), direct (p< 0.0001) and indirect (p< 0.0001) bilirubin levels, NIHSS score (p< 0.0001), and ischemic area (p< 0.0001) significantly predicted the outcome in these patients. Conclusion: Total, direct and indirect bilirubin levels was significantly associated with mortality in the acute phase of ischemic stroke patients.

Purpose: To investigate the association of peripheral calcification, as well as its sonographic features, with thyroid nodule malignancy. Material and methods: This study was prospectively conducted during 2015-2020 on patients diagnosed with thyroid nodule undergoing ultrasound-guided fine-needle aspiration in Shahid Beheshti teaching hospital or private offices in Babol, northern Iran. The ultrasonographic characteristics of the nodules, as well as the cytological findings, were recorded. Regression analysis was used to assess the relationship between sonographic results and malignancy. We also used receiver operator characteristics (ROC) analysis to estimate the ability of ultrasound to predict the characteristic features of malignancy, as estimated by the area under the curve (AUC). Results: A total of 1857 thyroid nodules were finally included, of which 84 were peripherally calcified nodules. There was a significant positive association between the nodule malignancy and peripheral calcification (OR = 2.23, 95% CI: 1.13-4.35). In the nodules with peripheral calcification, significant positive associations were seen between malignancy and lobulated margin (OR = 3.85, 95% CI: 1.02-14.54) and solid composition (OR = 4.05, 95% CI: 0.99-16.53). The ROC analysis indicated that AUC for lobulated margin and solid composition was 63.8% and 66.5%, respectively, in predicting malignant thyroid nodules. Conclusion: The findings showed that peripheral calcification on sonography can be a potential indicator of malignant thyroid nodules. Also, the presence of lobulated margin and/or solid composition, besides peripheral calcification, can be helpful in better distinguishing malignant from benign nodules.

Background Prevalence of coronary heart disease (CHD) risk factors are increasing in developing countries. The present study aimed to assess the prevalence of self-reported CHD and evaluate the role of various risk factors on its prevalence in the Tabari cohort study (TCS) population. Methods The enrollment phase of TCS was performed between June 2015 and November 2017. In the current study, data were derived from information collecting from the enrollment phase of TCS. In the enrollment phase, 10,255 individuals aged 35–70 living in urban and mountainous areas of Sari (northern part of Iran) were entered into the study. Educational level, socioeconomic and marital status, history of smoking, opium and alcohol abuse/addiction, level of daily physical activity, indices of obesity, and traditional risk factors of the participants were determined. Results The prevalence of CHD was measured at 9.2%. Older individuals (PPPPPPPPP Conclusion According to the results of the present study, it seems that the prevalence of CHD in the Iranian population is relatively high.

Concrete dams are one of the most important infrastructures in every country and the seismic safety assessment of them is a major task in dam engineering field. Dam–foundation–reservoir system analysis is a complex interaction problem because this system consists of three domains with different behaviors. For accurate analysis of this system, some important factors should be considered such as foundation mass and earthquake input mechanism. In this paper, the effect of foundation mass and earthquake input mechanism on seismic response of concrete gravity dam is investigated. For this purpose, two different methods are introduced for modeling of massed semi-infinite foundation in finite element method, namely free-field boundary condition and domain reduction method (DRM). To verify the feasibility of proposed methods for seismic analysis of dam–foundation–reservoir system, the displacement and stress outputs using proposed methods are compared with EAGD-84 results. The obtained results indicate that both methods are accurate enough for finite element modeling of massed foundation. Finally, Koyna concrete gravity dam is analyzed for rigid, massless and massed foundation cases using DRM and it is concluded that the foundation has significant effect on dam response and the common massless foundation approach overestimates the dam response.

Aim: To reduce in-hospital intervals by developing a prehospital notification (PHN) protocol which directly notifies a neurologist to prepare for possible treatment. Methods: A 24/7 connection was established between emergency medical services dispatch and the on-call neurologist. A database of all patients with in-hospital stroke code activation was developed, door-to-computed tomography (CT) time and door-to-needle time was recorded from January 2013 to December 2016. The statistical results were considered significant at p < 0.05. Result: PHN resulted in a significant reduction in door-to-CT time (median 14 vs 20; p < 0.001). Among patients who were treated with intravenous thrombolysis, door-to-needle time was significantly shorter in patients with PHN compared with non-PHN group (median 42 vs 70; p < 0.001). Conclusion: PHN effectively reduced door-to-CT and door-to-needle times. © 2018 2018 Reshad Mirnour.

