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Introduction: Multiple myeloma (MM) is a kind of blood cancer that is caused by the malfunction of plasma cells and their uncontrolled growth, which leads to a decrease in the level of immunity and the formation of bone lesions, especially in the spine, skull, pelvis, and ribs. Common symptoms in MM patients include severe bone pain, kidney problems, anemia, and frequent infections. This study aims to employ appropriate cure models to estimate the cure fraction and prognostic factors affecting overall survival (OS) in MM patients who have undergone transplantation. Materials and Methods: This study has analyzed the medical records of 52 patients with multiple myeloma who were admitted to Taleghani Hospital affiliated with Shahid Beheshti University of Medical Sciences in Tehran from January 2010 to August 2016 and were followed up until February 2022. Four cure models were applied to the data and it determined the cure fraction in the Inverse Gaussian model is higher than in other models, so prognostic factors affecting the survival of patients were examined using this model. Results: The mean age at diagnosis was 53.07 (SD =6.4). The 5-year survival rate for MM patients was 74%, and the long-term survival rate for patients in this study was 54.7%. Using the Inverse Gaussian model, the cure fraction was estimated at 54.4% Conclusion: This study applies cure models to find prognostic factors based on pre-transplant CBC test on the survival time of MM patients who have been treated with auto-HSCT, so the number of platelets pre-transplantation and the patient's age are effective predictors for overall survival.

Introduction: Neisseria and ureaplasma are considered to be the most important bacteria causing genital infection and infertility. The present study was conducted with the aim of searching for these two pathogens in the cervical secretions of infertile women, emphasizing molecular methods and determining drug resistance genes related to azithromycin and ciprofloxacin.Methods: In this descriptive study, endocervical samples obtained from cervical secretions of 135 infertile women and 135 healthy women referred to Shohada Tajrish Hospital from October 2018 to September 2019 were examined. Data were analyzed by SPSS statistical software (version 21). Chi-square test was used to investigate the relationship between infection and infertility in individuals. P

Introduction: Recurrent event data are common in many longitudinal studies. Often, a terminating event such as death can be correlated with the recurrent event process. A shared frailty model applied to account for the association between recurrent and terminal events. In some situations, a fraction of subjects experience neither recurrent events nor death; these subjects are cured. Methods: In this paper, we discussed the Bayesian approach of a joint frailty model for recurrent and terminal events in the presence of cure fraction. We compared estimates of parameters in the Frequentist and Bayesian approaches via simulation studies in various sample sizes; we applied the joint frailty model in the presence of cure fraction with Frequentist and Bayesian approaches for breast cancer. Results: In small sample size Bayesian approach compared to Frequentist approach had a smaller standard error and mean square error, and the coverage probabilities close to nominal level of 95%. Also, in Bayesian approach, the sampling means of the estimated standard errors were close to the empirical standard error. Conclusion: The simulation results suggested that when sample size was small, the use of Bayesian joint frailty model in the presence of cure fraction led to more efficiency in parameter estimation and statistical inference

Introduction: A cure rate survival model was developed based on the assumption that the number of competing reasons for the event of interest has the Geometric distribution and the time allocated to the event of interest follows the Generalized Birnbaum-Saunders distribution. Methods: The Geometric GB-S distribution was defined and two useful representations were represented for its density function which contributes to the creation of some mathematical properties. Furthermore, the parameters of the model with cure rate were estimated by using the maximum likelihood method. Results: Several simulations were performed and a real data set was analyzed from the medical area for different sample sizes and censoring percentages. Conclusion: By considering the advantages of the GGB-S model, the model can be implemented as an appropriate alternative to explain or predict the survival time for long-term individuals.

