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Abstract This study was carried out to develop a conceptual framework for determining the best interpolation method which mainly is employed to calculate the variability maps of electrical conductivity (EC) in neighboring regions. The considered case study is parts of the Khorasan Razavi province, Iran (including five aquifers Kashmar, Fariman, Doruneh, Sarakhs and Joveyn). In the first step, the empirical variogram (semi-variogram) was computed for the study area. The methods of the variability of a variable with spatial or temporal distance were considered to measure the semi-variogram function. In the next step, the best variogram model (e.g. spherical, exponential or Gaussian) was considered in the Geographic Information System (GIS) environment and f for the Environmental Sciences (GS+) software. By plotting the semi-variogram in GS+ program based on different method as Global Polynomial Interpolation (GPI), Inverse distance weighing (IDW), Radial basis function (RBF), Kriging method, Global Polynomial Interpolation (GPI), Local Polynomial Interpolation (LPI), the best variogram model fitted to spatial structure of the EC. Finally, by considering the acceptable range for different parameters which impact on EC and evaluating their impacts by scaling, the best interpolation method has been selected for that area for employing their neighborhood basin. Result indicated that the precipitation located within the range of 140 to 180 mm, RBI has the priority. This process is continued for all 14 parameters and eventually one method gets the most points.

Abstract Introduction Kirschner wires are frequently employed in orthopedic procedures. While most complications are minor, rare instances of distant pin migration can occur. Such migration is more prevalent in the shoulder region but has been reported elsewhere. Case presentation A 50-year-old Persian male with a right femoral neck fracture (Garden type IV) underwent closed reduction and internal fixation with three cannulated screws. During the procedure, a guide pin broke and remained lodged. Follow-up radiographs revealed the migrated pin in the patient’s chest wall near the 11th rib, necessitating surgical removal via thoracotomy. Conclusion This case underscores the potential for orthopedic implant migration. While often associated with smaller pins, the risk exists for all sizes. The timeframe for diagnosis varies significantly and in some cases it can be asymptomatic and discovered incidentally.

Background and purpose: The human body functions as an integrated and coordinated unit, with each part capable of influencing the entire system. Modern science views the body holistically, addressing not only the treatment of symptoms but also the root cause of any disorder, often located far from the apparent site of the issue. This study aims to examine the effect of immediate release and static stretching of the gastrocnemius muscle and plantar fascia within the superficial back line on range of motion and chronic neck pain. Materials and methods: In this randomized clinical trial, 32 subjects with nonspecific chronic neck pain, aged 30-40 years, were recruited. Participants were randomly assigned into two equal groups: a control group (16 participants) and an intervention group (16 participants). The intervention group performed release and stretching exercises using a foam roller and band, respectively, while the control group did not receive any intervention. Neck range of motion in the sagittal plane was measured using a goniometer, and pain levels were assessed using a visual analog scale before and after the protocol. Data were analyzed using paired t-tests and ANCOVA at a significance level of 0.05 with SPSS software. Results: The ANCOVA test revealed a significant difference between the intervention and control groups in terms of neck pain (P=0.001) and neck range of motion in the sagittal plane, including neck flexion (P=0.001) and neck extension (P=0.001) among individuals with chronic neck pain. Paired t-test results showed that, in the intervention group, there were significant differences between pre-test and post-test scores for neck pain, neck flexion, and extension range of motion after participating in the stretching and myofascial release exercises on the gastrocnemius muscle and plantar fascia (P=0.001). However, no significant differences were found in the control group between the pre- and post-test stages (P>0.05). Conclusion: The use of self-release interventions and stretching exercises on the gastrocnemius muscle and plantar fascia appears to increase range of motion and reduce neck pain. These results suggest tension transmission along the superficial back line, which extends from the plantar fascia to the frontal muscles of the skull, meaning intervention at any point in this chain can affect the entire pathway. This method could be beneficial for individuals with acute neck pain or in cases where direct neck intervention is not possible. By targeting other areas along this muscle chain, improvements in neck symptoms may be achieved. Over recent years, this concept has garnered significant research interest, with a proliferation of studies affirming the existence of the posterior superficial back line through laboratory and cadaver research. Clinically, factors such as the tissue's viscoelastic properties, nerve receptors, and changes in the extracellular matrix are proposed to facilitate tension transmission along muscle chains, though the precise mechanism remains a “black box” in fascia tissue research. (Clinical Trials Registry Number: IRCT20200209046422N2)

Abstract SpikoGen® COVID-19 vaccine is based on the spike protein extracellular domain of the ancestral Wuhan-Hu-1 strain modified by removal of the furin cleavage site and addition of stabilising mutations expressed as a recombinant protein in insect cells. It is formulated with Advax-CpG55.2™ adjuvant to ensure optimal immunogenicity. In this study, data from several SpikoGen® clinical trials was retrospectively analysed to assess for any effect of gender or age on seroconversion, neutralizing antibody levels or the incidence of adverse events. Following the 1st dose, older age was associated with a reduced rate of fatigue (RR 0.97, p < 0.001), headache (RR 0.98, p = 0.034) and myalgia (RR 0.97, p=0.016), following the 2nd dose, the rate of fatigue (RR 0.98, p = 0.017) but following the 3rd dose no effect of age on adverse events was evident. Similarly, following the 1st dose, men reported a 19% lower incidence of fatigue, 36% lower incidence of headache and 28% lower incidence of myalgia when compared to women. Interestingly, there was no relationship between age or gender and serum neutralizing antibody levels, although after each vaccine dose there was a consistent trend to women having a higher seroconversion rate. There was no correlation between neutralizing antibody levels and adverse events. Unlike what is seen with mRNA vaccines, reactogenicity trended lower after each subsequent SpikoGen® dose. Overall, SpikoGen® exhibited positive immunogenicity and low reactogenicity, indicating that a low incidence of adverse events does not equate to poor immunogenicity. SpikoGen® remains a promising protein-based vaccine platform for COVID-19 protection.

Abstract Introduction and importance Fibroepithelial polyps are rare benign lesions with uncertain origins. They are commonly found in the skin and genitourinary system. Fibroepithelial polyps in the external auditory canal are infrequent. Case presentation We report a 60-year-old Persian woman with an incidentally discovered painless fibroepithelial polyp in the right external auditory canal. Microscopic transcanal surgery confirmed the diagnosis after temporal computed tomography imaging showed a soft tissue mass. Clinical discussion Fibroepithelial polyps have an uncertain etiology and are typically asymptomatic. Surgical resection is the preferred treatment, and the prognosis following resection is generally favorable, with low recurrence rates. Conclusion This case highlights the rarity of fibroepithelial polyps in the external auditory canal and underscores the importance of considering them in the differential diagnosis of external auditory canal lesions.

Purpose: The current study aims to investigate the effect of a comprehensive warm-up program on functional movement (FM) patterns and landing errors of young male wrestlers. Methods: For this purpose, 50 wrestlers from Karaj City, Iran were selected as available to participate in the research and then randomly divided into two equal experimental groups (25 people) and a control group (25 people). Then, the landing error scoring system (LESS) test was used to evaluate the landing error, and deep squat, lunge, shoulder mobility, and rotational stability tests were used to measure the quality of movement patterns, and finally, the Nordic questionnaire was used to measure musculoskeletal pain. The experimental group performed special wrestling warm-up exercises for eight weeks and three sessions of 30 minutes per week. Results: The results of the chi-square test showed that the musculoskeletal pain in the knee area of the subjects in the experimental group improved significantly after eight weeks of training (P=0.04), but the musculoskeletal pain in the shoulder and trunk of the wrestlers did not improve significantly (P>0.05). The results of the U-Man-Whitney U test showed that among the variables related to performance, no significant difference was observed in the post-test in the right and left shoulder mobility test (P

Objectives: Pelvic belts are prescribed for back and pelvic pain during pregnancy and postpartum. This study reviews level II literature (randomized clinical trials and clinical trials) considering the effect of pelvic belt application on pain and functional disability in pregnant women with pelvic girdle pain or low back pain. Methods: Two reviewers independently performed a computerized literature search from PubMed/MEDLINE (NLM), Scopus, Web of Science, PEDro and Google Scholar databases. The included studies were agreed upon by the two reviewers, and a third reviewer mediated any disagreements. Data extraction was conducted by the two reviewers and cross-checked by a third reviewer. The quality of each included trial was assessed independently by the two reviewers and scored using the PeDro scale. Any discrepancies in selecting the studies and scoring them were resolved by a third collaborator. Results: A total of 9 studies met the inclusion criteria and were selected for the systematic review. Four fair- and one low-quality study reported more significant pain reduction by the flexible pelvic belt than the usual healthcare or physical therapy. In two fair- and one low-quality study, higher functional improvement was reported by belt than healthcare or physical therapy. Meanwhile, one high- and one fair-quality study showed no added functional ability in the flexible belt for health care or exercise. Discussion: The current review suggests using the flexible belt as a practical treatment approach in alleviating pain in pregnant women with pelvic girdle pain or low back pain (LBP) during pregnancy. However, the added efficacy in functional disabilities is controversial.

