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Bladder neck leiomyoma presenting with gross haematuria and clot retention is a rare clinical scenario. A thirty-three-year-old female presented to the emergency department with a history of lower abdominal pain and gross haematuria for a few days. Abdominal and pelvic ultrasonography examination was complimented with CT and MRI scans showing a 7.6 × 7 × 6.5 cm well-defined mass at the bladder base. There was also pelvic and retroperitoneal lymphadenopathy. Laparotomy with enucleation of the mass along with lymph node biopsy was performed with satisfactory control of the bleeding. Histopathology confirmed the diagnosis of leiomyoma of the bladder neck associated with tuberculous lymphadenopathy.

ANFIS-type algorithms have been used in various modeling and simulation problems. With the help of algorithms with more accuracy and adaptability, it is possible to obtain better real-life emulating models. A critical environmental problem is the discharge of saline industrial effluents in the form of buoyant jets into water bodies. Given the potentially harmful effects of the discharge effluents from desalination plants on the marine environment and the coastal ecosystem, minimizing such an effect is crucial. Hence, it is important to design the outfall system properly to reduce these impacts. To the best of the authors’ knowledge, a study that formulates the effluent discharge to find an optimum numerical model under the conditions considered here using AI methods has not been completed before. In this study, submerged discharges, specifically, negatively buoyant jets are modeled. The objective of this study is to compare various artificial intelligence algorithms along with multivariate regression models to find the best fit model emulating effluent discharge and determine the model with less computational time. This is achieved by training and testing the Adaptive Neuro-Fuzzy Inference System (ANFIS), ANFIS-Genetic Algorithm (GA), ANFIS-Particle Swarm Optimization (PSO) and ANFIS-Firefly Algorithm (FFA) models with input parameters, which are obtained by using the realizable k-ε turbulence model, and simulated parameters, which are obtained after modeling the turbulent jet using the OpenFOAM simulation platform. A comparison of the realizable k-ε turbulence model outputs and AI algorithms’ outputs is conducted in this study. Statistical parameters such as least error, coefficient of determination (R2), Mean Absolute Error (MAE), and Average Absolute Deviation (AED) are measured to evaluate the performance of the models. In this work, it is found that ANFIS-PSO performs better compared to the other four models and the multivariate regression model. It is shown that this model provides better R2, MAE, and AED, however, the non-hybrid ANFIS model provides reasonably acceptable results with lower computational costs. The results of the study demonstrate an error of 6.908% as the best-case scenario in the AI models.

Vaccines formulated with the Chlamydia muridarum native major outer membrane protein (nMOMP) have so far been shown to elicit the most robust protection against this pathogen. nMOMP is a membrane protein and therefore, detergents are used to keep it in solution. Detergents however, have toxic effects. To address this limitation, we tested a nMOMP proteosome vaccine and compared its ability to elicit protection against nMOMP solubilized in the detergent Z3-14. The two preparations were formulated with or without CpG + Montanide (C/M). As a control antigen we used ovalbumin. Mice vaccinated with nMOMP developed strong humoral and cell mediated Chlamydia-specific immune responses. Based on the IgG2a/IgG1 levels in serum and amounts of IFN-γ in splenocytes supernatants the immune responses were predominantly Th1-biased. The animals were subsequently challenged intranasally with 2 × 10(3)Chlamydia inclusion forming units (IFU) and the course of the infection was followed for 10 days when the mice were euthanized. Based on changes in body weight, weight of the lungs and number of IFU recovered from the lungs, mice immunized with nMOMP-Ps and nMOMP + Z3-14 adjuvanted with C/M showed the most robust protection. In summary, nMOMP-Ps should be considered as Chlamydia vaccine candidates.

