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Background: Pain control after posterolateral thoracotomy is very important for adequate respiration and to reduce pulmonary complications. Narcotic-induced respiratory depression requires different intercostal nerve block procedures with local anesthesia, such as bupivacaine, through an extrapleural catheter, paravertebral catheter and intrapleural injection in order to control pain and reduce narcotics consumption. The aim of this study is to determine the efficacy of bupivacain versus normal saline (N/S) in pain control after thoracotomy. Methods: In a single-blind clinical trial, forty patients were divided into two groups of 20 patients each. Group 1 (G.1) received a single dose (10 ml) of bupivacaine 0.5%, followed by continuous infusion of N/S (0.1 ml/kg/h) four hours after surgery. Group 2 (G.2) received a single dose (10 ml) of bupivacaine 0.5%, followed by a continuous infusion of bupivacaine (0.1 ml/kg/h) four hours after surgery. Postoperative pain was assessed every four hours for 48 hours by linear visual analog scale (VAS). If VAS > 5, then pethidine was injected at a dosage of 1 mg/kg/IM. VAS ≤ 3 was considered pain control. Results: TThe mean VAS at 8, 12, 16, 20 and 24 hours after surgery in G.1 was 7.6, 5.5, 6.6, 5.5 and 5.7, respectively, and in G.2 was 3.4, 3.7, 2.8, 2.1 and 1.9, respectively. There were significant differences between the two groups (for 12 hours P

Background/Aim: Information about functional outcome and quality of life after esophagectomy and esophageal reconstruction (ER) for the treatment of esophageal cancer, as evaluated by the patients themselves is limited. We aimed to study the post-surgical outcome of such patients to detect for the development of any complications that may arise from the surgery as well as to evaluate their quality of life following the surgery. Methods: From 1993 to 2003, 240 patients with stage I, II, or III esophageal carcinoma underwent esophagectomy at Razi Teaching Hospital located in the north of Iran. Of these, 192 patients filled out a questionnaire during a 2-year period (ranging from 12 to 48 months after surgical reconstruction). Among them, there were 134 men (69%) and 58 women (31%), and the mean age at the time of ER was 48 years (ranging from 22 to 75 years). Transhiatal esophagectomy, extended esophagectomy (three field operation), and Ivor-Lewis resection were done in 142 (73.95%), 30 (15.62%), and 20 patients (10.42%), respectively. Intestinal continuity after esophageal resection was established with stomach in 154 patients (80%), colon in 28 patients (14%), and small bowel in 10 patients (5.2%). Cervical anastomosis was established in 172 patients (89.6%), while intrathoracic anastomosis was performed in 20 patients (10.4%). Results: After ER, 66 patients (34.4%) suffered from dysphagia to solids and 50 patients (26%) required at least one or three postoperative dilatations for alleviation of symptoms. Gastroesophageal reflux was seen in 32 patients (16.66%) and was more common in thoracic anastomosis patients than in cervical anastomosis patients. Heartburn was present in 33 cases (17%), 30 of whom required medication (37%). The number of meals per day was three to four in 116 patients (60%), more than four in 51 patients (29%), and less than three in 19 patients (9.82%). The number of bowel movement per day increased in 52 patients (27%), decreased in 60 cases (31%), and unchanged in 80 patients (41%). Weight gain was reported by 38 patients (19.8%), and weight loss was reported by 50 patients (26%). No change in weight occurred in 100 patients (52%). Overall satisfaction was excellent in 29 patients (15%). Overall quality of life (work, pain-relief, vitality, and emotional status) was lower than in general population. Age, sex, and stage of cancer did not affect the functional outcome but affected the quality of life. Also patients who received cervical anastomosis and ER with colon had significantly fewer reflux symptoms. Most of the patients with colon reconstruction gained weight. Conclusions: Self-assessment of postoperative ER by the patients after esophagectomy for malignant disease demonstrates that undesirable symptoms are frequently present at short- and long-term follow-ups. Short- and long-term functional outcome is affected by the type of reconstruction after esophagectomy. Results of this study suggest that colon graft in ER is significantly advantageous compared with other methods because of the ability of patients to gain weight and avoid developing postoperative reflux. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to investigate the role of one of these models in the field of voice pathology and compare its performance in distinguishing the perceived dysphonia level., Methods: Demographic information, voice self-assessments, and acoustic measurements related to a sample of 50 adult dysphonic outpatients were presented to ChatGPT and Perplexity AI chatbots, which were interrogated for the perceived dysphonia level., Results: The agreement between the auditory-perceptual assessment by experts and ChatGPT and Perplexity AI chatbots, as determined by Cohen's Kappa, was not statistically significant (p = 0.429). There was also a low positive correlation (r s = 0.30, p = 0.03) between the diagnosis made by ChatGPT and Perplexity AI chatbots (r s = 0.30, p = 0.03)., Conclusion: It seems that AI could not play a vital role in helping the voice care teams determine the perceptual level of dysphonia., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: In this study, the correlations between traditional acoustic measures (TAMs) and cepstral analysis (CA) were explored in Persian., Methods: This investigation was a cross-sectional study including 179 dysphonic (n=141) and normophonic (n=38) speakers. The TAMs (jitter, shimmer, and noise-to-harmonic ratio) and CA (cepstral peak prominence, and cepstral peak prominence-smoothed) values were obtained during vowel prolongation, reading a standard sentence, and a non-standard running speech sample using Praat software. The difference of acoustic measures between normophonic and dysphonic speakers and intercorrelation among acoustic measures and correlation between the acoustic measures and perceived dysphonia levels was analyzed with independent t test, Mann-Whitney U test, Pearson, Spearman, and Kendall's Tau-b correlation tests using IBM SPSS Statistics., Results: The findings showed that dysphonic speakers had higher TAM values and lower CA values than normophonic speakers. (P < 0.05). In dysphonic speakers, a large correlation was discovered among all acoustic measurements (r = 0.52 to 0.96; P < 0.05), while in various perceived dysphonic speakers, there was a correlation of varying strength (r = 0.25 to 0.97; P < 0.05). Ultimately, there was a significant small-to-large correlation between the acoustic measures and perceived dysphonia levels (r = 0.34-0.58; P < 0.05)., Discussion/conclusion: This research demonstrated that Persian speakers with dysphonia experienced a rise in TAM and a corresponding reduction in CA. In the future, multi-parametric indices can be developed using both TAM and CA to include various aspects of vocal production and yield a single, comprehensive value., (S. Karger AG, Basel.)