Thoracic aortocaval fistula is a very rare cause of left to right shunt. Drainage of fistula into the superior vena cava (SVC) is very uncommon. Clinical symptoms depend on the size of the shunt. We report a rare case of an asymptomatic 27-year-old woman with congenital aortocaval fistula to the SVC with a small amount of left to right shunt that was considered for serial medical follow-up.

Sinus venosus atrial septal defect (ASD) accounts for 5% to 10% of ASDs. In contrast with the more common superior vena cava (SVC) type, the inferior vena cava (IVC) type of sinus venosus ASD with overriding IVC is extremely rare. The sinus venosus defect occur posterior to the fossa ovalis and is not regarded as true ASD. Transesophageal echocardiography (TEE) is a diagnostic procedure of choice due to close proximity of atrial septum to TEE transducer. However; it may not constantly yield detailed anatomical and functional characterization, and other imaging modalities such as cardiac magnetic resonance imaging (MRI) may be needed. We report the case of a 45-year-old woman with an undiagnosed hemodynamically significant IVC-type ASD without any anomalous drainage of pulmonary veins, who presented with progressive dyspnea.

Partial anomalous pulmonary venous connection is a rare congenital disease characterized by drainage of one or several pulmonary veins into the systemic venous system. It is extremely rare as an isolated anomaly. We report the case of a middle-aged woman with isolated drainage of an enormously enlarged right lower pulmonary vein into the right atrium with significant left-to-right shunt, severe right ventricular enlargement, and pulmonary hypertension.

In this study, multi-criteria shape optimization of an asymmetrical doublecurvature arch dam is presented. Simultaneous cost minimization of dam construction and maximum allowable tensile stress are investigated for an economical and safe design approach in the current study. Pareto front method was used to balance both the economy and safety of the design simultaneously, which can be di cult for both analysts anddecision-makers. A non-dominated solution based on the important parameters of dam analysis and design is presented. To help decision-makers in their decision, two diff erent methods are proposed. These methods for the case of an arch dam are Lombardi coe cient and equilibrium point methods. The obtained results indicate that these two methods can be helpful for designers without experience and information of previous designs.

A novel plastic-damage constitutive model for plain concrete is developed in this paper. For this purpose, the microplane theory is proposed for overcoming the deficiency of available anisotropic continuum plastic-damage models in reproducing the true anisotropic nature of damage in multidimensional loadings. Based on the microplane theory, the degeneration process in concrete is considered along with plastic deformations. Using the principle of strain energy equivalence, a transformation between the nominal and effective states of material is achieved, that results in a decoupled formulation for damage and plasticity. A yield function with multiple internal variables and a non-associative flow function are employed to describe the plastic behavior of concrete. In order to discriminate between the behavior of concrete in tension and compression, stress tensor is decomposed into tensile and compressive parts, and two sets of microplanes are defined for each material point, leading to corresponding independent anisotropic damage tensors in tension and compression. Several numerical examples are analyzed using the proposed model and robustness and accuracy of the formulation are assessed using the available experimental tests. In addition, superiority of the proposed model over the available isotropic and anisotropic formulations is demonstrated by comparisons between the different approaches. The effects of three different cubature schemes on the response of concrete specimens are also analyzed.

Abutments of concrete arch dams are usually crossed by several joints which may create some rock wedges. Abutment stability analysis and controlling the probable wedge movements is one of the main concerns in the design procedure of arch dams which should be investigated. For decades, the quasi-static method due to its simple approach is used by most of dam designers. In this study the dynamic method is presented and the obtained time history of sliding safety factors are compared to the quasi-static results. For this purpose, all three components of Kobe 1979 and Imperial Valley 1940 earthquakes are applied to the wedge, simultaneously and the magnitude and direction of wedge displacements are calculated based on Newmark method which is not possible in the quasi-static approach. A 3-D finite element model of Luzzone dam including dam-foundation-reservoir interactions is used to compute the thrust forces. The obtained results indicate that quasi static method is more conservative. The importance of uplift pressure effects on the abutment stability is investigated as well. It is shown that the uplift pressure can play a key role in the abutment stability analysis and it is necessary to control the uplift pressure and seepage in arch dam foundations.

