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In this paper, a new triple-switch triple-mode (TS-TM) high step-up DC-DC converter has been proposed. The proposed converter consists of three switches, four diodes, two magnetically coupled inductors, and three capacitors. This converter can provide a high voltage conversion ratio with high power efficiency and low voltage stress across the power semiconductor components. Due to the low voltage stresses of the power semiconductors and implementing the coupled inductors technique, the proposed converter is a low-cost and high-efficient structure in comparison to the other similar TS-TM structures. In order to clarify the advantages of the proposed converter, the required mathematical calculations and comparison results with similar converters are presented. Also, a novel TS-TM with transformer (TS-TMTR) has been proposed to overcome the electromagnetic interface (EMI) problems. Furthermore, a 500W experimental prototype is built and its performance with different values of duty cycles has been tested to prove the claimed features of the proposed converter. 94.5% maximum power efficiency of the assembled prototype has been obtained at 260W output power.

Early detection of infectious diseases is crucial for reducing transmission and facilitating early intervention. In this study, we built a real-time smartwatch-based alerting system that detects aberrant physiological and activity signals (heart rates and steps) associated with the onset of early infection and implemented this system in a prospective study. In a cohort of 3,318 participants, of whom 84 were infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), this system generated alerts for pre-symptomatic and asymptomatic SARS-CoV-2 infection in 67 (80%) of the infected individuals. Pre-symptomatic signals were observed at a median of 3 days before symptom onset. Examination of detailed survey responses provided by the participants revealed that other respiratory infections as well as events not associated with infection, such as stress, alcohol consumption and travel, could also trigger alerts, albeit at a much lower mean frequency (1.15 alert days per person compared to 3.42 alert days per person for coronavirus disease 2019 cases). Thus, analysis of smartwatch signals by an online detection algorithm provides advance warning of SARS-CoV-2 infection in a high percentage of cases. This study shows that a real-time alerting system can be used for early detection of infection and other stressors and employed on an open-source platform that is scalable to millions of users., In a prospective study, a smartwatch-based alerting system was able to detect pre-symptomatic and asymptomatic SARS-CoV-2 infection in a high percentage of cases.

Recent series have raised concerns about the oncologic outcomes of transanal total mesorectal excision for mid and low rectal cancer. There is a paucity of large data sets from the United States to contribute to the ongoing international discourse.This study aimed to investigate the rate of local recurrence and other oncologic outcomes in patients undergoing transanal total mesorectal excision for rectal adenocarcinoma.This study is a retrospective review of patients undergoing transanal total mesorectal excision for primary rectal cancer from January 2014 to December 2019.This study was conducted at a single academic tertiary care medical center in the United States.Consecutive patients aged ≥18 years undergoing surgical resection for primary rectal cancer were selected.The transanal total mesorectal excision procedures were performed utilizing a 2-team approach.Primary outcomes were pathologic quality, local and distant recurrence, treatment-related complications, and overall- and cancer-specific survival.Seventy-nine consecutive patients were included. The median age was 58 years (interquartile range, 50-64), and median BMI was 28 kg/m2 (interquartile range, 24.6-32.4). The mesorectum was complete in 69 patients (87.3%), nearly complete in 9 (11.4%), and incomplete in 1 (1.3%). There was circumferential resection margin involvement (1 mm) in 4 patients (5.1%), and no patients had a positive distal margin (1 mm) or intraoperative rectal perforation. Composite optimal pathology was achieved in 94.9% of specimens. Median follow-up was 29 months (range, 6-68). There were no local recurrences. Distant metastases were found in 10 (13.5%) patients and diagnosed after a median of 14 months (range, 0.6-53). Disease-free survival was 91.2% at 2 years, and overall survival was 94.7% at 2 years.Retrospective design, a single center, and relatively short follow-up period were limitations of this study.The oncologic outcomes of this cohort support the use of transanal total mesorectal excision in the surgical management of mid to low rectal cancer at centers with appropriate expertise. See Video Abstract at http://links.lww.com/DCR/B723.ANTECEDENTES:Estudios recientes han suscitado preocupación sobre los resultados oncológicos de la excisión total del mesorecto por vía transanal en casos de cáncer de recto medio y bajo. Existe una gran escasez de conjuntos de datos en los Estados Unidos, para contribuir en el actual discurso internacional sobre el tema.OBJETIVO:Investigar la tasa de recurrencia local y otros resultados oncológicos en pacientes sometidos a una excisión total del mesorrecto por vía transanal por adenocarcinomas de recto.DISEÑO:Revisión retrospectiva de pacientes sometidos a excisión total del mesorecto por vía transanal en casos de cáncer de recto primario desde enero de 2014 hasta diciembre de 2019.AJUSTE:Centro médico Universitario de atención terciaria único en los Estados Unidos.PACIENTES:Aquellos pacientes consecutivos de ≥ 18 años de edad, sometidos a resección quirúrgica por cáncer de recto primario.INTERVENCIÓN:Los procedimientos de excisión total del mesorecto por vía transanal se realizaron utilizando un enfoque de dos equipos.PRINCIPALES MEDIDAS DE RESULTADO:Los resultados primarios fueron la calidad anatomo-patológica de las piezas, la recidiva local y a distancia, las complicaciones relacionadas con el tratamiento y la sobrevida global específica para el cáncer.RESULTADOS:Se incluyeron 79 pacientes consecutivos. La mediana de edades fue de 58 años (IQR, 50-64) y la mediana del índice de masa corporal fue de 28 kg / m (IQR, 24,6-32,4). El mesorrecto se encontraba completo en 69 pacientes (87,3%), casi completo en 9 (11,4%) e incompleto en 1 (1,3%). Hubo afectación de CRM (1 mm) en 4 pacientes (5,1%) y ningún paciente tuvo un margen distal positivo (1 mm) o perforación rectal intraoperatoria. La histopatología óptima compuesta se logró en el 94,9% de las muestras. La mediana de seguimiento fue de 29 meses (rango 6-68). No se presentaron recurrencias locales. Se encontraron metástasis a distancia en 10 (13,5%) pacientes y se diagnosticaron después de una mediana de 14 meses (rango 0,6-53). La sobrevida libre de enfermedad fue del 91,2% a los 2 años y la sobrevida global fue del 94,7% a los 2 años.LIMITACIONES:Diseño retrospectivo, unicéntrico y período de seguimiento relativamente corto.CONCLUSIÓN:Los resultados oncológicos de este estudio de cohortes, apoyan la realización de excisión total del mesorecto por vía transanal para el tratamiento quirúrgico del cáncer de recto medio y bajo, en centros con la experiencia adecuada. Consulte Video Resumen en http://links.lww.com/DCR/B723. (Traducción-Dr. Xavier Delgadillo).

This study aims to compare the positive and negative symptoms of schizophrenia in patients who had psychotic symptoms more than one month after discontinuation of methamphetamine abuse. These factors were analyzed by the positive and negative syndrome scale (PANSS) questionnaire.Sixty participants were selected from patients referred to Iran Psychiatric Hospital with psychotic symptoms (delusions or hallucinations, disorganized behavior, and speech). The control group was 30 patients with schizophrenia based on a semi-structured interview according to DSMIV-TR (SCID). Thirty patients with a prolonged methamphetamine-induced psychotic disorder were also placed in the case group. For both groups of patients, questionnaires of PANSS, Brief Psychiatric Rating Scale (BPRS), and Global Assessment Of Functioning (GAF) were filled out after obtaining the companions' consent. The scale scores were compared between groups. We used the Mann-Whitney and the Chi-square test to evaluate the mean values of PANSS, BPRS, and GAF scores between the two groups.here was an insignificant difference in positive and general pathology scores between the two groups, but the total score of negative symptoms in the schizophrenia group was significantly higher than in the group of prolonged methamphetamine psychotic disorders (P=0.034). Average scores of uncooperativeness (0.008), difficulty in abstract thinking (0.004), motor retardation (0.002), unusual thought content (0.001), and hostility (0.011) in the schizophrenia group were significantly higher than those in the prolonged methamphetamine psychosis.The results showed that most of the disturbances in patients with schizophrenia might be more influenced by the expression of cognitive disabilities than those with methamphetamine psychosis. The difference in negative symptom scores suggests that schizophrenia and prolonged methamphetamine psychotic disorder can be two different disorders.General and positive symptoms scores don't have significant differences.Negative symptoms are much more in schizophrenia.Uncooperativeness, unusual thought content and, motor retardation have more scores in schizophrenia.In clinical practice, Schizophrenia and prolonged methamphetamine-induced psychotic disorder have some similar mental presentations. Additionally, in scientific literature, there is scarce evidence about these similarities. In this regard, this research was designed to investigate the aforementioned obscurity. Determination of similarities and differences between them helps us to address these disorders in terms of treatment and follow-up and awareness of their prognosis of them. This research is a case-control study in which we examine positive and negative psychotic symptoms in schizophrenia and prolonged methamphetamine-induced psychotic disorder. Researchers investigated psychotic symptoms with positive and negative syndrome scale (PANSS), brief psychiatric rating scale (BPRS), and global assessment of functioning (GAF) questionnaires. Moreover, results demonstrate general and positive symptoms scores don't have many differences but negative symptoms are much more in patients with schizophrenia than in patients with a prolonged methamphetamine-induced psychotic disorder. Also, other features like uncooperativeness, unusual thought content, motor retardation, difficulty in abstract thinking, and hostility have higher scores in schizophrenia than the others. In conclusion, this research showed that these disorders are two distinct disorders with some similarities in positive symptoms but not in all features. So, some studies can be designed about why there are similarities between them?

