Search

Over the past 25 years, tremendous progress has been made in increasing the evidence on child marriage and putting it to good use to reduce the prevalence of child marriage and provide support to married girls. However, there is still much to be done to achieve the Sustainable Development Goal target 5.3 of ending child marriage by 2030, and to meet the needs of the 12 million girls who are still married before age 18 each year. To guide and stimulate future efforts, the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, the World Health Organization, the UNICEF-UNFPA Global Programme to End Child Marriage, and Girls Not Brides: The Global Partnership to End Child Marriage convened an expert group meeting in 2019 to: (1) review the progress made in building the evidence base on child marriage since the publication of research priorities in this area in 2015, (2) identify an updated set of research priorities for the next ten years, and (3) discuss how best to support research coordination, translation, and uptake. This article provides a summary of the progress made in this area since 2015 and lists an updated set of research gaps and their rationale in four key areas: (1) prevalence, trends, determinants, and correlates of child marriage; (2) consequences of child marriage; (3) intervention effectiveness studies to prevent child marriage and support married girls; and (4) implementation research studies to prevent child marriage and support married girls. It also highlights a number of calls-to-action around research coordination and knowledge translation to support the emerging and evolving needs of the field.RéSUMé: Au cours des 25 dernières années, d'énormes progrès ont été réalisés pour mettre à jour les données concernant le mariage des enfants et les mettre à profit pour réduire la prévalence du mariage des enfants et apporter un soutien aux filles mariées. Cependant, il reste encore beaucoup à faire pour atteindre la cible 5.3 de l'Objectif de Développement Durable consistant à mettre fin au mariage des enfants d'ici 2030 et pour répondre aux besoins des 12 millions de filles qui sont encore mariées avant l'âge de 18 ans chaque année. Guider et stimuler les efforts futurs, tel est le Programme Spécial de Recherche de la Banque Mondiale PNUD-FNUAP-UNICEF-OMS, du Développement et la Formation à la Recherche en Reproduction Humaine, de l'Organisation Mondiale de la Santé, du Programme Mondial UNICEF-FNUAP pour mettre fin au mariage des enfants et « Des filles pas des Mariées » : le Partenariat Mondial pour mettre fin au mariage des enfants a convoqué une réunion de groupe d'experts en 2019 pour : 1. passer en revue les progrès accomplis dans la constitution de la base de données factuelles sur le mariage des enfants depuis la publication des priorités de la recherche dans ce domaine en 2015, 2. identifier un ensemble actualisé de priorités de recherche pour les dix prochaines années, et 3. discuter de la meilleure façon de soutenir la coordination, la traduction et la compréhension de la recherche. Cet article résume les progrès réalisés dans ce domaine depuis 2015 et répertorie sous forme de mise à jour un ensemble de lacunes dans la recherche et leur justification dans quatre domaines clés: 1) prévalence, tendances, déterminants et corrélatifs du mariage des enfants; 2) conséquences du mariage des enfants; 3) études ayant trait à l'efficacité des interventions pour prévenir le mariage des enfants et soutenir les filles mariées; et 4) études de recherche sur la mise en œuvre pour prévenir le mariage des enfants et soutenir les filles mariées. Il met également en évidence un certain nombre d'appels à l'action autour de la coordination de la recherche et de l'application des connaissances pour répondre aux besoins émergents et à l’évolution de ce domaine.En los últimos 25 años se ha avanzado enormemente y existe ahora más evidencia sobre el matrimonio infantil, y sobre como se debe poner la evidencia en práctica para reducir la prevalencia del matrimonio infantil y proporcionar apoyo a las niñas casadas. Sin embargo, aún queda mucho por hacer para alcanzar la meta 5.3 de los Objetivos de Desarrollo Sostenible de poner fin al matrimonio infantil para 2030, y para satisfacer las necesidades de los 12 millones de niñas que cada año se casan antes de los 18 años. Para orientar y estimular los esfuerzos futuros, el Programa Especial de Investigación, Desarrollo y Formación de Investigadores en Reproducción Humana del PNUD-FNUAP-UNICEF-OMS-Banco Mundial, la Organización Mundial de la Salud, el Programa Mundial para la Eliminación del Matrimonio Infantil de UNICEF-FNUAP y Girls Not Brides: La Alianza Mundial para Acabar con el Matrimonio Infantil convocó una reunión de un grupo de expertos en 2019 para: 1. Revisar los progresos realizados en la construcción de la base de evidencias sobre el matrimonio infantil desde la publicación de las prioridades de investigación en este ámbito en 2015, 2. Identificar un conjunto actualizado de prioridades de investigación para los próximos diez años, y 3. Debatir la mejor manera de apoyar la coordinación, la traducción y la aceptación de la investigación.Este artículo ofrece un resumen de los progresos realizados en este ámbito desde 2015 y enumera un conjunto actualizado de lagunas de investigación y su justificación en cuatro áreas clave: 1) prevalencia, tendencias, determinantes y correlaciones del matrimonio infantil; 2) consecuencias del matrimonio infantil; 3) estudios de eficacia de las intervenciones para prevenir el matrimonio infantil y apoyar a las niñas casadas; y 4) estudios de implementación para prevenir el matrimonio infantil y apoyar a las niñas casadas. También destaca una serie de llamados a la acción en torno a la coordinación de la investigación y la traducción de conocimientos para apoyar las necesidades emergentes y en evolución del campo.

