Search

Torcular dural sinus malformations (tDSMs) represent a rare subset of paediatric cerebrovascular malformations and are often diagnosed antenatally via ultrasound. The management of these in utero lesions remains controversial as previous studies suggested elective termination of the pregnancy because of their presumably high mortality and severe long-term morbidity. However, more recent evaluations have suggested that the overall prognosis for infants harbouring these lesions may be much better than previously believed. As such, we present the case of a neonate with a giant tDSM, diagnosed in utero, who was treated postnatally via staged transarterial and transvenous embolisation to alleviate worsening obstructive hydrocephalus and brainstem compression. We provide details regarding the surgical approach and long-term neurological outcomes for this patient. To the best of our knowledge, this is one of the largest reported tDSM presented in the literature.

Transradial access (TRA) has become increasingly utilized in neurointerventions because it reduces access site complications. However, radial artery anomalies can be difficult to navigate, often necessitating conversion to femoral access. We describe the case of a female patient in her early 70s who underwent preoperative embolization of a carotid body tumor via right TRA. Her radial angiogram demonstrated the presence of a radial artery loop which was successfully navigated with a triaxial system but would not spontaneously reduce, even after the guide catheter was advanced into the subclavian artery. However, manual manipulation of the catheters in the antecubital fossa under direct fluoroscopic visualization reduced the loop, allowing the procedure to continue transradially. Although most radial loops can be traversed and reduced using standard techniques, this case demonstrates that manual reduction can be successful when other measures fail. We recommend attempting this method prior to converting the access site.

The decisions made by agricultural households to adjust to climate change (CC) in Iran are not well known. This study is intended to investigate the influence of perceptions and socioeconomic, institutional features on farmers’ adaptation decisions about CC, which constitute the hypothetical statements of the study. We undertook a survey of 200 farm householders from 31 villages of Ilam Province, situated in the western Iran, as randomly selected. The result discloses that the proposed discriminant model matches the dataset well, with a strong effect size of partial eta-squared (η2 = 0.38). The analysis further signals that adapters are younger and more well-educated than non-adapters. Adapters are also knowledgeable about CC risks and institutional policy barriers. The adapters have subsidiary work, better access to credit, and have good contacts with expansion agents and specialists. The paper concludes that government authorities should provide farmers with the enriched capabilities and competencies enabling them to adapt to CC.

An integrated microwave photonic (IMWP) reconfigurable mixer, phase shifter, and frequency doubler based on the silicon photonics platform is proposed and theoretically investigated in this paper. The proposed structure consists of a novel dual-drive MachZehnder modulator (DDMZM) placed in parallel with an electro-optic phase modulator (PM). The novel DDMZM is a bias-free modulator that has advantages over conventional MZMs, such as bias-free operation and tunable optical-to-carrier sideband ratio (OCSR). The proposed novel structure can be configured as an IMWP phase tunable mixer or IMWP double-balanced mixer by properly adjusting optical wavelength and choosing the proper radio frequency (RF) hybrid coupler. Besides, the proposed IMWP reconfigurable mixer has the ability to perform up-converting, down-converting, RF frequency doubling, and phase shifting. The proposed structure is theoretically analyzed and is verified by simulations.

There is a significant decline in the number of intercity bus users in developing countries that makes company owners and service providers very concerned. Intercity bus service quality (BSQ) is significantly contributed to passenger satisfaction. Identification and improvement of the main criteria influencing the level of satisfaction are important to attract more passengers to public transport systems. In this regard, this paper aims to employ a Q-methodology to psychologically analyze the viewpoints of intercity bus passengers regarding the provided intercity BSQ. For this purpose, twenty-nine intercity bus users were surveyed based on the thirty-five statements. Finally, four distinct perspectives were derived that reflect the intercity bus passengers’ expectations. Perspectives A and B focused significantly on travel safety, travel time and terminal accessibility while perspectives C and D focused more on travel comfort. The findings also demonstrated that intercity bus passengers were less sensitive to staff behavior.

Background Pancreatic cancer (PC) is among the most lethal cancers worldwide, and the quality of care provided to PC patients is a vital public health concern. We aimed to investigate the quality of care of PC globally and to report its current burden. Methods The Quality of Care Index (QCI) was achieved by performing a Principal Component Analysis utilizing the results of the GBD study 2017. The QCI was defined as a range between 0 and 100, in which higher QCIs show higher quality of care. Possible gender- and age-related inequalities in terms of QCI were explored based on WHO world regions and the sociodemographic index (SDI). Results In 2017, Japan had the highest QCI among all countries (QCI = 99/100), followed by Australia (QCI = 83/100) and the United States (QCI = 76/100). In Japan and Australia, males and females had almost the same QCIs in 2017, while in the United States, females had lower QCIs than males. In contrast to these high-QCI nations, African countries had the lowest QCIs in 2017. Besides, QCI increased by SDI, and high-SDI regions had the highest QCIs. Regarding patients’ age, elderly cases had higher QCIs than younger patients globally and in high-SDI regions. Conclusion This study provides clinicians and health authorities with a wider vision around the quality of care of PC worldwide and highlights the existing disparities. This could help them investigate possible effective strategies to improve the quality of care in regions with lower QCIs and higher gender- and age-related inequities.