Purpose Timely identification and treatment of intracranial hematomas in patients with brain injury is essential for successful treatment. This study evaluates Infra-scanner as a handy medical screening tool for diagnosing, on-site, cerebral hematomas in patients with head injury. Materials and methods Patients referred to the emergency department of university hospitals with mild to moderate brain trauma, up to 12 h from injury were included. NIR sensors of infra-scan device were placed on the right and left frontal, temporal, peritoneal and occipital parts of the head and light absorption was recorded. Positive or negative cerebral hemorrhage cases were compared with contrast-enhanced CT scan results as the gold standard. Diagnostic parameters of the device and cases related to bleeding were analyzed and reported. Results A total of 300 patients were studied. Sensitivity of the infrasound scanner in the Iranian study population was 94.8 (95% CI: 88% -100) and its specificity was 86.9 (95% CI: 79% -99% 99). Negative predictive value (NPV) was 90.3% and positive predictive value (PPV) was 92.9%. Sensitivity in men (95.7%) (95%CI, 90% -1) was more than women (95% CI, 81% -99%)90%. At the ages of less than 36 years, sensitivity (95.3%) and specificity (87.1%) were more than sensitivity (94.4%) and specificity (86.5%) over 36 years old. If the test had been performed in less than / equal to two hours from trauma, the sensitivity (94.9%) and the specificity (92%) were greater than the sensitivity (94.6%) and the specificity (75%) during when the scan had been performed in more than two hours from trauma. In general, in extra-axial bleeding including EDH, SAH, SDH, the sensitivity was 95.1% and the specificity was 84.5%, while in intra-axial bleeding, including ICH and IVH, the sensitivity was lower (93.9%) and the specificity was 91.7. The sensitivity of the device in detecting bleeding in the occipital lobe (95.8%) was higher than other brain lobes. Conclusion This study shows that Infra-scanner is useful in initial examination and screening of patients with head injury and can be used as an adjunct to a CT scan or when not available and may allow earlier treatment which reduce the secondary damage to the hematoma.

Introduction: Asthma is defined as a chronic inflammatory airway disease. Recent studies have shown the association between metabolic syndrome and deterioration of lung functions in patients with asthma. The aim of this study was to evaluate the relationship between metabolic syndrome and asthma status. Methods: In this prospective cross-sectional study, 160 asthmatic patients attending Razi hospital in Guilan province were divided equally into two groups of 80 patients. The case group comprised asthmatic patient with metabolic syndrome and the control group involved asthmatic patient without metabolic syndrome. Blood pressure, height, weight, waist circumferences, fasting blood glucose and lipid profiles were measured by standard methods. Asthma severity was determined based on clinical symptoms and GINA criteria. To evaluate pulmonary function parameters, spirometry was performed for the patients. Results: Pulmonary function tests including FEF, FVC and FEV1 were significantly lower in the case group compared to the control group (P < 0.05). Also, a significant negative correlation was found between waist circumference, cardiovascular risk factors (including diabetes, hypertriglyceridemia, hypertension) with spirometric indices (P < 0.05). Conclusion: Metabolic syndrome causes major declines of pulmonary parameters in asthma patients; thus controlling metabolic syndrome might improve symptoms of asthma.

A stiffness-based method for the preliminary design of outrigger braced skyscrapers is proposed. The method is founded on the concept of uniform distribution of deformation. This approach originates from the minimum-compliance optimization, in which the stiffest layout for the structure is sought for a given amount of material. Design variables include: the flexural stiffness of the core structure, the outrigger-belt elevation, and the peripheral column dimensions. These parameters are specified by requiring the curvature to be kept constant, yet minimum, as long as the allowable stress and displacement constraints are imposed. The resulting procedure is presented through a simplified hand-calculation algorithmic framework, which may be used during the preliminary design stage to estimate the size of elements and to give an initial assessment of the structural behavior. In order to show the practical application of the proposed method, a structure equipped with one outrigger is designed using the proposed algorithm. The comparative analysis of the results reveals that the presented method provides a rather high degree of accuracy in practice.

Positron emission tomography (PET) offers an incredible wealth of diverse research applications in vascular disease, providing a depth of molecular, functional, structural, and spatial information. Despite this, vascular PET imaging has not yet assumed the same clinical use as vascular ultrasound, CT, and MR imaging which provides information about late-onset, structural tissue changes. The current clinical utility of PET relies heavily on visual inspection and suboptimal parameters such as SUVmax; emerging applications have begun to harness the tool of whole-body PET to better understand the disease. Even still, without automation, this is a time-consuming and variable process. This review summarizes PET applications in vascular disorders, highlights emerging AI methods, and discusses the unlocked potential of AI in the clinical space.

In this article, a novel ultrahigh voltage gain dc–dc boost converter with expandable diode-capacitor voltage multiplier (VM) cells is presented. The diode-capacitor VM cells and coupled inductors are employed in the presented topology to provide a higher voltage gain. Also, the main and the auxiliary power switches of the presented converter operate with zero voltage switching. The coupled inductors' leakage inductances control the rates of the current drop in the voltage multiplier diodes, which decreases their reverse recovery losses markedly. Moreover, the voltage stresses on all capacitors and semiconductors are reduced significantly. In this converter, the number of voltage multiplier cells, and the coupled inductors turn ratios provide three degrees of design freedom. These degrees of freedom are used to set the desired voltage stresses of the semiconductors within the desired range and to provide a high voltage gain at optimum duty cycles. The design and theoretical analysis of the presented converter are discussed. Finally, the performance of the presented converter is validated using a 500 W, 40 V/380 V laboratory prototype converter, and the experimental results confirm the theoretical calculation.

Background The present qualitative study was conducted to explain the experiences of secondary traumatic stress (STS) and its related factors in midwives working in maternity wards. Methods Data were collected using semi-structured interviews with 11 midwives working in the maternity wards of hospitals in Urmia, Iran, through in-depth interviews with open-ended questions. Data were analyzed using the conventional content analysis approach. Results The results of data analysis led to the extraction of three themes, seven main categories, and 18 subcategories. The first theme was “STS stimuli,” with the two categories of “Discriminatory approach to midwifery” and “The nature of the midwifery profession”. The second theme was “Traumatic outcomes”, which included the subcategories of “Psychological-emotional trauma”, “Physical trauma” and “Social trauma”. The third theme was “Risk management”, which had the two subcategories of “Reactive approach” and “Proactive approach”. Conclusions The results showed that, in addition to the traumatic nature of events that midwives experience during work as the secondhand victims, factors such as governance-organizational structure, unbalanced distribution of power, and poor supportive laws undermine their professional role and provide conditions conducive to STS. Therefore, avoiding traumatic situations and scientific and skill self-empowerment were the most important strategies adopted by the midwives in this study to prevent risky situations and cope with the consequences of STS. The participation of midwifery stakeholders in policy-making and adopting supportive legislation in redefining the position and role of midwives can play a major role in reducing STS and sustaining their role and position in maternal care.