Background: The novel coronavirus (COVID-19) was first reported in Wuhan, China, and has since then spread worldwide, resulting in a large number of hospitalizations and deaths. To the best of our knowledge, the study about the mental health status (depression, anxiety, and stress) among high school students during COVID-19 has not been performed in Iran. Objective: This study was performed to investigate rates of anxiety, depression, and stress among high school students during the pandemic of COVID-19. Method: This cross-sectional study was performed among high school students (12-18 years) from 30 April until 1 June 2020, in Hamadan City, west of Iran. In total, 2852 students contributed to the present study. Depression Anxiety and Stress Scale 21 (DASS-21) was used in this study. Statistical analyses were conducted in STATA 14 with a significant level of 0.05. Results: The present study showed that although stress status was normal among most high school students (70.3%), the status of anxiety and depression was high. The boys had reported a higher proportion of normal status of depression (51.62% vs. 44.97%), anxiety (31.71% vs. 26.91%), and stress (77.66% vs. 66.10%) compared to the girls. Also, students in grades 7-9 had reported a higher percentage of normal status in all three dimensions of stress, anxiety, and depression. Conclusion: These findings suggest that as rates of depression and anxiety are high, schoolage children may benefit from policymakers and other authorities’ active role.

Background Placenta previa describes a placenta that extends partially or completely over the internal cervical oss. Placenta previa is one of the leading causes of widespread postpartum hemorrhage and maternal mortality worldwide. Another cause of bleeding in pregnant women is Placenta accreta spectrum. Therefore, the aim of the present systematic review and meta-analysis is to determine the effect of prophylactic balloon occlusion of the internal iliac arteries in patients with placenta previa or placental accreta spectrum (PAS). Methods In this systematic review and meta-analysis, to identify and select relevant studies, the SID, MagIran, ScienceDirect, Embase, Scopus, PubMed, Web of Science, and Google Scholar databases were searched, using the keywords of internal iliac artery balloon, placenta, previa, balloon, accreta, increta and percreta, without a lower time limit and until 2020. The heterogeneity of the studies was examined using the I2 index, and subsequently a random effects model was applied. Data analysis was performed within the Comprehensive Meta-Analysis software (version 2). Results In the review of 29 articles with a total sample size of 1140 in the control group, and 1225 in the balloon occlusion group, the mean difference between the two groups was calculated in terms of Intraoperative blood loss index (mL) and it was derived as 3.21 ± 0.38; moreover, in 15 studies with a sample size of 887 in the control group, and 760 in the balloon occlusion group, the mean difference between the two groups in terms of gestation index (weeks) was found as 2.84 ± 0.49; and also with regards to hysterectomy balloon occlusion after prophylactic closure of the iliac artery, hysterectomy (%) balloon occlusion was calculated as 8.9 %, and this, in the hysterectomy control group (%) was obtained as 31.2 %; these differences were statistically significant and showed a positive effect of the intervention (P Conclusion The results of this study show that the use of prophylactic internal iliac artery balloon occlusion in patients with placenta previa or Placenta accreta spectrum has benefits such as reduced intraoperative blood loss, reduced hysterectomy and increased gestation (weeks), which can be considered by midwives and obstetricians.

Background Globally, sexual violence is prevalent, particularly for adolescent women. This cluster-randomized controlled implementation trial examines empowerment self-defense (ESD) for sexual assault risk reduction among school-age women in Malawi. Methods The unit of randomization and analysis was the school (n = 141). Intervention participants received a 12-h intervention over 6 weeks, with refreshers. Primary outcomes were past-year prevalence and incident rate of sexual violence. Secondary outcomes included confidence, self-defense knowledge, and, for those victimized, violence disclosure. Interaction effects on outcomes were evaluated with Poisson models with school-correlated robust variance estimates for risk ratios and incident rate ratios (baseline n = 6644, follow-up n = 4278). Results Past-year sexual assault prevalence was reduced among intervention students (risk ratio [RR] 0.68, 95% CI 0.56, 0.82), but not control students (interaction effect p

In mammals, sound is detected by mechanosensory hair cells that are activated in response to vibrations at frequency-dependent positions along the cochlear duct. We demonstrate that inner ear supporting cells provide a structural framework for transmitting sound energy through the cochlear partition. Humans and mice with mutations in GAS2, encoding a cytoskeletal regulatory protein, exhibit hearing loss due to disorganization and destabilization of microtubule bundles in pillar and Deiters' cells, two types of inner ear supporting cells with unique cytoskeletal specializations. Failure to maintain microtubule bundle integrity reduced supporting cell stiffness, which in turn altered cochlear micromechanics in Gas2 mutants. Vibratory responses to sound were measured in cochleae from live mice, revealing defects in the propagation and amplification of the traveling wave in Gas2 mutants. We propose that the microtubule bundling activity of GAS2 imparts supporting cells with mechanical properties for transmitting sound energy through the cochlea.

Background Endometriosis is one of the most common causes of infertility. The causes of the disease and its definitive treatments are still unclear. Moreover, Anti-Mullerian Hormone (AMH) is a glycoprotein dimer that is a member of the transient growth factors family. This research work aimed to identify the effect of unilateral and bilateral laparoscopic surgery for endometriosis on AMH levels after 3 months, and 6 months, using meta-analysis. Methods In this study, the articles published in national and international databases of SID, MagIran, IranMedex, IranDoc, Cochrane, Embase, Science Direct, Scopus, PubMed, and Web of Science (ISI) were searched to find electronically published studies between 2010 and 2019. The heterogeneous index between studies was determined using the I2 index. Results In this meta-analysis and systematic review, 19 articles were eligible for inclusion in the study. The standardized mean difference was obtained in examining of unilateral laparoscopic surgery for endometriosis (before intervention 2.8 ± 0.11, and after 3 months 2.05 ± 0.13; and before intervention 3.1 ± 0.46 and after 6 months 2.08 ± 0.31), and in examining bilateral laparoscopic surgery for endometriosis examination (before intervention 2.0 ± 08.08, and after 3 months 1.1 ± 0.1; and before intervention 2.9 ± 0.23 and after 6 months 1.4 ± 0.19). Conclusion The results of this study demonstrate that unilateral and bilateral laparoscopic surgery for endometriosis is effective on AMH levels, and the level decreases in both comparisons.