Objectives: Fatigue leads to an increase in joint restoration errors because of nervous system fatigue and a lack of understanding of joint position and imbalance that may be due to the changes in walking patterns and excessive pressure on bones and soft tissue structures, which may ultimately lead to injuries in climbers. Accordingly, this study investigates the effect of fatigue on the restoration error of the knee and ankle joint angles. Methods: This was a quasi-experimental study. A total of 35 mountaineers aged 20-35 years were selected by the non-random sampling method. This research was conducted on September 10, 2022, at the Tochal Climbing Rout in Velenjak, Tehran City, Iran. The tests were taken before and after a mountaineering program for a distance of 8 km at an average speed. The position sense of knee and ankle joints was evaluated using the Mobimed, which is a type of electrogoniometer. The normal distribution of the data was statistically analyzed using the Shapiro-Wilk test, and the data were analyzed using the paired t-test. The SPSS software, version 24, was used for all statistical operations (P≤0.05). Results: The findings showed that fatigue causes errors and significant changes in the restoration of knee and ankle joint angles and 30° (P=0.003), 45° (P=0.004), 60° (P=0.007), dorsiflexion of 10° (P=0.009) and plantar flexion of 20° (P=0.001), the restoration and sense of position is disturbed, which shows that fatigue is effective in understanding the state of the joints. Discussion: Fatigue increases the error of restoration of the knee and ankle joint angles, which can reduce the optimal performance of the muscles around the joints by reducing the person’s understanding of the angles and the sense of the joint position.

Abstract Background The choice of an appropriate similarity measure plays a pivotal role in the effectiveness of clustering algorithms. However, many conventional measures rely solely on feature values to evaluate the similarity between objects to be clustered. Furthermore, the assumption of feature independence, while valid in certain scenarios, does not hold true for all real-world problems. Hence, considering alternative similarity measures that account for inter-dependencies among features can enhance the effectiveness of clustering in various applications. Methods In this paper, we present the Inv measure, a novel similarity measure founded on the concept of inversion. The Inv measure considers the significance of features, the values of all object features, and the feature values of other objects, leading to a comprehensive and precise evaluation of similarity. To assess the performance of our proposed clustering approach that incorporates the Inv measure, we evaluate it on simulated data using the adjusted Rand index. Results The simulation results strongly indicate that inversion-based clustering outperforms other methods in scenarios where clusters are complex, i.e., apparently highly overlapped. This showcases the practicality and effectiveness of the proposed approach, making it a valuable choice for applications that involve complex clusters across various domains. Conclusions The inversion-based clustering approach may hold significant value in the healthcare industry, offering possible benefits in tasks like hospital ranking, treatment improvement, and high-risk patient identification. In social media analysis, it may prove valuable for trend detection, sentiment analysis, and user profiling. E-commerce may be able to utilize the approach for product recommendation and customer segmentation. The manufacturing sector may benefit from improved quality control, process optimization, and predictive maintenance. Additionally, the approach may be applied to traffic management and fleet optimization in the transportation domain. Its versatility and effectiveness make it a promising solution for diverse fields, providing valuable insights and optimization opportunities for complex and dynamic data analysis tasks.

Objectives International guidelines recommend cervical screening cessation at age 50 following two consecutive negative screens. However, many women aged 50 and older in low-income and middle-income countries (LMICs) have not had prior opportunity to screen. We examine the prevalence of cervical dysplasia and cervical cancer stage in Botswana women aged 50+ compared with 30–49, stratified by HIV status.Design Secondary analysis of data from two prospective cohort studies.Setting The screening cohort was recruited at health facilities in South East District. The cancer cohort was recruited from the primary public tertiary referral hospital and a private hospital in Gaborone, Botswana.Participants The screening cohort included 2570 women aged 30 and older recruited from February 2021 to August 2022. Screening eligibility included anyone with a cervix and without a prior history of cervical cancer. The cancer cohort included 1520 patients diagnosed with cervical cancer who sought care at the facilities where recruitment took place from January 2015 to December 2022.Primary and secondary outcome measures The prevalence of cervical intraepithelial neoplasia (CIN)2+ and cancer stage at diagnosis was compared across age groups, stratified by HIV status. Prevalence ratios were calculated for the association between age and CIN2+/CIN3+via log-binomial regression.Results The prevalence of CIN2+ was similar between 30–49 years old and 50+, both among women with HIV (WWH, 15.9% and 19.3%, respectively) and without HIV (13.3% and 10.4%, respectively). Similar findings were found when CIN3+ was used as the outcome. There were no statistically significant differences in prevalence ratios (PRs) across age groups for CIN2+ (adjusted PR (aPR) WWH 1.1 (95% CI 0.80 to 1.6); aPR HIV− 0.78 (95% CI 0.45 to 1.4) nor CIN3+ (aPR WWH 1.1 (95% CI 0.70 to 1.6); aPR HIV− 0.81 (95% CI 0.40 to 1.7)). Nearly half of cervical cancer diagnoses were made in women 50+; three-quarters of cases in women without HIV were diagnosed at 50+ years.Conclusions Our findings demonstrate the prevalence of high-grade cervical dysplasia and cervical cancer remains high beyond age 50 in both women with and without HIV in an LMIC context with high HIV prevalence. Screening women 50+ will allow treatment for cervical dysplasia and may provide early diagnosis of curable cervical cancer. These findings support the rapid introduction of high-performance cervical screening to increase access for women 50+.Trial registration number NCT04242823.

Background & Aims: The confirmed cases of the new coronavirus disease (COVID-19) have increased not only in China but also in Iran and around the world. COVID-19 vaccination not only protects the individual but also safeguards those in the community who are unable to be vaccinated. Due to this concern, the present study was conducted to determine the relationship between vaccination and its consequences in patients with COVID-19. Materials & Methods: This descriptive study was conducted in Asadabad city, in western Iran. The data for this project were collected from the database and records of patients with COVID-19 in Asadabad Health Department. In fact, the sample size included all patients with a positive PCR diagnosis in the year 2022. Nine hundred fifty-one patients were included in the study. The tool used was a checklist based on patient records. SPSS software was used to analyze the data, and a significance level of less than 0.05 was considered. Results: The mean age of patients with a positive PCR test was 20.8 ± 42.9 years. Of these, 68.5% were vaccinated, and 31.5% were not vaccinated. Among the 951 patients, 30 patients with a positive PCR died, 19 of whom were not vaccinated. There was a significant relationship between the outcome of the disease (death or discharge) and the number of vaccine doses (p value = 0.001). Conclusion: Due to the effectiveness of COVID vaccination in reducing hospitalization and mortality, it is recommended to design educational interventions to encourage people to increase vaccination coverage.