Introduction: Traumatic brain injury (TBI) is frequently encountered in geriatric patients, but there is a paucity of data describing TBI in the elderly. Here, we show the age of patients with TBI is increasing at our medical center and discuss the relationship between age and injury severity with patient outcomes.Methods: This is a retrospective analysis of 3,179 adult patients with TBI treated at the University of California, Davis Level 1 Trauma Center between 2009 and 2016. Age, Glasgow Coma Scale (GCS), and CT Rotterdam Scores were recorded. Age was analyzed as both a continuous and categorical variable (18–34, 35–50, 51–65, >65 years-old). Extended Glasgow Outcome Scale was obtained at 3 and 6 months and dichotomized into favorable and unfavorable outcomes. Multivariable general linear regression models, chi-square, logistic regression analyses and ANOVA were used for statistical analyses; a p < 0.05 was considered significant.Results: The mean age of patients was 52.2 ± 21.9 years with a male predominance (69%). There was a significant trend (p = 0.002) toward an increase in mean age each year, increasing by 4.4 years (p = 0.008) over the course of the analysis. Older patients had a higher mean GCS compared to younger patients with the same CT Rotterdam Score (p = 0.027), this becoming more pronounced with worse CT Rotterdam Scores. The >65 group had a 4-fold increased risk for unfavorable outcome when compared to the 18–34 group, this effect being most pronounced after mild TBI.Conclusions: The mean age of TBI patients is increasing at our trauma center. The largest disparity in outcomes across age was seen in patients with a mild GCS and low CT Rotterdam Scores, suggesting that these markers of injury severity may underestimate the severity of injury in the elderly population. This information highlights the need for clinical trials and validation of outcome markers in geriatric TBI.

Microbeams are key elements in most of the micro-electromechanical systems (MEMS). Electromechanical instability of microbeams in turn plays an important role in their applications. The shape and mechanical properties of microbeams dictate their functional characteristics. Focusing on their instability-based working mechanism, one can appreciate that viscoelasticity of MEMS materials cannot be neglected. Consequently, the analysis of instability in viscoelastic curved microbeams is an essential demand. In this research, assuming a clamped-clamped initially curved microbeam, the effects of viscoelastic behavior on the snap-through and pull-in instabilities are investigated. The standard inelastic linear solid model is used for the simulation of viscoelastic behavior. Integrodifferential governing equation of the curved viscoelastic microbeam is obtained by assuming modified couple stress theory and using Hamilton’s principle. By applying the Galerkin method, the obtained governing equation is discretized, converted to a nonlinear differential equation, and solved by MATLAB software. Through a quasi-static analysis, the voltage and location of snap-through and pull-in instabilities are identified. The effects of different viscoelastic parameters including the creep moduli and relaxation coefficient upon the snap-through and pull-in instabilities are investigated. The effects of different short- and long-term creeping characteristics of viscoelastic microbeam are studied and discussed in detail.

Background: Breast cancer is a common malignancy in which early breast cancer detection by the help of imaging can improve the treatment outcome. Thermography utilizes infrared beams which are fast, non-invasive, and non-contact and the output created images by this technique are flexible and useful to monitor the temperature of the human body. Case presentation: Our patient is a 25-year-old woman who was referred to Tehran's Imam Khomeini Hospital, Tehran University of Medical Sciences, in October 2014 and June 2017 to perform clinical examinations of breast cancer at the Invasive and New Radiology Research Center of Tehran. The results of the sonography for the left breast and bilateral axillary regions and sonography guided biopsy from the left axillary region indicated that: it was consistent with the tangential prominence at 11-12 O’ clock in the left breast tissue and echo gene was found without any suspected findings. Then, using the non-contact infrared imaging camera VisIR 640 (Thermoteknix Systems Ltd, Cambridge, UK), the feasibility of thermography method in the patient's follow-up was investigated. Conclusion: Thermography can be used to detect abnormal areas in the breast tissue that may have cystic origin. The results indicated that the accuracy of the identification and matching of patient cysts in mammography and ultrasonography with the results of thermography in both periods of October 2014 and June 2017. Considering the results, it is noteworthy that the diagnostic clock of the breast cysts in the patient is consistent with the results of the clinical trials with the thermography. Moreover, in a 2 years intervals, the status of thermal morphology status of the cystic region did not considerably change which showed a relatively stable status.

