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Abstract Background In the present study, we aimed to determine the frequency of the csgA, fimH, mrkD, foc, papaGI, papGII and papGIII genes, to provide and to design fimbrial adhesin gene (FAG) patterns and profiles for the isolated uropathogenic Escherichia coli (UPEC) strains. Methods The enrollment of 108 positive urine samples was performed during seven months, between January 2022 and July 2022. The UPEC strains were confirmed through the standard microbiological and biochemical tests. The antimicrobial susceptibility test was performed through the Kirby–Bauer disc diffusion method. Molecular screening of FAGs was done through the polymerase chain reaction technology. The statistical analyses including chi square and Fisher’s exact tests were performed to interpret the obtained results in the present study. Results As the main results, the antimicrobial resistance (AMR) patterns, multi- (MDR) and extensively drug-resistance (XDR) patterns and FAG patterns were designed and provided. fimH (93.3%), csgA (90.4%) and papG (37.5%) (papGII (30.8%)) genes were recognized as the top three FAGs, respectively. Moreover, the frequency of csgA-fimH gene profile was identified as the top FAG pattern (46.2%) among the others. The isolates bearing csgA-fimH gene profile were armed with a versatile of phenotypic AMR patterns. In the current study, 27.8%, 69.4% and 1.9% of the UPEC isolates were detected as extended-spectrum ß-lactamases (ESBLs) producers, MDR and XDR strains, respectively. Conclusions In conclusion, detection, providing and designing of patterns and profiles in association with FAGs, AMR feature in UPEC strains give us an effective option to have a successful and influential prevention for both of UTIs initiation and AMR feature.

Brown tumor is a condition associated with hyperparathyroidism that can affect various bones, including the facial skeleton. These tumors are typically well-defined radiolucent lesions but can grow large and cause disfigurement. It is crucial to diagnose brown tumors especially in the jaws early, as those involving the maxillo-mandibular region can exhibit highly aggressive behavior. Also, following parathyroidectomy or normalization of parathyroid hormone (PTH) levels, patients should be closely monitored for the presence of brown tumors. It is advisable to consider the removal of brown tumors even after the correction of underlying hyperparathyroidism. Regular follow-up examinations are necessary to assess the progression or regression of these tumors. In this study, we present a case of a 42-year-old female with renal failure and a history of parathyroidectomy presented with brown tumors in both jaws. The tumors showed aggressive characteristics such as cortical expansion and significant patient discomfort. After clinical and radiological evaluation, the patient underwent surgical excision, which involved total mandibulectomy and maxillectomy. The excised tissue was then subjected to histopathological analysis; the results confirmed brown tumor in both jaws.

Two-phase closed thermosyphons (TPCTs) are highly efficient heat transfer devices that leverage natural convection to transport heat over substantial distances with minimal temperature gradients. This study investigates the thermal performance of a novel TPCT equipped with an external liquid-vapor separator, compared to a conventional TPCT. The innovative design incorporates an external pathway connecting the condenser and evaporator sections. A comprehensive evaluation was conducted using three working fluids (water, methyl acetate, and ethanol) across a spectrum of heat inputs (50 ≤ Q ≤ 300 W) and filling ratios (25 %, 40 %, 55 %, 70 %, and 85 %). Optimal performance was consistently observed at a 70 % filling ratio for all fluids tested. While the conventional TPCT exhibited superior performance with methyl acetate, the novel TPCT demonstrated enhanced thermal efficiency when charged with water or ethanol. Notably, the novel TPCT using water reduced thermal resistance by approximately 63 % and 60.5 % compared to ethanol and methyl acetate, respectively, at a 50 W heat input and the optimal filling ratio. These findings underscore the critical influence of working fluid selection and offer valuable insights into the thermal characteristics of the novel TPCT. The results contribute significantly to the optimization and design of TPCTs for diverse applications.