Background Alveolar cleft grafting is a necessary procedure to restore bone defects. Randomized clinical trials (RCTs) are regarded as a golden standard for investigating the efficacy of treatments. Nevertheless, risk of bias (RoB) can still affect the validity of these trials. We aimed to conduct a systemic review of all control trials (CTs) using regenerative materials for alveolar cleft reconstructions to evaluate their RoB and perform a meta-analysis of new bone formation. Methods Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), EMBASE AND Google Scholar were searched up to October 2020. Thereafter, the articles underwent quality assessment (according to the Jadad scale and the Delphi list) for the evaluation of the RoB. Results A total of 15 trials met the inclusion criteria, none of which reached a full score. Of these, 20% didn't randomize the trails, 73,33% failed to describe the way of randomization, and none reported the double-blinded criteria. Furthermore, allocation concealment (99.9%), intention to treat (100%), and patient awareness (100%) were inadequately described. The meta-analysis found no significant difference between regenerative materials and iliac crest graft. Conclusion This review showed high RoB in CTs implying quality improvement of CTs is necessary. Meta-analysis showed no significant difference between the regenerative materials and autogenous grafts.

Introduction Up to now, numerous randomized controlled trials (RCTs) have examined various drugs as possible treatments for Coronavirus Disease 2019 (COVID-19), but the results were diverse and occasionally even inconsistent with each other. To this point,we performed a systematic review and meta-analysis to assess the comparative effectiveness of pharmacological agents in published RCTs. Areas covered A literature search was performed using PubMed, SCOPUS, EMBASE, and Web of Science databases. RCTs evaluating mortality and the average length of hospital stay to standard of care (SOC)/placebo/control were included. RCTs mainly were classified into five categories of drugs, including anti-inflammatory, antiviral, antiparasitic, antibody and antibiotics. Meta-analysis was done on 5 drugs classes and sub-group meta-analysis was done on single drugs and moderate or severe stage of disease. Expert opinion Mortality and the average length of hospital stay of COVID-19 patients were significantly reduced with anti-inflammatory drugs (odds ratio [OR]: 0.77, 95% confidence interval [CI]: 0.69 to 0.85, P

The emergence of high-throughput sequencing techniques has revealed a primary role of microRNAs (miRNAs) in a wide range of diseases, including cancers and neurodegenerative disorders. Understanding novel relationships between miRNAs and diseases can potentially unveil complex pathogenesis mechanisms, leading to effective diagnosis and treatment. The investigation of novel miRNA-disease associations, however, is currently costly and time consuming. Over the years, several computational models have been proposed to prioritize potential miRNA-disease associations, but with limited usability or predictive capability. In order to fill this gap, we introduce TSMDA, a novel machine-learning method that leverages target and symptom information and negative sample selection to predict miRNA-disease association. TSMDA significantly outperforms similar methods, achieving an area under the receiver operating characteristic (ROC) curve (AUC) of 0.989 and 0.982 under 5-fold cross-validation and blind test, respectively. We also demonstrate the capability of the method to uncover potential miRNA-disease associations in breast, prostate, and lung cancers, as case studies. We believe TSMDA will be an invaluable tool for the community to explore and prioritize potentially new miRNA-disease associations for further experimental characterization. The method was made available as a freely accessible and user-friendly web interface at http://biosig.unimelb.edu.au/tsmda/., Graphical abstract, This work proposes a novel model, TSMDA, for predicting miRNA-disease association using miRNA-target and disease-symptom information. TSMDA also encompasses two reliable negative sample selections to effectively predict miRNA-disease associations. TSMDA is freely available as a user-friendly web server for the community to explore potential associations for further experimental miRNA characterization.

This paper presents a vision-based crack detection approach for concrete bridge decks using an integrated one-dimensional convolutional neural network (1D-CNN) and long short-term memory (LSTM) method in the image frequency domain. The so-called 1D-CNN-LSTM algorithm is trained using thousands of images of cracked and non-cracked concrete bridge decks. In order to improve the training efficiency, images are first transformed into the frequency domain during a preprocessing phase. The algorithm is then calibrated using the flattened frequency data. LSTM is used to improve the performance of the developed network for long sequence data. The accuracy of the developed model is 99.05%, 98.9%, and 99.25%, respectively, for training, validation, and testing data. An implementation framework is further developed for future application of the trained model for large-scale images. The proposed 1D-CNN-LSTM method exhibits superior performance in comparison with existing deep learning methods in terms of accuracy and computation time. The fast implementation of the 1D-CNN-LSTM algorithm makes it a promising tool for real-time crack detection.

PURPOSE In 2016, Kaiser Permanente Northern California began regionalizing testicular cancer care using population-based tumor board review. This mixed methods evaluation describes implementation outcomes and learnings. METHODS We conducted in-depth interviews with key stakeholders, administered surveys to local oncologists and urologists, and used clinical data to evaluate changes in care delivery during 2015-2018. RESULTS An average of 135 patients with testicular cancer were diagnosed each year. Interviews with 16 key stakeholders provided several insights. Implementation resulted in high levels of satisfaction, was dependent on leadership and staff at various levels, and required technology and consulting solutions aligned to user agreements and clinical workflows. Of 123 local oncologists and urologists who completed surveys, 97% understood why care was regionalized and 89% agreed that tumor board review improved treatment decisions. Among 177 patients with stage I seminoma, the percentage appropriately observed rather than treated with adjuvant chemotherapy or radiation therapy increased from 48% (95% CI, 35 to 62) in 2015 to 87% (75 to 99) in 2018. Review altered care based on pathology and radiology re-review in 14.5 % of cases. CONCLUSION Regionalization was feasible and effective.

Background: The present study aimed to investigate the prevalence of substance use disorder in Iranian children and adolescents and its relationship with demographic characteristics and psychiatric comorbidities.Method: The data were taken from a national survey on the prevalence of psychiatric disorders in Iranian children and adolescents. The national survey was conducted on 30,532 children and adolescents aged 6-18 years. The psychiatric disorders were assessed by employing k-SADS-PL questionnaire and interviews carried out by 240 clinical psychologists with the participants and their parents. Data were analyzed by Chi-square test and logistic regression.Results: A total of 277 (0.97%) were diagnosed as people with substance use disorder which were further studied for comorbid disorders. Among the various types of drugs, hypnotic / sedative / anti-anxiety drugs were abused by 84 people (46.15%), cannabis by 68 (37.36%) and stimulants by 43 (23.63%). The variables of gender, place of residence, and father’s occupation and parents’ education level were identified as predictors of substance use disorder in children and adolescents. At the same time, 42.50% substances and alcohol abusing people had at least one comorbid psychiatric disorder and the highest Comorbidity was observed in oppositional defiant disorder, attention deficit and hyperactivity disorder and separation anxiety disorder (p≤0.05). Conclusions: The findings can be used in the prevention and treatment of substance use disorder and promotion of mental health in children and adolescents by focusing on the psychiatric comorbidities of people with substance use disorder.

Background: Guidelines do not suggest the routine use of methylprednisolone (MP) in patients with acute traumatic spinal cord injury (SCI). We tested the hypothesis regarding whether combination therapy with ceftriaxone and MP is superior to MP monotherapy in patients with acute traumatic SCI. Methods: In a randomized, triple-blind clinical trial, 60 patients with acute (first 8 hours of the injury) traumatic SCI were enrolled at the Tabriz University of Medical Sciences, Tabriz, Iran, between December 2016 and June 2017. Accordingly, the patients were randomly divided into 2 case and control groups (n = 30 each). Upon admission, all included patients received a bolus dose of MP at 33 mg/kg intravenously (IV) for 15 minutes. Then, after 45 minutes, MP infusion was continued for 24 to 48 hours at a 5.4 mg/kg IV dose. The case group received an additional dose of ceftriaxone at 1 g 2 times a day for 7 days through an IV route. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were checked and compared between case and control groups upon admission and on the fourth and eighth days. Also, sensory and motor functions were evaluated according to the American Spinal Injury Association (ASIA) grading score upon admission, on the third and seventh days, upon discharge and 6 months after admission. Results: Analyses showed a significant statistical difference between groups in the changes in CRP levels during days 1 and 4 (P = .001) and also during days 4 and 8 (P = .001). However, no significant statistical difference was detected in ESR levels changes between groups during days 1 and 4 (P = .073), and during days 4 and 8 (P = .069). ASIA scale was found to be significantly different between the MP plus ceftriaxone group and MP monotherapy upon admission and 6 months after treatment (P = .001 for both comparisons). However, the number of variations in the ASIA score had no significant statistical difference between groups 6 months after intervention (P = .465). Conclusion: The addition of ceftriaxone to the routine therapeutic protocol of acute SCI is accompanied by improved inflammation markers and functional outcomes 6 months after the intervention.