Introduction The main purpose of this study was to determine the diagnostic reference level (DRL) for routine digital radiography examinations in Mazandaran province. Materials and methods Thirteen digital radiographic examinations at 18 high-patient-load radiography centres were investigated. The indirect dosimetry method was performed based on the IAEA report. Average entrance skin dose (ESD) and the third quartile of ESD as the DRL were evaluated from the measurement made by a semiconductor dosemeter. Results DRL for the examinations of digital radiography was obtained as: Skull (postero-anterior [PA]): 2.2, skull (lateral [LAT]): 2.4, cervical spine (antero-posterior [AP]): 1.6, cervical spine (LAT): 1.7, thoracic spine (AP): 3.6, thoracic spine (LAT): 9.9, lumbar spine (AP): 5.3, lumbar spine (LAT): 11.8, chest (PA): 1.4, chest (LAT): 2.1, abdomen (AP): 4.3, pelvis (AP): 3.2 and hip (AP): 2.1 mGy. Conclusion Although DRL was not higher compared with the international organisations’ levels, it can be reduced by adequate training of radiographers.

Background and Purpose: Regarding usefulness of revascularization versus optimal medical therapy in patients with stable angina pectoris, data are challenging. The aim of this 12-month follow-up study was to compare the survival benefit associated with revascularization versus optimal medical therapy on the patients with stable angina pectoris. Materials and Methods: A prospective clinical study was conducted on 181 patients with stable angina pectoris or an evidence of myocardial ischemia that underwent coronary arteriography. Patients with left main or left main equivalent were excluded from our study. Of these patients, 57 received full medical therapy alone, 79 were assigned to the percutaneous coronary intervention (PCI) and 45 to the coronary artery bypass graft (CABG) group. The patients were compared for primary outcomes including cardiac death and non-fatal myocardial infarction and secondary outcomes including disabling angina by chi-square and Fisher’s exact test. Results: After 12 months, cardiac death occurred in 8.8% of patients in the medical group and 0.0% of patients in the PCI and CABG group. This was statistically significant (P = 0.004). Disabling angina occurred in 23.1% of patients in the medical group, 17.7% of patients in the PCI group, and 15.5% of patients in CABG group (P = 0.349). Cerebrovascular accident occurred in 1.9% of patients in the medical group, 1.3% of patients in the PCI group, and 6.7% of patients in CABG group (P = 0.167). These were not statistically significant. Conclusion: Revascularization compared with the optimal medical therapy may be a better strategy in reducing cardiovascular mortality in patients with stable angina pectoris and suitable coronary anatomy.

Trapezoidal Cemented Sand and Gravel Dam, namely Trapezoid CSG, is a new type of dam. Due to lack of dynamic studies in the field of CSG dam, this research was performed to analyze Trapezoidal CSG dam using dynamic Finite element method with ABAQUS Software. To investigate possible earthquake-induced damages, fragility curves are plotted based on damage index, the length of the cracks created at the dam base and the area of cracked elements in the dam. The seismic analysis indicated that minimum and maximum tensions are generated in the heel and toe of the dam, respectively. According to the fragility curves, with increase in PGA, the possibility of the exceeding the defined limit state is increased. However, the rate of increment is significantly reduced after PGA=0.4 g. Also, the same result is achieved for the second limit state. The "area of cracked elements" is more conservative criterion than the "crack length at the dam base", especially at PGA

Structural collapse is the main concern in the existing structures which are built in the seismic-prone regions. Therefore, the primary goal of the seismic provisions in building codes is to prevent the global collapse. Iran is located in the Alpine-Himalayan belt, and has experienced some of the most destructive earthquakes in the past century. To evaluate the extent to which the Iranian building code provisions meet this objective, the authors have conducted a detailed assessment of collapse risk on a set of moderate moment resisting reinforced concrete (RC) buildings. This study considers P-Delta effects, deterioration in strength and stiffness, and cyclic deterioration in structural components.Structural assessment is performed using OpenSees platform and the multiple-record incremental dynamic analysis (IDA). Results are presented in terms of the IDA capacity curves and the collapse fragility functions at different seismic hazard levels. Results show that probability of instability increases with height of the buildings. Moreover, the collapse confidence level was evaluated considering the available uncertainties. Assuming a minimum confidence level of 90% for the buildings, the collapse prevention limit state under the 2%/50 hazard level is not satisfied for the 9 and 12 story frames, and they need to re-designed.