An artificial ovary based on the alginate (ALG) hydrogel has been widely implemented to preserve prepubertal femalefertility. However, this platform is not fully capable of successful an ovary microenvironment simulation for follicledevelopment, holding great potential for its improvement. Therefore, this experimental study aimed to evaluate the effectof an amniotic membrane extract (AME) -loaded hydrogel on the mouse preantral follicles in vitro development.In order to have better follicle development, first, the impact of different concentrations of follicle-stimulating hormone(FSH) was evaluated on the mouse preantral follicles encapsulated in ALG. Later, the appropriate dose was adjustedfor the follicles encapsulated in the ALG-AME hydrogel. Results demonstrated that 100 mIU/ml FSH showeda significant follicle survival rate compared with 10 mIU/ml FSH (P=0.005). According to MTT assay finding, therate of weight loss, and rheology evaluations, ALG containing 1 mg/ml AME was identified as an optimal sampleof follicle culture instead of other AME concentrations. Follicle diameter significantly increased in the ALG-AME 1hydrogel compared with the ALG control group without AME (P=0.027). The storage modulus of ALG-AME 1 was773 Pa and retained the follicle morphology for 13 days. No statistically substantial difference was seen in survival,antrum cavity formation, and competent oocyte in terms of the normal chromosomal arrangement and meiotic spindlerate in comparison with the control group. It can be concluded that ALG-AME 1 could not significantly impact themouse preantral follicle.

In recent years, with the increased production of oilseed rape, there has been a simultaneous enhancement in reports on pathogens causing diseases. Magnetic technology has been recognized as a new agricultural method aimed at improving health and crop production. In this work, the effect of magnetic fields was studied on the mycelial growth and conidia formation of Leptosphaeria maculans Gol125 and Leptosphaeria biglobosa KH36, the causal agents of Phoma stem cancer (blackleg) disease in rapeseed. In addition, seeds exposed to eight direct frequencies of magnetic fields were impregnated with pathogen suspension and grown under greenhouse conditions. The growth speed of both pathogen isolates decreased by 1–28% in GOL125 and 6–46% in KH36 over time in cultures exposed to magnetic fields. However, the number of conidia increased significantly under magnetic field exposure, reaching 5.4 × 107 and 7.7 × 107 SFU/ml in KH36 and GOL125 isolates, respectively. Furthermore, in greenhouse conditions, an increase in photosynthetic pigment levels was observed in almost all of the magnetic field-treated plants. In addition, disease incidence decreased by around 6% in the magnetic field-treated plants. This study represents the first evaluation of magnetic technology in controlling plant diseases. The use of magnetic fields may present a viable strategy for a sustainable production system; however, it requires further advanced studies to improve plant health and productivity.

Abstract Metabolic dysfunction-associated steatohepatitis (MASH) is the most prevalent cause of liver disease worldwide, with a single approved therapeutic. Previous research has shown that interleukin-22 (IL-22) can suppress β-cell stress, reduce local islet inflammation, restore appropriate insulin production, reverse hyperglycemia, and ameliorate insulin resistance in preclinical models of diabetes. In clinical trials long-acting forms of IL-22 have led to increased proliferation in the skin and intestine, where the IL-22RA1 receptor is highly expressed. To maximise beneficial effects whilst reducing the risk of epithelial proliferation and cancer, we designed short-acting IL-22-bispecific biologic drugs that successfully targeted the liver and pancreas. Here we show 10-fold lower doses of these bispecific biologics exceed the beneficial effects of native IL-22 in multiple preclinical models of MASH, without off-target effects. Treatment restores glycemic control, markedly reduces hepatic steatosis, inflammation, and fibrogenesis. These short-acting IL-22-bispecific targeted biologics are a promising new therapeutic approach for MASH.