Background: Breast cancer is a common disease among women around the world. In Iran, it is the most prevalent cancer diagnosed in women. The objective of this study was to assess the cure rate of patients and the associated risk factors. Method: A retrospective cohort study was conducted on 446 patients with breast cancer admitted to the Shahid Ramezanzadeh Radiotherapy Center. Using R 3.2.2 software, the Kaplan-Meier curve, log-rank test, and cure joint frailty model were utilized in the analysis. Results: Of the 446 patients, 17.3% died, 20% experienced relapse, and 62.7% were censored. The 1-5-7-year disease-free survival rates were 95.3%, 73.4%, and 69.3%, respectively. In the cure model, stage, involved lymph node, and surgery were statistically significant. In the recurrence model, stage, involved lymph node, lymphovascular invasion, and hormone therapy were statistically significant. In the death model, stage, lymphovascular invasion, and involved lymph node had a statistically significant effect on the survival time. Conclusion: The cure joint frailty model is a good model when there is a high fraction of patients who do not experience any recurrence or death. In addition, this model allows for the separate estimation of explanatory variable effect on recurrence, death, and cure. The findings of our study can be conducive to preventing the unfavorable effects of breast cancer and increasing the survival of patients.

Background: Sexual compatibility between husband and wife is an effective factor in both sexual andmarital satisfaction. However, there is limited valid and reliable questionnaire to measure the degreeof sexual compatibility between the couples.Methods: In this exploratory mixed method study, 54 individuals were interviewed in the qualitativephase and 448 persons participated in the quantitative phase. Totally 502 participants (261 woman,241 men) took part in this study. According to 205 final codes derived from the qualitative phase,102 initial items were developed, the number of which reached 69 items after deletion and mergingperformed by the research team. After face validity, content validity and construct validity, 68 itemswere introduced into the construct validity phase.Results: Following exploratory factor analysis and promax rotation, the items were reduced to 35 in4 factors: “Requirements of a sexual relationship”, “Sexual agreement”, “Contextual obstacles” and“Outcomes of sexual compatibility”. The questionnaire Cronbach alpha and correlation coefficient ofthe test-retest method were 0.90 and 0.91, respectively.Conclusion: Final Questionnaire included 35 items in 4 point-Likert scale with total score of between35-140. This valid and reliable questionnaire is brief, easily interpreted and can measure the mainfactors affecting sexual compatibility with the spouse in clinics and research fields.

Background & Aim: Some women, throughout their life cycle, experience unintended pregnancy and had to decide on continuing or terminating it. Although the decision-making process always recurs, few studies have so far shed light on this complex, and context-based process. The aim of the present study was to explore Iranian women’s decision-making process to abort or continue an unintended pregnancy. Methods & Materials: This was a qualitative study using grounded theory approach. Data were collected through unstructured, in-depth interviews with 29 participants in Tabriz from March 2016 to May 2017. The participants were selected through the purposeful sampling method and data collection were continued until reaching data saturation. Data analysis was carried out concurrently with the data collection, using the MAXQDA software version 10. Results: Data analysis gave rise to four axial categories: “perceived threats”, “resistance mixed with indecision”, “values and supportive resources”, as well as “acceptance and confirmation of decision”. This means that the decision-making process among women with unintended pregnancy initially starts with a perceived threat as a main concern leading to their resistance towards accepting such a pregnancy, then exposure to threats arising from abortion can cause indecision and uncertainty in practicing abortion. In this respect, given the social support, women affected by religious values make efforts to choose the procedure with the least harm and threats and maximum acceptability and confirmability. “Confirmation of decision” is as well the outcome of the interactive process of decision-making. Conclusion: What can differentiate the theory of decision-making on abortion or continuation of an unintended pregnancy from the general theories of decision-making is its sociocultural confirmability. Social acceptance of abortion and childbearing in line with moral evaluation of fetal development directs the confirmability process of decision-making about unintended pregnancy.

Background: Ventilator-associated pneumonia (VAP) is the second common nosocomial infection in NICUs leading to some complications. Nurses are one of the main resources in health care that directly influence neonatal health care. Responsibility of most of preventive strategies related to VAP complications lies with nurses; therefore, nursing care should be assessed until the nurses show standard level of performance in hospitals. The aim of this cross-sectional study, conducted within 2015-2016, was to assess nursing care regarding VAP prevention in neonatal intensive care units (NICUs) in selected hospitals affiliated to Shahid Beheshti University of Medical Sciences.Methods: In this descriptive cross-sectional study, 100 observations of nursing care regarding VAP were selected by convenience method in NICUs of Mahdiyeh, Mofid, and Imam Hossein hospitals affiliated to Shahid Beheshti University of Medical Sciences within 2015-2016. The data collection tools included demographic information questionnaire and a developed checklist related to VAP prevention. The observations were assessed and documented with two sampling methods, including time and event sampling. The data were analyzed in SPSS software (version 16).Results: According to the results of the current study, the rate of compliance of nursing care with the standards for prevention of VAP in neonates under mechanical ventilation in NICU with developed standards was estimated at 62.81 percent.Conclusion: Authorities should pay more attention to nursing cares especially incompetent cares explained in this study to increase the health of hospitalized neonates, decrease complications, length of stay, and costs. Moreover, future research is needed to investigate the reasons of this incompetency.