Abstract Introduction Scapular anatomical neck fractures are among the most infrequent shoulder girdle fractures. Only seven radiologically confirmed cases of scapular anatomical neck fractures have been documented in the literature to date, of which only one case underwent delayed surgery. Case presentation A 34-year-old male Persian patient with morbid obesity was diagnosed with a scapula anatomical neck fracture after a motor vehicle collision. The radiographic assessment of the patient indicated an increase in the scapular glenopolar angle (73.9°). Due to concurrent chest and head injuries, surgical intervention was deferred until 6 weeks following the injury. The posterolateral limited Dupont–Evrard approach was used because of the patient’s extremely high body mass index. Two plates were utilized to achieve stable fixation of the glenoid neck fracture. Following a 1 year follow-up period, complete fracture union was successfully attained, resulting in a constant score of 79. Conclusions The most accurate radiographic indicators of these fractures are a superior fracture line located laterally to the coracoid process, a small inferior spike, and an elevated glenopolar angle. The only tendon attached to the glenoid is the long head of the triceps, making these fractures unstable; therefore, surgery is required in the majority of instances. The small size of the fractured component makes stabilization more difficult. Overall, anatomical scapular neck fractures are extremely uncommon and distinguished from other scapular fractures by their unique radiological and biomechanical characteristics. This case highlights the challenges encountered when managing scapular fractures in patients with morbid obesity. The delayed surgical intervention and the choice of surgical approach tailored to the patient’s specific anatomical and physiological considerations proved to be effective in achieving a favorable outcome.

Abstract The substitution of leucine to proline at position 39 (p.P39L) in human αB-crystallin (αB-Cry) has been associated with conflicting interpretations of pathogenicity in cataracts and cardiomyopathy. This study aimed to investigate the effects of the p.P39L mutation on the structural and functional features of human αB-Cry. The mutant protein was expressed in Escherichia coli (E. coli) and purified using anion exchange chromatography. We employed a wide range of spectroscopic analyses, gel electrophoresis, transmission electron microscopy (TEM), and atomic force microscopy (AFM) techniques to investigate the structure, function, stability, and fibrillation propensity of the mutant protein. The p.P39L mutation caused significant changes in the secondary, tertiary, and quaternary structures of human αB-Cry and increased the thermal stability of the protein. The mutant αB-Cry exhibited an increased chaperone activity and an altered oligomeric size distribution, along with an increased propensity to form amyloid aggregates. It is worth mentioning, increased chaperone activity has important positive and negative effects on damaged cells related to cataracts and cardiomyopathy, particularly by interfering in the process of apoptosis. Despite the apparent positive nature of the increased chaperone activity, it is also linked to adverse consequences. This study provides important insights into the effect of proline substitution by leucine at the N-terminal region on the dual nature of chaperone activity in human αB-Cry, which can act as a double-edged sword.

Abstract Introduction Designing, developing, and implementing a course without assessing and prioritizing instructional needs may result in inefficiency due to the disregard for the actual needs of the target population. The present study aimed to determine and prioritize medical students’ instructional needs regarding Massive Open Online Courses (MOOCs) at Shiraz University of Medical Sciences. Methods This survey study was carried out in three stages (2020–2021) using the Delphi technique. Purposive and snowball sampling methods were used to select the instructors. The students were selected through simple random sampling. The first round of the Delphi technique involved a questionnaire consisting of one open-ended question, completed by 49 basic/clinical faculty members and 47 senior medical students. In the second round, a 5-point Likert scale-based questionnaire was used to prioritize the instructional needs. The reliability of the questionnaire was verified by Cronbach’s alpha coefficient. In the third round, a focus group was used. A total of six expert faculty members and one senior medical student were invited to the focus group session to prioritize the needs. Data were analyzed using Friedman’s non-parametric ranking test in SPSS version 26. Results Ten instructional needs priorities were extracted, including common pharmacotherapies (antibiotics and narcotics), prescriptions, physiology, anatomy, physical examination, electrocardiography interpretation, radiography, computed tomography scans, serum electrolyte disorders, and cardiovascular and internal (endocrine and metabolic) diseases. The chi-squared calculated value (715.584) indicated a significant difference in the importance of the questionnaire’s questions (P

Breast cancer is a prevalent disease worldwide and the accurate diagnosis and prognosis of breast cancer are essential for the development of effective treatment plans. Pathology remains the gold standard for diagnosis and prognosis but with limitations such as time-consuming manual scoring and some error-prone results. Recently, deep learning techniques, especially convolutional neural networks (CNN), have been proposed for the interpretation of immunohistochemistry (IHC) results in breast cancer. The objective of this systematic review is to critically assess the existing literature on computer-aided systems for the interpretation of IHC results in breast cancer based on deep learning algorithms. We included studies with models that use novel approaches such as deep learning for quantitative measurements of immunohistochemically stained Ki-67, ER, PR, and HER2 images. We systematically searched PubMed, Scopus, and web of science up to September 2022. 15 studies (seven HER2, seven Ki67, and one ER/PR scoring studies) met our inclusion criteria. Various AI-based assays have been developed for different applications in breast pathology, including diagnostic and prognostic applications, as well as predictive values and responses to treatment. These algorithms have shown promise in improving the accuracy of breast cancer diagnosis and prognosis. It is essential to consider the differences in training and inter-observer variability while designing tools, and there is an urgent need to integrate the detection and analysis of various biomarkers at the same place and time to facilitate the formation of patients' reports and treatment.

Key Clinical Message FBS is associated with surgical interventions or malignancies and could occur idiopathically. Also, this case highlights the successful management of FBS symptoms with pharmacological intervention with gabapentin and carbamazepine.

Abstract This research paper presents the development of a nonlinear Muskingum model which achieves precise flood routing through river reaches while considering lateral inflow conditions. Fourteen pairs of flood hydrograph found at two specific United States Geological Survey (USGS) stations located along the Red River of the North, namely Grand Forks and Drayton, are used for the calibrations and validations of the Muskingum model. To enhance the accuracy of the procedure, a reach is divided into multiple sub-reaches, and the Muskingum model calculations are performed individually for each interval using the distributed Muskingum method. Notably, the model development process incorporates the use of the Salp Swarm algorithm. The obtained results demonstrate the effectiveness of the developed nonlinear Muskingum model in accurately routing floods through the very gentle river with a bed slope of (0.0002–0.0003). The events were categorized into three groups based on their dominant drivers: Group A (Snowmelt-driven floods), Group B (Rain-on-snow-induced floods), and Group C (Mixed floods influenced by both snowmelt and rainfall). For the sub-reaches in Group A, single sub-reach (NR = 1), the Performance Evaluation Criteria (PEC) yielded the highest value for SSE, amounting to 404.9 × 106. In Group B, when NR = 2, PEC results the highest value were SSE = 730.2 × 106. The number of sub-reaches in a model has a significant influence on parameter estimates and model performance, as demonstrated by the analysis of hydrologic parameters and performance evaluation criteria. Optimal performance varied across case studies, emphasizing the importance of selecting the appropriate number of sub-reaches for peak discharge predictions.

Abstract Background Radial head arthroplasty is a viable option in cases with terrible triad injuries of elbow, wherein the radial head sustains significant comminution that precludes reconstruction. Nevertheless, this alternative is not recommended for individuals with poor elbow skin conditions, accompanied neuropsychiatric disorders, or low patient compliance. This case report presents a patient with bilateral terrible triad injury, along with the aforementioned conditions. The report outlines the treatment challenges of such a case and proposes potential solutions. Case presentation A 37-year-old Persian male patient presenting with a bilateral terrible triad fracture–dislocation and a history of psychoactive substance abuse, was admitted to our emergency department. The patient underwent radial head replacement using a cement spacer containing antibiotics, due to the comminuted radial head in the presence of a contaminated wound on the left elbow. The fracture of the right side was successfully fixed. Subsequent to discharge, the patient did not attend any follow-up appointments. After a period of 6 months, he was admitted to the psychiatric ward and orthopedic consultation was requested to evaluate the patient. Conclusion In acute terrible triad injuries with unreconstructable radial head fractures where arthroplasty with metallic prostheses may not be suitable due to contaminated wounds, unstable psychiatric condition, and low patient cooperation, temporary orthopedic cement spacers can maintain elbow biomechanics, stability, and sterility.