As the aging population continues to grow, so will the incidence of age-related conditions, including idiopathic normal pressure hydrocephalus (iNPH). The pathogenesis of iNPH remains elusive, and this is due in part to the poor characterization of cerebral spinal fluid (CSF) dynamics within the brain. Advancements in technology and imaging techniques have enabled new breakthroughs in understanding CSF physiology, and therefore iNPH pathogenesis. This includes understanding the hemodynamic and microvascular components involved in CSF influx and flow. Namely, the glymphatic system appears to be the great mediator, facilitating perivascular CSF flow via astrocytic aquaporin channels located along the endothelium of the pial vasculature. The interplay between glymphatics and both arterial pulsatilty and venous compliance has also been recently demonstrated. It appears then that CSF flow, and therefore glymphatic function, are highly dependent on cardiocirculatory and vascular factors. Impairment in any one component, whether it be related to arterial pulsatility, microvascular changes, reduced venous drainage, or astrogliosis, contributes greatly to iNPH, although it is likely a combination thereof. The strong interplay between vascular hemodynamics and CSF flow suggests perfusion imaging and cerebral blood flow quantification may be a useful diagnostic tool in characterizing iNPH. In addition, studies detecting glymphatic flow with magnetic resonance imaging have also emerged. These imaging tools may serve to both diagnose iNPH and help delineate it from other similarly presenting disease processes. With a better understanding of the vascular and glymphatic factors related to iNPH pathogenesis, physicians are better able to select the best candidates for treatment.

BACKGROUND: There is no clear consensus on the optimal type of fixation in intercalary allograft reconstruction. In this study, we aimed to compare the rate of most common complications following the plate and nail fixation of the intercalary allograft. MATERIALS AND METHODS: We searched PubMed, EMBASE, Web of Science, Scopus, and Cochrane Library. Studies in which the complication rate of the single bridging plate and intramedullary nail fixation was extractable were included. Studies that used extra procedures such as cementation and fibular vascular graft augmentation were excluded. The primary outcome was the fixation-specific rate of nonunion. Secondary outcomes were the fixation-specific rate of fracture, infection, and local recurrence. RESULTS: In total, 13 studies with 431 reconstructions (352 reconstructions in the plate group and 79 reconstructions in the intramedullary nailing group) were included in this study. In the plate fixation, the rate of nonunion, fracture, infection and local recurrence was 12%, 11%, 11%, and 3%, respectively. In the intramedullary nail fixation, the rate of nonunion, fracture, infection, and local recurrence was 37%, 5%, 4%, and 0%, respectively. The rate of nonunion was significantly higher in the intramedullary nail group (OR = 6.34; 95% CI 2.98–13.49, P

Road transportation is the main source of greenhouse gas (GHG) emissions in Iran. Different road transport emissions reduction strategies (RTERS) can be defined to address this environmental problem. The present study aims to define a comprehensive set of RTERS according to the socio-economic conditions of Iran. Then, the defined strategies are evaluated using a new hybrid decision-making technique developed by integrating the conventional Q-methodology (QM), best–worst method (BWM) and evidential reasoning (ER) approach. The main advantages of the developed methodology include: simple Q-sorting, the capability of checking inconsistency ratio of judgments and dealing with uncertainty. A set of thirty-three RTERS was defined and then categorized into the following seven main strategies, including travel demand management (TDM), public transport management (PTM), traffic flow management (TFM), education, urban planning and development (UPD), and governmental rules and regulations (GRR). These strategies were assessed based on the views of twenty-three experts and government officials. Five perspectives on the importance of RTERS were derived using BWM and QM: 1—PTM-FCM, 2—UPD, 3—TDM, 4—FCM-PTM and 5—FCM. Finally, the ER approach was employed to aggregate these viewpoints. The aggregated perspective highlights that improving fuel quality and HOV systems are the most effective RTERS, while the mitigation policies based on deterrent rules and regulations are the least effective strategies. Accordingly, some managerial implications and suggestions are provided in this study.