The mechanical and electrical responses of the mammalian cochlea to acoustic stimuli are nonlinear and highly tuned in frequency. This is due to the electromechanical properties of cochlear outer hair cells (OHCs). At each location along the cochlear spiral, the OHCs mediate an active process in which the sensory tissue motion is enhanced at frequencies close to the most sensitive frequency (called the characteristic frequency CF). Previous experimental results showing an approximate 0.3 cycle phase shift in the OHC-generated extracellular voltage relative the basilar membrane displacement that is initiated at a frequency approximately one-half octave lower than the CF are repeated in the present paper with similar findings. This shift is significant because it brings the phase of the OHC-derived electromotile force near to that of the basilar membrane velocity at frequencies above the shift, thereby enabling the transfer of electrical to mechanical power at the basilar membrane. In order to seek a candidate physical mechanism for this phenomenon, we used a comprehensive electromechanical mathematical model of the cochlear response to sound. The model predicts the phase shift in the extracellular voltage referenced to the basilar membrane at a frequency approximately one-half octave below CF, in accordance with the experimental data. In the model, this feature arises from a minimum in the radial impedance of the tectorial membrane and its limbal attachment. These experimental and theoretical results are consistent with the hypothesis that a tectorial membrane resonance introduces the correct phasing between mechanical and electrical responses for power generation, effectively turning on the cochlear amplifier.SIGNIFICANCEThe mechanical and electrical responses of the mammalian cochlea are nonlinear exhibiting up to a thousand-fold difference in gain depending on the frequency and level of sound stimulus. Cochlear outer hair cells (OHC) are broadband electro-mechanical energy converters that mediate this nonlinear active process. However, the mechanism by which the OHC electromotile force acquires the appropriate phase to power this nonlinearity remains unknown. By analyzing new and existing experimental data and using a mathematical model, we address this open issue. We present evidence which suggests that a relatively simple feature, the frequency dependence of the radial impedance of the tectorial membrane, provides requisite mechanics to turn on the frequency-specific nonlinear process essential for healthy hearing.

The lack of oral or injectable formulations of ziconotide (ω-conotoxin peptide), a novel analgesic agent, limits research on potential neurobehavioral protective properties of this substance, including antidepressant-like effects. Here we expose rats to a stress paradigm that induces depression and memory impairment to assess the effects of ziconotide treatment. Ziconotide was administered intracerebroventricular (i.c.v.) to rats undergoing stereotaxic surgery at a single dose (1 μg/rat) or in repeated long-term applications (dosage groups: 0.1, 0.3, and 1 μg/rat). The antidepressant activity and memory-enhancing effects of ziconotide were examined via the forced swimming test, the Morris water maze test, and the passive avoidance learning test. Behavioral results showed that long-term i.c.v. ziconotide administration significantly decreased the immobility time and delayed the latency period to immobility in a dose-dependent manner compared to controls. In the passive avoidance learning test, the latency period increased, and in the Morris water maze test, the platform location latency time decreased. A single dose of ziconotide (1 μg/rat) did not show a significant effect on memory function or depression parameters during the same tests. Animals were sacrificed immediately after behavioral testing, and both hippocampi were removed and prepared for BDNF evaluation. Hippocampal BDNF levels were significantly increased in rats receiving long-term i.c.v. ziconotide compared to controls. Our results suggest that long-term consumption of ziconotide may attenuate the severity of depression-like behavior and could be useful for preventing memory impairments in various learning models by elevating BDNF levels.

Hearing relies on a series of coupled electrical, acoustical, and mechanical interactions inside the cochlea that enable sound processing. The local structural and electrical properties of the organ of Corti (OoC) and basilar membrane give rise to the global, coupled behavior of the cochlea. However, it is difficult to determine the root causes of important behavior, such as the mediator of active processes, in the fully coupled in vivo setting. An alternative experimental approach is to use an excised segment of the cochlea under controlled electrical and mechanical conditions. Using the excised cochlear segment experiment conducted by Chan and Hudspeth [Nat. Neurosci. 8, 149–155 (2005); Biophys. J. 89, 4382–4395 (2005)] as the model problem, a quasilinear computational model for studying the active in vitro response of the OoC to acoustical stimulation was developed. The model of the electrical, mechanical, and acoustical conditions of the experimental configuration is able to replicate some of the experiment results, such as the shape of the frequency response of the sensory epithelium and the variation of the resonance frequency with the added fluid mass. As in the experiment, the model predicts a phase accumulation along the segment. However, it was found that the contribution of this phase accumulation to the dynamics is insignificant. Taking advantage of the relative simplicity of the fluid loading, the three-dimensional fluid dynamics was reduced into an added mass loading on the OoC thereby reducing the overall complexity of the model.

Background: The present study was conducted to determine the response to treatment in patients with GTN, the survival rate and to investigate the outcomes of first pregnancy after chemotherapy. Materials and Methods: The treatment protocol was based on the FIGO Staging of GTN and the Modified WHO Prognostic Scoring. Results: Complete remission was achieved with MTX in 100% of the low-risk patients and with combination therapy in 91% of the high-risk cases. Out of 27 low-risk patients, 21 had no metastasis 6 had lung metastasis, 18 preserved their fertility and conceived in the first year following the chemotherapy. Out of 3 patients who had developed invasive moles, 1 got pregnant after chemotherapy. Four of the patients with choriocarcinoma conceived in the first year following the chemotherapy. In the patient with placental site trophoblastic tumors, there was no pregnancy due to hysterectomy. Conclusion: GTN was found to be a chemosensitive condition, but more effective therapeutic protocols are therefore required. Keywords: Gestational trophoblastic neoplasia, Choriocarcinoma, High dose chemotherapy, Pregnancy

Purpose To examine the association between exposures to violence in childhood, including exposure to multiple forms of violence, with young men's perpetration of intimate partner violence (IPV) in Malawi. Methods We analyzed data from 450 ever-partnered 18- to 24-year-old men interviewed in the Malawi Violence Against Children and Young Woman Survey, a nationally representative, multistage cluster survey conducted in 2013. We estimated the weighted prevalence for perpetration of physical and/or sexual IPV and retrospective reporting of experiences of violence in childhood and examined the associations between childhood experiences of violence and perpetration of IPV using logistic regression. Results Among young men in Malawi, lifetime prevalence for perpetration of sexual IPV (24%) was higher than for perpetration of physical IPV (9%). In logistic regression analyses, the adjusted odds ratios for perpetration of sexual IPV increased in a statistically significant gradient fashion, from 1.2 to 1.4 to 3.7 to 4.3 for young men with exposures to one, two, three, and four or more forms of violence in childhood, respectively. Conclusions Among young men in Malawi, exposure to violence in childhood is associated with an increased odds of perpetrating IPV, highlighting the need for programs and policies aimed at interrupting the intergenerational transmission of violence.