Abstract The IL-22RA1 receptor is highly expressed in the pancreas, and exogenous IL-22 has been shown to reduce endoplasmic reticulum and oxidative stress in human pancreatic islets and promote secretion of high-quality insulin from beta-cells. However, the endogenous role of IL-22RA1 signaling on these cells remains unclear. Here, we show that antibody neutralisation of IL-22RA1 in cultured human islets leads to impaired insulin quality and increased cellular stress. Through the generation of mice lacking IL-22ra1 specifically on pancreatic alpha- or beta-cells, we demonstrate that ablation of murine beta-cell IL-22ra1 leads to similar decreases in insulin secretion, quality and islet regeneration, whilst increasing islet cellular stress, inflammation and MHC II expression. These changes in insulin secretion led to impaired glucose tolerance, a finding more pronounced in female animals compared to males. Our findings attribute a regulatory role for endogenous pancreatic beta-cell IL-22ra1 in insulin secretion, islet regeneration, inflammation/cellular stress and appropriate systemic metabolic regulation.

The Circular Economy of the Automotive Industry’s Sustainable Supply Chain in the Case of Lithium-Ion Batteries is pioneering in environmental protection and ecological resource utilization. In addition to solving environmental problems, this method provides economic benefits by reducing the need for raw materials and lowering manufacturing costs. However, introducing a circular economy approach in the lithium-ion battery supply chain has numerous risks and challenges. This study addresses these challenges by crafting a framework that encapsulates the risks involved. It identifies the risks that evolving circular economy strategies might bring to the lithium-ion battery supply chain through an integrated Gray Delphi–DEMATEL–ANP method. Furthermore, this work introduces the Gray Degree of Possibility to unveil worst-case scenarios in risk analysis and extends it into zero-sum Game Theory. The study then formulates an improved zero-sum game model to determine optimal strategies for mitigating these risks. The numerical analysis reveals that, according to the proposed methodology, Environmental Pollution Risk emerges as the most critical, with a definite weight of 0.1525. This is followed by the Support Program Deficiency Risk at 0.1452 and the Improper Waste Management Risk at 0.1372.

Abstract Background There is little economic evidence on different modalities among patients with end-stage renal disease (ESRD) in Iran. This study aimed to assess the cost-utility of peritoneal dialysis (PD) and hemodialysis (HD) among ESRD patients in Iran. Methods From the health system perspective and with a 10-year time horizon, we conducted a cost-utility analysis based on a Markov model to compare three strategies of PD and HD [the second scenario (30% PD, 70% HD), the third scenario (50% PD, 50% HD) and the fourth scenario (70% PD, 30% HD)] among ESRD patients with the current situation (PD, 3% vs. HD, 97%) as the basic scenario (the first scenario) in Iran. Cost data for PD, HD and kidney transplantation were extracted from the medical records of 720 patients in the Health Insurance Organization (HIO) database. The Iranian version of the EQ-5D-5 L questionnaire was filled out through direct interview with 518 patients with ESRD to obtain health utility values. Other variables such as transition probabilities and survival rates were extracted from the literature. To examine the uncertainty in all variables included in the study, a probabilistic sensitivity analysis (PSA) was performed. TreeAge Pro 2020 software was used for data analysis. Findings : Our analysis indicated that the average 10-year costs associated with the first scenario (S1), the second scenario (S2), the third scenario (S3) and the fourth scenario (S4) were 4750.5, 4846.8, 4918.2, and 4989.6 million Iranian Rial (IRR), respectively. The corresponding average quality-adjusted life years (QALYs) per patient were 2.68, 2.72, 2.75 and 2.78, respectively. The ICER for S2, S3 and S4 scenarios was estimated at 2268.2, 2266.7 and 2266.7 per a QALY gained, respectively. The analysis showed that at a willingness-to-pay (WTP) threshold of 3,000,000,000 IRR (2.5 times the GDP per capita), the fourth scenario had a 63% probability of being cost-effective compared to the other scenarios. Conclusion Our study demonstrated that the fourth scenario (70% PD vs. 30% HD) compared to the current situation (3% PD vs. 97% HD) among patients with ESKD is cost-effective at a threshold of 2.5 times the GDP per capita (US$4100 in 2022). Despite the high cost of PD, due to its greater effectiveness, it is recommended that policymakers pursue a strategy to increase the use of PD among ESRD patients.