Background: Brucellosis in pregnancy is associated with severe outcomes ranging from abortion to neonatal development problems. Objective: The aim of this study is to evaluate the seroprevalence of brucellosis antibodies among pregnant women presented with spontaneous abortion and stillbirth. Methods: In this cross-sectional study, 80 cases (stillbirth or spontaneous abortion) and 80 healthy pregnant women were serologically examined for brucellosis antibodies using Coombs, Wright and 2-mercaptoethanol (2ME) brucella agglutination tests. The questionnaire consisting of the following data was prepared for all the participants: gestational age, age, history of abortion, parity, source of dairy consumption, contact with livestock, urban or rural living setup, serological outcomes and education levels. Results: The two groups were not significantly different in terms of the brucellosis test. Patients in the case group with and without infection were not significant in terms of contact with livestock, place of residence, dairy consumption, and history of abortion. However, education level was significantly different in the two, seropositive and seronegative, groups. Conclusion: Our study did not find a significant number of seropositive brucellosis cases associated with stillbirth and spontaneous abortion. Further studies with greater samples are therefore recommended.

BACKGROUND: Interferons are essential part of the innate immune system and have antiviral and immunomodulatory functions. We studied the effects of Interferon s-1a on outcomes of severe cases of COVID-19. MATERIAL AND METHODS: This retrospective study was conducted on hospitalized COVID-19 patients in Loghman-Hakim hospital from 20 February 2020 to 20 April 2020, Tehran, Iran. Patients were selected from two groups, the first group received Interferon s-1a in addition to standard treatment regimen, and the second group received standard care. The clinical progression of two groups during their hospital admission has been compared. RESULTS: We studied a total number of 395 hospitalized COVID-19 patients. Out of this number, 111 patients (33.5%) died (31.3% of the Interferon s-1a group and 34.1% of the control group). Mortality rate indicated no statistically significant difference between groups (p-value = 0.348), however for patients who were hospitalized for more than a week, the rate of mortality was lower in the Interferon s-1a group (p-value = 0.014). The median hospital stay was statistically longer for patients treated by Interferon s-1a (p-value

Utilization of novel agents such as brentuximab vedotin (BV) and check-point inhibitors (CI) has increased in patients with relapsed/refractory (r/r) classical Hodgkin Lymphoma (cHL). We conducted a retrospective study of 209 patients who had ASCT for r/r cHL at our institution and compared outcomes of those who had ASCT from 2010-2018 (cohort 2, n = 110) with those who had ASCT between 2000 and 2009 (cohort 1, n = 99). The median OS was 7.6 years for cohort 1 [HR 2.08; 95% CI 1.14-3.80; p = 0.017] and not reached for cohort 2; with 4-year improved OS difference of 15% (80% vs 65%) in cohort 2 vs cohort 1. The median PFS of cohort 1 was 30 months vs 39 months for cohort 2[HR 1.24; 95% CI 0.82-1.88; p = 0.3]. This study highlights improved OS of r/r cHL patients who have received ASCT in the novel agent era due to the exposure to agents such as BV and CIs.

Background Patients with end-stage kidney disease experience serious complications which affect their lives. Few studies have investigated the patients’ quality of life qualitatively from the perspective of family caregivers as the closest individuals to the patients. The family caregivers are directly involved in the patients’ disease progression and observe the changes, problems, and complications of disease and hemodialysis. This study aimed to explain the components of quality of life in hemodialysis patients from the family caregivers’ perspective. Methods In this qualitative inductive content analysis, 16 family caregivers of hemodialysis patients, presenting to the teaching hospitals of Tehran, Iran, were enrolled via maximum-variation purposive sampling; sampling continued until reaching data saturation. The data collection method included in-depth semi-structured interviews. Also, an inductive content analysis was carried out based on Elo and Kyngas’ method. Results A total of 311 codes, 19 subcategories, eight generic categories, and three main categories were extracted in this study. The main (and the generic categories) included mental and psychological problems (depressive mood, incompatibility and reduced tolerance, mental exhaustion, and deprivation of basic needs), social disruption (social isolation and social threats), and physical problems (general complications and disabilities and defects in the normal functioning of organs). Conclusion Family caregivers can be valuable information sources for formal caregivers to plan treatment for chronically ill patients who are mainly cared for at home. The present results can help us increase the existing knowledge on the impact of end-stage kidney disease and hemodialysis on the patients’ quality of life. It seems that addressing the issues related to quality of life, mentioned by the caregivers, can positively affect the patients’ quality of life and even reduce the caregivers’ burden.

State estimation is one of the main challenges in the microgrids, due to the complexity of the system dynamics and the limitations of the communication network. In this regard, a novel real-time event-based optimal state estimator is introduced in this article, which uses the proposed adaptive send-on-delta (SoD) nonuniform sampling method over wireless sensors networks. The proposed estimator requires low communication bandwidth and incurs lower computational resource cost. The threshold for the SoD sampler is made adaptive based on the average communication link delay, which is computed in a distributed form using the event-based average consensus protocol. The SoD nonuniform signal sampling approach reduces the traffic over the wireless communication network due to the events transmitted only when there is a level crossing in the measurements. The state estimator structure is extended on top of the traditional Kalman filter with the additional stages for the fusion of the received events. The error correction stage is further improved by optimal reconstruction of the signals using projection onto convex sets algorithm. Finally, an Internet of things (IoT) experimental platform based on LoRaWAN and IEEE 802.11 (WiFi) protocols are developed to analyze the performance of the state estimator for the IEEE 5 Bus case study microgrid.

Introduction: Parkinson’s disease is a neurodegenerative disease that disrupts functional brain networks. Many neurodegenerative disorders are associated with changes in brain communication patterns. Resting-state functional connectivity studies can distinguish the topological structure of Parkinson's patients from healthy individuals by analyzing patterns between different regions of the brain. Accordingly, the present study aimed to determine the brain topological features and functional connectivity in patients with Parkinson's disease, using a Bayesian approach. Method: The data of this study were downloaded from the open neuro site. These data include "Resting-State Functional MRI" (rs-fMRI) of 11 healthy individuals and 11 Parkinson’s patients with mean ages of 64.36 and 63.73, respectively. An advanced nonparametric Bayesian model was used to evaluate topological characteristics, including clustering of brain regions and correlation coefficient of the clusters. The significance of functional relationships based on each edge between the two groups was examined through false discovery rate (FDR) and network-based statistics (NBS) methods. Results: Brain connectivity results showed a major difference in terms of the number of regions in each cluster and the correlation coefficient between the patient and healthy groups. The largest clusters in the patient and control groups were 26 and 53 regions, respectively, with clustering correlation values of 0.36 and 0.26. Although there are 15 common areas across the two clusters, the intensity of the functional relationship between these areas was different in the two groups. Moreover, using NBS and FDR methods, no significant difference was observed for each edge between the patient and healthy groups (p-value>0.05). Conclusion: The results of this study show a different topological configuration of the brain network between the patient and healthy groups, indicating changes in the functional relationship between a set of areas of the brain.

Background: Spinal Anesthesia (SA) as a safe, reliable, and cost-effective method is widely used for Cesarean Section (CS). However, it is sometimes complicated by Post-Dural Puncture Headache (PDPH). Objectives: We investigated the frequency of PDPH in CS under SA and related risk factors in an academic referral hospital in the north of Iran. Materials & Methods: This descriptive cross-sectional prospective study was conducted at Alzahra hospital as an academic referral center affiliated with the Guilan University of Medical Sciences on 147 eligible cases During from May 2019 to October 2019. Then questionnaires containing questions about patients’ demographic data and some PDPH-related factors were filled out via face-to-face interviews. The collected data were analyzed by SPSS v. 21 using Chi-squared and and Fisher’s exact test. Results: The incidence of PDPH was 6.1%. Early ambulation, the number of attempts, and having a history of headache were significantly associated with a higher incidence of PDPH (P=0.001), while body mass index (P=0.106), age (P=0.093), and residents’ experience (P=0.384) had no significant association. None of our cases experienced a severe or persistent headache. Conclusion: The main predisposing factors for PDPH were found to be the history of HA, early ambulation, and the number of dura punctures. Women at risk for PDPH should be objectively screened before CS under SA.