At external beam radiotherapy for some tumors located at thorax region due to lack of information in gray scale fluoroscopic images tumor position determination is problematic. One of the clinical strategies is to implant clip as internal fiducial marker inside or near tumor to represent tumor position while the contrast of implanted clip is highly observable rather than tumor. As alternative, using natural anatomical landmarks located at thorax region of patient body is proposed to extract tumor position information without implanting clips that is invasive method with possible side effect. Among natural landmarks, ribs of rib-cage structure that result proper visualization at X-ray images may be optimal as representative for tumor motion. In this study, we investigated the existence of possible correlation between ribs as natural anatomical landmarks and various lung and liver tumors located at different sites as challenging issue. A simulation study was performed using data extracted from 4-dimensional extended cardiac-torso anthropomorphic phantom that is able to simulate motion effect of dynamic organs, as well. Several tumor sites with predefined distances originated from chosen ribs at anterior–posterior direction were simulated at 3 upper, middle, and lower parts of chest. Correlation coefficient between ribs and tumors was calculated to investigate the robustness of ribs as anatomical landmarks for tumor motion tracking. Moreover, a consistent correlation model was taken into account to track tumor motion with a rib as best candidate among selected ribs. Final results represent availability of using rib cage as anatomical landmark to track lung and liver tumors in a noninvasive way. Observations of our calculations showed a proper correlation between tumors and ribs while the degree of this correlation is changing depends on tumor site while lung tumors are more varied and complex with less correlation with ribs motion against liver tumors.

Objective: Hydatidiform pregnancy occurs in 1:1000 pregnancies worldwide; incidence is higher in Asian countries. In approximately 5% of cases of hydatidiform mole, clinical hyperthyroidism is present. The aim of this study was to examine the relation between HCG level and thyroid function test. Methods: During 5 years (2009-2013) we included 146 cases of molar pregnancies into the study at Imam Reza teaching hospital. The demographic and clinical data as well as serum initial HCG level and thyroid function test (TSH T3 T4) were retrieved and entered into prepared proformas. p < 0.05 was considered significant. Result: The mean age of patients was 29.31 years; mean of gestational age was 11.71 weeks; mean of gravidity was 2.32; mean of serum BHCG was 3.88E4; mean of T4 was 11.07 and mean of T3 was 1.97. In this study significantly inverse relation was observed between B-HCG and TSH (p = 0.05). We also found a significantly direct correlation between B-HCG and T3 (p = 0.01) and T4 (p = 0.01). Conclusion: We concluded significantly meaningful relationship between BHCG and T3, T4, TSH.

Background: The receptor for advanced glycation end-products (RAGE) is a multiligand transmembrane receptor that is overexpressed in various pathological conditions including cancers. However, the expression pattern of RAGE in breast cancer tumors is still not completely clear. Methods: In this study, we investigated the expression levels of RAGE in 25 fresh-frozen breast cancer samples and corresponding noncancerous tissue samples collected from breast cancer patients, by real-time polymerase chain reaction (PCR). Additionally, we performed immunohistochemistry on breast cancer specimens. Results: The results indicate a high expression of the RAGE-encoding gene in the cancerous tissues. RAGE expression at the mRNA and protein levels was statistically significantly up-regulated in advanced-stage and triple-negative breast tumors and node-positive tissues compared with other tissues (p < 0.001). A significant association between RAGE expression and tumor size was observed (p = 0.029). Conclusions: Overexpression of RAGE in advanced-stage tumors may be a useful biomarker for diagnosis and the prediction of breast cancer progression.

Objectives Maternal colonisation with extended-spectrum β-lactamase (ESBL)-producing micro-organisms can lead to transmission of such pathogens to neonates, resulting in considerable morbidity. The aim of this study was to determine the global prevalence of maternal colonisation with ESBL-producing Enterobacteriaceae (ESBL-E). Methods A systematic review of PubMed, Embase, Scopus, Web of Science and ProQuest databases as well as the grey literature was performed. Studies reporting the prevalence of ESBL-E colonisation during pregnancy or postpartum period were included. Prevalence data were grouped by geographic region. The pooled prevalence and 95% confidence interval (CI) was estimated by meta-analysis using a random-effects model. Results Nineteen studies with reports from 16 countries (seven studies from Africa, one study from South America, two studies from Asia and nine studies from Europe) reporting data for 7352 pregnant/postpartum women were included. The pooled prevalence of ESBL-E colonisation was 8% (95% CI 5–10%). Prevalence estimates were 15% (95% CI 5–24%) in Africa, 6% (95% CI 4–10%) in South America, 5% (95% CI 4–6%) in Asia and 4% (95% CI 2–5%) in Europe. The pooled prevalence was higher in studies with low risk of bias (10%; 95% CI 7–13%) compared with those with high risk of bias (3%; 95% CI 2–3%). Conclusion There was heterogeneity regarding ESBL-E colonisation rates in different continents. The pooled prevalence rate was higher in Africa compared with other areas. Given that the highest rate was observed in Africa, implementing screening efforts for ESBL-E colonisation during pregnancy may be justified.