Background: The standard of care for glioblastoma is concurrent chemoradiotherapy and adjuvant chemotherapy with Temozolomide. In this trial, we have investigated the impact of MGMT promoter methylation on prognosis and benefit from Temozolomide based chemotherapy in a group of patients with glioblastoma in our region. Methods: This retrospective study included glioblastoma patients treated in our institute between 2006 and 2011. We used methylation specific PCR to detect methylation in the promoter region of the MGMT gene. The Kaplan-Meier technique was used to calculate overall survival from the time of diagnosis to the time of death. We utilized the log-rank test and Cox-regression model for univariate and multivariate analyses of potential prognostic factors. Results: There were 78 patient participants with a median age of 50 (range: 20 to 75) years and a male to female ratio of 56/22. All patients underwent minimal surgical resection which was considered as a biopsy. All patients received adjuvant radiotherapy with a median dose of 60 Gy (54-60 Gy) and 25 patients received concomitant Temozolomide. The MGMT promoter methylation was found in 19 (24.4%) patients and was relatively more frequent in men (28.6%) compared to women (13.6%; P=0.16).This genetic change was associated with a significantly higher 2-year survival in men (57.2%) compared to women (16.8%; P

Background: One of the side effects of tramadol is seizure. Tramadol is a synthetic analgesic used to treat mild to moderate pain. Tramadol can cause seizures in the range of treatment and toxic doses. This seizure is usually in a generalized tonic-clonic from and usually occurs in the first 24 hours after ingestion. Case Presentation: The patient was a 32-year-old man referring to the emergency department with a right shoulder joint dislocation. It was reported that after a tonic-clonic seizure for about 1 minute, it has been followed by foaming at the mouth, eye lifting, urinary incontinence and loss of consciousness for about 5 minutes. He used a combination substance of sildenafil and tramadol to treat an early ejaculation. The patient has referred to the hospital 5 times with shoulder dislocation, without providing a detailed explanation about the use of tramadol and subsequent seizures Discussion: Tramadol misuse and overdose is a common medical issue in Iran and around the world. Regarding the arbitrary use of tramadol in Iran, especially through the non-scientific prescriptions by apothecaries in some cases such as early ejaculation treatment, attention to patient records along with the cause of referral is essential. Conclusion: Considering the prevalence of tramadol use, the community of physicians is advised to think of tramadol as a common cause for shoulder dislocation.

Nirmatrelvir, a novel, potent, orally bioavailable severe acute respiratory syndrome coronavirus 2 main protease inhibitor, coadministered with ritonavir for pharmacokinetic (PK) enhancement is licensed for the treatment of mild to moderate COVID‐19 in individuals at increased risk of progression to severe disease. Cytochrome P450 3A4 is the primary metabolic enzyme responsible for nirmatrelvir metabolism; however, when cytochrome P450 3A4 is inhibited by ritonavir, nirmatrelvir is primarily excreted, unchanged, in urine. Because of intended use of nirmatrelvir among individuals with hepatic impairment, this Phase 1 study (NCT05005312) evaluated the effects of hepatic impairment on nirmatrelvir PK parameters to assess the potential need for any dose adjustments in this population. Participants with normal hepatic function or moderate hepatic impairment (n = 8 each) were administered a single 100‐mg nirmatrelvir dose, with 100 mg of ritonavir administered 12 hours before, together with, and 12 and 24 hours after nirmatrelvir. Nirmatrelvir median plasma concentrations and systemic exposure measured by area under the plasma concentration–time curve from time zero extrapolated to infinite time and maximum observed plasma concentration values were comparable in both groups. Nirmatrelvir/ritonavir had an acceptable safety profile in both groups, and no clinically significant changes in laboratory measurements, vital signs, or electrocardiogram assessments were observed. Based on these results, no dose adjustment is deemed necessary in patients with moderate hepatic impairment and, by extension, in patients with mild hepatic impairment. [ABSTRACT FROM AUTHOR]