Abstract To evaluate the association of admission serum levels of 25(OH)D, parathormone and the related electrolytes with severity of illness and clinical outcomes in neurosurgical critically ill patients, serum levels of 25(OH)D, parathormone, calcium, magnesium, and phosphate, along with APACHE II score were measured for 210 patients upon admission. Mean serum 25(OH)D was 21.1 ± 7.4 ng/mL. 25(OH)D deficiency (less than 20 ng/dL) and elevated serum parathormone level were found in 47.6% and 38% of patients respectively. Hypocalcaemia, hypophosphatemia, hypomagnesaemia and hypermagnesaemia were found in 29.5%, %63.8, 41.9% and 27.6% of patients respectively. The APACHE II score was significantly correlated with serum levels of 25(OH)D, parathormone, calcium, and phosphate. Multivariate regression analysis adjusted by other risk factors showed that among all clinical outcomes, admission hypovitaminosis D was associated with longer duration of ICU stay and a high admission of parathormone was associated with in ICU mortality. We concluded that disorders of admission serum levels of 25(OH)D, parathormone, calcium, magnesium, and phosphate are related to the presence of multiple causal factors such as severity of disease and are not independently associated with clinical outcomes. Most often they are normalize spontaneously with resolution of the disease process.

Background: Exploring the expectations of postgraduate nursing students from their supervisors is required in order to meet the expectations, raise the general students' satisfaction, and enhance the students' capabilities to the highest degree possible. The present study was conducted to explore the expectations of postgraduate nursing students from their supervisors. Materials and Methods: This qualitative study was done through semi-structured individual interviews with seven PhD students and 14 master's students in two focus groups from three universities in Tehran, Iran. The data were analyzed using the inductive approach and through conventional content analysis. Results: The analysis of the data led to the extraction of five categories (support for the students, good communication skills, professional competence, guiding the students, and professionalism) within 12 subcategories. Conclusions: The results revealed that postgraduate students expect their supervisors not only to guide and support them in education and research but also have good communication skills, be professional, and value professionalism. Therefore, supervisors should try to meet these expectations and offer practical strategies for better realization of their needs.

Background: Woman’s orgasm plays a vital role in sexual compatibility and marital satisfaction. Orgasm in women is a learnable phenomenon that is influenced by several factors. Objective: The aim of this study is exploring obstacles to orgasm in Iranian married women. Materials and Methods: This qualitative study with directed content analysis approach was conducted in 2015-2016, on 20 Iranian married women who were individually interviewed at two medical clinics in Tehran, Iran. Results: Orgasm obstacles were explored in one category, 4 subcategories, and 25 codes. The main category was “Multidimensionality of women’s orgasm obstacles”. Subcategories and some codes included: Physical obstacles (wife’s or husband’s boredom, vaginal infection, insufficient vaginal lubrication), psychological obstacles (lack of sexual knowledge, shame, lack of concentration on sex due to household and children problems), relational obstacles (husband’s hurry, having a dispute and annoyance with spouse) and contextual obstacles (Irregular sleep hours, lack of privacy and inability to separate children’s bedroom from their parents, lack of peace at home). Conclusion: For prevention or treatment of female orgasm disorders, attention to physical factors is not enough. Obtaining a comprehensive history about physical, psychological, relational and contextual dimensions of woman’s life is necessary.

