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One of the principal challenges in the cloud is the task scheduling problem. Appropriate task scheduling algorithms are needed to achieve goals such as load balancing, minimum cost, minimum energy consumption, etc. Using meta-heuristic algorithms is a good way to solve scheduling problems in the cloud because scheduling is an NP-hard problem. In recent years, various meta-heuristic algorithms have been introduced, one of the most popular meta-heuristic algorithms to deal with optimization problems is the Grey Wolf Optimizer (GWO) algorithm. This paper introduces a novel GWO-based task scheduling (GWOTS) algorithm to map tasks over the available resources. The principal goal of this paper is to decrease execution cost, energy consumption, and makespan. The efficiency of the GWOTS algorithm is compared with the well-known meta-heuristic algorithms, namely Genetic Algorithm (GA), Dragonfly Algorithm (DA), Particle Swarm Optimization (PSO), Whale Optimization Algorithm (WOA), Ant Colony Optimization (ACO), Gravitational Search Algorithm (GSA), Sooty Tern Optimization Algorithm (STOA), Artificial Hummingbird Algorithm (AHA), Multi-Verse Optimizer (MVO), and Sine Cosine Algorithm (SCA). In addition, the performance of GWOTS is compared with three recently scheduling algorithms, namely SOATS, IWC, and CETSA. Experimental results show that the GWOTS algorithm improves performance in terms of makespan, cost, energy consumption, total execution time, resource utilization, throughput, and degree of resource load balance compared to other algorithms. [ABSTRACT FROM AUTHOR]

The magneto-transport Properties of granular films consisting of ultrafine metal and metal-oxide particles containing Fe, Ni, B and O have been studied between 4 and 300 K. As a function of temperature, the films show a transition from a poorly conducting to a metallic state at 260 K. This change in the transport mechanism is also reflected in the different magneto-resistance behavior for low and high temperatures. Key words- Thin Films, TMR.

Background: Usually the chest tube removal (CTR) has been described as one of the worst experiences by patients in the intensive care unit. Aim: This study aimed to compare the effects of cold therapy and relaxation on pain of CTR among the patients undergoes coronary artery bypass graft surgery. Materials and Methods: This single-blinded clinical trial was done on 80 post-cardiac surgery patients in the heart hospital of Sari-Iran. The patients were assigned to three randomized groups that included cold therapy, relaxation, and control groups. Data analysis was done by T-test, Chi-square, generalized estimating equations and repeated measures analysis variance tests. Results: The groups had no significant differences in pain intensity before CTR (P = 0.84), but immediately after CTR there was a significant difference between the treatment (cold application and relaxation groups) and control groups (P = 0.001). There was no significant difference between relaxation and cold therapy groups. Conclusion: Regarding the relaxation and cold application methods showed relatively equal effects on reducing the pain owing to CTR. Thus, the use of relaxation because of economics, without side effects, easy to use and effective is recommended by the authors to the practitioners. [ABSTRACT FROM AUTHOR]

Statement of Problem: Dental age is used for dental maturation description. Knowledge about dental maturation is useful for determination of the plan, time and retention period of orthodontic treatments. Purpose: The purpose of this research was to compare the dental age in subjects with vertical and horizontal growth patterns. Materials and Method: This analytic cross-sectional study was conducted on the panoramic and lateral cephalometric radiographs of 53 patients referred for orthodontic treatment including 26 boys and 27 girls, aged 8-12 years, with a mean chronological age of 9.5 years. The patients were selected according to their lower anterior facial height as a percentage of the total facial height on the cephalometric radiographs. Then the two groups, one with long and the other with short anterior facial height, were compared based on their dental ages. Dental age was determined for each subject on the panoramic view by two observers, using Demirjian's dental maturity score. The data were analyzed by independent and paired T-test, using SPSS. Results: The mean dental age and the mean chronological age in the subjects with long anterior facial height were 9.08±1.8 and 8.6±0.87 years, respectively ( p = 0.06). The patients with short anterior facial height demonstrated the mean dental age of 10.54±1.31 years and the mean chronological age of 10.25±1.09 years ( p = 0.32). There was no statistically significant difference in the dental age score between the two extreme groups. Also, there was no statistically significant difference in the dental and chronological age between girls and boys in patients with long and short faces ( p = 0.71, p =0.73). Conclusion: The difference in the dental age between long and short facial types in subjects aged 8-12 years is not clinically relevant. Boys with short anterior facial height demonstrated a tendency toward more advanced dental age (8 months), revealing no significant different; however, it should be considered important in the clinical study. [ABSTRACT FROM AUTHOR]

Background: Myocardial infarction (MI) is a major cause of death, particularly during the first year. The avoidance of potentially fatal outcomes requires expeditious preventative steps. Machine learning (ML) is a subfield of artificial intelligence science that detects the underlying patterns of available big data for modeling them. This study aimed to establish an ML model with numerous features to predict the fatal complications of MI during the first 72 hours of hospital admission., Methods: We applied an MI complications database that contains the demographic and clinical records of patients during the 3 days of admission based on 2 output classes: dead due to the known complications of MI and alive. We utilized the recursive feature elimination (RFE) method to apply feature selection. Thus, after applying this method, we reduced the number of features to 50. The performance of 4 common ML classifier algorithms, namely logistic regression, support vector machine, random forest, and extreme gradient boosting (XGBoost), was evaluated using 8 classification metrics (sensitivity, specificity, precision, false-positive rate, false-negative rate, accuracy, F1-score, and AUC)., Results: In this study of 1699 patients with confirmed MI, 15.94% experienced fatal complications, and the rest remained alive. The XGBoost model achieved more desirable results based on the accuracy and F1-score metrics and distinguished patients with fatal complications from surviving ones (AUC=78.65%, sensitivity=94.35%, accuracy=91.47%, and F1-score=95.14%). Cardiogenic shock was the most significant feature influencing the prediction of the XGBoost algorithm., Conclusion: XGBoost algorithms can be a promising model for predicting fatal complications following MI., (Copyright© 2023 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.)