Aim and background Cancer represents a major health problem with an exceedingly high toll on the patients, their families, and the economy. Cancers are also associated with high mortality rates. Existing therapies for cancer are generally ineffective with many side effects. Method A search was conducted on Pubmed, Google Scholar, Scopus, and web of science databases, and articles related to anticancer effects of resveratrol were collected. Results Resveratrol is a natural compound that can activate the Nrf2 transcription factor. Nfr2 translocates to the nucleus and induces antioxidant gene expression. In different cell lines, resveratrol can increase apoptosis and inhibit the proliferation of cancer cells. Conclusion We found that resveratrol shows efficacy for the treatment of cancer, but due to high controversy on the Nrf2 signaling pathway and mechanisms of resveratrol action, additional studies should be conducted to better characterize its mode-of-action in cancer. Graphical Abstract

Introduction: The most common types of injuries following blunt or sharp trauma of lungs and the pleural space are pneumothorax, hemothorax and hemopneumothorax, which in most cases are resolved through supportive care and thoracostomy (use of chest tubes). Removal of the CT (chest tube) can result in complication such as pneumothorax and accumulation of fluid in the pleural space. Despite the lack of a standard guideline regarding the management of patients post CT removal, it is advised to procure a CXR as a means of a conservative approach. However, most of the findings acquired from the post CT removal CXR are not clinically significant and in the case of patients requiring intervention, there are almost always clinical signs and symptoms present. Considering the prior statements, the lack of a standard guideline even in the general and thoracic surgery references, show cases the importance of this study. This study is set upon proving that, the omission of post CT removal CXR in asymptomatic patients will not have an impact on the clinical outcome of the case and will reduce the costs as well as the patients' exposure to radiation and hospital stay. Methods: This study is designed as cross-sectional study with a sample size of 200 patients who were hospitalized for CT insertion in the Surgery clinic of Razi and Poursina Hospitals in Rasht between 21/4/2019 and 20/4/2020 and matched our entry criteria. The patients were divided into 2 groups of 100, with one group being monitored without CXR and the other with the use of CXR. Some forms were designed as checklists for the task of data collection. The data analysis was done through Fisher's exact test, Chi square test and Mann Whitney U test. In addition, the Significance level was set at 0.05 (p value ≤ 0.05). Result: Out of the 200 patients included in our study, 120 were male (60%) and the rest (40%) were female. The most common underlying disease in both groups (with and without CXR) of our study was Hip fracture. In both groups, The most frequent reason for CT insertion was pleural effusion (36% and 43% in with CXR and without CXR groups respectively), but the difference between the 2 groups was not statistically significant (p = 0.597). In most of the cases, 1 CT was inserted and there was no statistically significant difference between the 2 groups. The difference between the 2 groups regarding the need for intervention (11 cases in the CXR group and 6 cases in the Non CXR group) was also statistically insignificant. The duration of hospital stay did not show a statistically significant difference between the 2 groups (p = 0.644). Conclusion: Our study suggests that whether a post CT removal CXR is obtained or not, will not make a statistically significant difference in the number of interventions, the cause of intervention, and the number of inserted CTs and the duration of hospital stay. Therefore, it can be suggested that the need for reintervention in post CT removal patients can be determined through clinical signs, symptoms and the surgeon's judgment, without the need for a routine CXR.

Background There is currently at least 1 biologic (adalimumab) approved in North America for treatment of Hidradenitis Suppurativa in the pediatric population. However, no reviews or clinical trials have specifically analyzed the effectiveness and safety data of biologic use in this population. The objective of this systematic review is to identify and summarize the outcomes of biologic therapy in pediatric patients with HS. Methods MEDLINE and EMBASE databases were used to conduct the search on Sept 18, 2020. Results The 15 included studies consisted of 26 patients, with the mean age of 15 ± 2.3 years. Females accounted for 53.8% ( n = 14/26) of cases. The mean duration of HS prior to biologic initiation was 3.5 ± 2.9 years, with the majority having Hurley Stage II. The 26 patients received 34 biologics in total: 85.3% treated with TNF alpha inhibitors (adalimumab n = 17, infliximab n = 10, etanercept n = 1, unspecified n = 1), 5.9% with IL-12/23 inhibitors (ustekinumab n = 2), 5.9% with IL-1 inhibitors (i.e., anakinra n = 2) and 2.9% received IL-23 inhibitors (i.e., guselkumab n = 1) biologics. Of the 26 patients, 23.1% ( n = 6/26) experienced complete resolution (CR), 73.1% ( n = 19/26) experienced partial resolution (PR), and 3.8% ( n = 1/26) had no resolution outcomes reported. The time to resolution of HS lesions after biologic initiation ranged from 10 days to 11.5 months (mean: 5.1 months). No adverse events were reported in the studies. Conclusion Although anti-TNF alpha were the most common biologics used for HS in pediatric cases, large-scale trials specific to pediatric patients with HS are needed to confirm these findings.

Background and aims: In late December 2019, a cluster of progressive pneumonia-like respiratory syndromes broke out in Wuhan, China. As the number of cases continued to rise, the 2019 coronavirus disease (COVID-19) has been declared a global public health emergency. The causative agent, i.e., SARS-CoV-2, is a highly contagious strain, which has resulted in the rapid worldwide outbreak of COVID-19. COVID-19 is an overwhelmingly transmissible disease that requires early and accurate diagnosis for proper and timely treatment of suspected cases. Materials and Methods: In order to accessthe scientific documentation and evidence related to the subject published during 2019 to 2021, English keywords including "COVID-19", "SARS-CoV-2", "Diagnosis", "Immunoglobulin G (IgG)", "Immunoglobulin M (IgM)", and ‘Polymerase Chain Reaction (PCR)" were searched in Medline, PubMed, and Google Scholar databases and Persian versions of these keywords were also looked for in Jihad-e Daneshgahi’s Scientific Information Database (SID) and Iranian Journals database (Magiran). Results: With respect to diagnosis, serum antibody assays, nucleic acid sequencing, and radiologic evaluation are among the most reliable methods to rule out the disease in suspicious cases. This review is a synopsis of the pathogenesis of coronavirus, which will mainly focus on the diagnostic methods, as well as laboratory changes in immunoglobulins, polymerase chain reaction results, and computed tomography (CT) findings. Conclusion: Early diagnosis matters in that it not only contributes to the prevention of further transmission of the virus by asymptomatic carriers but also paves the way for clinicians to accurately choose the best therapeutic approach depending on the status of the patients.

OBJECTIVE: The objective of our study is to determine frequency of bracket bond failure in relation to age, gender, most commonly involved tooth and quadrant. METHODOLOGY: In this descriptive cross-sectional study, a total of 100 patients with ages ranging from 10 to 30 years needing corrective orthodontic treatment were selected for the study. This survey was conducted at Altamash Institute of Dental Medicine, Karachi. The survey was initiated on 30th November 2019 and was concluded on 30th May 2020. A questionnaire was used to evaluate the frequency of bonded bracket failure in patients undergoing orthodontic treatment. The bonded metallic brackets were light cured for 40 seconds, and initial alignment arch wires were inserted. Bonded bracket failure was recorded over a period of six months. RESULTS: The initial debonding results of the present study demonstrated a high number of debonded brackets in mandibular dentition as compared to the maxillary dentition. Whereas, when the teeth were debonded for the second time, a greater number of maxillary teeth were found to be affected by the debonding of the brackets. Both genders demonstrated a greater rate of bracket debonding in the second premolar area and lowest in the molar area. In our study, age and gender had no significant relationship with bracket bond failure and teeth involved in debonding. CONCLUSIONS: The frequency of bonded bracket detachment during orthodontic treatment is very common. Our study concluded that females were more affected by the bracket bond failure as compared to the males along with the second premolar being the most commonly associated tooth during an active orthodontic treatment. KEYWORDS: Bonded brackets, Bracket failure, Frequency, Orthodontic treatment, Orthodontics

Hypertension is a predisposing factor for cardiovascular disease (CVD). The extant literature regarding the effects of folic acid supplementation on blood pressure (BP) is inconsistent. Therefore, this systematic review and meta-analysis of randomized controlled trials was conducted to summarize the effects of folic acid supplementation on BP. A systematic search was carried out in PubMed, Scopus, ISI Web of Science, and Cochrane library, from database inception to August 2021. Data were pooled using the random-effects method and were expressed as weighted mean difference (WMD) and 95% confidence intervals (CI). The pooled results of 22 studies, including 41,633 participants, showed that folic acid supplementation significantly decreased systolic BP (SBP) (WMD: -1.10 mmHg; 95% CI: -1.93 to -0.28; p = 0.008). Subgroup analysis showed that the results remained significant when baseline SBP was ≥120 mmHg, intervention duration was ≤6 weeks, intervention dose was ≥5 mg/d, in patients with CVD, males and females, and overweight participants, respectively. Furthermore, the changes observed in diastolic BP (DBP) (WMD: -0.24 mmHg; 95% CI: -0.37 to -0.10; p 6 weeks), low dose of folic acid (