Fragility curve, based on the performance-based earthquake engineering (PBEE), is a fundamental tool in assessing the probabilistic seismic performance of concrete gravity dams. Determination of the dam limit-states (LSs) is necessary for estimation of fragility curve. In this research, four LSs in seismic performance of massive structure have been utilized for Pine Flat dam. To address this, the Incremental Dynamic Analysis (IDA) method has been applied to the integrated dam-reservoir finite-element model. Evaluation of seismic behavior, demand and capacity of the tallest monolith has been investigated by implementing IDA. A new comprehensive method in terms of IDA and statistical analysis has been used for determination of each defined LS based on the certain value of the engineering demand parameter (EDP). To assess probabilistic performance of the dam, the exceeding probability of the LSs curves has been developed at various intensity measures based on the tree EDPs. It was found that the defined LSs have the capability indeed to be used in probabilistic framework.

Numerical simulation of dam-foundation-fault system, considering the earthquake source, propagation path, and local site e ects, was carried out for realistic and reasonable seismic safety analysis of concrete dams. The Domain Reduction Method (DRM) was used for seismic analysis of Dam-Foundation-Fault (DFF) system, in which a modular two-step methodology for reducing the computational costs in large domain analysis was introduced. In this method, seismic excitation is directly applied to the computational domain such that assigning arti cial boundary to the nite element models is more comfortable. In order to verify the implementation of the DRM in Finite Element Method (FEM), a simple 2D half-space under the Ricker wavelet excitation was examined. Then, to investigate the DRM as an appropriate method in seismic analysis of DFF system, the Koyna concrete gravity dam was modeled. Comparing the obtained results by usingboth the DRM in a small domain and the traditional approach in the large domain containing the source shows the e ciency of the DRM in terms of computational costs, such as running time and number of elements for seismic analysis of concrete gravity dams.

The dural sinuses are pathways for drainage of blood from brain to the internal jugular veins. Occipital sinus is a rare normal anatomical variaton of dural sinuses which acts as an alternatve drainage pathway when the transverse sinuses are hypoplastc. It drains blood from skull and brain to the internal jugular vein. The variatons can culminate in wrong diagnosis and imaging interpretaton. We reported a 33 years old pregnant woman presented with headache and normal neurological examinaton. Magnetc resonance imaging and magnetc resonance venography studies revealed occipital sinus as the main drainage pathway of the brain. Both the transverse sinuses were hypoplastc. Without considering this rare variaton such conditons can culminate in wrong diagnosis, which can be prevented by reportng such rare conditons.

Background The impact of contrast-induced acute kidney injury (CI-AKI) on patients with chronic renal disease is well-known. Remote ischemic preconditioning (RIPC) is a non-invasive method that can reduce the risk of CI-AKI, but studies on RIPC have had different results. The aim of the present study was to assess the potential impact of RIPC on CI-AKI. Methods In a randomized, double blinded, controlled trial, 132 patients with chronic renal dysfunction (glomerular filtration rate

Seismic performance and safety of a jointed arch dam, as an arch-shaped mass concrete structure, are investigated through the nonlinear incremental dynamic analysis. In this way, 12 proper ground motions are selected, each of them is scaled to 12 successively increasing intensity levels and applied to the dam. Three and seven contraction joints are inserted within the dam body, and stage construction is taken into account. Several main assumptions including dam–reservoir–foundation dynamic interaction, absorbing boundary conditions at the far-ends of the reservoir and foundation, and material and joint nonlinearities are considered. The failure modes of the dam are determined according to the distribution of damaged zones through the dam body. The results of the static analysis under dam self-weight and hydrostatic load show that the inclusion of the contraction joints and the stage construction do not considerably alter the tensile principal stresses; however, they increase the compressive stresses. In s...