Objective:The UK is one of the epicenters of coronavirus disease (COVID-19) in the world. As of April 14, there have been 93 873 confirmed patients of COVID-19 in the UK and 12 107 deaths with confirmed infection. On April 14, it was reported that COVID-19 was the cause of more than half of the deaths in London.Methods:The present paper addresses the modeling and forecasting of the outbreak of COVID-19 in the UK. This modeling must be accomplished through a 2-part time series model to study the number of confirmed cases and deaths. The period we aimed at a forecast was 46 days from April 15 to May 30, 2020. All the computations and simulations were conducted on Matlab R2015b, and the average curves and confidence intervals were calculated based on 100 simulations of the fitted models.Results:According to the obtained model, we expect that the cumulative number of confirmed cases will reach 282 000 with an 80% confidence interval (242 000 to 316 500) on May 30, from 93 873 on April 14. In addition, it is expected that, over this period, the number of daily new confirmed cases will fall to the interval 1330 to 6450 with the probability of 0.80 by the point estimation around 3100. Regarding death, our model establishes that the real case fatality rate of the pandemic in the UK approaches 11% (80% confidence interval: 8%–15%). Accordingly, we forecast that the total death in the UK will rise to 35 000 (28 000–50 000 with the probability of 80%).Conclusions:The drawback of this study is the shortage of observations. Also, to conduct a more exact study, it is possible to take the number of the tests into account as an explanatory variable besides time.

Summary Background We evaluated the frequency of incidental papillary thyroid microcarcinomas (mPTC) in thyroidectomies performed for benign diseases, to better characterize this nosologic entity and to assess the best treatment. Methods Between 2009 and 2017, a total of 1777 patients underwent surgery for benign thyroid disease. Patients with preoperative undetermined or positive for malignancy cytology were excluded, as well as incidental thyroid cancer larger than 1 cm. Results Total thyroidectomy was performed in 1649 patients (92.7%) and hemithyroidectomy in 128 (7.2%). Papillary thyroid cancer, sized between 2–10 mm, was found in 89 patients (5%), which were all by definition microcarcinomas (mPTC). In 11 patients mPTCs were multifocal and in 7 bilateral. Just 6 patients received hemithyroidectomy and later underwent radical surgery without complications. No tumor-related morbidity or mortality was observed. The χ2 test showed a statistically significant association between mPTC and non-toxic multinodular goiter. Discussion In the literature, the rates of incidental mPTC vary, due to various factors such as histopathological examination and sampling numbers. Regarding surgical treatment, some authors support a “conservative” approach for the positive prognosis, but considering that it can be associated with mortality, lymph node recurrence and metastasis, its treatment is still controversial. Conclusions Our experience confirms that total thyroidectomy in multinodular goiter is a safe procedure, which ensures endocrine control and oncologic complete tumor resection, in case of mPTC. In uninodular goiter, we recommend hemithyroidectomy; if mPTC is discovered, we suggest radical surgery especially in patients older than 50 years and with familial disposition for thyroid cancer and peripheral tumors larger than 5 mm and aggressive variants.

Most common machine learning (ML) algorithms usually work well on balanced training sets, that is, datasets in which all classes are approximately represented equally. Otherwise, the accuracy estimates may be unreliable and classes with only a few values are often misclassified or neglected. This is known as a class imbalance problem in machine learning and datasets that do not meet this criterion are referred to as imbalanced data. Most datasets of soil classes are, therefore, imbalanced data. One of our main objectives is to compare eight resampling strategies that have been developed to counteract the imbalanced data problem. We compared the performance of five of the most common ML algorithms with the resampling approaches. The highest increase in prediction accuracy was achieved with SMOTE (the synthetic minority oversampling technique). In comparison to the baseline prediction on the original dataset, we achieved an increase of about 10, 20 and 10% in the overall accuracy, kappa index and F‐score, respectively. Regarding the ML approaches, random forest (RF) showed the best performance with an overall accuracy, kappa index and F‐score of 66, 60 and 57%, respectively. Moreover, the combination of RF and SMOTE improved the accuracy of the individual soil classes, compared to RF trained on the original dataset and allowed better prediction of soil classes with a low number of samples in the corresponding soil profile database, in our case for Chernozems. Our results show that balancing existing soil legacy data using synthetic sampling strategies can significantly improve the prediction accuracy in digital soil mapping (DSM). Highlights Spatial distribution of soil classes in Iran can be predicted using machine learning (ML) algorithms. The synthetic minority oversampling technique overcomes the drawback of imbalanced and highly biased soil legacy data. When combining a random forest model with synthetic sampling strategies the prediction accuracy of the soil model improves significantly. The resulting new soil map of Iran has a much higher spatial resolution compared to existing maps and displays new soil classes that have not yet been mapped in Iran., Alexander von Humboldt‐Stiftung http://dx.doi.org/10.13039/100005156, German Research Foundation http://dx.doi.org/10.13039/501100001659, Soil and Water Research Institute, Agricultural Research, Education and Extension Organization, Karaj, Iran