Introduction: Considering that academic success is one of the most important topics for medical sciences schools and faculty members, this study was conducted to determine the predictors of academic success in students of Tabriz University of Medical Sciences., Methods: This cross-sectional study was performed on 542 students of the Tabriz University of Medical Sciences in Iran. The sampling method was stratified at random. The socio-demographic characteristics questionnaire, Multiple Intelligences Profiling Questionnaire (MIPQ), College Academic Self-Efficacy Scale (CASES), Personal Resource Questionnaire (PRQ-85-PART2), and the General Health Questionnaire (GHQ-28) were used to collect data. Data analysis was performed using the SPSS 16 software. The General Linear Model (GLM) was used to determine the predictors of academic success., Results: According to the Pearson correlation test, there was a significant positive correlation between academic grade point average (GPA) and social support (r=0.10, P=0.048), academic self-efficacy (r=0.36, P<0.001) and there was a significant negative relationship between GPA and total mental health score (r=-0.14; P=0.003) and its subdomains including anxiety (r=-0.10, P= 0.027), depression (r = -0.15, P = 0.002), and social dysfunction (r=-0.12; P=0.010). According to GLM, the variables of academic self-efficacy, and level of education were among the predictors of academic success, so the GPA increased significantly with academic self-efficacy (β:0.02, P<0.001). The GPA was greater in bachelor's students than in professional doctorate students (β:0.76, P<0.001). The significance level was considered at P<0.05., Conclusion: Due to the significant relationship between academic self-efficacy, and educational level with academic success, the promotion of self-efficacy is necessary for all students of all educational levels., Competing Interests: The authors declare that they have conflicting interests. This study was financially supported by National Agency for Strategic Research in Medical Education. The funder had no role in the study design, data collection, analysis, or manuscript production., (Copyright: © Journal of Advances in Medical Education & Professionalism.)

Aim: Electrospraying (ELS) was used to prepare micronized ibuprofen-isonicotinamide cocrystal (IBU-INA-ELS) and its properties were compared with the solvent evaporated cocrystal (IBU-INA-SE). Methods: Solid-state characterization of crystalline phase, production yield, particle size, powder flow, wettability, solution mediated phase transformation (SMPT), and dissolution rate were measured. Results: The ELS produced phase pure particles of IBU-INA with a size of 1.46 μm and yield of 72.3%. This cocrystal improved the intrinsic dissolution rate and powder dissolution rate of IBU by 3.6- and 1.7-fold, respectively. Our experiments showed that the dissolution of IBU-INA was affected by particle size, solubility, SMPT and wettability. Conclusion: ELS produced micronized cocrystals for improving dissolution of ibuprofen with a high yield in a single step and mild conditions.

This study focuses on developing a microarchitectural bilayer structure for stimulating the two top layers of skin tissue (epidermis and dermis) fabricated using a one-step freeze-drying method. Cellulose nanofibers (CNFs) and poly (vinyl) alcohol (PVA) were used as a biocompatible scaffolding material, and the composition was designed in such a way that it provides physical and biological property attributes. In this work, scaffolding materials with integrated layer structures and well interconnected and open pore structures were obtained. This bilayer structure had porosity with a pore size of 19.72 μm and 90.71 μm for the simulation of the epidermis and dermis, respectively. The production and expression of laminin, collagen IV, and keratin 10 proteins in the bilayer cryogel scaffolds obtained from the immunofluorescence study were 49.7 %, 63.8 %, and 49.3 %, respectively. The extracellular matrix (ECM) was produced in each scaffold layer. The observations confirmed that the porosity and pore size of both N1 and N2 layers were appropriate for the fibroblast and keratinocyte cells, respectively. H&E stained cross-sections of bilayer cryogel scaffolds illustrated epidermal and dermal layers produced by co-culturing keratinocytes and fibroblasts. Based on the results, the bilayer CNF/PVA scaffold can be used in skin tissue engineering applications. However, more experiments and in vivo evaluations are needed to express this conclusion more accurately., 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 © 2022. Published by Elsevier B.V.)

Background: Atrial fibrillation (AF) is the most common arrhythmia following open-heart surgery. Agents with antioxidant properties may reduce postoperative complications like postoperative AF (POAF) in patients undergoing open-heart surgery. This study was conducted to assess the effect of N-acetylcysteine (NAC) in prevention of AF following coronary artery bypass graft (CABG) surgery., Methods: Three hundred patients who underwent CABG surgery were entered in the study. Patients with contraindications for beta-blockers and patients were simultaneously replacing or repairing the valve with open-heart surgery were excluded. The patients were randomly divided into two groups (n = 150) and they were received NAC plus carvedilol or carvedilol. The patients were monitored for 5 days after surgery and the incidence of AF during hospitalization was recorded., Results: AF was detected in 14 patients in the NAC with Carvedilol group (9.33%) and 23 patients in Carvedilol group (15.33%). There was no significant difference in the incidence of POAF between the two groups (p value = 0.112). The result of multivariable regression model represented that although the incidence of POAF was lower in NAC plus carvedilol group, it wasn't statistically significant (p value = 0.10)., Conclusions: NAC was not associated with a decreased incidence of AF following CABG surgery., (© 2022 Wiley Periodicals LLC.)