Adverse childhood experiences (ACEs) exhibit a dose–response association with poor health outcomes in adulthood, including HIV. In this analysis, we explored the relationship between ACEs and HIV sexual risk-taking behaviors among young adults in Malawi. We analyzed responses from sexually active 19- to 24-year-old males and females ( n = 610) participating in the Malawi Violence Against Children Survey. We tested the association between respondents’ exposure to six ACEs (having experienced emotional, physical, or sexual violence; witnessing intimate partner violence or an attack in the community; one or both parents died) and infrequent condom use in the past year and multiple sexual partners in the past year. We used logistic regression to test the association between ACEs and these sexual risk-taking behaviors. A majority (82%) of respondents reported at least 1 ACE, and 29% reported 3+ ACEs. We found positive unadjusted associations between the number of ACEs (1-2 and 3+ vs. none) and both outcomes. In adjusted models, we found positive associations between the number of ACEs and infrequent condom use (adjusted odds ratio [aOR]: 2.7, 95% confidence interval [CI]: [1.0, 7.8]; aOR: 3.7, CI: [1.3, 11.1]). Among young adults in Malawi, exposure to ACEs is positively associated, in a dose–response fashion, with engaging in some sexual risk-taking behaviors. HIV prevention efforts in Malawi may benefit from prioritizing programs and policies aimed at preventing and responding to violence against children.

The mechanical and electrical responses of the mammalian cochlea to acoustic stimulus are nonlinear and tuned. This is reflective of the electromechanical response of the outer hair cells (OHC) which are responsible for mediating the active process necessary for normal hearing. In this paper, we use the experimental data in conjunction with simulations to study nonlinear amplification in the cochlea. The sound-evoked voltage inside the scala tympani was measured for a range of frequencies and pressure levels. The experimental data show a notch in the voltage response at frequencies below the characteristic frequency (CF). This notch is seen to locate the onset of nonlinear amplification (in the frequency domain). In order to interpret the experimental data, a comprehensive three-dimensional model of the cochlea is used. Our model predicts the notch in the extracellular voltage as well as the phase relations observed from the experiments. The notch frequency in the model corresponds to the tectorial membrane (TM) radial resonance obtained when the TM is attached to the limbus but uncoupled from the OHC cilia. At this resonance, the shearing force applied to the HB by the TM is minimum, resulting in smaller HB deflection, current transductions, and the notch in voltage. Our analysis of the model results shows that the phase shift around this notch introduces the correct phasing between mechanical and electrical responses for effective power amplification. Hence, the model results implicate a central role of the TM in amplification.

Introduction Prenatal exposure to maternal anxiety and inappropriate levels of glucocorticoids may influence intrauterine growth and affect later health outcomes. We examined the relationship between maternal anxiety, maternal serum, and fetal cord blood cortisol. Methods Eighty-four pregnant women with gestational age above 37 weeks admitted for elective caesarian section were studied. The Spielberger State–Trait Anxiety Inventory was used to assess maternal anxiety. Maternal blood was sampled immediately before caesarean section. Cord blood sample was taken immediately after birth. Multiple regression analysis was performed. Results Maternal trait anxiety score, maternal serum cortisol, and neonatal weight were associated with the fetal cord blood cortisol (r = 0.21, P = 0.04). Bivariate correlation analysis revealed a positive correlation between maternal trait anxiety and fetal cord blood cortisol (r = 0.21, P = 0.03). Conclusions These data suggested that high maternal trait anxiety increases fetus cord blood cortisol and may regulate fetal growth.

Pain in pharynx is one of the leading complaints raised by patients with the common diagnosis pointing to: sore throat, odynophagia, pharyngitis and tonsillitis [1]. Recently, an interesting case of a 47-year-old patient (male-dentist) who claimed to have acquired a sudden sharp pain in pharynx (throat) location was observed. The absurd strength of the pain prevented the patient to even hold short-length verbal communications. The preliminary examinations by a general practitioner (GP) failed to conclude anything from the examinations; therefore the patient was referred for further investigation by specialists. The additional tests and examinations such as laryngoscopy and MRI did not suggest any leads to an appropriate diagnosis either. Inadvertently, the patient had noticed a strong correlation between the pain and the daily mouthwash dose. This was later investigated further and confirmed by the patients’ trial methods. Conclusion: In this case report, it is suggested that mouthwash may contaminate the oral soft tissue and cause a neurological pain.

Background: Placenta previa (P.P) is a rare pregnancy complication where a placenta particularly or completely covers the internal cervical os thereby preventing normal vaginal delivery. This study was conducted to evaluate the relationship between repeated cesarean deliveries and sub- sequent development of placenta previa. Methods & Materials: This cross-sectional study was held in Imam Reza Hospital Kermanshah-Iran during 2008-2011. This study included all pregnant women with repeated cesarean sections while nullipara and patients with placenta previa without previous surgery were excluded. Diagnosis was made on ultrasound and at surgery. Results: among 2696 Women, 98 cases had P.P (3.63%). The mean age was 30 years, 76.5% (75 cases) had gravidity 2 and 3 and 87.8% (86 cases) had parity 1 - 3. Anterior location of placenta was 44.9% while posterior was 55.1%. 48% were complete P.P, 32.7% low lying P.P, 13.3% marginal P.P, and 6% Partial P.P. 26.5% of patients had history of abortion. 55.1% of patients had male fetus. There was an increase in frequency of placenta previa with just one previous C-section (74.5%). Fre- quency of accreta P.P 32% (n = 7), increta (14.3%, n = 3) and percreta 28% (n = 6). Among those who underwent emergency hysterectomy (21 cases) 23.8% cases had no abnormal placentation. 30.6% of newborns had birth weight < 2500 g. Conclusion: we concluded that patients with history of one pervious cesarean delivery had more Placenta previa and need to hysterectomy were more than those with history of 2 and 3 previous cesarean delivery. The most common type of abnormal placentation was accreta, percreta and increta respectively. *