Background: The learning environment has a significant role in determining nursing students' academic achievements and course satisfaction. Creating a proper educational environment is therefore necessary for improving the quality of teaching and learning, and for delivering competent graduates to society. Objective: The present study was conducted to explore teachers' and postgraduate nursing students’ experience of the educational environment in Iran. Methods: This qualitative study uses an inductive approach and conventional content analysis. Data were collected through semi-structured face-to-face interviews with seven PhD students, seven faculty members (directors) and two focus groups comprising of fourteen master’s students in total, selected from three major universities in Tehran, Iran. Results: Seven subcategories were extracted from the data, including the organizational context, interactive climate, teachers’ competency, student appreciation, research centeredness, educational guidance and professionalism. Conclusion: The educational environment of postgraduate nursing programs in Iran encompasses different dimensions that can serve as both key points for educational environment evaluators and as guidelines for officials at different levels, to modify the weaknesses and improve the strengths of the system.

Background: Survival time is one of the indicators used for evaluation of the quality of care in different types of malignancies, including breast cancer. The present study aimed to estimate the survival rate of breast cancer and its related factors among Iranian patients. Methods: Overall, 3148 cases of breast cancer who referred to the Cancer Research Center in Shahid Beheshti University of Medical Sciences, Tehran, Iran during 1994-2017 participated in this longitudinal study. Survival estimates were calculated using the Kaplan-Meier method and the Bayesian generalized Birnbaum–Saunders model with cure rate from geometric distribution. Clinical, pathological, and biological variables as potential prognostic factors were entered in univariate and multivariate analyses. In order to identify the significant prognostic factors, 95% highest posterior density (HPD) intervals were used. Results: The overall 1, 5, 10, 15, 20 and 25-year survival rate were 95%, 75%, 60%, 47%, 46% and 46%, respectively. A significant relation was observed between survival time and the variables such as age, size of tumor, number of lymph nodes, stage, histological grade, estrogen receptor, progesterone receptor, and lymphovascular invasion. Conclusion: The findings of this study might help the health managers to plan long-term programs considering regional determinants, public education, and screening for early detection of breast cancer cases which can eventually influence the overall survival rate of these patients.

Objective (s): Many women throughout their life cycle experience unintended pregnancy and need to decide on continuing or terminating it. In addition, elective abortion is illegal and forbidden in some countries and hence, unintended pregnancy is a matter of great sensitivity and importance for women who live in such countries. Currently, there is no measurement tool for assessing women’s decision-making status facing an unintended pregnancy. This study aimed to develop and evaluate the psychometric properties of a measure for assessing women’s decision-making about their unintended pregnancies. Methods: The present study was a sequential exploratory study. In the first section, the decision-making process of unintended pregnant women was explored using the content analysis approach. The data were collected through a semi-structured interview by 23 participants in Tabriz. In the second section, items were formed based on the meaning units, which extracted from qualitative section. The validity of the instruments was assessed using face, content and constructs validity. For evaluation of face validity, qualitative and quantitative (item impact score) methods were used. The content validity was assessed by 15 experts. The construct validity was assessed by exploratory factor analysis. The sample size was calculated by multiplying the number of items by ten. Internal consistency, and Intraclass correlation coefficient (ICC) were used to assess the reliability of the instruments. Results: The instrument had 4 components and 27 items. The components of the instrument included: avoidance-justification strategies, resistance against accepting the pregnancy, analytical strategies and confirmatory strategies. Four components explained 50.81% of variance. The instrument was found to have high internal consistency (Cronbachchr('39')s α = 0.86) and adequate test-retest reliability (ICC = 0.94). Conclusion: The present instrument a valid measure related to unintended pregnant women’s decision-making.

Abstract Background: 4cure models are a model to analyze survival data that these models exist for long term survivors. Cure models are a special type of survival model where it is assumed that there are a proportion of subjects who had never event, thus, survival curve will eventually reach a plateau. Therefore, standard survival models are not appropriate because they do not account for the possibility of cure.The aim of the present research is to apply non-mixture cure model to analyze survival of patients with colorectal cancer. Materials and Methods: We studied 232 patients with colorectal cancer who were visited and treated at Taleghani Hospital Research Center for Gastroenterology and Liver Disease in Tehran. These patients were diagnosed from 1987 to 2012 and followed up until 2013. The Effect of age, gender, family history, body mass index and site of infection were studied. Kaplan-Meier and Non-Mixture cure Model were used for analzing data. Results: The ten-year survival rate after diagnosis in the studied patients was 64 % .A total of 60 (25.8 %) deaths due to colorectal cancer were observed. The mean of age at the time of diagnosis was 51.6 years. Based on non-mixed cure model, the rangs of age was 45-65 years old and BMI were significant. Conclusion: When the population is divided into two groups (susceptible and non- susceptible individuals), using Cox semi-parametric model is not appropriate. Therefore, we should use cure models.