Background: In addition to physical problems, the COVID-19 crisis continues to impose serious psychological adverse effects on people's mental health, which plays a major role in the efficiency of every community. Students, especially medical sciences students, suffer from more stress as a result of exposure to COVID-induced stressors. It is, therefore, essential to measure mental health and its relationship with social support in medical sciences students during the COVID pandemic. The present study was conducted to determine the mental health status of students and its correlation with social support., Methods: This cross-sectional study was conducted using random sampling on 280 students of Tabriz University of Medical Sciences in Iran in 2020. Socio-demographic profile scale, Mental Health Test (GHQ-28), and the scale of Perceived Social Support (PRQ-85) were used to collect data. Participants completed the questionnaires online., Results: Considering the potential confounding variables, a general linear model (GLM) was utilized to determine the relationship between mental health and perceived social support. Mean (± standard deviation) of total mental health score 26.5 (12.5) was in the acceptable range of 0-63., and 56% of students suffered from a mental disorder. Mean (± standard deviation) of social support score 128.2 (21.0) ranged from 25 to175. According to Pearson's correlation coefficient, there was a significant inverse correlation between social support score and total mental health score and all its subscales [p < 0.001; r =  - 0.294 to - 0.536]. According to the GLM, mental health score decreased significantly with social support score [p = 0.0001; - 0.32 to - 0.20; CI 95%; B = 0.26]., Conclusions: Given the inverse relationship between social support and mental health, it is suggested to increase the level of social support for students at all times, especially during the stressful COVID-19 pandemic to improve their mental health.

The aim of this study was to fabricate a novel bilayer scaffold containing cellulose nanofiber/poly (vinyl) alcohol (CNF/PVA) to evaluate its potential use in skin tissue engineering. Here, the scaffolds were fabricated using a novel one-step freeze-drying technique with two different concentrations of the aforementioned polymers. FE-SEM analysis indicated that the fabricated scaffolds had interconnected pores with two defined pore size in each layer of the bilayer scaffolds that can recapitulate the two layers of the dermis and epidermis of the skin. Lower concentration of polymers causes higher porosity with larger pore size and increased water uptake and decreased mechanical strength. FTIR proved the presence of functional groups and strong hydrogen bonding between the molecules of CNF/PVA and the efficient crosslinking. The MTT assay showed that these nanofibrous scaffolds meet the requirement as a biocompatible material for skin repair. Here, for the first time, we fabricated bilayer scaffold using a novel one-step freeze-drying technique only by controlling the polymer concentration with spending less time and energy., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Despite the available data on demographic information of oral squamous cell carcinoma (OSCC), the changing trend of histopathologic pattern of OSCC has not conducted yet, in Iran. The aim was to investigate the pattern of histopathologic features of OSCC in Iran by analyzing the patients referred to Cancer Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran, during 2006-2015., Materials and Methods: The study was a retrospective institutional study. The pathology records with the diagnosis of OSCC were retrieved from Iran National Tumor Bank, Cancer Biology Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran, during 2006-2015. The demographic characteristics and histopathologic features were recorded and analyzed for possible trend. Descriptive analysis was used for statistical interpretation., Results: The data showed an increasing number of moderately and poorly differentiated OSCC. Accordingly, higher increasing rate in tumor size and vascular, perineural invasion was detected., Conclusion: On the basis of histopathologic features, moderately differentiated OSCC with increasing rate of tumor size and vascular, perineural invasion was indicated in recent decade. Based on the findings, lower differentiation potentially is compatible with worsen prognosis., Competing Interests: There are no conflicts of interest.

Background and Purpose: Anxiety is one of the most common responses of patients awaiting coronary artery bypass graft (CABG) surgery to stressful conditions before surgery. This study is intended to examine the effect of inhalation aromatherapy with rose essential oil on the anxiety of patients undergoing CABG surgery., Materials and Methods: This was a single-blind randomized clinical trial of 66 patients undergoing CABG surgery. The experimental group inhaled three drops of 4% rose essential oil for 10 minutes one night and one hour before surgery. The control group did not receive any intervention from the research team., Results: The level of anxiety was measured before and 30 minutes after the intervention using the Spielberger's Anxiety Inventory. Prior to surgery, an independent t-test showed that the mean score of anxiety was not significantly different between the experimental and control groups (p = 0.41). Aromatherapy with rose essential oil did not cause any significant differences in state anxiety (P = 0.41), trait anxiety (P = 0.90), and total anxiety (P = 0.69)., Conclusion: Our results revealed that inhalation aromatherapy with rose essential oil could not significantly reduce anxiety in CABG patients. Future research with larger sample sizes and using different concentrations of rose essential oil are needed to achieve more definitive conclusions., (Copyright © 2018. Published by Elsevier Ltd.)