COVID-19 outbreak has put the whole world in an unprecedented difficult situation bringing life around the world to a frightening halt and claiming thousands of lives. Due to COVID-19’s spread in 212 countries and territories and increasing numbers of infected cases and death tolls mounting to 5,212,172 and 334,915 (as of May 22 2020), it remains a real threat to the public health system. This paper renders a response to combat the virus through Artificial Intelligence (AI). Some Deep Learning (DL) methods have been illustrated to reach this goal, including Generative Adversarial Networks (GANs), Extreme Learning Machine (ELM), and Long/Short Term Memory (LSTM). It delineates an integrated bioinformatics approach in which different aspects of information from a continuum of structured and unstructured data sources are put together to form the user-friendly platforms for physicians and researchers. The main advantage of these AI-based platforms is to accelerate the process of diagnosis and treatment of the COVID-19 disease. The most recent related publications and medical reports were investigated with the purpose of choosing inputs and targets of the network that could facilitate reaching a reliable Artificial Neural Network-based tool for challenges associated with COVID-19. Furthermore, there are some specific inputs for each platform, including various forms of the data, such as clinical data and medical imaging which can improve the performance of the introduced approaches toward the best responses in practical applications.

Dietary patterns among South African older adults indicate a moderate intake of total fat and salt, as well as a high sugar intake. Total fat, saturated fat, sugar and salt intakes are associated w...

Photonic reservoir computing (RC) enables us to introduce artificial neural networks (ANNs) as a deployable hardware-based processing unit beyond the von Neumann architecture. Its unique approach to consider only the output layer weights as adaptive, reduces training complexity and enables the use of ANNs in time-sensitive areas like optical communications. In this paper, we numerically investigate and evaluate the requirements of a photonic RC using an active silicon micro-ring resonator as a photonic integrated circuit (PIC) based reservoir system to compensate for transmission impairments such as chromatic dispersion and nonlinear effects occurring in optical transmission systems. We compare the performance of this RC with results from digital signal processing using Kramers-Kronig reception of distorted PAM-4 symbols from a 56 GBaud WDM transmission experiment over 100 km uncompensated SSMF.

Complement dysfunction results in impaired ability in clearing apoptotic cell debris that may stimulate autoantibody production in systemic lupus erythematosus (SLE). Herein, we provided a comprehensive search to find and meta-analyze any complement gene polymorphisms associated with SLE. The ITGAM, C1q, and MBL gene polymorphisms were included in this meta-analysis to reveal the exact association with SLE risk. Electronic databases, including Scopus, PubMed, and Google Scholar, were searched to find studies investigating the ITGAM, C1q, and MBL gene polymorphisms and SLE risk in different populations. The pooled odds ratio (OR) and its corresponding 95% confidence interval (CI) were used to analyze the association between ITGAM, C1q, and MBL gene polymorphisms and susceptibility to SLE. According to inclusion criteria, a total of 24 studies, comprising 4 studies for C1QA rs292001, 5 studies for C1QA rs172378, 9 studies for ITGAM rs1143679, 8 studies for MBL rs1800450, 3 studies for MBL2 rs1800451, and 3 studies for MBL2 rs5030737, were included in the final meta-analysis. A significant positive association was found between rs1143679 and SLE risk, while rs1800451 significantly associated with decreased SLE susceptibility. In summary, ITGAM gene rs1143679 SNP and MBL gene rs1800451 SNP were positively and negatively associated with SLE risk, respectively.

Coronavirus disease 2019 (COVID-19) and its spread prevention actions (SPAs) have affected a large number of human activities globally in 2020-2021. Temporary lockdowns, stay-at-home policies, movement restrictions, and personal health care actions have relatively changed the daily life routine in urban areas which can eventually affect the characteristics of municipal wastewater (MW). This study evaluates the performance of wastewater treatment plants (WWTPs) during COVID-19 pandemic and related SPAs. This evaluation also considers MW variations in quality and quantity and compares the performance of WWTPs (2020) with earlier data (2015–2019). For this purpose, 23 WWTPs located in Isfahan province, Iran, were chosen as the study area and classified based on their locations, biological treatment unit, and capacities. Results indicate that the inflow of WWTPs increased 20 % on average during SPAs, while the concentrations of COD and BOD in MW decreased 23 and 16 %, respectively. Nevertheless, the performance of WWTPs remained rather constant. It is concluded that increasing the dilute domestic proportion of MW, particularly in smaller communities, as a matter of COVID-19 SPAs could not impose adverse impacts on wastewater treatment operations and pollution removal. Different types of secondary treatment units, such as activated sludge, stabilization pond, and aerated lagoon showed stable performances. However, disinfection was enhanced in WWTPs in order to reduce the probability of viral transmission via wastewater for reuse. This study also recommends that the characteristics of MW, and not treated wastewater, can be used as an indicator for coordinating SPAs in similar epidemics. This notification can be helpful for the management of WWTPs and risk control in urban areas.