Background: Pediatric nurses are responsible for caring for children and their families; thus, investigating missed care in the pediatric ward is important and helps to improve the quality of care. Accordingly, this study aimed to explain the perceptions of pediatric nurses about missed care.Methods: This study was conducted using content analysis on 15 pediatric nurses selected by purposive sampling. The data were collected through in-depth semi-structured interviews. After obtaining informed consent, interviews were audio-recorded and transcribed verbatim. MAXQDA software (version 10) was used to facilitate coding and thematic analysis.Results: Four main categories emerged from the data analysis, including missed family-centered care, unsafe care, predisposing factors, and adverse outcomes.Conclusion: The findings showed that from the perspective of pediatric nurses, missed care occurs in different dimensions, including psychological support, communication, education, assessment, drug treatment, and infection control, and it can ultimately lead to mother’s dissatisfaction and bring about adverse effects on the child’s recovery besides harming the nurse.

Background: The current study aims to assess cardiovascular risk factors (CVRFs) among diabetic versus nondiabetic nonalcoholic fatty liver disease (NAFLD) patients. NAFLD is the most common hepatic disorder worldwide which is directly associated with diverse CVRFs such as type 2 diabetes mellitus (T2DM) and metabolic syndrome (MS). Materials and Methods: The current cross-sectional population-based study has been conducted on 1031 NAFLD patients. After excluding 340 prediabetes patients, the NAFLD patients were divided into T2DM and normal blood glucose (NBG). Then, CVRFs were compared between the two groups. Results: Out of 691 NAFLD cases included in the study, 337 (48.8%) patients had T2DM. In the T2DM and NBG groups, the body mass index (BMI) was 31.2 ± 4.6 and 29.9 ± 4.3 kg/m2, respectively (P = 0.001). The waist circumference was 102.2 ± 10.2 and 97.6 ± 10.6 cm, respectively (P < 0.001). The systolic blood pressure was 123.3 ± 15.6 and 119.6 ± 13.6 mmHg, respectively (P = 0.043). The triglyceride levels were 191.9 ± 104.7 and 176.5 ± 89.6 mg/dL, respectively (P = 0.042). Generally, these factors were significantly higher among the diabetic patients. Besides, cardiovascular disease (CVD), hypertension, and MS were statistically more prevalent in NAFLD patients with T2DM (P < 0.001) than nondiabetic NAFLD patients. In multiple logistic regression models, the odds ratio of CVD, hypertension, and MS was 2.18, 2.12, and 6.63 for patients with T2DM compared with NBG, respectively. Adjustment was made for age, sex, BMI, smoking, and physical activity. Conclusion: CVRFs were higher in NAFLD patients with T2DM than NAFLD patients with NBG.

Abstract Dead-time is the most important disturbance in a voltage-source inverter’s operation. It introduces low-order harmonics at the inverter’s output voltage. To compensate for the dead-time effects in three-phase grid-tied inverters, this paper proposes a Linear Quadratic Gaussian (LQG) multivariable control approach. The LQG multivariable control is known as a robust control approach while provides a high band-width for the closed-loop system. Therefore, it promises significant attenuations in the dead-time introduced harmonics. To achieve a high performance, we run the three-phase grid-tied inverter in the current-controlled mode. Based on the nominal multivariable model derived for the three-phase grid-tied inverter in a synchronous reference frame, the LQG controller is composed such that the closed-loop system exhibits robust stability while attenuates disturbances significantly. The dead-time introduced harmonics produce disturbances in the synchronous reference frame with the highest frequencies. This is the reason for considering the dead-time as the most important disturbance in an inverter’s operation. For an experimental set-up manufactured for the three-phase grid-tied inverter, we developed a detailed model in MATLAB/Simulink. It is employed for the performance verifications of designed LQG controller. Extensive results are presented for different important scenarios, based on which, the excellent performance of proposed approach is proven. In fact, by employing the proposed approach, the dead-time introduced harmonics are significantly attenuated such that a Total Harmonics Distortions (THD) of about 5% is achieved for the injected currents to grid which meets the IEEE 1547 standard.

Introduction. Disability to recognize emotional and mental states from other people’s facial expressions is acknowledged as one of the major developmental-behavioral problems in autistic children. Therefore, this study aimed to investigate the effect of traditional and computer emotional facial training on the recognition of facial emotional states in children with autism and mother-child relation and parental competence in mothers of autistic children. Material and Methods. The present was clinical trial study. The children in the both groups were trained during 10 sessions. In traditional group children training using 40 images related to four situations as happiness, sadness, anger, and fear. The children in the computer group trained with the Let’s Face It software. These questionnaires were completed one day before and one day and one week after performing the intervention. The data were analyzed using SPSS software. Results. Findings showed that emotional state training has improved the identification of emotional states (p = 0.01), mother-child relation (p = 0.001) and parental competence (p = 0.001) in the both groups. There was also a statistically significant difference between the scores of identifying face emotional states (p = 0.01), mother-child relation (p = 0.001) and parental competence (p = 0.001) in the both groups. But training in traditional group was effectiveness than computer grope. Conclusion. Teaching emotional face to children with autism improved the recognition of emotional states by these children, and subsequently improved the mother-child relationship and motherly sense of competence in the mothers of these children.

Background: COVID-19 is a respiratory disease pandemic and a major global health problem that can cause acute respiratory distress syndrome (ARDS). Previous studies have shown an inverse link between toxoplasmosis and COVID-19. This study aimed to evaluate the association between COVID-19 and toxoplasmosis infection. Methods: In this cross-sectional descriptive study, samples were taken from 360 patients, 50% of whom were men and 50% were women. Of the patients, 180 were determined to be COVID-19-positive by the ELISA kit, and 180 were in the control group. Some demographic characteristics, such as sex, age range, and occupation, were also recorded. Results: This study was conducted on 180 COVID-19-positive patients, of whom 26.7% were in the 16-30-year age group, 25.1% were self-employed, and 31.7% had anti-Toxoplasma gondii antibodies. Among the 180 control patients, 21.1% had antibodies for T. gondii. Of the 57 patients who were co-infected with both COVID-19 and toxoplasmosis, men had higher infection rates (63.2%) than women (36.8%). There was a significant relationship between co-infections with COVID-19 and toxoplasmosis with occupation, but not with age. Conclusion: The study found that people with toxoplasmosis infection have a 1.73 times higher risk of contracting COVID-19. The findings suggest that infectious agents could be a predisposing factor, possibly due to changes in cytokine levels.

Abstract Background Choosing the appropriate treatment approach for a multifocal comminuted open fracture of humerus with severe soft tissue defect is a challenging issue, which could be interesting for every orthopedic surgeon especially for those working in the trauma centers. Case presentation This study described an innovative approach using titanium elastic nailing to treat a multifocal comminuted open fracture of humerus with severe soft tissue defect. In this study, we report a 40-year-old Persian female patient in whom the treatment achieved complete fracture union and skin graft healing by elastic medullary nailing, vacuum dressing, and skin grafting. Conclusions Elastic medullary nailing is a viable option for reconstruction of simultaneous comminuted fracture and soft tissue defect.

Abstract Background In cases with injuries to the shoulder region, the combination of acromioclavicular joint dislocation, reverse Hill–Sachs lesion, and proximal humeral fracture is a very rare condition. Case presentation This study described a 38-year-old male Persian patient with simultaneous acromioclavicular joint dislocation, proximal humeral fracture, and reverse Hill–Sachs lesion due to motor vehicle crash injury who underwent arthroscopic acromioclavicular joint fixation using tight rope technique. In the 7-month follow-up period following the surgical fixation, range of motion was approximately normal. Reduction and hardware were intact, no dislocation or apprehension to dislocation was observed. Patient only had minor shoulder pain at the end of range of motion and a dull pain on the site of incision over the clavicle in deep touch. Our findings showed acceptable arthroscopic outcomes in the management of such complex case. Conclusion Our experience on this case showed acceptable outcomes of the arthroscopic treatment of the acromioclavicular joint dislocation in the management of such a complex case with associated injuries to the shoulder region.