The aim of this study was to determine the accuracy of fuzzy rule-based classification that could noninvasively predict CAD based on myocardial perfusion scan test and clinical-epidemiological variables. This was a cross-sectional study in which the characteristics, the results of myocardial perfusion scan (MPS), and coronary artery angiography of 115 patients, 62 (53.9%) males, in Mazandaran Heart Center in the north of Iran have been collected. We used membership functions for medical variables by reviewing the related literature. To improve the classification performance, we used Ishibuchi et al. and Nozaki et al. methods by adjusting the grade of certaintyCFjof each rule. This system includes 144 rules and the antecedent part of all rules has more than one part. The coronary artery disease data used in this paper contained 115 samples. The data was classified into four classes, namely, classes 1 (normal), 2 (stenosis in one single vessel), 3 (stenosis in two vessels), and 4 (stenosis in three vessels) which had 39, 35, 17, and 24 subjects, respectively. The accuracy in the fuzzy classification based on if-then rule was 92.8 percent if classification result was considered based on rule selection by expert, while it was 91.9 when classification result was obtained according to the equation. To increase the classification rate, we deleted the extra rules to reduce the fuzzy rules after introducing the membership functions.

Double-outlet right ventricle (DORV), a clinically important congenital heart disease, occurs in 1-3% of persons with congenital heart disease. It may occur as an isolated cardiac defect, together with other cardiac lesions, or in association with extracardiac anomalies. Other rare cardiac anomalies include an anomalous muscle bundle (AMB) in the right ventricular outflow tract (RVOT) and an accessory tricuspid valve leaflet. We report a very rare case of concomitant DORV, AMB in the RVOT and accessory tricuspid valve leaflet in a 17-year-old male patient. The patient eventually died from severe decompensated heart failure. To the best of our knowledge, such a case has not been previously reported in the literature.

The permeability of roller-compacted concrete (RCC) substantially affects its functionality and safety. This study investigates the effect of mix design parameters on the performance of RCC. For this purpose, approximately 500 laboratory specimens were prepared and tested. A formula and an artificial neural network (ANN) were proposed to predict the permeability coefficient of RCC by considering the main parameters, which were then verified independently using new specimens. Furthermore, the experimental data were analyzed by the Taguchi method and analysis of variance (ANOVA) to evaluate the level of parameter contribution. Based on the results, the permeability coefficient was highly dependent on the mix design and strength of the RCC specimens. The ANN model can predict the permeability coefficient of RCC more accurately than the proposed formula. The statistical analyses revealed that the water-to-cement ratio had the highest effect on the permeability coefficient and the mechanical properties. The findings of this investigation indicated valuable information regarding cost and time savings as well as eliminated laboratory trial and error in designing RCC structures.

U ovom se radu razmatra procjeđivanje zemljane brane simuliranjem procjednog toka i toplinskih parametara. Jednadžbe za izjednačavanje masa i za konvekciju-difuziju diskretizirane su pomoću metode konačnih elemenata radi rješavanja tih pojava u zasićenim i nezasićenim zonama. Predloženi model je provjeren na primjeru zemljane brane Shamil. Analizirani su materijali raznih karakteristika provodljivosti te je izvršena usporedba s mjernim podacima. Rezultati pokazuju da se ispitivanjem temperaturnih varijacija pojava procjeđivanja može jasnije sagledati nego kod piezometarske kontrole procjeđivanja., The earth-fill dam leakage is studied in this paper by applying the seepage flow and thermal simulation. The mass balance and convection-diffusion equations are discretized based on the finite element method to solve the phenomena in saturated and unsaturated zones. The Shamil embankment dam is used for verification of the proposed model. Different conductivity cases are analyzed and compared against measured data. Results show that investigation of temperature variations can magnify the effect of leakage more clearly than the inspection of seepage piezometric levels.