Introduction: It was reported that voice can carry information about personality and psychological distress. In the current study, the relationship between five-factor personality traits and psychological distress with voice was enlightened from diverse aspects., Methods: A total of 119 participants (55 with and 64 without dysphonia) sustained vowels /a/ and /i/, read six standard sentences, and answered a question. Three raters auditory-perceptually evaluated the vocal samples using the Persian version of CAPE-V. The participants were distributed into four groups (vocally healthy, mild, moderate, and severe dysphonia). They completed two questionnaires: NEO Five-Factor Inventory (NEO-FFI) and Depression, Anxiety, and Stress Scale-21., Results: Results showed that the conscientiousness (U = 1146.500, z = -3.27, p = .001) in the dysphonia group was significantly less than the vocally healthy group. Depression (U = 1381.000, z = -2.03, p = .042) and anxiety (U = 1181.000, z = -3.10, p = .002) in the dysphonia group were significantly higher than in the vocally healthy group. In comparing different abnormal overall voice qualities, the mild dysphonia group revealed significantly lower conscientiousness (p = .001) and significantly higher anxiety (p = .002) relative to the vocally healthy group., Conclusions: Findings indicated that the conscientiousness trait could play an influential role in persons with dysphonia and its psychological status. The voice care team should consider conscientiousness and psychological distress during the assessment and treatment of dysphonic patients., (© 2024 The Author(s). Brain and Behavior published by Wiley Periodicals LLC.)