Given the growing trend of population aging worldwide and the rising prevalence of chronic diseases in this age group, the need to care for older adults is increasing, which puts a heavy burden on family caregivers

BackgroundHip fractures are highly prevalent in the elderly, with intertrochanteric (IT) fractures of the femur constituting about half of the fractures in this region. We aimed to evaluate the levels of serum calcium and vitamin D in patients with stable or unstable IT fractures to study their contribution to the severity of IT fracture.Materials and methodsUsing a prospective cross-sectional design, we enrolled patients with IT fractures admitted to two referral orthopedic centers in 2022. Unstable IT fracture was defined as those with reverse obliquity or a trans-trochanteric pattern of fracture, a large or comminuted posteromedial fragment, and subtrochanteric extension of the fracture. Serum 25 (OH) vitamin D and calcium levels were the main study variables assessed by lab tests and compared among the two study groups: stable and unstable IT fractures.ResultsA total of 286 patients with a mean age of 70.5 ± 7.3 years and a female predominance (60.4%) were included in the final analysis. Among the patients, 139 (48.6%) had stable IT fractures, and 147 (51.4%) had unstable IT fractures. The mean serum level of vitamin D was significantly higher in the stable group (30.3 ± 7.0) compared to the unstable group (26.5 ± 6.1) (P-value = 0.007). Increasing age was associated with a decreasing level of serum vitamin D; however, the association was weak and not statistically significant (P-value = 0.319). The mean serum calcium level was higher among stable cases (8.6 ± 0.7) compared to unstable cases (8.4 ± 0.9); however, the difference was not statistically significant (P-value = 0.540). Vitamin D and calcium levels were almost similar among males and females.ConclusionLower levels of serum vitamin D were significantly associated with unstable IT fractures, and supplementation with this element might prevent severe fractures of this type and other fragility hip fractures.

Key Clinical Message Regaining restorative space for fullmouth reconstruction in a patient with deep bite and worn dentition by conservative approach in current vertical dimension and also using minimally invasive concept is recommended. Abstract Full mouth reconstruction of a deep bite patient with severely worn dentition is a challenging situation for the prosthodontists. This study represents minimally invasive procedures in mentioned condition without increasing vertical dimension. After 3 years of follow up no complication was observed.

Background Post-dural puncture headache (PDPH) is one of the most common complications in patients undergoing spinal anesthesia. The present systematic review and meta-analysis aimed to assess the therapeutic and prophylactic effects of aminophylline and theophylline on PDPH. Methods Relevant studies were identified by searching the following electronic databases, without language restriction, until June 2020: Scopus, EMBASE, MEDLINE, Google Scholar, Web of Science, Cochrane Library-CENTRAL, and CINAHL Complete. Random effects models were used to calculate the standardized mean difference (SMD) and risk ratios (RRs) with 95% confidence intervals (95% CI) to assess the therapeutic and prophylactic effects of aminophylline and theophylline on PDPH, respectively. The Cochrane tool was used for the quality assessment of the included studies. The certainty of the evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation method. Results Of the 1,349 initial records, 15 met our eligibility criteria (6 studies on therapeutic and 9 on prophylactic effects). A significant reduction in the pain score was observed following aminophylline/theophylline treatment (SMD = –1.67; 95% CI, –2.28 to –1.05; P < 0.001, I2 = 84.7%; P < 0.001). Subgroup analysis revealed that the therapeutic effect was significantly higher when these agents were compared to placebo than when conventional therapies were used. The risk of PDPH after aminophylline administration was not significantly reduced (RR = 0.74; 95% CI, 0.42 to 1.31; P = 0.290). Conclusions Theophylline and aminophylline have therapeutic, but not prophylactic, effects on PDPH.

Background: In the last few decades, concern over environmental safety has increased significantly. One of the main causes of environmental degradation is the discharge of untreated pollutants into water bodies. This study examined the efficiency of the photo-Fenton oxidation process to remove chemical oxygen demand (COD) and total organic carbon (TOC) from petroleum wastewater.Methods: Experiments were designed using the Box-Behnken method- a model of the response surface method (RSM) by MINITAB software. First, a wooden chamber equipped with UV lamps installed in the center was applied. The effect of effective parameters on the photo-Fenton process, including naphthalene concentration (10-70 μg/L), pH (2-7), H2O2 (50-800 mg/L), Fe (5-80 mg/L), contact time (10-120 minutes) and UV rays was investigated.Results: The highest removal efficiency of the COD (case 89.27) was at achieved at pH = 2, UV = 24, naphthalene concentration 10 μg/L, Fe concentration 36.06 mg/L, hydrogen peroxide content 800 mg/L, and contact time 120 min. Besides, the highest removal efficiency of the process in removing TOC was 71.04% obtained at 2 pH = 24, UV = 24, and a reaction time of 120 min.Conclusion: Based on the results of this research, the photo-Fenton process has a significant efficiency in removing COD and TOC from petroleum effluents containing cyclic aromatic hydrocarbons and can be utilized as an efficient method for the treatment of petroleum wastewaters.

Abstract This study aims to establish whether zinc (Zn) and cadmium (Cd) share similar physiological mechanisms for uptake and translocation in cacao plants (Theobroma cacao L.). Multiple-collector ICP-MS was used to determine the Zn stable isotope compositions in the roots, stems and leaves of 19 diverse cacao genotypes grown in hydroponics with 20 µmol L−1 CdCl2. Additional plants of one genotype were grown in hydroponic solutions containing lower Cd concentrations (0 and 5 µmol L−1 added CdCl2). Regardless of the Cd concentration used in the exposures, the Zn stable isotope compositions show the same systematic patterns in plant organs, with δ66Znroot > δ66Znstem > δ66Znleaf (δ66Zn denotes relative differences in 66Zn/64Zn ratios in parts per thousand). The mean Zn stable isotope fractionation between the plants and the hydroponic solutions was ε66Znuptake = –1.15 ± 0.36‰ (2SD), indicating preferential uptake of isotopically light Zn by plants from the hydroponic solution. The mean stable isotope fractionation factor associated with translocation of Zn from roots to shoots, ε66Znseq-mob = + 0.52 ± 0.36‰ (2SD), shows that isotopically heavy Zn is preferentially sequestered in the cacao roots, whilst isotopically light Zn is mobilised to the leaves. A comparison with the Cd stable isotope compositions of the same plants shows that both isotopically light Zn and Cd are preferentially taken up by cacao plants. In contrast to Zn, however, the cacao roots retain isotopically light Cd and transfer isotopically heavy Cd to the leaves.

Background and Objective: Cesarean Scar Pregnancy (CSP) is a rare and life-threatening complication that involves implantation of a gestational sac at the location of a previous cesarean scar. The presence of a cesarean scar in the uterus can have a significant effect on the placental implantation location. Knowing more about the location of placental implantation in CSP can help manage and prevent the threatening complications of this disorder. The aim of this study is to investigate the placental implantation location in cesarean scar pregnancies. Methods: This cross-sectional study was conducted on 44 patients diagnosed with CSP in the first trimester of pregnancy at Imam Khomeini Hospital in Ahvaz from March 2020 to February 2022. Demographic and clinical information of mothers, number of pregnancies and previous cesarean deliveries, and ultrasound results and placental location were reviewed based on the patients' medical records. The location of the placenta was determined and checked based on four anatomical locations in the endometrial cavity by transabdominal ultrasound between the 11th and 14th weeks of pregnancy. Findings: The mean age of the patients was 33.95±5.09 years. The number of previous cesarean sections was between 1 and 4 and the average was 2.32±0.93. The most common location of the placenta was anterior (61.4%), followed by fundal (29.5%) and posterior (9.1%). The number of previous cesarean deliveries did not have a significant effect on the placental implantation location. Conclusion: The results of this study showed that although the most common placental implantation location in CSP is the anterior location, the posterior placenta can also be present in scar pregnancy and it is not necessary to be in the anterior placenta to make the diagnosis of CSP.