A sinus of Valsalva aneurysm is a dilatation of the aortic wall caused by the lack of continuity between the middle layer of the aortic wall and the aortic valve. It has an incidence of

This study was carried out to compare the individual and family characteristics of students- studying at high school level in East Azerbaijan, Iran- with their disciplinary function. Using multistage sampling method, we selected 372 and 338 low and high disciplinary students, respectively. According to Fisher's exact test, the students dicsiplinary function was significantly related to: the educational level of their parents; students academic failure; and the students GPA. No significant difference was found between the students’ height and their disciplinary function. Also, there was no relationship between parents’ age and the students’ disciplinary performance.

The growth in computer processing power has made it possible to use time-consuming analysis methods such as incremental dynamic analysis (IDA) with higher accuracy in less time. In an IDA study, a series of earthquake records are applied to a structure at successively increasing intensity levels, which causes the structure to shift from the elastic state into the inelastic state and finally into collapse. In this way, the limit-states and capacity of a structure can be determined. In the present research, the IDA of a concrete gravity dam considering a nonlinear concrete behavior, and sliding planes within the dam body and at the dam-foundation interface, is performed. The influence of the friction angle and lift joint slope on the response parameters are investigated and the various limit-states of the dam are recognized. It is observed that by introducing a lift joint, the tensile damage can be avoided for the dam structure. The lift joint sliding is essentially independent of the base joint friction angle and the upper ligament over the inclined lift joint slides into the upstream direction in strong earthquakes.

Damage assessment of concrete arch dams is carried out through nonlinear Incremental Dynamic Analysis (IDA) of a typical arch dam. In this study the Morrow Point arch dam is subjected to a set of 12 three-component earthquakes each scaled to 12 increasing intensity levels. The dam–foundation interaction effects have been investigated by varying foundation's modulus of elasticity to be equal and half of dam concrete's modulus of elasticity. Damage propagation through the dam body is investigated and various IDA curves are created. The performance and various limit-states of the dam structure are examined based on the obtained results. Simple damage indices are proposed through comparison of response demands in earthquake analysis with the determined structural capacities. It was found that the proposed damage indices can properly indicate state of damage in the dam body.

In the present paper, spatially variation input effects on seismic responses of arch dams have been studied. Recorded ground accelerations at the dam foundation interface of Pacoima dam during January 13, 2001 were used for the purpose of this investigation. A numerical finite element model was developed for dynamic analysis of the dam reservoir system. The modified version of NSAD-DRI finite element program was used for the analysis and the ground acceleration time histories were interpolated at all dam foundation interface nodal points. Total and pseudo static displacements as well as developed stresses due to uniform and non uniform excitations are obtained. The results reveal that multiple support excitations can have profound effects on the dam responses.

Objective: To assess the impact of pre-procedural remote ischemic preconditioning on the incidence of myocardial complications following percutaneous coronary intervention. Background: Ischemic preconditioning of a remote vascular territory improves the subsequent ischemic tolerance of distant organs. Method: The Myocardial Event Reduction with Ischemic Preconditioning Therapy (MERIT) trial recruited 80 consecutive patients undergoing elective angioplasty with drug-eluting stents to receive two 5-min lower limb tourniquet occlusions or an un-inflated tourniquet (controls) 1 h before the procedure. The primary outcome was troponin T level at 24 h. Secondary outcomes were intra-procedural chest pain and ST-segment deviation. Results: 6 patients in the control group and 2 in the ischemic preconditioning group had pre-procedural raised troponin T ( p = 0.23). This increased to 16 (40%) in the control group and 5 (12.5%) in the study group at 24 h ( p = 0.01). Fewer patients in the study group experienced intra-procedural chest pain (1 vs. 7, p = 0.056). Mean ST-segment deviation time was 13 ± 35 s in the study group and 58 ± 118 s in the control group ( p = 0.02). At a mean follow-up of 11 months, the major adverse cardiac event rate did not differ significantly between the groups. Conclusion: These data suggest that ischemic preconditioning reduces the absolute risk of post-procedure cardiomyocyte necrosis by 27.5%, and reduces intra-procedural chest pain and ST-segment deviation in patients undergoing percutaneous coronary interventions. We suggest its routine use in percutaneous coronary intervention, although the long-term prognostic impact in this patient group warrants further investigation.

An open spandrel arch bridge is analysed in this paper. A computer code is written to create a model from geometrical data, so as to solve the optimisation problem. An optimum design procedure is conducted in the paper, and the total material volume of the bridge substructure is adopted as an objective function. The substructure includes the column and the reinforced-concrete arch. Finally, the optimization technique is implemented using the Simultaneous Perturbation Stochastic Approximation algorithm.