Purpose The accuracy of stereotactic body radiotherapy (SBRT) is limited by tumor motion. Selection of the most suitable motion mitigation strategy requires good understanding of the geometric and dosimetric consequences. In this study, we compare the geometric and dosimetric accuracy of four motion adaptation strategies for liver SBRT. Methods Fifteen liver SBRT patients received respiratory gated IMRT or conformal treatments in three fractions. The CTV-PTV margin was 5 mm axially and 7–10 mm cranio-caudally. The CTV and PTV were covered with 95% and 67% of the prescribed mean CTV dose, respectively. The gating was guided by implanted electromagnetic transponders (Calypso) with a 3–4 mm gating window near full exhale. The time-resolved target position error was calculated during each treatment fraction for (1) the actual gated treatments and simulated treatments with (2) MLC tracking, (3) adaptation to intrafraction baseline drift by inter-field couch corrections in case the mean error exceeded 2 mm, and (4) adaptation to interfraction motion only by pre-treatment CBCT image-guidance. The geometric errors were used to calculate motion margins and motion-induced reductions in CTV D 95 relative to the planned dose ( Δ D 95 ). Results The mean (range) number of couch corrections to compensate for tumor drift was 2.8 (0–7) with gating, 1.4 (0–5) with baseline shift adaptation, and zero for the other strategies. The motion margins were 3.5 mm (left–right), 9.4 mm (cranio-caudal) and 3.9 mm (anterior–posterior) without intrafraction motion adaptation, approximately half of that with baseline shift adaptation, and 1–2 mm with MLC tracking and gating. With 7 mm CC PTV margins the mean (range) of Δ D 95 was 8.1 (0.6–29.4)%-points (no intrafraction motion adaptation), 4.0 (0.4–13.3)%-points (baseline shift adaptation), 1.0 (0.3–2.2)%-points (MLC tracking) and 0.8 (0.1–1.8)%-points (gating). With 10 mm CC margins Δ D 95 was instead 4.8 (0.3–14.8)%-points (no intrafraction motion adaptation) and 2.9 (0.2–9.8)%-points (baseline shift adaptation). Conclusions Baseline shift adaptation can mitigate gross dose errors without the requirement of real-time motion monitoring. MLC tracking and gating are, however, much more effective strategies ensuring high similarity between planned and delivered doses. Gating was slightly better than MLC tracking dosimetrically, but had lower duty cycle and required several couch corrections to maintain the tumor exhale position inside the gating window.

Objective: Manual removal of placenta is performed in 1–3% of cases, and although it is a well-established and relatively safe procedure, it is not without complications. We carried out this study to determine whether intraumbilical vein oxytocin injection reduces the need for manual removal of placenta and shortens the third stage of labor, in comparison with placebo. Materials and Methods: In this randomized clinical trial, 178 women with singleton pregnancy and normal delivery were studied in 1 year. Immediately after fetus delivery, oxytocin infusion (20 IU/L) was started in both groups. Moreover, 10 IU oxytocin and 1 mL normal saline were injected into the umbilical vein of women in the experimental and control groups, respectively. The duration of third-stage labor, need for manual delivery of placenta, and drug side effects were evaluated in both groups. With regard to the mean level of hemoglobin before and after delivery, the two groups were compared using the Levene test and independent t test, and other qualitative variables of the two groups were compared using the χ2 test. Results: The women who received intraumbilical vein oxytocin had a shorter third stage of labor as compared with the placebo group (4.24 ± 3.27 min vs. 10.66 ± 7.41) (p

There were no significant differences in the distribution of embryos reaching to 2- cells, 4- cells, morula or blastocysts culturing on human endometrial stromal cells (Secretory or proliferative phases). The percent of morula in stage A (without fragmentation), stage B (50% fragmentation) and did not showed significant differences between two coculture groups. Thus, the phase that the endometrial stromal cells were in thereby did not affect on the quality of embryos.

In external beam radiotherapy, one of the most common and reliable methods for patient geometrical setup and/or predicting the tumor location is use of external markers. In this study, the main challenging issue is increasing the accuracy of patient setup by investigating external markers location. Since the location of each external marker may yield different patient setup accuracy, it is important to assess different locations of external markers using appropriate selective algorithms. To do this, two commercially available algorithms entitled a) canonical correlation analysis (CCA) and b) principal component analysis (PCA) were proposed as input selection algorithms. They work on the basis of maximum correlation coefficient and minimum variance between given datasets. The proposed input selection algorithms work in combination with an adaptive neuro‐fuzzy inference system (ANFIS) as a correlation model to give patient positioning information as output. Our proposed algorithms provide input file of ANFIS correlation model accurately. The required dataset for this study was prepared by means of a NURBS‐based 4D XCAT anthropomorphic phantom that can model the shape and structure of complex organs in human body along with motion information of dynamic organs. Moreover, a database of four real patients undergoing radiation therapy for lung cancers was utilized in this study for validation of proposed strategy. Final analyzed results demonstrate that input selection algorithms can reasonably select specific external markers from those areas of the thorax region where root mean square error (RMSE) of ANFIS model has minimum values at that given area. It is also found that the selected marker locations lie closely in those areas where surface point motion has a large amplitude and a high correlation. PACS number(s): 87.55.km, 87.55.N

Frontal and side impacts are both important aspects in designing of a crashworthy high-speed train nose. Therefore a proper design should be considered both conditions and, compatibility should be made among the features that improve train nose crashworthiness under different accident situations at the same time. In order to achieve this goal according to aerodynamic rules there is not many options for changing the external shape of high-speed train nose therefore, a systematic study has been conducted to examine possible strategies to design crashworthy internal structure for the high-speed train nose that provide the best features under both frontal and side impact conditions. For this purpose, various multi-layer noses are studied and the best internal layer geometry is proposed. At the last step effects of foam usage in different spaces between internal and external layers of nose is shown.