Purpose: To determine the effectiveness of risk minimisation measures (RMM) to avoid inadvertent daily instead of weekly methotrexate (MTX) use, introduced by the European Medicines Agency (EMA) from 2019 onwards. Methods: Using a cross‐sectional online survey in France, Greece, Germany, Poland, and Sweden in 2022, we assessed awareness, knowledge, and self‐declared behaviour for respondents who prescribed, dispensed, or used once‐weekly MTX in the last 3 months. Respondents' answers were considered as 'successful' with regards to RMM effectiveness (vs. unsuccessful) if they provided correct ('desirable') responses to 100% of questions regarding awareness and self‐declared behaviour and correct responses to ≥80% of questions about knowledge. Per target population, an outcome was considered successful if achieved by ≥80% of respondents. Effectiveness of RMM was defined by ≥80% being successful on all outcomes. Results: One‐hundred‐fifty‐one prescribers, 150 pharmacists, and 150 patients completed the survey. Success rates were 56% (95% CI 48.0%–64.3%) for awareness, 42% (95% CI 34.4%–50.7%) for knowledge, and 31% (95% CI 23.8%–39.2%) for self‐declared behaviour among prescribers, 18% (95% CI 12.8%–25.8%) for awareness, 7% (95% CI 3.7%–12.7%) for knowledge, and 50% (95% CI 41.7%–58.3%) for self‐declared behaviour among pharmacists, and 29% (95% CI 21.6%–36.6%) for awareness, and 3% (95% CI 1.1%–7.6%) for knowledge among patients. Overall success was not attained by any target population. Conclusions: RMM were evaluated as not effective across outcomes of awareness, knowledge, and self‐declared behaviour in prescribers, pharmacists, and patients. Findings suggested we need continued efforts for RMM across all target populations and across all outcomes. [ABSTRACT FROM AUTHOR]

Background: medications are complex and influence the body in multiple ways. Post-development analysis of medications remains highly advantageous, as it allows for comprehensive understanding of the safety profile over extended periods and can direct future improvements to enhance the therapeutic benefits while minimizing risks. Our primary goal was to examine whether a substantial relationship exists between such patient experiences and the statistical analysis of data about the same medications from clinical trials. Methods: Patient feedback regarding medication commonly prescribed for psychiatric conditions was obtained from a publicly available website webmd.com. We searched clinicaltrials.gov for statistical analysis regarding the same medications. Data from webmd.com was subjected to sentiment analysis, while clinicaltrails.gov data underwent statistical analysis. Results: the findings suggest a general connection between the two data sources. Medications with a greater amount of patient feedback generally attract more research attention, although with some exceptions. Additionally, medications approved for children receive less feedback online compared to those for adults and seniors. Medications for seniors receive more positive and neutral feedback in contrast to those for children and adults. Conclusions: online platforms offer a space for patients to share their experiences with using specific medications, potentially contributing to the enhancement of patient care and aiding researchers in further studies. [ABSTRACT FROM AUTHOR]

Economic transparency will lead to economic stability and corruption decline. Thus the shortage of transparency mechanisms, laws and procedures will raise corruption and make it tough to cutout corruption. Also, loss of transparency in financial and economic system creates to instability, inappropriate allocation of resources, the boom of injustice and inequality and as a result paves the way for all sorts of financial and economic corruption and misuse. The greater transparency economic growth, the lower the cost of entry into economics and accordingly with rising economic competitiveness, the condition for development and economic growth will be advanced. So, considering the vital role of transparency in economics, this study first explores transparency and corruption then with the panel data, looks at the relation between economic transparency and economic growth in Middle East countries over the last 13 years (2003-2015). In other words, this paper aims to show how the transparency variable influences economic growth. The specific purpose is to find out whether there is a positive or negative connection between transparency and economic advancement in the countries under investigation. The results of the research show that the relation between transparency and economic growth in the Middle East countries is direct and significant. Also the relation between gross capital formation and labor force participation is direct and significant with the economic growth of these countries.

In this paper we describe a coding, modulation, and spatial processing technique for fixed broadband wireless Internet access applications and provide examples of its performance. This technique is built on Orthogonal Frequency Division Multiplexing (OFDM) and is known as Vector OFDM (VOFDM). We compare VOFDM with conventional Single Carrier Modulation (SCM), and show that it provides substantial performance improvements over SCM. 1. It divides the channel into narrowband, flat fading, subchannels and thus it is more resistant to frequency selective fading as compared to single carrier systems. 2. By using FFT techniques, it is computationally efficient. 3. It can be combined with coding and interleaving to recover symbols lost due to the frequency selectivity of

In this paper, the authors propose an algorithm that increases and decreases the transmission speed according to a user-specified function. The design objective is to regulate baud as efficiently as possible and ensure that in each transmission interval, transmitter and receiver bauds are equal for some period of time during data transmission. An equivalent discrete-time version of the protocol is verified by using the COSPAN software. Application for this adaptive baud protocol for wireless communication is seen in a platoon setting within an Automated Highway System (AHS).