Background: Paying attention to psychiatric disorder in childhood and adolescence is critical. It causes the occurrence of mental disorders in adulthood. The present study aimed to explore the frequency of mental disorders among children and adolescents in Zahedan City, Iran. Materials & Methods: This was a descriptive and cross-sectional study. Individuals aged between 6 and 18 years were included in this investigation. In total, 1003 children and adolescents were selected by the random cluster sampling method. To collect the required information, in addition to demographic information, the Schedule for Affective Disorders and Schizophrenia (K-SADS-PL) for school-age Children-Present and Lifetime version was employed. The obtained data were analyzed using multivariate logistic regression method. Results: A total of 1003 children and adolescents participated in the study; of them, 489 (48.8%) and 514(51.2%) were males and females, respectively. The Mean±SD age of study participants was 11.96±3.99 years. Moreover, 86.8% of the study subjects were from urban areas and 13.2% from rural areas. The highest prevalence of psychiatric disorders concerned behavioral disorders (6.8%); anxiety disorders (6.7%); The lowest prevalence were related to post-traumatic stress disorder (0.2%) and autism (0.1%). The overall prevalence of psychiatric disorder among children and adolescence was 14.4%. Conclusion: This study found a high prevalence of psychiatric disorders similar to previous studies in the same age groups. The estimates played an important role in designing useful programs and interventions.

The aim of this study was to compare the effect of vaginal progesterone with 17-alpha-hydroxyprogesterone caproate (17OHP-C) in prevention of preterm birth in high-risk pregnant women undergo cercl...

An increasing amount of evidence has emerged suggesting that hidradenitis suppurativa (HS) is associated with inflammatory arthritis. This study reviewed the incidence, prevalence, and predictors of inflammatory arthritis in patients with HS. A comprehensive literature search was conducted in CINAHL, Embase, and Medline from inception to February 14, 2020. Articles were included in the review if they provided data on disease epidemiology or predictors of adult or pediatric HS patients with comorbid inflammatory arthritis. There are no validated diagnostic criteria for HS, thus we considered patients as having HS if they had at least one diagnostic code in a hospital or claims database or a diagnosis of HS/inflammatory arthritis in a medical record. The same criteria were used to confirm presence of inflammatory arthritis. We identified an increased incidence of rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) in HS patients when compared with estimates in the general population. We identified a relatively high prevalence of RA, spondyloarthritis (SpA), and PsA in HS patients when compared with estimates in the general population. There was evidence to suggest that patients who are younger than 30, male, have severe HS, or are taking infliximab or adalimumab (which may also be confounded by HS disease severity) may be at greater risk for specific subtypes of inflammatory arthritis. However, further data are needed to confirm these associations. The increased incidence and prevalence of inflammatory arthritis within HS patients underscore the need for increased awareness and interdisciplinary partnership within rheumatology and dermatology.

Introduction: Chronic kidney disease is a serious problem and patients need active self-care. This study focuses on the relationship between self-care and its predictive factors in hemodialysis (HD) patients. Methods: This multicenter correlational study was conducted on 201 HD patients referring to HD centers in the west of Tehran, Iran. A multi-stage sampling method was used to select the samples. Data were collected using self-care Scale, Paloutzian-Ellison Spiritual Well-Being Scale, and Connor Davidson Resilience Questionnaires. Data were analyzed using SPSS software version 13 and descriptive statistics and linear regression with stepwise method. Results: The mean (SD) scores of self-care, resilience, and spiritual well-being were 35.5 (5.69), 53.4 (12.94), and 97.4 (17.9), respectively. Univariate analysis showed that self-care had a statistically significant relationship with gender, occupation, education, being diabetic, and hyperlipidemia. Self-care positively correlated with the resilience and negatively correlated with age. Multivariate regression indicated that the resilience (β=0.78, P=0.001), being diabetic (β=-0.09, P=0.01), and age (β=-0.11, P=0.005) could be predictors of self-care. These variables accounted for 78% of variance in self-care in HD patients. Conclusion: Our results showed that resilience was positively correlated with self–care, but being diabetic and age were negatively correlated with self-care in HD patients. Therefore, the health care providers should pay more attention to HD patients who are diabetic and older, as they are at a higher risk of having impaired self-care.

BACKGROUND Scarring is an unfortunate result of acne because it causes the psychological and cosmetic problems for the patients. Unfortunately, no single treatment is suitable, and using multiple methods may have a better result. The autologous fat and stromal vascular fraction (SVF) cells and their secretory factors can enhance the angiogenesis, collagen synthesis, and migration of fibroblasts, therefore regenerate hurt tissues. Moreover, other treatments for acne scarring, such as platelet-rich plasma (PRP), induce the increase in scare. AIMS This study aimed to verify the effectiveness of transplantation of autologous fat, SVF cells, and PRP as cell therapy techniques on atrophic acne scars. PATIENTS/METHODS This study included 9 adult patients with atrophic acne scars on face. All patients received the transplantation of autologous fat, stromal vascular fraction (SVF) cells, and PRP. The treatment outcome was measured by biometric assessment (VisioFace 1000 D, Colorimeter, multi-probe adapter Cutometer, Tewameter, Mexameter, and skin ultrasound imaging system), and also, the satisfaction of patients was evaluated. The patients were followed 6 months after the treatment. RESULTS There was a significant improvement in the skin pores, spots, skin lightness and melanin content of skin, skin elasticity, and TEWL (transepidermal water loss) after 6 months of the treatment. Furthermore, denser skin layers were observed both in the epidermis and in the dermis. Moreover, 66.6% of patients showed good satisfaction after the treatment. CONCLUSION In brief, the transplantation of autologous fat, SVF cells, and PRP is an effective cell therapy for atrophic acne scars.

Background: Artificial intelligence (AI) is known to provide effective means to accelerate and facilitate clinical and research processes. So in this study it was aimed to compare a AI-based method for cardiac segmentation in positron emission tomography/computed tomography (PET/CT) scans with manual segmentation to assess global cardiac atherosclerosis burden. Methods: A trained convolutional neural network (CNN) was used for cardiac segmentation in 18F-sodium fluoride PET/CT scans of 29 healthy volunteers and 20 angina pectoris patients and compared with manual segmentation. Parameters for segmented volume (Vol) and mean, maximal, and total standardized uptake values (SUVmean, SUVmax, SUVtotal) were analyzed by Bland-Altman Limits of Agreement. Repeatability with AI-based assessment of the same scans is 100%. Repeatability (same conditions, same operator) and reproducibility (same conditions, two different operators) of manual segmentation was examined by re-segmentation in 25 randomly selected scans. Results: Mean (± SD) values with manual vs. CNN-based segmentation were Vol 617.65 ± 154.99 mL vs 625.26 ± 153.55 mL (P =.21), SUVmean 0.69 ± 0.15 vs 0.69 ± 0.15 (P =.26), SUVmax 2.68 ± 0.86 vs 2.77 ± 1.05 (P =.34), and SUVtotal 425.51 ± 138.93 vs 427.91 ± 132.68 (P =.62). Limits of agreement were − 89.42 to 74.2, − 0.02 to 0.02, − 1.52 to 1.32, and − 68.02 to 63.21, respectively. Manual segmentation lasted typically 30 minutes vs about one minute with the CNN-based approach. The maximal deviation at manual re-segmentation was for the four parameters 0% to 0.5% with the same and 0% to 1% with different operators. Conclusion: The CNN-based method was faster and provided values for Vol, SUVmean, SUVmax, and SUVtotal comparable to the manually obtained ones. This AI-based segmentation approach appears to offer a more reproducible and much faster substitute for slow and cumbersome manual segmentation of the heart.

Natural disasters play a main role in human life. It should be taken into consideration that it is impossible to predict these disasters from happening, but preparation for a good response for these disasters can be a good solution to decrease post-damage casualties in the cities. Herein, Disaster Management Bases in terms of prevention, preparation and dealing with the crisis play a key role, especially in Tehran and in times of natural disasters. There is no doubt that a high level and efficient function of these bases has a striking correlation with the way they are located in both an urban and regional level in a way that in addition to providing security of the bases against disasters, based on the service area they could be able to provide good services for the areas of crisis. This paper tries to use Multi Criteria Decision Making (MCDM) techniques and spatial analysis method in order to assess the effectiveness of these bases. Based on assessments Disaster Management Bases have spontaneously distributed in Tehran and have located in inappropriate places. Thus using MCDM with GIS analysis, the best locations in case study area was proposed.