Tooth development is widely used for age estimation and staging physical maturity. It is of great importance in dental age estimation in forensic dentistry, orthodontic treatment planning, and pediatric endocrinology. This study aimed to compare the accuracy of two age estimation methods, i.e., the London Atlas and Smith's method, using the panoramic view of developing teeth. In this descriptive-analytic study, panoramic radiographs of 339 healthy individuals, including 145 boys and 194 girls, were assessed. The participants aged between 5.00 and 15.99 years. Dental age of the subjects was determined by the London Atlas of Human Tooth Development and Eruption and Smith's method. The collected information was entered in the SPSS software (Ver.18). Differences and correlations between chronological and dental age were assessed by paired t tests and Pearson's correlation analysis. In all analyzes, the significance level was considered less than 0.05. The mean chronological age of the subjects was 10.13 ± 2.92 years. The mean ages estimated by the London Atlas and Smith's method were 10.29 ± 2.91 and 9.89 ± 2.84 years, respectively. Paired t test showed that the differences between the mean chronological age and mean estimated ages using the London Atlas and Smith's method were not significant (P = 0.15 and 0.16, respectively). Our findings showed that both methods had high accuracy for age estimation, but the London Atlas is easier to use.

Background and Purpose: Atelectasis is the most common pulmonary complication after open heart surgery. This study was intended to examine the effects of pleasant olfactory mental imagery on postoperative atelectasis in patients undergoing open heart surgery., Materials and Methods: This is a randomized controlled clinical trial. The sample consisted of 80 patients who were randomly assigned to either practice olfactory mental imagery (test group) or receive routine care (control group). A card with the image of roses was given to patients and they were asked to look at the image, visualize the scent of roses in the mind, and then sniff as much as possible, hold their breath for 2s and eventually exhale slowly through the nose. This procedure was consecutively repeated five times. After a fifteen-minute break, patients proceeded to practice olfactory mental imagery with other fruit images (banana, apple, and lemon). The test group executed the olfactory mental imagery for two hours in the morning and two hours in the afternoon on postoperative days 1 and 2. The control group received the routine ICU care. A questionnaire collected information on sociodemographic characteristics and clinical parameters. Chest radiographs were used to diagnose atelectasis, which were evaluated by the hospital radiologist., Results: No statistically significant differences were observed between the two groups regarding sociodemographic, medical and surgical information. The incidence of atelectasis in the test group (40%, n=16) was significantly lower than in the control group (67.5%, n=27) on postoperative day 2 (p=0.02)., Conclusion: Our findings suggest that olfactory mental imagery can improve respiratory function and reduce the risk of atelectasis in patients with cardiac surgery., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

This study aimed to determine the prevalence and species of Cryptosporidium among HIV/AIDS patients in southwest of Iran. Two hundred fifty faecal samples from HIV patients were examined for the presence of Cryptosporidium oocysts using a conventional coproscopic approach. Such oocysts were detected in 18 (7.2%) out of 250 faecal samples. Genomic DNAs from 250 samples were then subjected to a nested-PCR-RFLP technique targeting different loci of 18S rRNA gene for species identification. Out of 250 samples, 27 (10.8%) were positive for different Cryptosporidium spp; Restriction patterns resulting from the digestion of the nested amplicon with restriction endonucleases VspI and SspI showed that C. parvum (70.38%) was the most prevalent species, followed by C. hominis (25.92%) and C. meleagridis (3.7%), respectively. The mean CD4+ T-cell count was 215 cells/μL. There was a strong association between cryptosporidiosis and CD4+ T-cell count (P = 0.000) with the highest prevalence recorded among patients with CD4+ T-cell count < 200 cells/μL. This confirms that there is a low opportunity for this parasite to get established as the patients CD4+ T-cell count increases. Also HIV infection increased the risk of having Cryptosporidium. Our epidemiological findings are useful for any preventive intervention to control disease diffusion., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background and Aim: Post-operative self-care behaviors, have positive effects on increase in adaptability, and reduce cardiac surgery patients' disability. The present study is carried out aimed at determining the effect of education based on a health promotion model on the patients' self-care behaviors after coronary artery bypass surgery., Methods: This is a semi-experimental study carried out in Mazandaran (Iran) in 2016. Two hundred and twenty patients who participated in the study were selected using a simple random sampling method from a population of postoperative patients, and divided into control and experimental groups (110 patients in each) using block (AABB) randomization. Self-designed self-care questionnaires based on a health promotion model were distributed among the patients once before and three months after intervention. The data were analyzed by SPSS-22, Chi-Square tests, Mann-Whitney and ANCOVA at the significance level of p<0.05., Results: The average score of total self-care behaviors in cardiac surgery patients was not significant between the two groups before education (p=0.065), but after training, a significant difference was observed between the two groups (p<0.001). The analysis of ANOVA with repeated measure indicated that following the intervention, significant difference was observed between the two groups in terms of improvement of self-care behaviors after excluding the effect of pre-test and controlling demographic and health-related characteristics., Conclusions: Developing and implementing a training program based on the health promotion model can enhance self-care behaviors and reduce the number of admissions in patients after cardiac surgery., Competing Interests: Conflict of Interest: There is no conflict of interest to be declared.