Background During the first wave of COVID‐19, many Iranians were poisoned by ingesting hand sanitizers and/or alcoholic beverages to avoid viral infection. To assess whether the COVID‐19 pandemic resulted in an increased prevalence of accidental hand sanitizer/alcoholic beverage exposure in children and adolescents, we compared pediatric hospitalization rates during COVID‐19 and the previous year. For poisoning admissions during COVID‐19, we also evaluated the cause by age and clinical outcomes. Methods This retrospective data linkage study evaluated data from the Legal Medicine Organization (reporting mortalities) and hospitalization data from nine toxicology referral centers for alcohol‐poisoned patients (age 0 to 18 years) for the study period (February 23 to June 22, 2020) and the pre‐COVID‐19 reference period (same dates in 2019). Results Hospitalization rates due to ethanol and methanol exposure were significantly higher in 2020 (n = 375) than 2019 (n = 202; OR [95% CI] 1.9 [1.6, 2.2], p, During the first wave of COVID‐19 pandemic, Iran experienced the worldwide biggest methanol outbreak recorded to date. The outbreak triggered by consumption of toxic alcoholic beverages or hand sanitizers, partially motivated by the belief that ingestion would protect against COVID‐19 infection. Our study shows that children and adolescents were also affected, with 22 deaths due to methanol exposure recorded in 2020. These were significantly higher in Feb‐June 2020 (during COVID‐19), compared to the corresponding time period in 2019.

OBJECTIVE By using machine learning, our study aimed to build a model to predict risk and time to total knee replacement (TKR) of an osteoarthritic knee. METHODS Features were from the Osteoarthritis Initiative (OAI) cohort at baseline. Using the lasso method for variable selection in the Cox regression model, we identified the 10 most important characteristics among 1,107 features. The prognostic power of the selected features was assessed by the Kaplan-Meier method and applied to 7 machine learning methods: Cox, DeepSurv, random forests algorithm, linear/kernel support vector machine (SVM), and linear/neural multi-task logistic regression models. As some of the 10 first-found features included similar radiographic measurements, we further looked at using the least number of features without compromising the accuracy of the model. Prediction performance was assessed by the concordance index, Brier score, and time-dependent area under the curve (AUC). RESULTS Ten features were identified and included radiographs, bone marrow lesions of the medial condyle on magnetic resonance imaging, hyaluronic acid injection, performance measure, medical history, and knee-related symptoms. The methodologies Cox, DeepSurv, and linear SVM demonstrated the highest accuracy (concordance index scores of 0.85, Brier score of 0.02, and an AUC of 0.87). DeepSurv was chosen to build the prediction model to estimate the time to TKR for a given knee. Moreover, we were able to decrease the features to only 3 and maintain the high accuracy (concordance index of 0.85, Brier score of 0.02, and AUC of 0.86), which included bone marrow lesions, Kellgren/Lawrence grade, and knee-related symptoms, to predict risk and time of a TKR event. CONCLUSION For the first time, we developed a model using the OAI cohort to predict with high accuracy if a given osteoarthritic knee would require TKR, when a TKR would be required, and who would likely progress fast toward this event.

This case report describes a 31-year-old man with 10 years of cocaine and cannabis dependence who developed reverse Takotsubo cardiomyopathy (rTC), a rare variant of Takotsubo cardiomyopathy. He presented to the Emergency Department (ED) with severe left temporal headache and vomiting which began whilst smoking cannabis and several hours after smoking methamphetamine and using cocaine via insufflation. Computed tomography and angiography of the brain was normal, and the headache resolved with analgesia. Urine drug screen was positive for benzodiazepines, cannabinoids, cocaine, opiates (attributed to morphine administered in ED) and amphetamines. Three hours later he had a seizure and within 10 min developed cardiogenic shock with antero-inferior ST segment depression on electrocardiogram and troponin-T rise to 126 ng/L. Coronary angiography demonstrated normal coronary arteries. Transthoracic echocardiogram demonstrated severely impaired left ventricular (LV) systolic function with ejection fraction 15–20% and hypokinesis sparing the apex. Thyrotoxicosis, nutritional, vasculitic, autoimmune and viral screens were negative. Cardiac magnetic resonance imaging demonstrated severe LV functional impairment with dilated and hypocontractile basal segments, and T2 hyperintensity consistent with myocardial oedema and rTC. He received supportive management. Proposed mechanisms of rTC include catecholamine cardiotoxicity and coronary artery vasospasm. In this case, multiple insults including severe headache, cannabis hyperemesis and cocaine and methamphetamine-induced serotonin toxicity culminated in a drug-induced seizure which led to catecholamine cardiotoxicity resulting in rTC. Clinicians should be cognizant of stress cardiomyopathy as a differential diagnosis in patients with substance use disorders.