Abstract Social media (SM) exerts important effects on health-related behaviors such as eating behaviors (EB). The present study was designed to determine the direct and indirect association of SM addiction with EB in adolescents and young adults through body image (BI). In this cross-sectional study, 12–22 years old adolescents and young adults, with no history of mental disorders or psychiatric medications usage were studied through an online questionnaire shared via SM platforms. Data were gathered about SM addiction, BI, and EB in its sub-scales. A single approach and multi-group path analyses were performed to find possible direct and indirect associations of SM addiction with EB through BI concerns. Overall, 970 subjects, 55.8% boys, were included in the analysis. Both multi-group (β = 0.484, SE = 0.025, P

Background and purpose: Human pluripotent stem cells (hPSCs) with the ability to differentiate into adult cells have provided a new perspective for treatment of some diseases. But, the efficiency of differentiation methods to generate hematopoietic progenitor cells (HPCs) is faced with multiple challenges. In the present study, we investigated the formation of hemato-endothelial-like structures and HPCs from hPSCs. Materials and methods: To generate hemato-endothelial structures and HPCs, in first method, three-dimensional aggregations of hPSCs were co-cultured on OP9 cells. In second and third methods, embryoid bodies (EBs) were differentiated spontaneously or directly in the culture medium containing BMP4, bFGF, SCF, and VEGF. In differentiation process, cell morphology was evaluated by microscopic observation and the expression of CD34 and CD45 markers were analyzed by flow cytometry. In addition, the ability of HPCs to differentiate into various types of blood cells was evaluated using colony formation assay, Wright-Giemsa staining, and CD86 immunofluorescence staining. Results: Findings showed that all three methods generated cells with endothelial-like morphology and HPCs. These cells were able to proliferate, form cell clusters with different efficiency and differentiate into erythroid cells, macrophages, and dendritic cells. Conclusion: The use of cultured cells in defined conditions without a feeder layer is preferred in cell therapy. Therefore, despite the ability of all these methods to generate HPCs, direct differentiation of EBs under defined conditions is a better option for generatingHPCs from hPSCs.

Objectives: Due to the importance of postpartum maternal health and the effect of pregnancy on the increase of recti diastasis rectus abdominis (DRA), this study aimed to compare the effect of eight weeks of core and Kegel exercise with emphasis on correcting the respiratory pattern on DRA in multiparous women. Methods: This is a semi-experimental study that was conducted on 45 pregnant women who had given birth six weeks ago selected according to the inclusion criteria. Individuals were divided into three selected training groups, including central area, Kegel, and control. The covariance analysis was used for intergroup comparison and a correlated t-test was used for comparison within a group. The statistical analysis was done by SPSS software, version 27. Results: The results of this study showed the effect of both training programs on reducing the distance between the recti-abdominal muscles (P0.045). Discussion: Due to the reduction of pain and DRA, it seems that using the two training programs can lead to desirable results for the people and represents the importance of using the exercises in the postpartum period.

Background: Available evidence on the efficacy of sweet solutions for reducing pain in infants is insufficient. This study aimed to assess the effects of 10% oral dextrose on the pain of infants during venipuncture. Methods: This randomized controlled clinical trial was done on 60 infants undergoing venipuncture. Eligible infants were randomly assigned into an intervention and control group. Two minutes before venipuncture, 2 ml of 10% oral dextrose solution and 2 ml of water were given to the intervention and control groups, respectively. The infants' pain intensity during the procedure was measured by two independent experts based on the Face, Legs, Activity, Cry, and CONSOL ability Behavioral Pain Scale. Data were analyzed using independent t-test and ANOVA tests. A P-value of ≤0.05 was considered statistically significant. Results: The mean (±standard deviation) age of infants in the intervention and control groups were 6.37 (2.96) and 9.03 (3.10) months, respectively (P0.05). In addition, the standardized mean difference in pain score between the two groups was -0.2 (95% confidence interval: -0.30 to 0.71). Despite a significant difference (P=0.003) in the pain score between females and males, the effect of intervention after gender effect correction was not statistically significant. Conclusion: Using 2 ml of 10% oral dextrose 2 minutes before venipuncture has a weak and non-significant effect on the pain of infants. Based on the effect size and 95% confidence interval, conducting further trials with a larger study population is recommended.

Abstract Studies show that regularly consuming whole grains reduce the risk of obesity and a wide range of chronic diseases. Despite this, studies reveal that students are consuming fewer whole grains. In the present study, we aimed to investigate the barriers to the consumption of whole grains among Iranian students. This cross-sectional study examined students at Fasa, Iran in 2020–2021. The online questionnaires were completed by students after receiving informed consent. Statistical analysis was performed using SPSS 26 and Chi-square, t-test, and logistic regression (P > 0.05). The current study involved 1890 students (1287 (68.1%) girls and 603 (31.9%) boys). Despite the preference for white flour bread among 53.8% of all students, 77.4% ate other whole-grain products, and 75.2% consumed all products at least once a week. Additionally, barriers such as access issues (70.5%), family supply issues (91.8%), lack appeal (72.8%), non-consumption by classmates (96.2%), and high prices in recent years (43.9%) were identified as obstacles to whole grain consumption. Furthermore, white bread eating students had significantly lower appetite levels and tended to eat fast food more often than those who ate whole grains (P

Background and Objective: Because students receive a variety of educational services during their studies, their view of the services provided can be considered as one of the characteristics of quality in the university. This study was conducted to determine the quality of educational services from the perspective of nursing students. Methods: A cross-sectional study was performed in the School of Nursing of Golestan University of Medical Sciences with a sample of 164 people. The data collection tool was a valid and reliable SERVQUAL questionnaire. Data analysis was performed using SPSS-23 statistical software. Findings: In all five dimensions of educational services (physical dimensions, guarantee, accountability, confidence, and empathy) there was a negative gap between the current and desired status of students and the quality of educational services. The highest mean gap was in the dimension of empathy and responsiveness (-1.73) and the lowest mean gap was related to the tangible dimension (-1.43). The age of students was directly and significantly related to the quality gap in the dimensions of confidence (P = 0.028) and empathy (P = 0.046). Gender of students with total quality gap (P = 0.004) and in the dimensions of confidence (P = 0.018), accountability (P = 0.003), guarantee (P = 0.013) and empathy (P = 0.001) P) and students' education also had a significant relationship in terms of confidence (P = 0.001). Conclusion: Students' expectations are beyond their perception of the current situation and in none of the dimensions, their expectations have been met. Holding effective communication training courses and receiving feedback can play an effective role in improving the quality of educational services.

Development of human brain is the essential process in the prenatal period of human growth. The total surface of human brain area is 1820 cm2, and the average cortical thickness is 2.7 mm. We reviewed and referred to several articles in this field. Comparative studies of the primate's brain show that there are general architectural basis governing the brain growth and evolutionary development. In this study, it is discussed about the human brain development with highlighting on the main mechanisms in the embryonic stage and early postnatal life as well as the general architectural values in brain evolution from primates to now. It is suggested that neurodevelopment involves some genetic bases in the neural stem cells proliferation, cortical neurons migration, cerebral cortex folding, synaptogenesis, gliogenesis, and myelination of neural fibers.