The present study aimed to design and evaluate the psychometric properties of the Paternal Adaptation Questionnaire (PAQ). The study was a mixed (qualitative and quantitative) sequential exploratory study. In the qualitative phase, a preliminary questionnaire with 210 items emerged from in-depth interviews with 17 fathers and 15 key informants. In the quantitative phase, psychometric properties of the PAQ were assessed. Considering cutoff points as 1.5 for item impact, 0.49 for content validity ratio (CVR), and 0.7 for content validity index (CVI), items of the questionnaire were reduced from 210 to 132. Assessment of the content validity of the questionnaire demonstrated S-CVR = 0.68 and S-CVI = 0.92. Exploratory factor analysis resulted in the development of a PAQ with 38 items classified under five factors (ability in performing the roles and responsibilities; perceiving the parental development; stabilization in paternal position; spiritual stability and internal satisfaction; and challenges and concerns), which explained 52.19% of cumulative variance. Measurement of internal consistency reported a Cronbach’s α of .89 for PAQ (.61-.86 for subscales), and stability assessment of the PAQ through the test–retest demonstrated Spearman’s correlation coefficients and intraclass correlation coefficient of .96 (.81-.97 for subscales). It was identified that the PAQ is a valid and reliable instrument that could be used to assess fatherhood adaptation with the paternal roles and fathers’ needs, as well as to design appropriate interventions and to evaluate their effectiveness.

Background: Growth failure, constituting one the health problems in children below 2 yr of age, can lead to major complications such as death or mental, emotional and physical disabilities. The present study aimed to investigate effective factors on growth failure in the height and weight of less than 2 yr old children of Khorramabad, Iran in 2013. Methods: This present longitudinal retrospective study used stratified and clustered sampling. Based on growth curves in family records, the incidence times of growth failure in height and weight of each child were recorded. In the next stage, using recurrent events model (proportional rate model), along with SAS software (version 9.2), the data were modeled. Results: According to proportional rate model, the effect of mothers’ educational level on the rate of growth failure in the height and weight of children was significant (P=0.046, P=0.049) and the effect of fathers’ job was significant only on growth failure in children’s weight (P

Misclassification error is a common problem of cancer registries in developing countries that leads to biased cancer rates. The purpose of this research is to use Bayesian method for correcting misclassification in registered cancer incidence of eighteen provinces in Iran. Incidence data of patients with colorectal cancer were extracted from Iranian annual of national cancer registration reports from 2005 to 2008. A province with proper medical facilities can always be compared to its neighbors. Almost 28% of the misclassification was estimated between the province of East Azarbaijan and West Azarbaijan, 56% between Fars and Hormozgan, 43% between Isfahan and Charmahal and Bakhtyari, 46% between Isfahan and Lorestan, 58% between Razavi Khorasan and North Khorasan, 50% between Razavi Khorasan and South Khorasan, 74% between Razavi Khorasan and Sistan and Balochestan, 43% between Mazandaran and Golestan, 37% between Tehran and Qazvin, 45% between Tehran and Markazi, 42% between Tehran and Qom, 47% between Tehran and Zanjan. Correcting the regional misclassification and obtaining the correct rates of cancer incidence in different regions is necessary for making cancer control and prevention programs and in healthcare resource allocation.