The accuracy of stereotactic body radiotherapy (SBRT) in the liver is limited by tumor motion. Selection of the most suitable motion mitigation strategy requires good understanding of the geometric and dosimetric consequences. This study compares the geometric and dosimetric accuracy of actually delivered respiratory gated SBRT treatments for 15 patients with liver tumors with three simulated alternative motion adaptation strategies. The simulated alternatives are MLC tracking, baseline shift adaptation by inter-field couch corrections and no intrafraction motion adaptation. The patients received electromagnetic transponder-guided respiratory gated IMRT or conformal treatments in three fractions with a 3-4 mm gating window around the full exhale position. The CTV-PTV margin was 5 mm axially and 7-10 mm cranio-caudally. The CTV and PTV were covered with 95% and 67% of the prescribed mean CTV dose, respectively. The time-resolved target position error during treatments with the four investigated motion adaptation strategies was used to calculate motion margins and the motion-induced reduction in CTV D 95 relative to the planned dose (ΔD 95). The mean (range) number of couch corrections per treatment session to compensate for tumor drift was 2.8 (0-7) with gating, 1.4 (0-5) with baseline shift adaptation, and zero for the other strategies. The motion margins were 3.5 mm (left-right), 9.4 mm (cranio-caudal) and 3.9 mm (anterior-posterior) without intrafraction motion adaptation, approximately half of that with baseline shift adaptation, and 1-2 mm with MLC tracking and gating. With 7 mm CC margins the mean (range) of ΔD 95 for the CTV was 8.1 (0.6-29.4)%-points (no intrafraction motion adaptation), 4.0 (0.4-13.3)%-points (baseline shift adaptation), 1.0 (0.3-2.2)%-points (MLC tracking) and 0.8 (0.1-1.8)%-points (gating). With 10 mm CC margins ΔD 95 was instead 4.8 (0.3-14.8)%-points (no intrafraction motion adaptation) and 2.9 (0.2-9.8)%-points (baseline shift adaptation). In conclusion, baseline shift adaptation can mitigate gross dose deficits without the requirement of real-time motion adaptation. MLC tracking and gating, however, more effectively ensure high similarity between planned and delivered doses.

The external shape of a high-speed train nose is usually designed according to the aerodynamic considerations and to minimise the drag forces and noises. Crashworthiness of the nose is another aspect that is important from the passive-safety point of view. To improve the crashworthiness characteristics, usually there are not many options for changing the external shape of a high-speed train nose; therefore, a systematic study has been conducted to examine possible strategies in order to design crashworthy external and internal structures for a high-speed train nose. It is observed that the longer and slender noses show better crashworthiness characteristics. In addition, various multi-layer noses are studied, and the best internal-layer geometry is proposed. At the last step the effects of foam usage in different spaces between internal and external layers of the nose are shown.

The tectorial membrane (TM) is strategically located in the mammalian cochlea, anchoring the apical pole of the outer hair cell stereocilia and hovering just above the sensory inner hair cell stereocilia. Genetic mutations of TM-specific proteins cause nonsyndromic deafness in humans while experiments in mutant mice clearly demonstrate the impact that manipulations of TM structural proteins have on hearing thresholds and cochlear sensitivity. This direct evidence shows the importance of this cochlear structure. Mathematical models (with Zwsilocki as an early proponent) have long incorporated the TM but have not included a complete electrical and fluidic coupling. We show that an electromechanical model of the active processes in the cochlea combined with a fluid-structure model that strongly couples the basilar membrane and the TM to the cochlear fluids is crucial in understanding the low and high frequency response in a base-to-apex model of the cochlea. Specifically, we show that the onset of nonlinearity at high frequencies is due to a radial resonance of the uncoupled TM and investigate the influence of fluid-loading on the TM and TM viscoelasticity on the low-pass behavior seen in the apex. A connection of this new wave bearing mechanism to otoacoustic emissions will be discussed.The tectorial membrane (TM) is strategically located in the mammalian cochlea, anchoring the apical pole of the outer hair cell stereocilia and hovering just above the sensory inner hair cell stereocilia. Genetic mutations of TM-specific proteins cause nonsyndromic deafness in humans while experiments in mutant mice clearly demonstrate the impact that manipulations of TM structural proteins have on hearing thresholds and cochlear sensitivity. This direct evidence shows the importance of this cochlear structure. Mathematical models (with Zwsilocki as an early proponent) have long incorporated the TM but have not included a complete electrical and fluidic coupling. We show that an electromechanical model of the active processes in the cochlea combined with a fluid-structure model that strongly couples the basilar membrane and the TM to the cochlear fluids is crucial in understanding the low and high frequency response in a base-to-apex model of the cochlea. Specifically, we show that the onset of nonlineari...

Hearing relies on a series of coupled electrical, acoustical (fluidic) and mechanical interactions inside the cochlea that enable sound processing. A positive feedback mechanism within the cochlea, called the cochlear amplifier, provides amplitude and frequency selectivity in the mammalian auditory system. The cochlear amplifier and stability are studied using a nonlinear, micromechanical model of the Organ of Corti (OoC) coupled to the electrical potentials in the cochlear ducts. It is observed that the mechano-electrical transduction (MET) sensitivity and somatic motility of the outer hair cell (OHC), control the cochlear stability. Increasing MET sensitivity beyond a critical value, while electromechanical coupling coefficient is within a specific range, causes instability. We show that instability in this model is generated through a supercritical Hopf bifurcation. A reduced order model of the system is approximated and it is shown that the tectorial membrane (TM) transverse mode effect on the dynamics is significant while the radial mode can be simplified from the equations. The cochlear amplifier in this model exhibits good agreement with the experimental data. A comprehensive 3-dimensional model based on the cross sectional model is simulated and the results are compared. It is indicated that the global model qualitatively inherits some characteristics of the local model, but the longitudinal coupling along the cochlea shifts the stability boundary (i.e., Hopf bifurcation point) and enhances stability.