Introduction: Congenital heart disease is the most common congenital anomaly. About 50% of Neonates with congenital heart disease are asymptomatic in the first few days of life and are not diagnosed on initial examination. Pulse oximetry is a non-invasive method that can show the percentage of oxygen saturation in the blood and congenital heart disease. Methods: This was a descriptive cross-sectional study and the sampling method was census. Echocardiography was performed for all neonates with spo2 less than 95% and also neonates who were diagnosed with a problem by a cardiologist. After collecting the samples, the results obtained from pulse oximetry, physical examination and echocardiography were analyzed using SPSS software version 16 and statistical tests of Kolmogorov-Smirnov normality and Spearman correlation. Was investigated. Results: In pulse oximetry evaluation, 1.9% of neonates had spo2 (arterial oxygen saturation) less than 95%. 1.7% of neonates had heart problems in physical examination and 2.12% of neonates had heart problems in echocardiography. The highest correlation between pulse oximetry and echocardiography was 0.917. Conclusion: Considering the diagnostic importance of congenital heart diseases and their impact on a person's life, it is recommended that pulse oximetry be added to physical examinations at birth as a screening method for heart disease.

Introduction: Aluminum phosphide (ALP), locally known as "Rice Tablet", is a cheap and powerful pesticide used frequently to protect cereals. Cases of ALP toxicity have grown dramatically in recent decades by using it for suicide purposes. Treatment of ALP toxicity is largely supported by various remedies as there is no specific antidote. This study deals with the epidemiology of ALP toxicity in Khuzestan (Iran) and assesses the clinical and paraclinical manifestations, as well as the results of various treatments during the last 12 years. The study further examines the next suicidal intentions and subsequent complications of poisoning with ALP. Methodology: The records of all patients with ALP toxicity admitted to Razi Hospital in Ahvaz from 2006 to 2017 were reviewed within a retrospective study. Epidemiological and demographic information, clinical and paraclinical manifestations, and the results of various treatments were extracted. Data on the subsequent complications and the next suicidal intentions in those who have survived a suicide attempt were gathered and analyzed. Results: Of the 48 patients studied, 50% were male and the mean age was 29.33±10.45. Most of the toxicities were orally and with the intention of suicide in Ahvaz and Andimeshk. A total of 71.42% of the dead have been carried to this center. The majority of cases were reported from urban areas and in August and during summer. The most prevalent clinical signs were loss of consciousness, nausea, and vomiting. There were some differences in the experimental and EKG results. A meaningful correlation was observed between the administration and/or consumption of ranitidine, NAC, and intravenous sodium bicarbonate with treatment outcomes. Only one case of reattempt to suicide has been reported, and hematuria, ascites, and pleural effusion were widely visible in survivors. Conclusion: On-call counseling may decrease the rate of mortality in dispatching patients. Clinical and paraclinical manifestations can be useful in the diagnosis or prognosis. Patients' follow-up, actions to enhance public awareness, restrictions on the distribution of ALP, and availability of alternative substances can be helpful to diminish cases of ALP toxicity and/or death. Keywords: Aluminum phosphide (ALP), Rice tablets, Poisoning, Khuzestan

Alzheimer’s disease (AD) consists of the gradual process of decreasing volume and quality of neuron connection in the brain, which consists of gradual synaptic integrity and loss of cognitive functions. In recent years, there has been significant attention in AD classification and early detection with machine learning algorithms. There are different neuroimaging techniques for capturing data and using it for the classification task. Input data as images will help machine learning models to detect different biomarkers for AD classification. This marker has a more critical role for AD detection than other diseases because beta-amyloid can extract complex structures with some metal ions. Most researchers have focused on using 3D and 4D convolutional neural networks for AD classification due to reasonable amounts of data. Also, combination neuroimaging techniques like functional magnetic resonance imaging and positron emission tomography for AD detection have recently gathered much attention. However, gathering a combination of data can be expensive, complex, and tedious. For time consumption reasons, most patients prefer to throw one of the neuroimaging techniques. So, in this review article, we have surveyed different research studies with various neuroimaging techniques and ML methods to see the effect of using combined data as input. The result has shown that the use of the combination method would increase the accuracy of AD detection. Also, according to the sensitivity metrics from different machine learning methods, MRI and fMRI showed promising results.