Introduction: The time use of people in the occupation areas is affected by conditions, such as disability, environment, and family changes. One of these disabilities is Cerebral Palsy (CP), which requires long-term care. This study aimed to determine the difference between time use of mothers of school-aged children with CP with mothers of pre-school children with CP. Materials and Methods: The present study is a descriptive/analytical study. A total of 64 mothers of children with CP along with their children, aged 4-12 years, were participated in this study. They were divided into two groups; mothers of pre-school and mothers of school-aged children. In this study, mother’s time use form was used to collect data. Then, the obtained data were analyzed by SPSS-19 conducting the Independent t test and Mann-Whitney tests to compare the two groups. Results: There was a significant difference between two groups with respect in working days of the week (P=0.009). This study indicated that mothers of the schoolgoer children allocated more time for their children. There was no significant difference between the two groups with respect to their time use on holidays and weekends. Conclusion: According to the findings, particular attention must be paid to the quality of life of mothers with school-aged children who have CP.

Background: Colorectal cancer constitutes one of the most common causes of cancer mortality worldwide. The incidence of this malignancy has risen in Iran during the last years. This study aims to estimate the survival of colorectal cancer patients and its prognostic factors using parametric competing risks model. Methods: In a retrospective study, we used data from 1060 patients with colorectal cancer in the cancer registry of the Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, from 2004 to 2015. Analysis was performed using parametric competing risks model with Weibull distribution. R software was used for all analyses with significance level set at 0.05. Results: In total, 380 patients (35.8%) had died due to colorectal cancer, 49 patients (4.6%) had died for other causes, and 631 patients (59.5%) survived until the end of the study period. Mean survival for the 1060 patients was 59.96 ± 1.46 months with a median of 45.5 months. Multivariable analysis revealed factors such as age at diagnosis and body mass index (BMI) to significantly affect death by colorectal cancer (p < 0.001). Conclusion: According to the findings of the generalized Weibull parametric competing risks model, only age at diagnosis and BMI were factors influencing the survival of colorectal cancer patients in this study.

Introduction: Mothers of children with Autism Spectrum Disorders (ASD) have the lowest grade of quality of life compared with mothers of children with other disorders like mental retardation, learning disorders, or physical impairments. To the best of our knowledge, there is no study on the influence of severity of disorder and occupational performance of autistic child on mother’s quality of life. This study aims to determine the relationship between quality of life of these mothers with severity of disorder and occupational performance in their autistic children. Materials and Methods: The participants included 35 mothers and their children with ASD (aged 3 to 7 years). They were selected by available sampling method from Tehran City, Iran. Severity of disorder and occupational performance were respectively measured by Gilliam Autism Rating Scale 2 and Canadian Occupational Performance Measure. Results: The relationship between mothers’ quality of life and severity of their children’s ASD was significant (except for two components of physical roles [P=0.276] and bodily pains [P=0.174]. Also correlation of mothers’ quality of life and occupational performance was significant (except for four dimensions of physical functioning [P=0.439] , physical roles [P=0.801], bodily pains [P=0.105] and role emotional [P=0.140]). Conclusion: The results show that quality of life of mothers of autistic children is significantly associated with severity of disorder and occupational performance of children, but its relationship with severity of disorder is more pronounced than occupational performance. Therefore, in order to improve mother’s quality of life, the severity of symptoms of ASD should be decreased and child’s occupational performance increased.

BACKGROUND:It is assumed that obesity adversely affects the health related quality of life (HRQOL) of women with polycystic ovary syndrome (PCOS), not only due to the excess weight, but also due to several other obesity induced metabolic and reproductive consequences. We aimed to compare the effects of excess body weight on the HRQOL between women with PCOS and controls. METHODS:This is a case control study of 142 women with PCOS and 140 age- and BMI- matched controls. The Iranian version of short form health survey 36 (SF 36) was used to assess HRQOL. Domains of SF 36 were compared in women with PCOS and controls using multivariate analysis of covariance. The Pearson correlation was used to assess the correlation between body mass index (BMI) and domain scores of SF 36, and the differences between two correlations in cases and controls, using Fisher's Z test. RESULTS:Women with PCOS had significantly lower scores for both, the physical and the mental component summary scales, compared to controls. In the cases, a significant negative correlations were observed for BMI with physical function (r = - 0.301, P