Hearing relies on a series of coupled electrical, acoustical (fluidic) and mechanical interactions inside the cochlea that enable sound processing. The stability of the cochlea is studied using a nonlinear, micromechanical model of the organ of Corti (OoC) coupled to the electrical potentials in the cochlear ducts. The OoC is part of the mammalian cochlea that contains auditory sensory cells that both identify fluid-born vibrations in the cochlea and amplify the cycle-by-cycle motions of the cochlear structures. This process occurs through local resonance of the OoC system. In the mammalian cochlea, an active process accounts for the ear’s exquisite sensitivity and its remarkable responsiveness for a range of frequencies and intensities. Numerical and analytical techniques are utilized to examine the stability of this system. It is observed that the cochlear active process, controls the stability. We show that instability in this model is generated through a supercritical Hopf bifurcation. Furthermore, a reduced order model of the system is approximated and it is shown that the tectorial membrane (TM) transverse mode effect on the dynamics is significant while the radial mode can be simplified from the equations. We compare the cross sectional model with the comprehensive 3-dimensional model of the cochlea. It is indicated that the global model qualitatively inherits some characteristics of the local model, but the longitudinal coupling along the cochlea enhances stability (i.e., shifts the Hopf bifurcation point).Copyright © 2014 by ASME

Leiomyosarcoma (LMS) compared to other types of uterine cancers is rare uterine malignancy with a very aggressive course and poor prognosis. We report confirmed histopathologically uterine leiomyosarcoma by IHC study in virgin woman. Case A: 58-year-old woman was admitted with a history of abdominal enlargement with 4-5 month duration of lower abdominal lump. Tumor marker CA-125 was raised. She underwent hysterectomy, bilateral salpingo-oophorectomy and resection of degenerated leiomyoma's. Conclusion: The gold standard of uterine leiomyosarcoma treatment is surgery. The prognosis of uterine leiomyosarcoma depends on the extent of disease at the time of diagnosis and the mitotic index in women.

Hearing relies on a series of coupled acoustical, electrical, and mechanical interactions in the auditory periphery. There exists a distinct nonlinear amplification process inside the cochlea that enables sound processing of a broad range of frequencies and intensities. The precise operating principles of the active mechanics underlying nonlinear cochlear amplifier remains an open question in biophysics. Using the experimental protocol devised by Chan & Hudspeth of an excised cochlear segment as a model problem, we develop a computational model for studying the active in vitro response of the organ of Corti (OoC) to acoustical stimulation. Both experiment and theory show that there exists a traveling wave even for a very small, 700 mm cochlear segment. However, we show that the contribution of the traveling wave on the partition dynamics is insignificant in this preparation as the phase accumulation is less than one-tenth of a cycle. This finding enables us to reduce the macroscopic fluid dynamics of the ...

Hypertension disorders are associated with higher rates of maternal, fetal, and infant mortality, and severe morbidity, especially in cases of severe preeclampsia, eclampsia, and HELLP syndrome. The aim of the study was to determine maternal outcomes in pregnant women with severe preeclampsia.The data source consisted of 349 cases with severe preeclampsia.A cross-sectional study was undertaken on 349 cases of severe preeclampsia in pregnancy.The patients selected for this study were from those who presented at Kermanshah University of Medical Sciences, Department of Obstetrics and Gynecology during 2007-2009.Statistical analysis was performed using SPSS 16 software and conducting Chi square and independent sample t tests. Demographic data involving age, parity, gestational age, clinical, and laboratory findings were recorded from the medical files. In addition, delivery route, indications of cesarean delivery, and maternal complications were determined.Of the 349 severely preeclampsia cases, among the 22 cases (6.3 %) who had suffered from eclamptic seizers, 17 cases (77.3 %) were in the age group of 18-35 years (P = 0.351) and 13 cases (59.1 %) in the gestational age group of 28-37 weeks (P = 0.112). One case (0.3 %) was demonstrated to have HELLP syndrome. Placental abruption was obstetric complication in 7.7 % (27 cases). Delivery route was vaginal in 120 cases (34.4 %), while 229 cases (65.6 %) underwent cesarean delivery. The most frequent maternal complication (37 cases) reported was coagulopathy (10.6 %).We concluded that severe preeclampsia and eclampsia are associated with higher rates of maternal severe morbidity and that these two factors still remain the major contributors to maternal morbidity in Iran.

The mammalian cochlea amplifies the sound born vibration of the microstructures of the OoC through a frequency and level dependent active process. The somatic motility of the mechanosensory outer hair cells (OHCs) is hypothesized as the key element of the cochlea active mechanism. During the sound stimulation, the OHCs respond to the membrane potential fluctuation through a fast alteration of their length. This cellular length change applies an active harmonic force to both sides of the OHC (reticular lamina (RL) on the apical part and basilar membrane (BM) on the basal part), and boosts the OoC motion. In this paper, we use the in vivo experimental data on the OHC extracellular receptor potential together with the displacement of the OoC structural components to estimate energy exchange between the modes. It is found that when the OHC transmembrane potential leads the BM displacement by a phase between 0 and 180 degree, with an optimal value of 90 degree, the electrical power is transmitted into the BM m...

One of the principal questions in the cochlea biophysics is the determination of relative contributions of the two active processes, OHC somatic motility and HB motility, to the mechanics of the cochlea. Because of the difficulty of eliminating one mechanism without affecting the other, an unambiguous in vivo measurement differentiating their effects remains elusive. Theoretical models, therefore, have been used as one way to examine the contributions of the two active mechanisms to cochlear mechanics. In this paper, we use a physiologically based model of the mammalian organ of Corti to study the hearing active process and the relative contributions of these active forces. This local model integrates the electrical, acoustic, and mechanical elements of a cross section of the cochlea. The nonlinear dynamics of this model are studied with a special emphasis on the regions of stability and the amplification of the mechanical response arising from the active processes. [Work supported by NIH-NIDCD R01-04084 and NIH NIDCD-T32-000011.]