PURPOSE To compare postoperative complications of laparoscopic surgery (LS) with open surgery (OS) in surgical intussusception patients. METHODS From March 2015 to February 2018, infants between 6 to 24 months old had the clinical and sono-graphical signs of intussusception enrolled in this double-blind, randomized clinical trial. We divided surgical intussusception patients into two groups. In the LS group, we evaluated patients by direct laparoscopic observation, on-table hydrostatic enema, and mechanical reduction of intussusception. In the OS group, we performed the conventional technique. These patients were followed for 2 years after procedures for comparison of postoperative complications between the two groups. RESULTS We had 52 patients who needed surgical exploration (26 in each group). There were four (15%) and seven (27%) patients with self-reduced intussusception in LS and OS groups, respectively. The conversion rate was 31% (eight cases). Five cases (19%) in the LS group and four cases (15%) in the OS group needed bowel resections. Operating time was longer in the LS group (P ≤ 0.006), and the postoperative complication rate was higher in the OS group (P ≤ 0.021). DISCUSSION Laparoscopy is a screening tool to determine the need for OS in surgical intussusception patients. Laparoscopy reduces the incidence of OS and its complications.

Variations in load demands, changes in system parameters, and the continuous integration of renewable energy sources leave scopes of improvements in the performance of a load frequency controller (LFC). To address such issues, a gravitational search algorithm (GSA)-based LFC is proposed to incorporate dynamic state variations in multiarea power systems. It helps to minimize the frequency deviations in individual areas and power deviations in the tie lines maintaining the system stability. The proposed method is validated on a two-area photovoltaic (PV) integrated thermal power system.

Introduction: Lead is a heavy metal with vast usage in the industry. Lead toxicity affects any organ in the body. It causes various clinical presentations, which leads to diagnostic complexity. Regarding recent increased observation of cases with lead toxicity in our center, we aimed to evaluate the frequencies of lead toxicity in patients referred to Imam-Reza Hospital’s laboratory and find a possible relationship between the blood lead level (BLL) and hematological and biochemical tests. Methods: From 2016 to 2017, the patients referred to Imam-Reza hospital’s laboratory to detect BLL enrolled in the study. Among them, 254 adult cases with BLLs≥10 μg/dl were selected. Complete blood counts and peripheral blood smear were done. Other lab data were extracted from hospital files. Results: The mean BLL of 1649 participants was 59.11±116.25 μg/dl, ranging from 0 to 1580. Sixty nine percent of them had lead toxicity. Eighty-one percent (n=1341) of patients were males and 18.7% (n=308) were females. In 254 selected cases, the mean BLL was 138.17±189.98 μg/dl. There were significant inverse correlations between BLL and red blood cell counts, hemoglobin, mean cell hemoglobin, total iron-binding capacity, target shape and basophilic stippling, as well as positive correlations between BLL and white blood cell counts, red cell distribution width, neutrophil counts and iron. Conclusion: Lead toxicity seems to be more frequent than it is expected. Patients with unexplained anemia with increased iron and decreased total iron-binding capacity are better to be evaluated for BLL.

Intraoperative pathologic diagnosis traditionally involves frozen section histopathology, which may be labor and time intensive. Indeed, a technique that streamlines the acquisition and evaluation of intraoperative histologic data may expedite surgical decision-making and shorten operative time. Stimulated Raman histology (SRH) is an emerging technology that allows for more rapid acquisition and interpretation of intraoperative histopathologic data.A blinded, prospective cohort study was performed for 82 patients undergoing resection for a central nervous system tumor. Of these, 21 patients were diagnosed with glioma either intraoperatively or postoperatively on permanent section histology and included in this study. Time to diagnosis (TTD) and diagnostic accuracy relative to permanent section (the gold standard) were compared between SRH-based diagnosis and conventional frozen section histology. Diagnostic concordance with permanent section was also compared between frozen histopathology and SRH diagnosis.Diagnostic accuracy was not significantly different between methods (P = 1.00). Diagnostic concordance was not significantly different between methods when comparing 95% confidence intervals for kappa values (κ = 0.215; κ = 0.297; κ = 0.369). Lastly, mean TTD was significantly shorter with SRH-based diagnosis compared with frozen section (43 vs. 9.7 minutes, P0.0001). SRH was able to identify key features associated with varying glioma types.SRH allows for rapid intraoperative diagnosis without sacrificing diagnostic accuracy. SRH may serve as a promising adjuvant to conventional histopathology to expedite intraoperative pathology consultation and surgical decision-making.