Abstract Blocking CD73 ectonucleotidase has been proposed as a potential therapeutic approach for cancer treatment. The present study aimed to investigate the antitumor effect of a novel EGFR-Targeted liposomal CD73 siRNA formulation in combination therapy with liposomal doxorubicin in the 4T1 mouse model. CD73 siRNA was encapsulated into nanoliposomes by the ethanol injection method. After preparation, characterization, morphology, and stability evaluation of formulations, the toxicity was measured by MTT assay. Uptake assay and efficiency of the liposomal formulations were investigated on the 4T1 cell line. The liposomal formulation containing CD73 siRNA was targeted with GE11 peptide for in vivo evaluations. Following biodistribution analysis, the antitumor activity of prepared formulations in combination with liposomal doxorubicin was studied in mice bearing 4T1 metastatic breast cancer cells. Finally, the induction of immune response of formulations in concomitant treatment with liposomal doxorubicin was evaluated in the tumor microenvironment of a mouse model of breast cancer. The size of prepared liposomal formulations at N/P = 16 for the liposomal CD73 siRNA and GE11-liposomal CD73 siRNA groups were 89 nm ± 4.4 and 95 nm ± 6.6, respectively. The nanoparticle’s PDI was less than 0.3 and their surface charge was below 10 mV. The results demonstrated that N/P = 16 yielded the best encapsulation efficiency which was 94% ± 3.3. AFM results showed that the liposomes were spherical in shape and were less than 100 nm in size. The results of the MTT assay showed significant toxicity of the liposomes containing CD73 siRNA during the 48-h cell culture. Real-time PCR and flow cytometry results showed that liposomes containing CD73 siRNA could effectively downregulate CD73 expression. Liposomal formulations were able to significantly downregulate CD73 gene expression, in vivo. However, CD73 downregulation efficiency was significantly higher for the targeted form compared to the non-targeted formulation (P value

Objectives: The present study was designed to evaluate and compare the screening markers of spontaneous and in vitro fertilization (IVF) pregnancies in individuals who underwent combined screening in the first trimester of pregnancy. Materials and Methods: In this retrospective study, we examined the difference between natural and assisted-reproductive technology (ART) pregnancies in 2252 mothers from January 2011 to October 2019. In both groups, the first trimester screening parameters including NT, free beta-human chorionic gonadotropin (β-hCG), and PAPP-A were measured. Results: According to the results of the present study, BMI was higher in the group that became pregnant by IVF compared to the normal pregnancy group (P

Abstract Motor neuron diseases such as spinal cord injuries and amyotrophic lateral sclerosis are known as the most common disorders worldwide. Using stem cells (e.g., human umbilical cord blood mesenchymal stem cells) is currently a potent medical approach for modulating the impact of neural damages and regeneration of spinal cord injuries. MicroRNAs (miRNA) are taken into account as principal regulators during differentiation. The miRNAs play a significant role in stem cell self-renewal and fate determination. There are few studies on how miRNAs regulate neural differentiation in stem cells. The purpose of this study is to explore miRNA profiles of CB-MSCs during differentiation into motor neuron-like cells. Human CB-MSCs were isolated and characterized using flow cytometry. Cell differentiation has been induced by combining retinoic acid (RA) and sonic hedgehog (Shh) in a two-step protocol for 14 days. Then, cell differentiation was confirmed by immunocytochemistry and flow cytometry. The miRNA was analyzed using Illumina/Solexa sequencing platform. In this regard, three libraries were prepared to investigate the effect of these two biological morphogens on the miRNA profile of the differentiating cells. These libraries were Control (non-treated CB-MSCs), Test 1 (RA + /Shh +), and Test 2 (RA-/Shh-). Quantitative RT-PCR was employed to verify miRNA expression. CB-MSCs were spindle-shaped in morphology, and they did not express hematopoietic markers. After differentiation, the cells expressed motor neuron markers (i.e., Islet-1, SMI-32, and ChAT) at the protein level after 14 days. The analysis of miRNA sequencing demonstrated a significant up-regulation of miR-9-5p and miR-324-5p in Test 1 (RA + /Shh +). Also, there is a considerable down-regulation of mir-137 and let-7b in Test 2 (RA-/Shh-). These results have been obtained by comparing them with the Control library. Indeed, they were responsible for neuron and motor neuron differentiation and suppression of proliferation in neural progenitor cells. Furthermore, significant up-regulation was detected in some novel microRNAs involved in cholinergic, JAK-STAT, and Hedgehog and MAPK signaling pathways. CB-MSCs are potent to express motor neuron markers. This procedure has been performed by developing a two-week protocol and employing Shh and RA. The miRNA profile analysis showed a significant up-regulation in the expression of some miRs involved in neuron differentiation and motor neuron maturation. MiR-9-5p and miR-324-5p were up-regulated at the early stage of differentiation. Also, miR-137 and miR-let-7b were downregulated in the absence of RA and Shh. Furthermore, several novel miRNAs involved in cholinergic, Hedgehog, MAPK, and JAK-STAT signaling pathways have been detected. However, further studies are still necessary to validate their functions during motor neuron generation and maturation.

Aims: Deep sense plays a significant role in sensory control feedback, joint stability, coordination and balance. Despite the important role of vision and Proprioceptive Neuromuscular Facilitation on functional skills in athletes, a few studies have been conducted in this regard. This study aimed at investigating the effects of Proprioceptive Neuromuscular Facilitation exercises on dynamic visual acuity and performance of young female basketball players. Instrument & Methods: In this is semi-experimental study, 34 young basketball players were randomly classified into two intervention and control groups. In the intervention group, the participants were involved the program of Proprioceptive Neuromuscular Facilitation. Moreover, in the control group, the participants performed their own daily routine exercises. Harrison Basketball Skills was used for measuring the sport performances. Also, dynamic visual acuity was measured by the PowerPoint. The SPSS software (version 23) was used for statistical analysis. Findings: The results implied that PNF exercises resulted in a significant increase in the Sport performance and dynamic visual acuity in the intervention group. A statistically significant difference was observed in the Sport performance and dynamic visual acuity between the intervention and control groups before doing the exercise protocol. Conclusion: It can be concluded that the Proprioceptive Neuromuscular Facilitation can be used to enhance the performance and dynamic visual acuity in basketball players and other dynamic sports.

Objective: Physical activity increases mental health, enhances feelings of worth, reduces depression, and increases mental strength. This study aimed to determine the effect of exercise on the self-esteem and happiness of operating room students. Methods: This research is a quasi-experimental study. The Participants were 80 undergraduate students in the operating room of Arak University of Medical Sciences. After obtaining written consent, the subjects were selected by convenience sampling and randomly assigned to the experimental and control groups (40 students in each group). The experimental group walked 30 minutes per day for eight weeks. The self-esteem and happiness of both groups were measured before and after the intervention using the Rosenberg self-esteem questionnaire and the Oxford happiness questionnaire. The obtained data were analyzed using an independent t test and paired t test in SPSS v.16 software. Results: The mean scores of self-esteem and happiness before the intervention in the experimental group were 3 ±4.23 and 43.08±19.01, and in the control group were 3.47±4.30 and 39.40±19.48, respectively. After the intervention, The mean scores of self-esteem and happiness were 6 ± 3.85 and 52.16±19.28 in the experimental group and 3.97±4.75 and 41.05±18.80 in the control group. The results showed a significant difference in the experimental group (P 0.05). Conclusion: Exercise can play an influential role in increasing students’ self-esteem and happiness, thereby promoting their mental health and improving their quality of life. Therefore, it is recommended that sports programs be held at the university to promote happiness and increase students’ self-esteem.

Background and Objective: Poisoning is one of the most common causes of emergency room visits. Opioids and methadone are the causes of unintentional poisoning, especially in children, who have a high burden of emergency referrals in children's hospitals. This study was performed to evaluate methadone poisoning in the pediatric emergency department in Gorgan, North of Iran. Methods: This cross-sectional study was performed on the records of patients admitted (85 boys and 70 girls) cases due to methadone poisoning in Taleghani Hospital in Gorgan, North of Iran during 2001-19 .The symptoms of patients and the costs of treatment and care of patients were analyzed. Results: A total of 258 cases of poisoning were registered, of which 155 (60%) were methadone poisoning. Poisoning occurred for 136 cases (87.8%) with methadone syrup and for 19 cases (12.2%) with methadone tablets. The mean of age and age range was 47.94±36.25 months and 4-156 months, respectively. The mean and standard deviation of the time interval from consumption to the time of admission was 164.84±160.11 minutes and the maximum and minimum time interval were 720 and 15 minutes, respectively. 34 cases (22%) were conscious, 110 cases (71.5%) had impaired level of consciousness, seven cases (4.5%) presented with cardio respiratory arrest and three patients (1.9%) presented with seizures and one child (0.1%) was dead. Moises, bradypnea and apnea were seen in 78 (51.3%), 62 (40%) and 7 (4.5%) children, respectively. Six children had a history of hospitalization due to methadone poisoning, of which 2 were the day before, 3 were the month before, and 1 was 2 years ago. Two children were addicted. The mean±SD of the number of hospitalization days were 2.39±1.57 and the minimum and the maximum were 1 and 9 days. The mean±SD of hospitalization cost was 7642249±5341725 Rials. The average consumption of naloxone was 6.83± 10.41mg and the minimum and the maximum were one and 68 milligrams. Conclusion: The results of this study showed that meiosis is not observed in half of children with methadone poisoning. Therefore, it is recommended that in the case of children with impaired level of consciousness or seizures without a specific reason; methadone poisoning should be concerned as a differential diagnosis by medical staff and this diagnosis should not be ignored only in the absence of meiosis or respiratory dysfunction.