Background. Biclustering algorithms for the analysis of high-dimensional gene expression data were proposed. Among them, the plaid model is arguably one of the most flexible biclustering models up to now. Objective. The main goal of this study is to provide an evaluation of plaid models. To that end, we will investigate this model on both simulation data and real gene expression datasets. Methods. Two simulated matrices with different degrees of overlap and noise are generated and then the intrinsic structure of these data is compared with biclusters result. Also, we have searched biologically significant discovered biclusters by GO analysis. Results. When there is no noise the algorithm almost discovered all of the biclusters but when there is moderate noise in the dataset, this algorithm cannot perform very well in finding overlapping biclusters and if noise is big, the result of biclustering is not reliable. Conclusion. The plaid model needs to be modified because when there is a moderate or big noise in the data, it cannot find good biclusters. This is a statistical model and is a quite flexible one. In summary, in order to reduce the errors, model can be manipulated and distribution of error can be changed.

Background: With aging, the ovarian reserve is decreased and that is a major contributor to poor ovarian response to exogenous gonadotropins. The aim of the present study is to evaluate the role of Dexamethasone on ovarian response in infertile patients aged over 35 years undergoing IVF/ICSI cycles.Materials and Methods: In this triple blind placbo-control clinical trial study, a total of 72 infertile women over age 35, undergoing IVF/ICSI cycles, referred to Royan Institute from May 2000 to May 2002 were selected. Dexamethasone co-treatment (1mg/d) was started on the 21st of their preceding menstrual cycle and it was continued until oocyte aspiration. The main outcome measures were number of retrieved oocytes, number of fertilized and transferred embryos, number of used HMG, serum E2 level on HCG injection day, and pregnancy rate.Results: There was no significant statistical difference in age, duration of infertility, Body mass index, hormonal tests, number of retrieved oocytes and transferred embryos. However, the number of used HMG was significantly lower in Dexamethasone group compared to placebo group (30.6±13.39 versus 41.64 ± 18.34) (p

Background: Infertility is defined as failure in pregnancy after one year of unprotected intercourse. Several centers have reported different causes of infertility. The most common causes of infertility are: male factor such as sperm disturbance, female factor such as ovulation dysfunction and tubal factor, both male and female factor, and unexplained infertility. The aim of this study was to survey the epidemiology of infertility in Royan institute.Material and Methods: In this descriptive retrospective study, 2492 infertile couples were studied.These couples were selected by systematic sampling among couples referred to Royan institute between 1995 and 2001.All existing demographic data and diagnostic methods were recorded in questionnaires .Results were analyzed using SPSS version 11.5.Results: In this study, the frequency of primary and secondary infertility was 90.1% and 9.9%, respectively. Among 2492 couples, 50.5% had male factor, 28.6% had female factor, 11.6% had both male and female factors and in 9.3% of couples, the cause of infertility was unknown Results showed that 32.3% of men had normal spermogram, 23.6% of couples had azoospermia, and 40.3% had sperm disturbance including oligospermia, asthenospermia, oligoasthenospermia and teratospermia .3.8% were not able to collect sample for semen analysis. Among women, different infertility factors included: ovarian factor (20.36%), tubal factor (12.64%), uterine factor (4.13%), endometriosis (1.28%) and recurrent abortion (0.68%). 50.48% of women were normal.Conclusion: Although male factor was the most common cause of infertility in Royan institute, we can not conclude that this factor is the most common cause of infertility in Iran since this center is considered referral especially for male infertility. We suggest performance of similar researches in other centers to evaluate the most common causes of infertility in Iran.