Background and Purpose: Arterial hypoxemia is one of the most common respiratory complications following cardiac surgery. This study was intended to examine the effects of pleasant olfactory mental imagery on postoperative hypoxemia in patients undergoing open heart surgery., Materials and Methods: This is a randomized controlled clinical trial. The sample consisted of 80 patients who were randomly assigned to either practice olfactory mental imagery (experimental group) or receive routine care (control group). A card with the image of roses was given to patients and they were asked to look at the image, visualize the scent of roses in the mind, and then sniff as much as possible, hold their breath for 2 s and eventually exhale slowly through the nose. This procedure was consecutively repeated five times. After a fifteen-minute break, patients proceeded to practice olfactory mental imagery with other fruit images. The experimental group executed the olfactory mental imagery for two hours in the morning and two hours in the afternoon on postoperative days 1 and 2., Results: No statistically significant differences were observed between the experimental and control groups regarding sociodemographic characteristics, medical and surgical information. This study also demonstrated that the mean Spao2 was significantly higher in the experimental group (97.400 ± 1.70) than the control group (96.465 ± 1.70) (p = 0.015)., Conclusion: The results of this study suggest that olfactory mental imagery can improve arterial oxygenation in patients with cardiac surgery., (Copyright © 2017. Published by Elsevier Ltd.)

Aims: This study aims to compare different doses of magnesium administered via cardioplegic solutions to prevent atrial fibrillation (AF) after coronary artery bypass graft (CABG) surgery., Methods: A total of 120 patients who were scheduled for elective CABG surgery using cardiopulmonary bypass were enrolled in this double-blind, randomized clinical trial. After fulfilling the inclusion criteria, they were randomly allocated into three groups (A, B, and C). Patients in groups A, B, and C received 60, 80, and 100 mg/kg of magnesium sulfate via cardioplegic solutions during aortic cross-clamp, respectively. Postoperative AF was assessed by continuous ECG monitoring during 3 days after surgery. Also serum magnesium, potassium, and calcium levels were assessed during the study period., Results: The findings revealed significant differences in four point measurements of serum magnesium level after surgery (P<.001). In particular, it was observed that 10 (26.3%) patients in group A, 4 (10%) patients in group B, and 2 (5.4%) patients in group C had AF after surgery. This indicates patients receiving magnesium at doses of 80 and 100 mg/kg had lower rates of AF occurrence than those receiving 60 mg/kg dose of magnesium (P=.02). Additionally, no significant difference was found in serum calcium and potassium concentration between the three groups throughout the study period., Conclusion: Magnesium administration via the cardioplegic solution during aortic cross-clamping at doses of 80 and 100 mg/kg can reduce the risk of AF occurrence after CABG compared to the dose of 60 mg/kg. Considering the lower rate of AF incidence and shorter length of ICU stay in patients receiving 100 mg/kg of magnesium, it seems reasonable to administer 100 mg/kg magnesium during aortic cross-clamp to prevent postoperative AF., (© 2016 John Wiley & Sons Ltd.)

Background: Advances in coronary artery surgery have reduced patient morbidity and mortality. Nevertheless, patients still have to face physical, psychological, and social problems after discharge from hospital., Objectives: The objective of this study was to determine the efficacy of Pender's health promotion model in predicting cardiac surgery patients' lifestyles in Iran., Methods: This cross-sectional study comprised 220 patients who had undergone coronary artery bypass graft (CABG) surgery in Mazandaran province (Iran) in 2015. The subjects were selected using a simple random sampling method. The data were collected via (1) the health-promoting lifestyle profile II (HPLP II) and (2) a self-designed questionnaire that included two main sections: demographic characteristics and questions based on the health-promoting model constructs., Results: Spiritual growth (28.77 ± 5.03) and physical activity (15.79 ± 5.08) had the highest and lowest scores in the HPLP II dimensions, respectively. All the health promotion model variables were significant predictors of health-promoting behaviors and explained 69% of the variance in health-promoting behaviors. Three significant predictors were estimated using regression coefficients: behavioral feelings (β = 0.390, P < 0.001), perceived benefits (β = 0.209, P < 0.001), and commitment to a plan of action (β = 0.347, P < 0.001)., Conclusions: According to the results of the study, health-promoting model-based self-care behaviors can help identify and predict cardiac surgery patients' lifestyles in Iran. This pattern can be used as a framework for discharge planning and the implementation of educational interventions to improve the lifestyles of CABG patients.

Background: Direct observation cannot detect caries under restorations; therefore, the aim of this study was to compare the accuracy of radiographs and DIAGNOdent in detecting caries under restorations in primary teeth using histologic evaluation., Materials and Methods: A total of 74 previously extracted primary molars (37 with occlusal caries and 37 without caries) were used. Class 1 cavity preparations were made on each tooth by a single clinician and then the preparations were filled with composite resin. The accuracy of radiographs and DIAGNOdent in detecting caries was compared using histologic evaluation. The data were analyzed by SPSS version 21 using Chi-square, Mc Namara statistical tests and receiver operating characteristic curve. The significance was set at 0.05., Results: The sensitivity and specificity for DIAGNOdent were 70.97 and 83.72, respectively. Few false negative results were observed, and the positive predictive value was high (+PV = 75.9) and the area under curve was more than 0.70 therefore making DIAGNOdenta great method for detecting caries (P = 0.0001). Two observers evaluated the radiographs and both observers had low sensitivity ( first observer: 48.39) (second observer: 51.61) and high specificity (both observers: 79.07). The +PV was lower than DIAGNOdent and the area under curve for both observers was less than 0.70. However, the difference between the two methods was not significant., Conclusion: DIAGNOdent showed a greater accuracy in detecting secondary caries under primary molar restorations, compared to radiographs. Although DIAGNOdent is an effective method for detecting caries under composite restorations, it is better to be used as an adjunctive method alongside other detecting procedures.