In this paper, application of the Endurance Time (ET) method in seismic analysis of concrete gravity dams has been investigated. The ET method is based on time history analysis of structures, subjected to specially designed intensifying acceleration functions. It is expected that by developing its application in analysis of concrete dams, useful information on the seismic behavior of such dams at various excitation intensities can be obtained. Results from linear analysis of Folsom and Koyna dams under real earthquakes and ET acceleration functions have been compared. It is shown that the ET method can predict the response of concrete gravity dams to individual earthquakes with reasonable accuracy in linear analysis. In order to evaluate concrete gravity dams by linear analysis, the target time has been assumed to correspond to the OBE level of earthquake. Endurance criteria can be set as the time when the desired damage index(es), e.g. maximum principal stress, reaches its allowable value. The design can be considered satisfactory if endurance time is more than target time and vice versa. Also, potential application of the ET method in non-linear analysis of concrete gravity dams has been investigated. It is shown that crack profiles during earthquakes could be traced by the ET method.

Left atrial dissection (LatD), defined as the forced separation of the left atrial (LA) wall layers by blood, is a rare and severe complication of cardiac surgery. It is most frequently associated with atrioventricular junction injuries. We report a case of infected LatD after coronary artery bypass graft, mitral valve replacement, aortic valve replacement and ascending aortic root replacement. The patient was presented with septicemia and disseminated intravascular coagulation. To the best of our knowledge, this is the first case report of LA dissecting flap concomitant with attached infective vegetations identified by transesophageal echocardiography.

In the present paper, effects of non-uniform excitation due to spatially variation of seismic waves under the reservoir bottom on linear and nonlinear responses of arch dams are studied. Foundation is assumed to be massed and infinite elements are utilized to model semi-infinite medium via the far-end boundary of the foundation FE model. A continuum crack propagation model based on the smeared crack approach in 3D space is introduced. Reservoir's water is assumed compressible and the coupled system is solved using the staggered method. As a case study, Amir-Kabir double curvature arch dam in Iran is selected to investigate seismic behavior of the system. Two cases are analyzed in which wave travelling velocities are taken as 650 m/s and infinity. According to the results, non-uniform excitation leads to reduction in seismic response of the system and, in addition, frequency content of the response is different completely in comparison with the system under the uniform excitation.

In this study, the abutment stability of arch dams for two cases of pseudo-static and dynamic methods were compared based on limit state equilibrium method. For the pseudo-static approach, unit accelerations were applied to the model in three directions for calculating thrust forces. For dynamic analysis, three components of ground acceleration time histories of Kobe earthquake, 1979 were applied to the finite element model of dam-foundation-reservoir, and the thrust forces were obtained. The effect of reduction factors in pseudo-static analysis is investigated in order to obtain the reduction factor that corresponds to wedge movement in dynamic analysis. For this purpose, the reduction factors have been increased from 0.5 to 1. The obtained results indicate that pseudo-static results are more conservative than the dynamic analysis method for small reduction factors and the reduction factor plays a key role on the abutment stability analysis.

Background: Estimation of bronchiolitis severity in infants is still an important issue and there are no standard methods to help physicians for better evaluation and management of clinical status of these patients. The aim of this study was to investigate the role LDH concentration in NW as a biomarker in evaluation the outcome of patients suffering bronchiolitis in Bu Ali Hospital, Ardabil.Methods: 100 children with bronchiolitis aged below 2 years entered the study. Nasal wash sample was extracted from all patients using 2 ml of normal saline. Samples were sent to laboratory to measure LDH level. Data were analyzed by statistical methods in SPSS.16.Results: The mean age of patients was 6.9±3.7 months and 57% of them were male. 42% of patients had mild bronchiolitis and 58% of them suffered from severe bronchiolitis. The LDH level of nasal wash fluid was neither related with gender nor with age. But it was significantly lower in patients who required oxygen therapy and had fever compared with those who did not require oxygen therapy and without fever. Moreover, LDH level showed a significant negative association with hospital stay (r= -0.570, p