Objectives/hypothesis: This study aimed to validate the acoustic voice quality index version 03.01 (AVQIv3) and the acoustic breathiness index (ABI) in the Persian language., Methods: Six judges assessed the severity degree of the abnormal overall voice quality (hoarseness) and breathiness from continuous speech (cs) and sustained vowel (sv) in 136 voices samples of dysphonic and 45 vocally healthy participants. Firstly, the time length of cs and sv was balanced out for a higher level of ecological validity. Secondly, the concurrent validity and diagnostic accuracy were statistically analyzed with the Spearman rank-order correlation, and the receiver operating characteristics, likelihood ratio, and Youden index., Results: There was substantial inter-rater reliability between judges regarding hoarseness and breathiness. Twenty syllables were identified as the standardized number of syllables for the cs part. Sufficient correlations were found between AVQI and hoarseness (r s = 0.74), and between ABI and breathiness (r s = 0.74), respectively. The thresholds of 1.63 (sensitivity of 73.2% and specificity of 91%) and 2.97 (sensitivity of 70% and specificity of 87%) yielded the highest level of diagnostic findings for AVQI and ABI, respectively., Conclusion: The AVQIv3 and ABI are reliable indices to quantify the abnormal overall voice quality and breathiness in the Persian language., Competing Interests: Declaration of Competing Interest The last author created the ABI and contributed to the development of the AVQI v.03. He also acts as a scientific advisor in the creation of the VOXplot software., (Copyright © 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: The relationship between personality traits and psychological distress with acoustic characteristics was investigated in the present study, regarding the existence of dysphonia, abnormal overall voice quality (AOVQ), and dysphonia type., Methods: Fifty-five participants with dysphonia and 64 participants without dysphonia completed NEO Five-Factor Inventory and Depression, Anxiety, and Stress Scale-21. Jitter, shimmer, noise-to-harmonic ratio (NHR), cepstral peak prominence (CPP), and cepstral peak prominence-smoothed (CPPS) were calculated in sustained vowel /a/ by Praat . Three expert speech and language pathologists divided participants with dysphonia into mild, moderate, and severe, based on the AOVQ. Pearson and Spearman correlation tests were performed by IBM SPSS Statistics ., Results: The findings were indicative of large correlations between agreeableness with CPP, conscientiousness with shimmer, depression with jitter and shimmer, and anxiety with shimmer in patients with functional dysphonia ( p  < 0.05). The results showed small to medium significant correlations between agreeableness with jitter and NHR, conscientiousness with CPP in participants without dysphonia, and depression with jitter in the participants with dysphonia ( p  < 0.05). Lastly, no significant correlation was observed between personality traits and psychological distress with acoustic characteristics in mild, moderate, and severe AOVQ groups ( p  > 0.05)., Conclusion: In participants with functional dysphonia, personality traits and psychological distress can provide some information about acoustic characteristics and vice versa., Level of Evidence: 3., Competing Interests: The authors report no conflict of interest., (© 2023 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Introduction: Voice production can be affected in early laryngeal cancer. The purpose of this study was to investigate the correlation between Voice Handicap Index (VHI) and Voice-Related Quality of Life (V-RQOL) among patients with early laryngeal cancer., Methods: Twenty-seven patients with early laryngeal cancer (T1, T2) and a mean age of 59.35 ± 7.77 years who were visited in Amir-Alam hospital, took part in this study. After a diagnosis of early laryngeal cancer by a laryngologist, the patients filled out the Persian versions of the VHI and V-RQOL questionnaires., Results: The results showed the mean total score of VHI and V-RQOL were 65.94 ± 14.21 and 48.64 ± 9.75% in patients with early laryngeal cancer, respectively. These results indicated the total and subscales' scores of VHI increased while the scores of VRQOL decreased. The Pearson correlation between total scores of the VHI and V-RQOL was - 90. Also, there was a negative significant correlation between total and subscales' scores of VH and VRQOL (r Pearson= -0.46 to -0.90, p  ≤ 0.05)., Conclusion: Our findings demonstrated decreased quality of life related to voice in patients with laryngeal cancer who were in the early stages of tumor growth (T1, T2). Regarding the high negative significant correlation between results of VHI and V-RQOL in patients with early laryngeal cancer, both questionnaires can be used instead of each other for saving time in voice clinics., Competing Interests: Conflict of InterestThe authors of this article have no financial or non-financial conflict of interest.Competing InterestsThe authors declare no conflict of interest in this research., (© Association of Otolaryngologists of India 2022. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Introduction: COVID-19 has various long-lasting effects on different aspects of health and life. This study aimed to evaluate the general health and voice-related quality of life (QOL) and assess their correlation in patients with COVID-19 compared to healthy people., Study Design: This was a cross-sectional study., Methods: Sixty-eight subjects (with a mean age of 40.07 ± 5.62 years) participated in two groups including 34 recovered-COVID-19 patients and 34 healthy subjects. All participants completed the Persian version of Short Form 36 (SF-36) and Voice Handicap Index (VHI). The patients were assessed two months after recovery when they were discharged from the hospital., Results: The results showed the COVID-19 patients got significantly lower scores in all subcategories and two main components of SF-36 compared to the healthy group (P < 0.005). Also, the patients held significantly higher results in VHI and its subscales (P < 0.005). A significant correlation was observed between the physical and mental component summary (PCS and MCS) of SF-36 with a total score of VHI in the COVID-19 patients., Conclusion: COVID-19 has negative consequences on various aspects of general health and voice-related QOL. Two months after recovery from COVID-19, the patients had the worst scores in all subscales of SF-36 and also, decreased physical, emotional, and functional voice-related QOL which reveals the persistent effect of COVID-19 even after recovery. The general health and voice-related QOL had a noticeable correlation in recovered COVID-19 patients that demonstrates the effect of voice quality in different aspects of life., (Copyright © 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: This study aimed to investigate the relationship of cepstral analysis (Cepstral Peak Prominence [CPP] and Cepstral Peak Prominence-Smoothed [CPPS]) with voice self-assessments (The Persian version of vocal tract discomfort [VTDp] scale and non-standard hoarseness self-assessment [NHS] questionnaire)., Methods: 223 participants (159 with and 64 without dysphonia) were asked to utter the vocal tasks namely vowels /a/ and /e/, six standard sentences, and a non-standard connected speech sample. CPP and CPPS were calculated in these three vocal tasks using the "Praat" software. The participants also asked to complete the VTDp scale and the NHS questionnaire., Results: The means of frequency and severity the VTDp and the means of NHS were statistically different between the dysphonic and normal voice groups (P < 0.05), except for tickling (P > 0.05). There was a very low significant correlation between cepstral analysis with aching and in the dysphonic group (P < 0.05). However, a very low to low significant correlation between cepstral analysis with burning, tight, aching, tickling, sore, and both frequency and severity subscales scores of the VTDp in the normal voice group (P < 0.05). Moreover, the means of the cepstral analysis did not differ significantly between all scores of the NHS in the dysphonic the normal voice groups (P > 0.05), except for 1 with 3, 4, and 5 in the dysphonic group (P < 0.05)., Conclusion: The cepstral analysis can provide some information about the status of vocal tract and person's perception of his/her own voice quality., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives/hypothesis: This study set out to uncover the correlation between maximum phonation time (MPT) with acoustic and cepstral analysis in the dysphonic and control groups, considering the effects of sex and dysphonia type., Methods: For this cross-sectional study, a sample of 179 attendees (141 dysphonic and 38 control) were randomly selected and requested to sustain the vowel /a/ as long as they could with their habitual pitch and loudness. Reading standard sentences and conversational connected speech tasks were obtained too. Using Praat, the MPT, jitter, shimmer, noise-to-harmonic ratio, cepstral peak prominence (CPP), and smoothed cepstral peak prominence (CPPS) were calculated in the target vocal tasks., Results: There was a very low to low significant correlation (r = 0.00-0.50) between MPT amounts and acoustic analysis in the dysphonic group (P < 0.05), except for between MPT with shimmer (P > 0.05). In contrast, findings showed no significant correlation between MPT and acoustic analysis in the control group, not even separated by sex (P > 0.05). There was a very low to low correlation between MPT amounts and acoustic analysis in the male dysphonic group (P < 0.05), except for the MPT with shimmer (P > 0.05). There was no significant correlation between MPT and acoustic analysis in the female dysphonic group (P > 0.05), except for MPT with CPP (sustained vowel) (P < 0.05). Finally, very low to high correlations between MPT and some of the acoustic analysis in all the different dysphonia types were observed (P < 0.05)., Conclusions: MPT contains some information about the acoustic features of the dysphonic voice, specifically the CPP and smoothed cepstral peak prominence. The data suggested that the observed relationship between MPT and the acoustic analysis has the capacity to be considered for the development of new multiparametric tests of voice assessment in dysphonia, regarding the sex and dysphonia type., (Copyright © 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: The liver is the most common organ of the body that is at risk of getting affected by hydatid cyst (75%). All lobes of the liver can be involved with the formation of hydatid cyst, but the right lobe is more involved than the left lobe. The rate of involvement of liver dome and segments 7 and 8 of the right lobe has not been reported so far, but the best treatment for liver hydatid cyst has been found to be surgery., Materials and Methods: In this study, 240 patients with liver hydatid cyst underwent surgery from 2005 to 2017. In this retrospective study, the variables of gender, age, number of liver cysts, involvement of lobe and segments, simultaneous involvement of liver and lung, laparotomy, thoracotomy, the number of patients referred due to the lack of finding cysts in laparotomy, and surgical complications were analyzed., Results: The results showed that the majority of patients were males with age ranging from 8 to 68 years. Right lobe involvement was observed in most of the patients. About 62 patients showed involvement of liver dome and segments 7 and 8. Therefore, 62 patients underwent thoracotomy according to the criteria introduced and the rest of the patients ( n = 178) underwent laparotomy. The results showed that there was a potential for capitonnage in 46 patients in thoracotomy. The pain score was 4-5 according to the VAS criterion. The rate of using analgesic drug did not show significant difference between the two methods., Conclusion: During the manipulation, cysts might be ruptured and give rise to complications such as spread of the disease, shock, and anaphylaxis, which may be followed by legal complaints. Therefore, in order to perform the surgery successfully, a new method along with computed tomography (CT) scan has been introduced in this study, which can be very helpful., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Family Medicine and Primary Care.)