Introduction: The principal cause for death in the world is cardiovascular disease. Poor lifestyle is a contributing element in this regard. The objective of this study was to estimate the effects of health-related variables and lifestyle variables on the results of exercise stress tests in patients with cardiovascular disease in Iran., Methods: The study population in this case-control study was 220 patients who were candidates for exercise stress tests in Mazandaran Province (Iran) in 2015. The patients were divided randomly into two groups based on the results of their exercise stress tests, i.e., positive (110 patients) and negative (110 patients). The data collection tool was a standard questionnaire entitled "Health promotion lifestyle profile-II." The data were analyzed using mean, standard deviation, the chi-squared test, and logistic regression by SPSS version 22 software., Results: The risk of a positive exercise stress test increases with age. The age group above 65 was 1.049 times more at risk of a positive exercise stress test than the age group of less than 45. The people with dyslipidemia had 1.635 times greater risk of positive exercise stress tests than the group without dyslipidemia. In addition, patients with hypertension had 1.579 times greater risk of positive exercise stress tests than the group without hypertension. The lack of individual health responsibility (Odds ratio (OR): 1.622), stress management (OR: 1.592), and physical activity (OR: 1.245) contributed more to positive exercise tests than the other risk factors., Conclusion: Educational interventions can improve the responsibility for health, physical activity, and stress management among people with the risk of cardiovascular disease.

Statement of the Problem: The sphenoid sinus is a common target of paranasal surgery. Functional endoscopic sinus surgery is likely to endanger the anatomic variations of vital structures adjacent to the sphenoid sinus., Purpose: The aim of this study was to determine the variations of sphenoid sinus and the related structures by using cone-beam computed tomography (CBCT)., Materials and Method: In this descriptive-analytic study, CBCT images of 103 patients aged above 20-years were selected (206 sides). Degree of pneumatization of sphenoid sinus, pneumatization of the anterior clinoid process, pterygoid process, protrusion of optic canal, vidian canal, and foramen rotundum, as well as prevalence of sinus septa were recorded. Examinations were performed using On-Demand software (Version 1); data were analyzed by using chi-square test., Results: There was a statistically significant correlation between the pterygoid pneumatization and vidian canal protrusion (p< 0.001), and foramen rotundum protrusion (p< 0.001). The optic canal protrusion was found to be significantly associated with the anterior clinoid pneumatization and pterygoid process (p< 0.001). Statistically significant relationship was also observed between the carotid canal protrusion and pterygoid process pneumatization (p< 0.001)., Conclusion: The anatomical variations of the sphenoid sinus tend to give rise to a complexity of symptoms and potentially serious complications. This variability necessitates a comprehensive understanding of the regional sphenoid sinus anatomy by a detailed CBCT sinus examination.

Background and Aim: As the most common postoperative pulmonary complication after cardiac surgery, atelectasis is one of the most important and serious early postoperative complications and one of the most important causes of prolonged hospitalization, increased costs, and mortality rise. Therefore, the present study was aimed at specifying the frequency of atelectasis in patients following coronary artery bypass graft and its associated factors in Mazandaran Heart Center in 2013-2014., Materials and Methods: The present investigation was a descriptive cross-sectional study in which sequential sampling was used. It was conducted on 375 patients whose coronary artery bypass graft had been performed by the same surgeon and anesthesiologist. For data collection, first the patients' demographic variables and the information of their surgery were retrieved through their profiles, direct observation, patient inquiry, and the collected data were recorded in the data collection forms. Then, atelectasis was measured before the surgery and on the first and second days after it by taking CXR whose results were checked by two radiologists who were not aware of the previous observations. Data were analyzed through t-test, Pearson test, and Chi-square test using SPSS 16.0., Results: The results of the present study indicated that, 123 out of 375 patients (32.8%) were diagnosed with at least one type of tattletales during the first three days after the surgery. The mean age of the patients who were diagnosed with atelectasis was 62.9±9 and most of them were female. The results also showed that there was a significant relationship between postoperative frequency of atelectasis and the patients' pulmonary diseases and underlying diseases like diabetes and hyperlipidemia, smoking and alcohol use before the surgery, and transfusion of 4 units of packed red blood cells during the surgery (p<0.05)., Conclusion: Atelectasis is the most common postoperative complication which emerges more in patients with pulmonary and underlying diseases than other patients.

Introduction: As the most common postoperative pulmonary complications after cardiac surgery, atelectasis is one of the most important and serious early postoperative complications and one of the most important causes of prolonged hospitalization, increased costs, and mortality rise. Therefore, the present study was aimed at specifying the frequency of atelectasis in patients following coronary artery bypass graft and its associated factors in Mazandaran Heart Center in 2013-2014., Materials: The present investigation was a descriptive cross-sectional study in which sequential sampling was used. It was conducted on 375 patients whose coronary artery bypass graft had been performed by the same surgeon and anesthesiologist. For data collection, first the patients' demographic variables and the information of their surgery were retrieved through their profiles, direct observation, patient inquiry, and the collected data were recorded in the data collection forms. Then, atelectasis was measured before the surgery and on the first and second days after it by taking CXR whose results were checked by two radiologists who were not aware of the previous observations. Data were analyzed through t-test, Pearson test, and Chi-square test using SPSS 16.0., Results: The results of the present study indicated that, 123 out of 375 patients (32.8%) were diagnosed with at least one type of tattletales during the first three days after the surgery. The mean age of the patients who were diagnosed with atelectasis was 62.9 and most of them were female. The results also showed that there was a significant relationship between postoperative frequency of atelectasis and the patients' pulmonary diseases and underlying diseases like diabetes and hyperlipidemia, smoking and alcohol use before the surgery, and transfusion of 4 units of packed red blood cells during the surgery (p<0.05)., Conclusion: Atelectasis is the most common postoperative complication which emerges more in patients with pulmonary and underlying diseases than other patients.