Introduction: This study presents the elements and methodology of the reinforcement learning model according to the agent-based conceptual model of hospital accreditation in Iran. The elements and methodology of the mentioned model will create a favorable study base for creating a smart and multi-agent hospital accreditation system and environment simulation trends to provide efficient guidelines to relevant agents and policymakers. This study aims to address the main research questions concerning the uncertainties related to the reinforcement learning elements and the methodology selection in a multi-agent socio-technical system.Methods: To collect the necessary information to understand the elements and identify hospital accreditation processes, agents, the environment, and their interactions, systematic reviews of sources, scientific document reviews, and semi-structured interviews with experts were conducted. Interviewees were selected from university faculty members, hospital managers, and quality improvement officers through a targeted non-random snowball sampling method. The interviews were summarized using grounded-theory-based methods and a sequential and systematic approach. The characteristics of the machine learning process were collected using a systematic review method from the "Iran Hospital Accreditation Guide 2022". The process of selecting the features was done by correctly choosing the output features of the model, which are the actions of the agent. The list of agent actions was extracted as a general non-binary tree based on the classification of the tree structure from the conceptual content of the document.Findings: The extracted reinforcement learning model seeks to find the optimal chains of operational actions under conditions where quantitative data of the hospital are available. The most important elements of the model are:Set of States: Hospital accreditation factors such as input variables, output variables, indicators, parameters, and fixed numbers related to the metrics of each conceptual agent in the "Iran Hospital Accreditation Guide 2022".Set of Actions: Actions of intelligent agents in each reinforcement learning episode, paths from the hierarchically clustered binary tree, which are operational actions that can be performed in the hospital per set of state features.Reward Function: "Obtaining the highest possible score in the hospital ranking system by performing the least number of necessary actions."Policy Function: Based on the learning process of each agent, it relies on a DQN deep neural network and a gradient reduction algorithm.Operational Agents: The operational goal of each conceptual agent is "maximizing the accreditation points of the metrics of the relevant field by recommending the least measures."General Cycle of the Model: In this structure, each intelligent agent, a subset of the nine conceptual agents, has a multi-layered neural network. The characteristics of related states are entered into this neural network, and in the output, based on the special policy function definition of that agent, a map of optimal actions is created according to the agent's current conditions and states.Neural Network Model: The neural network of the intelligent agent is derived from the conceptual agent "management and leadership," specifying the input, hidden, and output layers of the network. Conclusion: Summarizing the background of related research showed that the approach to designing hospital accreditation models could be divided into two groups: "conceptual models without using intelligent agents" and "conceptual models using intelligence and operating systems". The investigations showed that these studies had the expected results and that the efficiency and effectiveness of the models and processes proposed by them had the necessary validity.

Hypothesis: This study was conducted with the aim of synthesizing and identifying an injectable hydrogel based on chitosan/laponite. First, water-soluble chitosan was obtained from the reaction of chitosan/glycidyl trimethylammonium chloride (GTMAC). Then, an injectable hydrogel was prepared from its combination with Laponite nanoparticles.Methods: Chitosan was reacted with GTMAC with ratios of 1:1, 3:1 and 6:1. Using FTIR and H1NMR, the successful synthesis of water-soluble chitosan was confirmed. Besides that; Thermal stability, solubility in water, ability to absorb and retain moisture, zeta potential, biocompatibility and antibacterial activity of modified samples were investigated and compared with pure chitosan. Then, the optimal sample of modified chitosan was combined with laponite at a ratio of 1:1, and the physicochemical, injectability, self-healing, rheological, and biocompatibility properties of this hydrogel were investigated.Findings: The substitution percentage of QCS1, QCS3 and QCS6 samples was above 25%, 50% and 74%, respectively. QCS3 and QCS6 samples showed better water solubility at different pHs. By increasing the percentage of substitution, the surface charge became more positive and the antibacterial activity was improved. However, the higher percentage of cell viability in the QCS3 sample makes it more suitable for biological applications. After hydrogel formation, the ionic and hydrogen interactions between the QCS/LAP in the hydrogel was confirmed by FTIR. Elemental analysis confirmed the uniform distribution of laponite in the hydrogel. SEM images showed a reduction in pore size after incorporating Laponite in the hydrogel. Rheological studies showed a 5-fold increase in the mixed shear modulus after the addition of laponite. Also, the gelation time of the hydrogel was calculated about 5 minutes. The percentage of cell viability obtained by the MTT test after 72 hours was 93%. Consequently, the introduced hybrid hydrogel can be a suitable choice for tissue engineering and drug delivery applications.