Abstract Amyotrophic lateral sclerosis (ALS) is a lethal neurodegenerative disease that in most cases occurs sporadic (sALS). The disease is not curable, and its pathogenesis mechanisms are not well understood yet. Given the intricacy of underlying molecular interactions and heterogeneity of ALS, the discovery of molecules contributing to disease onset and progression will open a new avenue for advancement in early diagnosis and therapeutic intervention. Here we conducted a meta-analysis of 12 circulating miRNA profiling studies using the robust rank aggregation (RRA) method, followed by enrichment analysis and experimental verification. We identified miR-451a and let-7f-5p as meta-signature miRNAs whose targets are involved in critical pathogenic pathways underlying ALS, including ‘FoxO signaling pathway’, ‘MAPK signaling pathway’, and ‘apoptosis’. A systematic review of 7 circulating gene profiling studies elucidated that 241 genes up-regulated in sALS circulation with concomitant being targets of the meta-signature miRNAs. Protein–protein interaction (PPI) network analysis of the candidate targets using MCODE algorithm revealed the main subcluster is involved in multiple cascades eventually leads apoptosis, including ‘positive regulation of neuron apoptosis. Besides, we validated the meta-analysis results using RT-qPCR. Indeed, relative expression analysis verified let-7f-5p and miR-338-3p as significantly down-regulated and up-regulated biomarkers in the plasma of sALS patients, respectively. Receiver operating characteristic (ROC) analysis also highlighted the let-7f-5p and miR-338-3p potential as robustness plasma biomarkers for diagnosis and potential therapeutic targets of sALS disease.

There are various methods and services which help elders protect their independency and ability and take care. Like aging in place (AIP), that is a home and community-based model. Despite its importance, this concept is still ambiguous and there is no comprehensive definition for it. This study aims to clarify and conceptualize the meaning of AIP and to develop a context-based definition. In this qualitative study, the concept was developed using a hybrid model during three theoretical phases, fieldwork and final analysis. In the theoretical phase, 30 selected articles, following a systematic search in Web of sciences-Scopus-PubMed databases using the keywords “Aging in place”, “Aging at home” and “Aging in community”, during 2000–2019 were screened and analyzed. After providing the working definition, the fieldwork phase directed qualitative content analysis was performed on interviews conducted with seven eligible elderly. Finally, in the final phase, after comparing the findings of the previous two phases, the final definition was presented. The results of the hybrid model extracted and identified various definitions of AIP and attributes, antecedent and consequences of AIP. attributes included; independency, belonging to the place, maintaining network, living in one's own home and community, safety, comfort, non-institutionalization, first preference, and life routines continuity. Antecedents included; health, physical environment, financial ability, socialization, information support, technology, AIP antecedent prediction, community services and transportation. Finally, Consequences included; Individual acceptability and community acceptability. Also final definition was provided. If the AIP and its related factors are known and provided so that elders can stay in their homes, then they do not have to choose a nursing home and thus stay out of the community. As a result, following the AIP, both the elderly and community will be satisfied.

Background and Aims: The Coronavirus has become a global pandemic that has affected most countries in the world. Hairdresser salon as a public place can transmit infectious diseases, such as AIDS, hepatitis as well as viral, fungal, and skin diseases that are often due to non-compliance with hygiene principles. This study aimed to investigate the observance of health instructions regarding the prevention and control of Coronavirus disease in men's hairdresser salons in Birjand, Iran, in 2020. Materials and Methods: In this cross-sectional descriptive study, 145 hairdresser salons in Birjand were selected through the random sampling method. The data collection tool was a checklist that was prepared according to the guidelines of the Ministry of Health and Medical Education. The obtained data were analyzed in SPSS software (version 18) using Mann-Whitney and Kruskal-Wallis tests at a significance level of ≤ 0.05. Results: The findings showed that the total mean score of the observance of workplace health and hygiene guidelines was 24.28±2.52 and the average observance of health instructions in the field of health and personal protection, building hygiene, tool and equipment hygiene, and food hygiene were 13.73±2.08, 2.31±0.68, 7.22±0.64, and 1.01±0.11, respectively. Observance of health instructions was found to have a significant relationship with age and geographical region (P≤0.05). Conclusion: According to the results, it seems necessary to train hairdressers in terms of observing health instructions. Moreover, men’s hairdresser salons should be continuously monitored by health experts.

Background: The prevalence of hookah is increasing worldwide and in all age groups, especially among women. Therefore, this study was conducted to determine the effect of web-based educational program in the prevention of hookah smoking among girls in Kermanshah, Iran, using theory of planned behavior (TPB).Methods: This study was a randomized controlled trial performed on 110 adolescent girls in Kermanshah City in 2020. Multistage random sampling was used in this study. The data collection tool included a researcher made questionnaire. Designed intervention was implemented for the intervention group in 5 educational sessions according to analysis of pre-test results. Data were collected 3 months after the end of the training intervention. Data analysis was carried out using SPSS software.Findings: The presented interventions significantly improved the structures of attitude (P < 0.001), subjective norms (P < 0.001), and intention (P < 0.001) in the intervention group compared with the control group. However, the difference between perceived behavioral control score in the two groups was not significant (P = 0.131). There was also a significant difference in reducing the behavior of hookah smoking between the intervention and control groups after the educational intervention.Conclusion: Using web-based interventions is a good educational strategy for prevention of hookah smoking in adolescent girls.

Background and Aim: Children with Attention Deficit Hyperactivity Disorder are a good target group for cognitive rehabilitation Because their behavioral problems, including inattention, impulsivity, and hyperactivity, have a specific cognitive and cerebral origin. This adaptation of behavior to cognitive function provides an opportunity to repair behavior by strengthening cognitive function. This study aimed to compare the effectiveness of cognitive rehabilitation based on virtual reality technology as a new method and classical cognitive rehabilitation in improving the executive functions of children with attention deficit hyperactivity disorder. Methods & Materials: This research was a quasi-experimental study using a pre-test-post-test design with a control group. The statistical population included all children aged 7-12 years with Attention Deficit Hyperactivity Disorder in Tehran in 1398 who were selected by convenience sampling method and randomly divided into 3 groups of 12 people. In the pre-test stage, participants were assessed with the Attention Deficit Hyperactivity Disorder Rating Scale and the Computer Integrated Visual and Auditory Test (IVA-2). The first group received a virtual reality-based cognitive rehabilitation package and the second group received a Captain Log computer cognitive rehabilitation package, 12 sessions twice a week. No intervention was performed in the control group during this period. Post-tests were taken from all 3 groups after the intervention. Univariate analysis of covariance (ANCOVA) was used to analyze the data using SPSS software v. 26. Ethical Considerations: This study was approved by the Research Ethics Committee of the Islamic Azad University, Central Tehran Branch (Code: IR.IAU.CTB.REC.1400.001). Results: The results showed that both methods of cognitive rehabilitation intervention had a significant effect on cognitive functions (selective attention, sustained attention) of Attention deficit hyperactivity disorder (ADHD) children (P0.05). Conclusion: Virtual reality-based cognitive rehabilitation is as effective as classical cognitive rehabilitation on selective attention and sustained attention in children with ADHD. Virtual reality-based cognitive rehabilitation can be used as a new approach to rehabilitating this disorder.