Rationale: We hypothesized that valerian root might prevent cognitive dysfunction in coronary artery bypass graft (CABG) surgery patients through stimulating serotonin receptors and anti-inflammatory activity., Objectives: The aim of this study was to evaluate the effect of Valeriana officinalis root extract on prevention of early postoperative cognitive dysfunction after on-pump CABG surgery., Methods: In a randomized, double-blind, placebo-controlled trial, 61 patients, aged between 30 and 70 years, scheduled for elective CABG surgery using cardiopulmonary bypass (CPB), were recruited into the study. Patients were randomly divided into two groups who received either one valerian capsule containing 530 mg of valerian root extract (1,060 mg/daily) or placebo capsule each 12 h for 8 weeks, respectively. For all patients, cognitive brain function was evaluated before the surgery and at 10-day and 2-month follow-up by Mini Mental State Examination (MMSE) test., Results: Mean MMSE score decreased from 27.03 ± 2.02 in the preoperative period to 26.52 ± 1.82 at the 10th day and then increased to 27.45 ± 1.36 at the 60th day in the valerian group. Conversely, its variation was reduced significantly after 60 days in the placebo group, 27.37 ± 1.87 at the baseline to 24 ± 1.91 at the 10th day, and consequently slightly increased to 24.83 ± 1.66 at the 60th day. Valerian prophylaxis reduced odds of cognitive dysfunction compared to placebo group (OR = 0.108, 95 % CI 0.022-0.545)., Conclusion: We concluded that, based on this study, the cognitive state of patients in the valerian group was better than that in the placebo group after CABG; therefore, it seems that the use of V. officinalis root extract may prevent early postoperative cognitive dysfunction after on-pump CABG surgery.

Background and aims. Tooth development is widely used in determining age and state of maturity. Dental age is of high importance in forensic and pediatric dentistry and also orthodontic treatment planning .The aim of this study was to compare the accuracy of four radiographic age estimation methods. Materials and methods. Orthopantomographic images of 537 healthy children (age: 3.9-14.5 years old) were evaluated. Dental age of the subjects was determined through Demirjian's, Willem's, Cameriere's, and Smith's methods. Differences and correlations between chronological and dental ages were assessed by paired t-tests and Pearson's correlation analysis, respectively. Results. The mean chronological age of the subjects was 8.93 ± 2.04 years. Overestimations of age were observed following the use of Demirjian's method (0.87 ± 1.00 years), Willem's method (0.36 ± 0.87 years), and Smith's method (0.06 ± 0.63 years). However, Cameriere's method underestimated age by 0.19 ± 0.86 years. While paired t-tests revealed significant differences between the mean chronological age and ages determined by Demirjian's, Willem's, and Cameriere's methods (P < 0.001), such a significant difference was absent between chronological age and dental age based on Smith's method (P = 0.079). Pearson's correlation analysis suggested linear correlations between chronological age and dental age determined by all four methods. Conclusion. Our findings indicated Smith's method to have the highest accuracy among the four assessed methods. How-ever, all four methods can be used with acceptable accuracy.

Background and Objectives: One of the main treatment methods of coronary artery disease is coronary artery bypass graft (CABG) surgery. The anxiety level in patients undergoing this surgery is relatively very high. Thus, reducing anxiety in these patients is an important step toward wellness. This study aimed to compare the effects of peer education (PE) and orientation program (OP) on the anxiety levels of patients before CABG surgery. Material and Methods: This randomized controlled trial was conducted in 2014 at the Mazandaran Heart Center on three groups of 50 persons each: PE, OP, and control (Cl). The anxiety levels of patients in each group were measured one day and one hour before the surgery. All groups received routine education. In addition, the PE group received PE and the OP group received OP. Two questionnaires were used to collect the demographics and the clinical data; and Spielberg state anxiety questionnaire was used to measure the anxiety level. Data from descriptive statistics, chi-square, ANOVA, ANCOVA, Bonferroni, and Fisher exact test were analyzed in SPSS v20 software. Findings: The mean anxiety score before surgery was not significantly different in the three groups (P=0.955). However, after the intervention at 1 h before surgery, the mean anxiety level in the PE and OP group was lower than in the Cl group (P=0.000). However, the mean anxiety score between PE and OP groups showed no significant difference (P=0.051). Conclusion: Both PE and OP group reduced the anxiety naturally developed in a patient before surgery. Although the influence of the PE group was greater in reducing anxiety, the use of this technique in clinical practices required further studies.