Objectives Hospitalization is a vulnerable period for the elderly. During this period, they are at risk of falling. There are various clinical guidelines for fall prevention, whose usefulness depends on their quality and clinical acceptance. This study was to evaluate the methodological quality of selected clinical guidelines for fall prevention in hospitalized elderly people in Iran using the Appraisal of Guidelines, Research, and Evaluation (AGREE) checklist. Methods & Materials A systematic search was conducted for clinical guidelines published from 2009 to 2020 using the keywords clinical guideline, falling, prevention, aged, and hospitalization. Of 351 clinical guidelines identified, 4 guidelines were selected based on the inclusion and exclusion criteria and by a purposive sampling method. The quality of the selected guidelines was evaluated by 5 experts independently using the AGREE II checklist. Based on the quality scores, the guidelines were categorized as “highly recommended” or “recommended with modifications”. Results The "Falls Assessment and Prevention of Falls in Older People", "Preventing Falls and Harm From Falls in Older People", and "Preventing Falls and Reducing Injury from Falls" were categorized as highly recommended, while the "Post Fall Multidisciplinary Management Guidelines for Western Australian Health Care Settings" was categorized as “recommended with modifications”. Therefore, they can be localized and used to reduce the risk of falls in hospitalized elderly people in Iran. The mean overall scores of 6 domains for the guidelines were as follows: 91. 1% for “clarity of presentation”, 86. 6% for “scope and purpose”, 83. 6% for “stakeholder involvement” 72. 08% for “editorial independence”, 71. 14% for “rigor of development”, and 66. 66% for “applicability”. Conclusion Evaluation of the methodological quality of clinical guidelines using the AGREE tool should be done to be able to be used in clinical practice. It is recommended to use these tools in updating the current or future clinical guidelines to ensure their methodological quality.

The subject of predicting global crude oil prices is well recognized in academic circles. The notion of hybrid modeling suggests that the integration of several methodologies has the potential to optimize advantages while reducing limitations. Consequently, hybrid techniques are extensively used in contemporary research. In this paper, a novel decompose-ensemble prediction approach is proposed by integrating various optimization algorithms, namely biography-based optimization (BBO), backtracking search algorithm (BSA), teaching-learning-based algorithm (TLBO), cuckoo optimization algorithm (COA), multi-verse optimization (MVO), and multilayer perceptron (MLP). Furthermore, the aforementioned approaches, namely BBO-MLP, BSA-MLP, and TLBO-MLP, include the de-compose-ensemble technique into the individual artificial intelligence model in order to enhance the accuracy of predictions. In order to validate the findings, the forecast is conducted using the authoritative data on oil prices. This study will use three primary indicators, including EMA 20, EMA 60, EMA 100, ROC, and AUC assessments, to assess and evaluate the efficacy of the five methodologies under investigation. The below findings are derived from the conducted research: Based on the achieved AUC values of 0.9567 and 0.9429, it can be concluded that using a multi-verse optimization technique is considered the most suitable strategy for effectively handling the dataset pertaining to crude oil revenue. The next four approaches likewise have a significant AUC value, surpassing 0.8. The AUC values for the BBO-MLP, BSA-MLP, TLBO-MLP, and COA-MLP approaches were obtained as follows: (0.874 and 0.792) for training and testing stages, (0.809 and 0.792) for training and testing stages, (0.9353 and 0.9237) for training and testing stages, and (0.9092 and 0.8927) for training and testing stages, respectively. This model has the potential to contribute to the resolution of default probability and is very valuable to the credit card industry. Broadly speaking, this novel forecasting approach serves as a notable predictor of crude oil prices.