Summary Background & Aims High quality and precise methods are needed when monitoring changes in body composition among colorectal cancer (CRC) patients and healthy subjects. The aim of this study was to estimate precision of the Dual-energy X-ray absorptiometry (Lunar iDXA, GE Healthcare software enCORE version 16) in measuring body composition in CRC patients and healthy subjects. Methods Precision error of iDXA in measuring body composition was investigated in the current study. Thirty CRC patients and 30 healthy subjects, including both men and women underwent two consecutive whole-body DXA scan with repositioning. Precision estimates of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) in the abdominal region, and total fat mass (FM), fat-free mass (FFM), lean mass (LM), bone mineral density (BMD) and bone mineral content (BMC) were calculated. Results Precision error expressed as coefficient of variation (% CV) of VAT and SAT were estimated to be 3.56 % and 3.28 % among CRC patients, and 5.30 % and 3.46 % among healthy subjects. Estimated precision errors for body masses in the total region ranged between 0.49-1.01 % and 0.40-0.88 % in CRC patients and healthy subjects, respectively. Least significant change (LSC) in VAT mass, SAT mass, FM and LM were 140.9 g, 121.4 g, 637.0 g and 701.0 g, respectively, among CRC patients. Among healthy subjects the LSC in VAT, SAT, FM and LM were 80.93 g, 98.90 g, 484.0 g and 618.0 g, respectively. Only minor and non-significant differences between the two consecutive measurements for each body compartment were observed within both populations, and we found no systematic bias in the distribution of the differences. Conclusion The Lunar iDXA demonstrated high precision in body composition measurements among both CRC patients and healthy subjects. Hence, iDXA is a useful tool in clinical following-up and interventions targeted towards changes in body composition.

In the digital economy, many business-to-business companies expect their salespeople to promote e-commerce channels to customers as alternative ways to purchase. However, salespeople are often hesitant to comply with this approach, which despite its high practical relevance, has been rarely examined by academic research. Therefore, the authors develop a theoretical framework outlining key determinants of salespeople’s promotion of e-commerce channels. To this end, the authors integrate relational-selling theory with goal-setting theory and test their conceptualization using a multilevel data set comprising surveys of 68 salespeople, 220 customers, and objective company data. The results show that salespeople who are more relational-selling oriented are less likely to promote the use of e-commerce channels—especially if a customer has a negative attitude toward e-commerce or if competitors are focused on personal selling. With these findings, our study helps managers improve their salespeople’s essential role as promoters of e-commerce channels.

Background Body image is the main element of an individual’s personality that may be influenced by many factors during menopause. We aimed to assess the relationship between postmenopausal women’s body image with the severity of menopausal symptoms. Methods This was a cross-sectional study on 300 postmenopausal women, aged 45 to 65 years old, in Tehran, Iran. We recruited the samples using the multi-stage sampling method. Tools for data collection were: 1) the Menopausal Rating Scale (MRS), 2) the Fisher’s Body Image questionnaire and 3) a socio-demographic questionnaire. We analyzed data using the independent samples t-test, Pearson correlation coefficient, Spearman’s correlation coefficient, and multiple linear regression tests. Results Three hundred women aged 55.11 ± 3.99 years old, participated in the study. Mean scores for body image and MRS were 163.07 ± 21.17 (Range: 46–230) and 16.45 ± 8.38 (Range: 0–44), respectively. About 50% of women had severe symptoms of menopause (MRS score ≥ 17). There was a negative correlation between the total score and the score of all dimensions of body image with the total score and all dimensions of MRS (P P P P P = 0.36), their occupation (P = 0.007) and housing status (P = 0.012). There was also a significant negative correlation between women’s lower body organs image with the number of children (P = 0.017, r = − 0.14). According to the multiple linear regressions model, severity of menopausal symptoms (Beta = − 0.45, P P = 0.005) are the significant related factors with postmenopausal women’s body image. Conclusions Body image is correlated with menopausal symptoms of women during menopause. Therefore, it seems that interventions aimed at relieving the annoying symptoms of menopause can help to improve their body image. Also, body image could be influenced by some socio-demographic factors which should be considered in menopause health promotion programs.

Loss or dysfunction of the pancreatic beta cells or insulin receptors leads to diabetes mellitus (DM). This usually occurs over many years; therefore, the development of methods for the timely detection and clinical intervention are vital to prevent the development of this disease. Glucagon-like peptide-1 receptor (GLP-1R) is the receptor of GLP-1, an incretin hormone that causes insulin secretion in a glucose-dependent manner. GLP-1R is highly expressed on the surface of pancreatic beta cells, providing a potential target for bioimaging. In this review, we provide an overview of various strategies, such as the development of GLP-1R agonists (e.g., exendin-4), and GLP-1 sequence modifications for GLP-1R targeting for the diagnosis and treatment of pancreatic beta cell disorders. We also discuss the challenges of targeting pancreatic beta cells and strategies to address such challenges.

Metallic bone fixations, due to their high rigidity, can cause long-term complications. To alleviate metallic biomaterials’ drawbacks, in this research new Glass Fiber/Polypropylene (GF/PP) composite internal fixations were developed, and an investigation of their mechanical behavior was performed through in vitro biomechanical experiments. Short randomly oriented, long unidirectional prepreg, and long unidirectional fiber yarn were considered as reinforcements, and the effects on their mechanical properties of different manufacturing processes, that is, 3D printing and heat-compressing, were investigated. The constructed fixation plates were tested in the transversely fractured diaphysis of bovine tibia under axial compression loading. The overall stiffness and the Von Mises strain field of the fixation plates were obtained within stable and unstable fracture conditions. The samples were loaded until failure to determine their failure loads, strains, and mechanisms. Based on the results, the GF/PP composite fixation plates can provide adequate interfragmentary movement to amplify bone ossification, so they can provide proper support for bone healing. Moreover, their potential for stress shielding reduction and their load-bearing capacity suggest their merits in replacing traditional metallic plates.

PurposeThe present study attempted to identify, measure and prioritize key green human resource management (GHRM) practices to achieve the lean-agile mindset in the steel industry.Design/methodology/approachFollowing an in-depth review of the literature, this study identifies GHRM practices. Then, the effect of green HRM practices on the lean-agile mindset was evaluated using structural equation modeling (SEM). In the next step, using the fuzzy analytic hierarchy process (FAHP), prioritization of practices that have significant effects on lean-agile mindset were discussed.FindingsThe present study introduced eight GHRM practices. The results of SEM showed a significant and positive effect of all GHRM practices on lean-agile mindset. Prioritization of GHRM practices by the FAHP was defined as green reward management, green education and development, green performance evaluation, green discipline management, green employment, green safety and health management, green selection and green career design.Research limitations/implicationsThe present study suffers from some limitations. First, the research was conducted at a temporal section. Second, this research has been conducted in a particular industry.Practical implicationsThe present study encourages human resource managers to increase their efforts to achieve green employees and put employee greenery in their strategic goals.Social implicationsSuccessful implementation of GHRM programs has positive consequences at the individual, organizational and community levels. Implementation of the identified actions increases employee vitality at the individual level. At the organizational level, the work environment of environmentally friendly organizations is also more attractive to job seekers. Finally, at the social and extra-organizational level, a green lifestyle is spread in the community, which will lead to a healthy and green environment.Originality/valueEmphasizing environmental principles on the one hand and creating the lean-agile mindset on the other are effective factors on maintaining the competitive advantage of industries. In this regard, the present study presented two innovations in HRM literature: (1) assessing the effect of GHRM practices on lean-agile mindset and (2) prioritizing GHRM practices based on the lean-agile mindset.