In this project, different photosensitizers were prepared using different ratios of nickel, manganese, and iron. Then, multiple analysis were performed to evaluate their efficiency, and the most suitable one was used to be coated by hyaluronic acid to improve the nano-platform's biocompatibility and target ability. Moreover, another chemical targeting agent (riboflavin) was used to further improve the target ability of the prepared nano-platform. Different spectroscopies and thermal analysis were used to determine the physical and chemical characteristics of the prepared nano-platform. Also, in order to determine the biocompatibility of the nano-platform, in vitro and in vivo tests such as blood hemolysis, blood aggregation and lethal dose were performed. Then, an anti-cancer agent (curcumin) was loaded on the selected nano-platform to makes us able utilizing the synergistic effect of chemotherapy and photodynamic therapy simultaneously. Finally, the cell cytotoxicity results showed that the prepared nano-platform had a great anti-cancer potential which can make it a great candidate as a dual photo and chemo therapy agent for treatment of breast cancers., Competing Interests: Declaration of competing interest None., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Introduction: Carcinoid tumors are malignant neoplasms of neuroendocrine cells. This study tended to evaluate the demographic and rare clinical characteristics of patients with thoracic carcinoid tumor during 2006-2016 at Razi and Aria Hospitals in Rasht., Materials and Methods: The present study was performed on records of 43 patients with lung carcinoid tumors referred to Razi and Aria Hospitals of Rasht during 2006-2016. Information on age, gender, rare clinical symptoms, smoking history, diagnosis tools, treatment, and outcome were analyzed., Results: Of 43 patients treated with definitive diagnosis of carcinoid tumor pathology, 31 patients had typic carcinoid tumor and 12 patients with atypic carcinoma (mean age 43.14 ± 15.16 years). The most common clinical symptom was cough and hemoptysis. Two cases presented with cushing syndrome, The most common diagnostic method in this study was simultaneous use of both CT scans and bronchoscopy. In 95.3% of cases, the tumor was pulmonary and in 4.7% of cases, it was extrapulmonary. Right lower lobe was the most common site of tumors and most of the surgeries used were lobectomy., Conclusion: This study showed that the most common clinical sign of thoracic carcinoid is cough and the tumor is pulmonary in 95.3% of cases. Right lower lobe was the most common site of tumors and most of the surgeries used were lobectomy. outcome was good., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Family Medicine and Primary Care.)

Background: The study of user satisfaction with public transport services is of key interest for enhancing public transport ridership. However, the elevated risks of virus transmission on public transport associated with COVID-19 have resulted in a shift towards private vehicles. This issue is of concern to policymakers due to reduced levels of public transport use and increased private vehicle trips. Thus, it is relevant to re-evaluate attributes impacting user satisfaction during the COVID-19 pandemic to understand how this compares to related research undertaken before the pandemic., Methodology: Through a survey of 507 Tehran Metro users, the structural patterns among 33 metro service attributes were determined using Exploratory Factor Analysis (EFA). A service quality model of the Tehran Metro service (including cleanliness, ventilation/temperature, congestion, operation hours, ticket, information, reliability, and safety) was then designed using Confirmatory Factor Analysis (CFA). Attributes and latent constructs were classified using Importance - Performance Analysis (IPA)., Findings: Attributes associated with general congestion in the metro, the performance of the metro during peak hours, cleanliness, and temperature/ventilation were found to be among the most influential attributes during the pandemic., Conclusion: Before the COVID-19 pandemic, time and cost effectiveness were key attributes affecting the choice of travel mode. Due to the outbreak of the virus, safety and health have been identified as the main attributes affecting the choice of travel mode. In this research, with a case study of the Tehran metro, it was found that there is a shift in attributes affecting service quality towards cleanliness, congestion and temperature/ventilation. As a result, a range of policies is needed to deal with the effect of COVID-19 on metro services. These include: increasing the number of metro services, reducing the time interval between metro services, improving air conditioning, and regular cleaning of vehicles. Policymakers can use the results of this study to improve user satisfaction with metro services and increase ridership levels during the pandemic., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 World Conference on Transport Research Society. Published by Elsevier Ltd. All rights reserved.)

Objective: Bullous lung disease is characterised by the development of bullae within the lung parenchyma. Smoking is considered as a main risk factor of bullae formation. The clinical manifestation varies from asymptomatic bullae to severe respiratory distress. The exact medical approach is still controversial. Here, we aimed to evaluate the patient clinical characteristics and the indication of surgery in the patients., Methods: This study was an analytic cross-sectional study in Razi hospital, Rasht, Iran, in 2016-2020. A total of 110 patients with newly diagnosed lung bullae underwent evaluation based on a checklist, which assessed the variables as clinical characteristics, bullae features, the medical treatment, and its complication. Eventually, statistical analysis was performed by using SPSS v21.0., Results: : A total of 110 patients were enrolled. All the patients were smokers. In 72.9%, the primary presentation was respiratory distress, which needed surgical resection with no recurrence over 8 months. The clinical manifestation varies from asymptomatic bullae in 4.3% and pneumonia in 34.3% to respiratory distress in 61.4%. There was no statistical correlation between clinical manifestation and all the studied variables excluding respiratory distress (p value: 0.659). Seventy patients underwent surgical treatment, in which 20 cases were complicated by air leak that was managed by the chest tube in 16 patients and the Heimlich valve in four patients. No evidence of recurrence was detected., Conclusion: The main risk factor of bulla formation is smoking. Because of various clinical presentations, the appropriate medical approach is of paramount importance., Competing Interests: None

COVID-19 has been associated with a decline in public transport ridership in many cities. However, the impact of the pandemic on passenger perceptions of public transport, particularly loyalty, has remained largely unexplored. Using a case study of Tehran's bus system, this paper aims to assess the moderating effect of COVID-19 on passenger loyalty. A cross-sectional survey of bus users was conducted in two similar periods, before and during COVID-19. The data was analysed using structural equation modelling, with the effect of observed heterogeneity evaluated using multiple indicators multiple causes models and multi-group analysis. The results indicate that during COVID-19, perceptions of service quality have improved, particularly in relation to comfort (including crowding), safety, reliability and information. While this has led to increased customer satisfaction, loyalty to the system has decreased. An increase in the perceived attractiveness of using private cars was found to be the primary factor for reducing passenger loyalty with the perceived monetary and psychological costs of using cars being less effective in encouraging people to use the bus. Taking into account the significant utility of private vehicles in urban transportation during COVID-19, the present study identifies feasible areas for improving the performance of bus services to increase satisfaction with this form of public transport among car owners., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 Elsevier Ltd. All rights reserved.)