Background: Atrial Fibrillation (AF) is a common complication after open heart surgery and is frequently associated with increased hospital stay, complications, and mortality rates. The effect of β-blockers on prevention of supraventricular arrhythmias has been confirmed in several prospective randomized studies., Objectives: This clinical trial aimed to compare the preventive effects of carvedilol and metoprolol on occurrence of AF after CABG surgery., Patients and Methods: This prospective, double-blind, randomized clinical trial was conducted on 150 patients (55 females, 95 males; mean age: 59 ± 10 years) who underwent CABG surgery. The patients with no contraindication for β-blocker use were randomly divided into two groups of carvedilol and metoprolol Tartarate (n = 75). Treatment with β-blocker was started on the first postoperative day (metoprolol, 25 mg BD; carvedilol, 6.25 mg, BD) and the dosage was regulated according to the patients' hemodynamic response. All the patients were monitored 5 days after the surgery and incidence of AF and other complications was recorded in both groups., Results: AF was detected in 18 patients in the carvedilol group and 21 patients in the metoprolol group (P = 0.577). The results of Fisher Exact test showed no significant relationship between the type of the drug and the occurrence of AF (P < 0.05). Nevertheless, the prevalence of AF was higher in the renal failure group. AF was mostly recorded on the second and third days after the surgery. The results showed an association between old age and higher occurrence of AF. AF was recorded in 11 patients (14%) in the metoprolol group and 9 ones (12%) in the carvedilol group, with Left Ventricle Ejection Fraction (LVEF) being between 35% and 45% (P = 0.587). However, no significant difference was found between the two groups in this regard., Conclusions: In the patients with sufficient ejection fraction, no difference was observed in using carvedilol or metoprolol in prevention of post-CABG AF. Yet, given the anti-oxidant and anti- inflammatory effects of carvedilol, it might be more beneficial in comparison to metoprolol, particularly in the patients with lower ejection fractions or heart failure.

Background: Usually the chest tube removal (CTR) has been described as one of the worst experiences by patients in the intensive care unit., Aim: This study aimed to compare the effects of cold therapy and relaxation on pain of CTR among the patients undergoes coronary artery bypass graft surgery., Materials and Methods: This single-blinded clinical trial was done on 80 post-cardiac surgery patients in the heart hospital of Sari-Iran. The patients were assigned to three randomized groups that included cold therapy, relaxation, and control groups. Data analysis was done by T-test, Chi-square, generalized estimating equations and repeated measures analysis variance tests., Results: The groups had no significant differences in pain intensity before CTR (P = 0.84), but immediately after CTR there was a significant difference between the treatment (cold application and relaxation groups) and control groups (P = 0.001). There was no significant difference between relaxation and cold therapy groups., Conclusion: Regarding the relaxation and cold application methods showed relatively equal effects on reducing the pain owing to CTR. Thus, the use of relaxation because of economics, without side effects, easy to use and effective is recommended by the authors to the practitioners.

Background: The styloid process and the attached ligaments have the potential for calcification and ossification in specific conditions. The purpose of this study was to evaluate the relationship between the elongated styloid process (ESP) frequency and some of the systemic health factors of patients over 40 years of age., Materials and Methods: In this analytical-descriptive study, 296 panoramic radiographs of patients over 40 years of age (165 female and 131 male) referred to the Dental School of Khorasgan Azad University were selected. The length of the styloid process was measured by a special ruler and recorded in a questionnaire form. Other data such as sex, age, height, weight, blood pressure, heartbeat and the number of teeth present in the mouth were also recorded. The lengths equal to or more than 30 mm on the radiographs were considered as ESP. Data analysis were done by independent t-test, Pearson correlation coefficient and Chi-square test at a significance level of < 0.05., Results: ESP was observed in 135 cases (45.6%). There was a significant relationship between ESP and the body height, weight and the blood pressure, but there was no significant correlation between ESP, the heartbeat and the number of teeth present in the mouth., Conclusion: Because of the significant relationship between the length of the styloid process and the blood pressure, height and weight it is reasonable to evaluate a patient's systemic health conditions when radiographic signs of ESP are observed.

Perioperative hyperglycemia is common in patients with type 2 diabetes undergoing Coronary Artery Bypass Graft (CABG) surgery and there is a direct relation between postoperative hyperglycemia and mortality rate in these patients. The aim of the present study is to determine the efficacy of metformin on glycemic control in diabetic patients after CABG surgery. In a randomized double blind clinical trial, 100 patients with type 2 diabetes admitted in open heart ICU after CABG surgery in Mazandaran Heart Center were enrolled. They were randomly assigned to two intervention and control groups. Three hours after extubation, therapeutic antiglycemic regimens were applied in these two groups and continued for three days. Intervention group received regular insulin infusion along with two metformin 500 mg tablets per twelve hours while control group received regular insulin infusion with two placebo tablets per twelve hours. Blood glucose level and other parameters were measured and recorded in determined intervals. To analyze the data, independent T-test, paired T-test, Mann-Whitney and repeated measure ANOVA tests were employed. Mean blood glucose level was not significantly different in the two groups at the beginning of the ICU admission; however, mean glucose level in insulin-metformin group, twelve hours after the initiation of the study, was significantly lower than insulin group (p < 0.05). In addition, mean doses of potassium and insulin demand as well as mean number of episodes of hyperglycemia, hypoglycemia and glucose levels out of the accepted range were significantly lower in insulin-metformin group (p < 0.05). Alterations in mean levels of lactate, BE, pH and creatinine were not statistically significant in these two groups. It seems that adding metformin to insulin leads to a better glycemic control in type two diabetic patients undergoing CABG surgery without causing metabolic acidosis. Therefore, it might be a potential option in blood glucose control protocol in this group of patients.