INTRODUCTION: Type 1 Diabetes Mellitus (T1DM) is an auto immune reaction against insulin secreting beta cells. Exogenous insulin administration is the only standard treatment for T1DM. However, despite tight glycemic control many patients will develop chronic life-threatening complications. Recently, stem cell transplantation has been suggested as a novel treatment for eliminating the beta cell damage and promoting their regeneration by modulating auto-immunity. To our knowledge; this is the first preliminary report of placenta derived MSCs (PLMSCs) transplantation in juvenile T1DM. METHOD: An Open label non-randomized phase 1 clinical trial was designed to evaluate the safety of PLMSCs transplantation in new onset juvenile T1DM (IRCT20171021036903N2). PLMSCs were manufactured in our clean room facility using a Xeno-free/GMP compliant protocol. The first series of patients (n = 4) received one dose of1 × 10(6) PLMSCs/kg intravenously. Diabetic clinical and laboratory parameters and side effects were evaluated weekly for the first month, monthly for 6 months, and then every 3 month till 1 year. RESULTS: Serious adverse events were not seen during 1 year follow-up. Partial remission and hypoglycemic attacks were happened one month after transplantation in two patients. ZnT8-Ab decreased till month 3 and then increased again in all patients. Anti Gad-Ab decreased till month 3 of follow up then increased. DISCUSSION: This preliminary report of our phase I clinical trial demonstrated the short term safety of PLMSCs transplantation in juvenile T1DM. To prove the long term safety and probable efficacy of this treatment more investigations are needed. TRIAL REGISTRATION: Iranian Registry of Clinical Trials: IRCT20171021036903N2

PurposeEngineering design and operational decisions depend largely on deep understanding of applications that requires assumptions for simplification of the problems in order to find proper solutions. Cutting-edge machine learning algorithms can be used as one of the emerging tools to simplify this process. In this paper, we propose a novel scalable and interpretable machine learning framework to automate this process and fill the current gap.Design/methodology/approachThe essential principles of the proposed pipeline are mainly (1) scalability, (2) interpretibility and (3) robust probabilistic performance across engineering problems. The lack of interpretibility of complex machine learning models prevents their use in various problems including engineering computation assessments. Many consumers of machine learning models would not trust the results if they cannot understand the method. Thus, the SHapley Additive exPlanations (SHAP) approach is employed to interpret the developed machine learning models.FindingsThe proposed framework can be applied to a variety of engineering problems including seismic damage assessment of structures. The performance of the proposed framework is investigated using two case studies of failure identification in reinforcement concrete (RC) columns and shear walls. In addition, the reproducibility, reliability and generalizability of the results were validated and the results of the framework were compared to the benchmark studies. The results of the proposed framework outperformed the benchmark results with high statistical significance.Originality/valueAlthough, the current study reveals that the geometric input features and reinforcement indices are the most important variables in failure modes detection, better model can be achieved with employing more robust strategies to establish proper database to decrease the errors in some of the failure modes identification.

Background As there is no consensus over the efficacy of extracorporeal shockwave therapy in the management of spinal cord injury complications, the current meta-analysis aims to investigate preclinical evidence on the matter. Methods The search strategy was developed based on keywords related to ‘spinal cord injury’ and ‘extracorporeal shockwave therapy’. A primary search was conducted in Medline, Embase, Scopus and Web of Science until the end of 2020. Studies which administered extracorporeal shockwave therapy on spinal cord injury animal models and evaluated motor function and/or histological findings were included. The standardised mean difference with a 95% confidence interval (CI) were calculated. Results Seven articles were included. Locomotion was significantly improved in the extracorporeal shockwave therapy treated group (standardised mean difference 1.68, 95% CI 1.05–2.31, P=0.032). It seems that the efficacy of extracorporeal shockwave therapy with an energy flux density of 0.1 mJ/mm2 is higher than 0.04 mJ/mm2 ( P=0.044). Shockwave therapy was found to increase axonal sprouting (standardised mean difference 1.31, 95% CI 0.65, 1.96), vascular endothelial growth factor tissue levels (standardised mean difference 1.36, 95% CI 0.54, 2.18) and cell survival (standardised mean difference 2.49, 95% CI 0.93, 4.04). It also significantly prevents axonal degeneration (standardised mean difference 2.25, 95% CI 1.47, 3.02). Conclusion Extracorporeal shockwave therapy significantly improves locomotor recovery in spinal cord injury animal models through neural tissue regeneration. Nonetheless, in spite of the promising results and clinical application of extracorporeal shockwave therapy in various conditions, current evidence implies that designing clinical trials on extracorporeal shockwave therapy in the management of spinal cord injury may not be soon. Hence, further preclinical studies with the effort to reach the safest and the most efficient treatment protocol are needed.

Treating actinic keratosis (AK) and photodamaged skin is critical to reduce the risk of progression to skin cancer. Laser resurfacing for AK treatment is available as either lesion-directed or field therapy. Laser resurfacing removes the superficial epidermis and dermis containing actinic damage, promoting re-epithelialization of healthy skin. Although laser resurfacing has been explored as a modality for AK treatment in the literature, studies summarizing its efficacy in the treatment of AK are lacking. This review summarizes existing research on laser resurfacing as a monotherapy for AK treatment, highlighting the various laser resurfacing modalities available for AK treatment as well as their complications and efficacy in comparison to other therapies. Despite longer healing time, fully ablative laser resurfacing, including carbon dioxide and erbium-doped yttrium aluminum garnet were found to be more effective for AK treatment than fractional ablative techniques. Although some studies suggest laser resurfacing monotherapy as less efficacious than photodynamic therapy, and equally effective to 5-fluorouracil and 30% trichloroacetic acid, clinical trials of larger sample size are required to establish stronger evidence-based conclusions. Moreover, laser resurfacing used as lesion-directed therapy, as opposed to the usual field-therapy, requires further investigation.

AIM Methamphetamine-induced psychosis and neuropsychological impairments are common among patients with methamphetamine use disorder. Given some preclinical and clinical studies reporting potential effects of minocycline, a second-generation tetracycline, on correcting manifestations of drug addiction, this study aimed to examine the effectiveness of minocycline in attenuating psychotic symptoms and neuropsychological impairments in chronic methamphetamine users. METHOD Five men with treatment-resistant methamphetamine use disorder and psychotic symptoms were selected using a convenience sampling method, and they were administered a daily dose of 200-mg minocycline for 8 weeks; within this period, psychiatric and neuropsychological assessments (including memory and executive functions) were carried out at the baseline, week 2, week 4, week 8, and 2-month follow-up. RESULTS The findings showed that minocycline attenuated both positive (Cohen d = 0.63) and negative (Cohen d = 0.53) methamphetamine-induced psychotic symptoms and also improved patients' neuropsychological functions, particularly their auditory working memory (Cohen d = 0.45). CONCLUSIONS These results provide promising evidence regarding the positive effects of minocycline as adjunctive pharmacotherapy for patients with methamphetamine use disorder. However, given that this was an open-label study, further research is warranted to draw a firm conclusion about the effectiveness of minocycline for methamphetamine-induced psychosis and neuropsychological deficits.

Background Considerable disparities exist on the use of adipose tissue-derived stem cells (ADSCs) for treatment of spinal cord injury (SCI). Hence, the current systematic review aimed to investigate the efficacy of ADSCs in locomotion recovery following SCI in animal models. Methods A search was conducted in electronic databases of MEDLINE, Embase, Scopus, and Web of Science until the end of July 2019. Reference and citation tracking and searching Google and Google Scholar search engines were performed to achieve more studies. Animal studies conducted on rats having SCI which were treated with ADSCs were included in the study. Exclusion criteria were lacking a non-treated control group, not evaluating locomotion, non-rat studies, not reporting the number of transplanted cells, not reporting isolation and preparation methods of stem cells, review articles, combination therapy, use of genetically modified ADSCs, use of induced pluripotent ADSCs, and human trials. Risk of bias was assessed using Hasannejad et al.’s proposed method for quality control of SCI-animal studies. Data were analyzed in STATA 14.0 software, and based on a random effect model, pooled standardized mean difference with a 95% confidence interval was presented. Results Of 588 non-duplicated papers, data from 18 articles were included. Overall risk of bias was high risk in 8 studies, some concern in 9 studies and low risk in 1 study. Current evidence demonstrated that ADSCs transplantation could improve locomotion following SCI (standardized mean difference = 1.71; 95%CI 1.29–2.13; p I2 = 72.0%; p pfor odds ratios > 0.05). Conclusion We conclude that any number of ADSCs by any prescription routes can improve locomotion recovery in an SCI animal model, at any phase of SCI, with any severity. Given the remarkable bias about blinding, clinical translation of the present results is tough, because in addition to the complexity of the nervous system and the involvement of far more complex motor circuits in the human, blinding compliance and motor outcome assessment tests in animal studies and clinical trials are significantly different.