Objectives/hypothesis: The validity of cepstral analysis (Cepstral Peak Prominence [CPP] and Cepstral Peak Prominence-Smoothed [CPPS]) as an indicator of perceptual dysphonia was investigated in the Persian language STUDY DESIGN: Cross-sectional study., Methods: A total of 223 participants (159 with and 64 without dysphonia) uttered vowels /a/ and /i/, six standard sentences, and non-standard connected speech. All vocal samples were perceptually evaluated by three raters on a visual analog scale and put into four groups (normal voice, mild, moderate, and severe perpetual dysphonia). CPP and CPPS of sustained vowel /a/, reading the second standard sentence, and a sentence extracted from non-standard connected speech were established using "Praat" software. Statistical analysis involved a one-way factorial analysis of variance (ANOVA), Kruskal-Wallis H, Kendall's Tau-b correlation, t test, and receiver operating characteristics (ROC) curve., Results: The results showed that CPP of sustained vowels and reading the standard sentence and CPPS of sustained vowel differed significantly (P < 0.05), except between the normal voice and mild perpetual dysphonia groups (P > 0.05). The CPP of non-standard connected speech, CPPS of reading the standard sentence, and non-standard connected speech differed significantly between all groups (P < 0.05). The mean of cepstral analysis of all tasks, "averaged CPP," and "averaged CPPS" were significantly different between two groups of the normal voice and perceptual dysphonia (P < 0.05). Correlation between the cepstral analysis and the perceptual ratings demonstrated that the correlation coefficients for CPP and CPPS were between 0.4 and 0.6 (P < 0.05). ROC curve analysis revealed that the area under the ROC curve for "averaged CPP" and "averaged CPPS" was greater than 0.8 (P < 0.05). The values of 22.11 and 12.29 were determined as cut-off scores of "averaged CPP" and "averaged CPPS," respectively., Conclusions: Cepstral analysis was known as useful clinical tool for diagnosis of perpetual dysphonia and determining its severity level in the Persian language., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

The medicinal plant, Scutellaria orientalis , is used for the treatment of several diseases in North-western of Iran. The purpose of this study was to investigate the phytochemical content, cytotoxicity assay against SW-480 and HCT-116 cells and anti-haemolytic activities using HPLC-PDA, GC/MS, MTT and spectrophotometry methods, respectively. Phytochemical screening revealed the presence of different terpenoids and flavonoids such as baicalin, tricin and wogonin and also some of the other medicinally active compounds such as conhydrine and cannabidiol. MTT results revealed that HCT-116 cells were more sensitive to examined extracts compared with SW-480 cells. Methanol extract had the most anti-proliferative activity against HCT-116 and SW-480 cells at 48 h with IC50 values of 614.5 and 592.3 µg/mL, respectively. Also, all samples had no significant haemolytic effect on human erythrocytes. Our results revealed that S. orientalis root extract has a promising anticancer activity, indicating the presence of major anti-cancer agents on human colon cell lines.

This review provides a summary of recent progress in the development of different nano-platforms for the efficient synergistic effect between photodynamic therapy and chemotherapy. In particular, this review focuses on various methods in which photosensitizers and chemotherapeutic agents are co-delivered to the targeted tumor site. In many cases, the photosensitizers act as drug carriers, but this review, also covers different types of appropriate nanocarriers that aid in the delivery of photosensitizers to the tumor site. These nanocarriers include transition metal, silica and graphene-based materials, liposomes, dendrimers, polymers, metal-organic frameworks, nano emulsions, and biologically derived nanocarriers. Many studies have demonstrated various benefits from using these nanocarriers including enhanced water solubility, stability, longer circulation times, and higher accumulation of therapeutic agents/photosensitizers at tumor sites. This review also describes novel approaches from different research groups that utilize various targeting strategies to increase treatment efficacy through simultaneous photodynamic therapy and chemotherapy.

In this project, a biocompatible block copolymer including poly ethylene glycol and poly caprolactone was synthesized using ring-opening reaction. Then, the copolymer was conjugated to folic acid using lysine as a linker. Also, curcumin (CUR) was used as a therapeutic anticancer agent. Nanoprecipitation method was used to prepare CUR-loaded polymeric micelles. Different methods including Fourier-transform infrared spectroscopy, transmission electron microscopy (TEM), and dynamic light scattering (DLS) were used to characterize the prepared nanocarriers (NCs). MTT assay and hemolysis assay were used to evaluate in vitro anticancer efficiency and biocompatibility of the prepared NCs, respectively. The results proved efficiency of NCs as a drug delivery system (DDS) in various aspects such as physicochemical properties and biocompatibility. Also, in vivo results showed that NCs did not show any severe weight loss and side effects on mice, and the anti-cancer study results of the CUR-loaded NCs proved that the conjugation of folic acid on the surface of NCs as a targeting agent could increase the therapeutic efficacy of CUR.