Background: To evaluate the effect of metformin on ovulation and pregnancy rate in clomiphene citrate resistant women with polycystic ovary syndrome (PCOS).Material & Methods: In this clinical trial each patient, regarding her previous resistance to Clomiphene, served as her own control. A total of 35 clomiphene citrate resistant PCOS patients, referring to Royan institute were studied. Clomiphene citrate resistance was defined as having failure of ovulation during at least three cycles using clomiphene citrate doses up to 200 mg/day on cycle days 3-7 after a withdrawal bleeding with progesterone. Metformin was used alone or in combination with clomiphene citrate. First, the patients received metformin up to 1500 mg/day for 8 weeks. During the next 2-3 cycle if the patients did not become pregnant, clomiphene was added with increments of 100 mg (up to 150 mg/day). Follicular development and ovulation were monitored by ultrasound scans and mid-luteal progesterone level. Menstrual pattern, ovulation, and pregnancy rate were evaluated during the two stages of treatment.Results: After 8 weeks of meformin monotherapy, ovulation occurred in 23 cases (65.7%) and 7 patients (20%) became pregnant. Among other patients (28/35) who were treated with Clomiphene Citrate and metformin for 64 cycles, 19 patients (67.8%) had proper ovulation and five of them (17.8%) became pregnant. Totally, metformin induced ovulation in 31 of 35 patients (88.6%) and twelve (34.3%) of them achieved pregnancy.Conclusion: Metformin alone or in combination with clomiphene is a very effective treatment in inducing ovulation and pregnancy in clomiphene resistant women with PCOS.

Introduction: Aging is a dynamic and progressive process characterized by morphological, functional, and psychological changes, which restricts adaption to the environment and reduces the quality of life. Maintaining the ability of performing activities of daily living (ADL) is vital to the elderly and poor motor function is associated with higher dependency. Thus, this study aimed to evaluate the efficacy of hand resistance training and dexterity as a treatment package on the performance of ADL in the elderly. Material and Methods: A total of 20 senior adults were randomly (picking up by coded envelopes) assigned to intervention and control groups. We used Barthel test to evaluate the performance of ADL, and Box and Block test to evaluate the hand function. Results: According to results, changes in ADL were not statistically significant over time (P=0.583). However, the results of Box and Block test showed that right- and left-hand performance changes over time was statistically significant (P=0.002). Conclusion: Based on the results, 6 weeks training could improve hand function and dexterity and maintain the ability to perform ADL in the elderly.

Introduction: The prevalence of allergic airway diseases has dramatically increased in recent years all over the world. Murine models of allergic airway inflammation have provided helpful information about treatment and cellular and molecular mechanisms of the disease. Previous published works using murine models to investigate latex allergy did not introduce a complete characteristic eosinophilic allergic airway inflammation. Latex allergy is important due to serious health impacts and widespread use of its products. Thus, the aim of this study was to establish a new mouse model of latex allergic airway inflammation using aerosol inhalation. Materials and Methods: Initially, four groups of mice were injected intraperitoneally (IP) with 0, 10, 50, or 200 µg of latex extract and their serum anti-latex IgE titers were compared using ELISA to find out the optimum dose for IP injection. In the second stage, a standard protocol of inhalation was designed and three doses of latex extract solutions including 1%, 0.1%, and 0.01% were used to induce allergic airway inflammation. Characteristics of this model were shown by studying different parameters including bronchoalveolar lavage (BAL), cytokines (Interleukin-5 [IL-5] and interleukin-13 [IL-13]) and serum anti-latex IgE and IgG1 titers by ELISA, specific histologic changes in the lung and eosinophilia of the bone marrow, peripheral blood, BAL, and lung inflammatory foci. Results: The aerosol inhalation of 1% latex allergens solution and pre-sensitization with 50 µg of latex in this study resulted in the development of characteristic allergic airway inflammation in BALB/c mice. These features included elevated allergen specific IgE and IgG1, peripheral blood, BAL and bone marrow eosinophilia and characteristic inflammatory response in lung with eosinophil infiltration. Elevated levels of IL-5 and IL-13 can be a sign of this type of inflammation. Conclusion: This paper describes a latex aerosol inhalational challenge model of eosinophilic airway inflammation in latex pre-sensitized BALB/c mice.

Survival analysis methods deal with a type of data, which is waiting time till occurrence of an event. One common method to analyze this sort of data is Cox regression. Sometimes, the underlying assumptions of the model are not true, such as nonproportionality for the Cox model. In model building, choosing an appropriate model depends on complexity and the characteristics of the data that effect the appropriateness of the model. One strategy, which is used nowadays frequently, is artificial neural network (ANN) model which needs a minimal assumption. This study aimed to compare predictions of the ANN and Cox models by simulated data sets, which the average censoring rate were considered 20% to 80% in both simple and complex model. All simulations and comparisons were performed by R 2.14.1.