Background: The study aimed to investigate oral health status and its relationship with oral health-related quality of life in the elderly in Isfahan, Iran, in 2022. Materials and Methods: This cross-sectional study was conducted in Isfahan, with 460 elderly participants. During interviews with the participants, their demographic information, their medical and dental history, oral health-related behaviors, self-perceived oral health, and clinical examinations were collected, and the Geriatric Oral Health Assessment Index (GOHAI) was completed. The final conclusions were made using the Generalized Linear Model (GLM) test. Results: The mean (sd) scores were 45.05 (8.62) for GOHAI, 5.44 (2.96) for self-perceived oral health, and 18.11 (5.76) for DMFT (Decayed, Missing and Filled teeth). Moreover, the number of remaining teeth on average was 11.78 (11.89), 39.56% of the participants did not brush their teeth, 40% of the elderly had complete dentures, and 27.17% had dental insurance. After adjusting and modifying the variables, the GLM test revealed that strong predictors for higher GOHAI scores were the higher levels of education (p < .001), the higher frequency of remaining teeth (p = 0.002), more pleasant self-perceived oral health (p < .001), and dental insurance (p = 0.04). Conclusions: According to the findings, the elderly's oral health-related quality of life in Isfahan was low, which was caused by the following factors: edentulism, few numbers of remaining teeth, high DMFT score, elderly' non-adjustment with dentures and their low quality, inappropriate oral health-related behaviors, lack of complementary insurance for dentistry, and non-using dental services, and low levels of education.

Introduction: This study aimed to investigate alpha power in successful and unsuccessful free throws of elite and novice basketball players.Methods: The current research was quasi-experimental and was implemented in a time series design. Two Elite (10 participants with a mean age of 22.25 ± 1.34) and Novice (10 participants with a mean age of 22.55 ± 1.80) groups participated voluntarily. The data were measured using 28 electrodes from a 32-channel wireless device and were analyzed using the repeated measures analysis of variance test (p≥0.05).Results: The alpha power of the elite group was higher than the novice group (P=0.001). The successful throws showed lower alpha power than unsuccessful throws (P=0.006). In the comparison of the two groups, the alpha power in the unsuccessful throws of the elite group was higher than in their successful throws (p=0.001), but no difference was observed between the alpha power of the successful and unsuccessful throws of the novice group (p=0.584). The alpha power during the execution time of the free throw task was higher than the pre-execution time (p

Objectives Planning for active aging to manage the conditions of old age is one of the inevitable priorities that requires knowing its facilitators and barriers from the perspectives of beneficiaries. In this regard, this study aims to identify the facilitators and barriers to active aging in Iran from the perspective of older adults and geriatric experts. Methods & Materials This is a qualitative study that was conducted in 2022 using the content analysis method. Participants were 20 older adults and 21 experts in geriatrics who were selected using a purposive sampling method based on the inclusion criteria. Semi-structured, in-depth interviews and focus groups were used for data collection. Data were analyzed using Graneheim and Lundman’s content analysis method. Lincoln and Guba’s criteria were used to determine the credibility, transferability, dependability, and confirmability of the data. Results Four main categories were extracted for barriers to active aging (individual, family, structural, and health system-related) and four main categories for facilitators of active aging (older adults’ existential capacity, family capacity, community capacity, and health system capacity). Conclusion Health system-related barrier is one of the barriers to planning for active aging in Iran. The results of this study provide valuable information to experts in geriatrics, scholars, and elderly care centers for developing interventions to promote active aging in Iran.