Objectives: Excessive or disharmonious activity of internal and external laryngeal muscles causes a type of dysphonia known as muscle tension dysphonia (MTD). MTD is often diagnosed based on laryngoscopic findings and clinical history. Several diagnostic and classification systems have so far been proposed based on increased supraglottic activity to determine MTD. Various studies have shown that increased supraglottic activity may also be observed in those with normal voice. The present study aimed to precisely examine the incidence of abnormal muscle tension pattern (aMTP) in those with normal voice in comparison with those with MTD. The secondary goal of this study was comparative examination of acoustic parameters and maximum phonation time (MPT) in the group with MTD and normal individuals., Material and Methods: Participants were 75 people with MTD (41 women and 34 men) and 50 individuals with normal voice and no history of dysphonia (20 women and 30 men). Laryngoscopic evaluation was performed for all participants by considering four types of aMTP. Acoustic analyses, including cepstral peak prominence, jitter, shimmer and NHR, as well as MPT examination were performed., Results: A significant difference between the MTD group and control group was observed in all MTPs except for MTP 2 (lateral-to-medial approximation of the false vocal folds) (P = 0.367, χ 2 (1) = 0.81). In other MTPs, a significant difference existed between the control and MTD groups in terms of aMTP incidence (P < 0.05)., Conclusion: On the four aMTPs, results revealed that one must exercise caution in diagnosing MTD based on MTP 2 (medial compression of ventricular folds), and this must not be the sole criterion for diagnosis. Moreover, cepstral peak prominence and MPT analyses are of high clinical significance., (Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Hydatid cysts are fluid-filled sacs containing immature forms of parastic tapeworms of the genus Echinococcus. The most prevalent and serious complication of hydatid disease is intrabiliary rupture, also known as cystobiliary fistulae. In this study, a sporadic case of biliary obstruction, cholangitis, and septicemia is described secondary to hydatid cyst rupture into the common bile duct and intraperitoneal cavity., Case Presentation: A 21-year-old Iranian man was admitted to the emergency ward with 5 days of serious sickness and a history of right upper quadrant abdominal pain, fatigue, fever, icterus, vomiting, and no appetite. In the physical examination, abdominal tenderness was detected in all four quadrants and in the scleral icterus. Abdominal ultrasound revealed intrahepatic and extrahepatic biliary duct dilation. Gallbladder wall thickening was normal but was very dilated, and large unilocular intact hepatic cysts were detected in segment IV and another one segment II which had detached laminated membranes and was a ruptured or complicated liver cyst., Conclusion: Intrabiliary perforation of the liver hydatid cyst is an infrequent event but has severe consequences. Therefore, when patients complain of abdominal pain, fever, peritonitis, decreased appetite, and jaundice, a differential diagnosis of hydatid disease needs to be taken into consideration. Early diagnosis of complications and aggressive treatments, such as endoscopic retrograde cholangiopancreatography and surgery, are vital.

Background: The most common cause of primary spontaneous pneumothorax (PSP) is subpleural bleb apical rupture. Little is known about the relationship between PSP and exercise and return to exercise the time. In this study, we tend to investigate the relationship between training and PSP and time of return to exercise and previous activities., Method: This study was designed as a case series and the sample size included all patients diagnosed with PSP in Razi and Poursina and Aria hospitals of Rasht during 2015-2017 based on inclusion criteria. Variables were analyzed using Fisher's exact test, Chi-square, Mann Whitney U and t-test (p<0.05)., Results: The most common treatment type in patients was transaxillary thoracotomy with pleurodesis with iodine (TTP) in 58.2% and tube thoracostomy and pleurodesis in 41.7%, which was not statistically significant between athletes and non-athletes (p=0.806). Athletes who underwent TTP after four weeks and those treated with tube thoracostomy and pleurodesis after 8-12 weeks were advised to return to their previous activity. Of athletes, 9.5% had a recurrence; of non-athletes, 9.8% had a recurrence. Of athletes, 4.8% did not tolerate returning to their last activity; of non-athletes, 7.3% did not tolerate returning to their previous activity regardless of treatment, and this difference was not significant., Conclusion: Our study showed no significant difference between clinical manifestations and image findings and the frequency of treatment and complications in both athlete and non-athlete patients. There is no increase in recurrence and intolerance at the time recommended for return to previous activity., (© 2021 Manouchehr A, et al.)

Purpose: Individuals with aphasia (IWA) show various impairments in speech, language, and cognitive functions. Working memory (WM), a cognitive system that functions to hold and manipulate information in support of complex, goal-directed behaviors, is one of the impaired cognitive domains in aphasia. The present study intended to examine the effects of a WM training program on both memory and language performance in IWA., Method: This quasi-experimental study with an active control group was performed on 25 people with mild or moderate Broca's aphasia aged 29-61 years resulting from left hemisphere damage following ischemic stroke. Participants were assigned into two groups, including a training group (n = 13) and a control group (n = 12). The treatment and control groups received WM training and routine speech therapy, respectively. Two separate lists of WM tests, including one list for both pre-training assessment and training program and a second list for the post-training assessment, were used in this study., Results: The treatment group showed significant improvements in both trained and non-trained WM tasks (near transfer effect) and language performance (far transfer effect) compared to the control group., Conclusion: Given the good generalizability of the WM training program on both WM and language performance, WM training is suggested as part of the rehabilitation program in aphasia., (Copyright © 2020 Elsevier Inc. All rights reserved.)