It seems that the main goal of Islamic finance is equal distribution because Islam believes that the mass exploitation of resources for obtaining maximum profits could create inequity in society; besides the principles of Islamic transaction are required to check inequities, exploitation and the creation of an imbalance in Islamic society by using a different type of concepts, rules and principles to eradicate unjust enrichment. In other words, Islamic banks are in the race to innovate and introduce many numbers of products and services to remain competitive in the industry as well as profitable. In order to compete with conventional banks and capture greater profits and market share, Islamic banks are making huge ef-forts to acquire the maximum number of customers by providing and offering a large number of products as an alternative for interest-based banking services and products. Malaysia is one of the first countries in the world that started Islamic banking and supported this type of banking for customers around the world. It has been argued that this country is the most developed nation in the world in the area of Islam-ic banking and the competition that exists between Islamic banking and convention banking methods is very fierce. This paper summarizes different phase of Islamic banking in this country and the steps that has been passed by this nation to have such a success in the banking industry.

The accurate determination of strength parameters of rocks such as uniaxial compressive strength (UCS) and elastic modulus (E) using direct and laboratory methods require substantial time and cost. Therefore, the production of predictive relationships and models to forecast the UCS and E is of critical necessity in rock engineering. This study deals with the estimation of UCS and E of sandstones from petrographic characteristics by an artificial neural network (ANN) and multiple regression. For this purpose, 130 core specimens were prepared from sandstones in different locations in Iran. The specimens were tested to determine UCS, E, dry density, and porosity. Also, the petrographic studies including the determination of 11 textural and mineralogy parameters were performed on selected samples. The performance of the ANN model and regression analysis was evaluated using the criteria such as correlation coefficient (R), root mean squared error (RMSE), and variance account for (VAF). According to the ANN results, values of R, RMSE, and VAF were obtained to be 0.925, 0.089, and 97% for UCS and 0.876, 0.094, and 96% for E, respectively. In comparison, for the MLR model, the obtained R, RMSE, and VAF were 0.845, 0.101, and 95% for UCS and 0.797, 0.116, and 93% for E, respectively. A comparison between the findings illustrated that the ANN model was more suitable for forecasting the UCS and E compared with the MLR method.

The current study proposes a new DEA model to evaluate the efficiency of 39 Chinese commercial banks over the period 2010–2018. The paper also, in the second stage, investigates the inter-relationships between efficiency and some bank-specific variables (i.e. bank profitability, bank size, expenses management, traditional business and non-traditional business) under the Robust Endogenous Neural Network Analysis. The findings suggest that the sample of Chinese banks experiences a consistent increase in the level of bank efficiency up to 2015; the efficiency score is 0.915, after which the efficiency level declines and then experiences a slight volatility, while finally ending up with an efficiency score of 0.746 by the end of 2018. We also find that among different bank ownership types, the state-owned banks have the highest efficiency, the rural commercial banks are found to be least efficient and the foreign banks experience the strongest volatility over the examined period. The second-stage analysis shows that bank size exerts a positive influence on the development of non-traditional banking business and a proactive expense management, bank size and non-traditional businesses have a positive impact on efficiency levels, while bank profitability, traditional businesses and expenses management have negative influences on bank efficiency.

Widespread investigation has revealed the promising ability of suicidal genes in the treatment of glioma tumors; nevertheless, promoting their effects relies on the ability to apply suitable vehicles and techniques. In this study, the safety and feasibility of using bone marrow-derived mesenchymal stem cells (MSCs) in combination with prodrug for treatment of patients with primary and secondary glioblastoma multiform (GBM) was assessed. Five GBM patients were recruited. Following gross total resection of the tumor and adjuvant radiotherapy and chemotherapy, intracerebral injection of autologous MSCs transduced with lentivirus containing herpes simplex virus thymidine kinase (HSV-TK) was performed followed by intravenous administration of ganciclovir for 2 weeks. The treatment was well tolerated by all patients. Mild-to-moderate fever, headache, and cerebrospinal fluid leukocytosis were evident in three, two, and one patient, respectively. The progression-free survival (PFS) and overall survival (OS) of patients were 95.79 ± 51.40 and 128.85 ± 48.81 weeks, respectively. The 1-year PFS and OS were 60% and 100%, respectively, among our patients, and two patients had more than 3 years of OS and more than 2 years of PFS. It seems that intracerebral administration of bone marrow MSC containing the HSV-TK gene in combination with intravenous ganciclovir would be safe and feasible in the treatment of patients with GBM.