In the present study, we successfully synthesized nanocarriers (NCs) based on Y-shaped miktoarm copolymers, Poly Ethylene Glycol-Lysine-(Poly Caprolactone) 2 (PEG-Lys-PCL 2 ), which were loaded by baicalein (B) through the nanoprecipitation process to assess their in-vitro and in-vivo properties. We applied various methods and measurements including proton nuclear magnetic resonance (HNMR), dynamic light scattering (DLS), differential scanning calorimetry (DSC), Fourier-transform infrared spectroscopy (FTIR), MTT assay, hemolysis test, lethal dose, real-time PCR, and Morris water maze. The results of DLS indicated that the size and zeta potential of the obtained NCs and B-loaded NCs were acceptable. Also, in-vivo and in-vitro biocompatibility examinations proved that miktoarm-based NCs were safe, and all rats treated with miktoarm-based NCs did not exhibit any remarkable weight loss during the experiment. The results of the Morris water maze (in-vivo test) revealed that the normal saline-treated group, as well as B-miktoarm + Scopolamine (M + B + S) and B-miktoarm-Tween80 + Scopolamine (M + B + T + S) pretreatment groups, spent more time in the target quadrant. Thus, this experiment showed that pretreatment of rats with M + B + S and M + B + T + S had the most effects on spatial memory. According to quantitative PCR analysis, we hypothesized that, in comparison with other experimental groups, pretreatment of rats with M + B + T + S could be more effective in preventing cholinergic dysfunction, brain oxidative stress and cognitive deficits which cause by Scopolamine HBr. This outcome may be partially due to the upregulation of DHCR24, SELADIN, and SIRT6 in entire of the hippocampal region of normal saline-treated and M + B + T + S pretreatment groups. These results may be because mimicking the cell membrane structure would be an excellent feature for miktoarm, and partial coating of Tween-80 can play a critical role for PEG-Lys-PCL 2 -based NCs in crossing the brain cell membrane, and they can easily be uptaken by the cells. Eventually, all of the obtained data confirmed that PEG-Lys-PCL 2 miktoarm star copolymers are suitable for delivering therapeutic agents to the brain for the treatment of Alzheimer's disease (AD). Also, it seems that baicalein should be taken into account as a potent compound for the treatment of AD., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

In The present project, a variety of MnFe 2 O 4 (Mn) and Cr 2 Fe 6 O 12 (Cr)-based nanocarriers (NCs) were synthesized as photosensitizer and NCs for delivery of chemotherapeutic curcumin (CUR) and provide a new structure for Photodynamic Therapy (PDT). For determining efficiency of NCs release study, MTT assay, lethal dose test and hemolysis assay were carried out. The release study showed the release of CUR from NCs was pH-dependent, but, every NCs had its own behavior for releasing the drug. The data acquired from the release study showed the CUR release from Mn can reach to over 90% at acidic media instead of 41% at neutral media. However, the CUR released from Cr were approximately equal as Cr had equal zeta potential at both media. Hemolysis activity and lethal dose test displayed the cytotoxicity of NCs was neglectable at both in vitro and in vivo study. Also, the results of anti-cancer activity assay (MTT assay) showed that both of Cr and Mn NCs are suitable systems for PDT. Therefore, the results demonstrated that Mn is suitable NCs for PDT and anticancer drugs delivery of therapeutic drugs.

Purpose: In this study, methoxy poly (ethylene glycol)-poly (ε-caprolactone) (mPEG-PCL) di-block copolymers were synthesized. The purpose of this work is to investigate the in vivo anti-inflammatory effects of simvastatin-loaded micelles., Methods: The structure of synthesized copolymers was characterized by using HNMR, FTIR, and GPC techniques. Simvastatin was encapsulated in micelles through a single-step nano-precipitation method, leading to the formation of simvastatin-loaded mPEG-PCL (simvastatin-mPEG-PCL) micelles. In this study, the anti-inflammatory effects of simvastatin/mPEG-PCL micelles versus indomethacin were investigated in acute inflammation-induced rats. The paw edema thickness was measured 1, 2, 3, and 4 h after injection of formulation. The inhibition of edema in various groups were calculated and reported by percentages., Results: The results showed that the zeta potential of micelles was about -14.9 ± 0.47 mV and the average size was in range of 66.10 ± 0.34 nm. Simvastatin was encapsulated in mPEG-PCL micelles with a loading capacity of 9.63 ± 0.87% and an encapsulation efficiency of 64.20 ± 0.79%. Simvastatin and simvastatin-mPEG-PCL micelles showed significant anti-inflammatory activity in the present study., Conclusions: This study revealed that simvastatin and simvastatin/mPEG-PCL micelles both have anti-inflammatory effects and suggested that statins have potential anti-inflammatory activity along with their lipid lowering properties.

Objectives: In instrumental voice assessment, multiparametric models reflect the multidimensional nature of voice and are therefore better than models that reflect only a single dimension of voice. The Dysphonia Severity Index (DSI) is one of the most common multiparametric models. In voice assessment, race, language, and structural and physiological features affect the acoustic, aerodynamic, and voice range profile measures. Given these differences, this study was conducted to design and evaluate a multiparametric and objective model for assessing the severity of dysphonia in Persian-speaking populations., Material and Methods: This study examined 300 participants with several types of dysphonia (104 women and 196 men) and 100 healthy individuals (63 women and 37 men). Five acoustic parameters, three aerodynamic parameters, and seven voice range profile parameters were measured for designing the model. Perceptual evaluation was performed using the grade, roughness, breathiness, asthenia, strain scale. The logistic regression analysis was used to determine the factors affecting the DSI and each component's coefficient., Results: Of the 15 parameters assessed, shimmer, vital capacity, semitone range, and voice onset time of /pa/ remained in the model with their coefficients. This section presents the DSI model for the examined population. The discriminant analysis showed that this combination corresponds to 47.8 of the perceptual assessment: DSI = 0.289 (shimmer) + 0.0001 (VC) - 0.059 (STR) - 13.278 (VOT&#95;Pa)., Conclusion: In this study, the DSI corresponded to the physiological, linguistic, and racial characteristics of the Persian-speaking population with or without voice disorder., (Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

In this project, a core-shell polymersome based on miktoarm star-copolymer:methoxy poly-ethylene glycol-lysine-(poly-caprolactone) 2 was synthesized by a new method as controlled targeted drug delivery systems for codelivery of the chemotherapeutic methotrexate (MTX) and curcumin (CUR). Some properties of these nanocarriers (NCs), such as surface morphology, structure, surface charge, stability, and biocompatibility, were evaluated by proton nuclear magnetic resonance, dynamic scanning colorimetry, Fourier-transform infrared spectroscopy, dynamic light scattering, atomic force microscopy, critical aggregation concentration, hemolysis test, MTT assay, and lethal dose 50 (LD50). The AFM results showed that the uniform spherical morphology of NCs have an average size of about ∼60 nm. The drug loading of NCs was about 14.13 and 10.93% for CUR and MTX, respectively. The NCs revealed pH-sensitivity in drug release. The release of drugs from miktoarm-based NCs in neutral pH was lower than in acidic medium because of faster degradation of polymersome in acidic environment. MTT assay results showed that the drug-loaded NCs did not show significant toxicity due to which cell viability maintain over 82% at 300 μg/mL concentration. Also, synthesized miktoarm showed hemolysis lower than 3%. This result was repeated in LD50, and all mice which treat with 5000 mg/kg were still alive after 24 h. These result confirmed safety of miktoarm star copolymer. Eventually, the goal of this study is the application of water-soluble star copolymers miktoarm with pH dependent release properties for designing a new drug delivery carrier and using CUR for enhancing anticancer properties of MTX. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 2817-2826, 2018., (© 2018 Wiley Periodicals, Inc.)

This data was acquired using a cross-sectional design in which medical records of patients admitted at Arya and Razi Hospitals of Rasht from 2006 to 2015 were examined. The patients' demographic data, history of smoking and opium, underlying disease, clinical symptoms at admission, the utilized diagnostic method, duration of hospitalization, findings of chest CT scan, type of pneumothorax, and therapeutic technique were collected through a questionnaire. The collected data were encoded and analyzed using SPSS 21.0. Smoking rate was measured in the primary and secondary spontaneous pneumothorax groups and acquired pneumothorax group. The most frequent underlying disease in the patients with secondary spontaneous pneumothorax (SSP) was COPD that was observed in 41 patients (51.25%). The frequency of bleb was measured in the three groups. Out of 38 patients (15.01%) with recurrence of pneumothorax, 68.42% had PSP type. Chest tube was the most frequently used therapeutic technique, which was utilized 92.88% out of 235 patients.

Introduction: Retrosternal goiter refers to any thyroid enlargement in which over 50% of the thyroid permanently located under the thoracic inlet or the lower pole of thyroid is not palpable with the neck in hyperextended position. Due to the increasing number of surgical procedures of retrosternal goiter, the present study was carried out to examine the symptoms, diagnosis, treatment, and treatment complications in retrosternal goiter patients., Materials and Methods: Data related to demographic data (age and gender), clinical symptoms (dyspnea, dysphagia, dysphonia, lumps in neck, and hoarseness), methods of diagnosis (computed tomography [CT], chest X-ray [CXR], ultrasonography, and magnetic resonance imaging), and postoperative complications (bleeding, early and late dysphonia, early and late dyspnea, transient and permanent hypocalcemia, transient, and permanent recurrent laryngeal nerve paralysis) were collected., Results: According to the results 71.4% of patients were women and most of the participants (67.1%) aged 45-60 years. Mass in the neck was the most frequent symptoms before surgery (88.6%). The most common incision for thyroidectomy (95/7%) was neck Collar incision. Diagnosis method in 82.9% and 17.1% of cases was, respectively, based on CT scans with CXR and CT scans with CXR and ultrasound. According to the postoperative pathologic findings, 58.5% of the cases were multinodular goiter, 22.9% were papillary cell carcinoma, 7.1% were medullary carcinoma, 5.7% were anaplastic carcinoma, 5.7% were thyroid lymphoma, and only 1.4% were thyroid adenoma. Postoperative complications occurred in 47.14% of patients. Most common complication was early transient dysphonia., Conclusion: This study recommends that retrosternal goiter should be operated early under suitable conditions, and the best diagnosis tool and best surgery methods are CT scan and surgery with collar incision, respectively., Competing Interests: There are no conflicts of interest.

Objectives: Aerodynamic evaluations can provide useful information about the interaction between the respiratory and the phonation systems. The present study was conducted to investigate the relationship of maximum phonation time (MPT), vital capacity (VC), and phonation quotient (PQ) with perceptual evaluation in different types of dysphonia. The relationship between these parameters and the type of dysphonia was also examined., Materials and Methods: The study participants consisted of 300 individuals with different types of dysphonia (104 women and 196 men) and 100 healthy samples (63 women and 37 men). A professional speech-language pathologist conducted the perceptual evaluation based on the G (grade) component of the GRBAS scale, which stands for grade, roughness, breathiness, asthenia, and strain. VC was measured using a spirometer and MPT using a stopwatch. PQ was calculated as the ratio of VC to MPT., Results: The difference between the mean ± standard deviation of PQ, VC, and MPT were found to be significant at all the four degrees of dysphonia severity (P < 0.001). There was a significant difference in mean MPT and VC between the genders (P < 0.001), but no significant gender differences were observed in terms of the mean PQ (P = 0.346). The study participants were classified into four groups, including the organic dysphonia group, neurologic dysphonia and functional dysphonia groups, and the normal group; the study variables measured were found to be significantly different between all the four groups (P < 0.001)., Conclusion: As MPT and PQ were correlated with the perceptual G (grade) and differentiated dysphonic from healthy individuals, clinicians are recommended to take account of them in their instrumental evaluations., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Introduction: Malignant pleural effusion (MPE) is determined by the detection of malignant cells in pleural fluid or pleural tissue. Neoplasm of lung, breast, ovary and lymphoma are the causes of more than 75% of MPE. Pleurodesis is a usual technique in the management of MPE to achieve a symphysis between two layers of the pleura, and various chemical agents have been used in an attempt to produce pleurodesis. With regard to complications and limitations of these sclerosing agents, efficacy and safety of povidone-iodine have been investigated in this study., Materials and Methods: Between June 2014 and June 2016, 63 consecutive patients were admitted to the Department of Thoracic Surgery because of symptomatic MPE. After insertion of a chest tube, pleurodesis with instillation of povidone-iodine was performed. Thyroid and renal function tests were checked, and success rate as well as recurrence of MPE was monitored in the next follow-up visits., Results: The complete response to this procedure was about 53.57%, and failure of treatment was 10.71% with efficacy of 82.2%. The most common complication was pain during instillation (26.9%). Changes in thyroid and renal function tests were not significant., Conclusion: Povidone-iodine is a safe and effective agent with minor side effects in pleurodesis of patients with MPEs and can be used as an accessible and low-cost alternative than other sclerosing agents., Competing Interests: There are no conflicts of interest.