Purpose: The present study was conducted with the aim of determining the level of participation of public library librarians in Tehran in online social networks to provide services during the COVID-19 pandemic. Method: This research is applied in terms of purpose and was conducted using a survey method. The research population at the time of the research (July and August 2023) included all the librarians of public libraries in Tehran (152 people) from whom a sample of 109 people was selected according to Morgan’s table, and 105 questionnaires were analyzed in the final analysis. The data collection tool was a researcher-made questionnaire. Data analysis was done at two levels of descriptive and inferential statistics using SPSS (version 26). In order to check the average difference between the main research variables, one-way analysis of variance parametric test was used. Findings: The results showed that the librarians had the greatest knowledge about "Bale" messenger and the lowest knowledge about "SoroushPlus". The level of knowledge of librarians regarding social networking tools and the level of influence of the organization on their knowledge of tools has been lower than the average level. The level of necessity and acceptance of social networking tools is "high" and the level of use of these tools by librarians is "moderate". There was a significant difference between the average opinions of librarians about knowledge and acceptance as well as acceptance and use of these networks, while no significant difference was observed between the average opinions of participants about the two variables of knowledge and use of online social networks. Originality/value: Although according to the results of this research, the level of influence of the organization in the librarians’ knowledge of social networking tools is reported to be lower than average, and the level of influence of the organization in the knowledge of content production tools in these sites is reported to be small, the role of the organization in the librarians’ knowledge cannot be ignored. Therefore, the results of this research, by determining the attitude of the research population towards social networking sites, the extent of acceptance and use of these sites by them and identifying the weaknesses and strengths of public libraries in using social networking sites, can be applied by managers and planners of public libraries in order to provide a suitable platform for using the social networking sites, remove barriers to using them, and improve information service.

Key Clinical Message Innovative mixed treatment offers hope for persistent mixed urinary incontinence (MUI): PRP‐Fibrin Glue‐Stem Cell injection, Botox, and TVT in a single session. Successful case study reveals promising outcomes, emphasizing the need for further research. Abstract Mixed urinary incontinence is a complaint of stress and urge incontinence which affects patients' quality of life and dramatic changes in patients' physical, mental, and socioeconomic status. The treatment is challenging and depends on the dominance of one of the complaints to the other. The progress in the method of treatment is still under discussion. This study reports treatment of a MUI case in a 56‐year‐old, with a history of MUI of 7‐year duration, which was persistent to pharmacological treatment, pelvic muscle training, biofeedback, and anti‐incontinence surgery (Burch Colposuspension). PRP‐Fibrin Glue‐Stem Cell injection, Botox injection, and TVT were performed in a one surgery session. Patient was discharged with ability to urinate with acceptable amount of post void residue. After 3‐month follow‐up, patient was completely satisfied and happy. Further research is needed to substantiate the efficacy of these mixed treatments for MUI.

Abstract Background and Aims Perianal fistula is a prevalent anorectal condition originating from an infectious crypt extending to the external opening. Multiple surgical methods exist for treating perianal fistulas; however, selecting the appropriate options is still controversial. Our study aims to evaluate seton replacement versus other surgical methods in treating perianal fistula. Methods This study recruited 72 patients presenting with perianal discharge and diagnosed with perianal fistula through intra‐sphincteric, trans‐sphincteric, and supra‐sphincteric examinations at Imam Reza and Besat Hospitals from July 2022 up to March 2023. Regarding case‐control design, patients were divided into two groups: the first group (n = 36) underwent seton insertion, while the control group (n = 36) received alternative surgical methods. Follow‐up was conducted for 1 month post‐discharge, with monthly visits for 6 months. Patients were evaluated for fistula tract healing, seton loosening, and daily secretion rate (based on infected pads) during each visit. Finally, the two groups were compared in terms of improvement rates. Results In the seton group, approximately 94.4% of patients showed improvement. However, the difference between the groups was insignificant (p = 0.494). Seton replacement was performed in 52% of patients, with the majority requiring replacement twice (61%). Improvement rates were highest among cases with two seton replacements, although the difference was not statistically significant (p = 0.073). Following seton replacement, the most common treatment methods were endoanal flap and fistulotomy, with observed improvement in 10 cases for each procedure. Conclusion This study highlights that draining seton remains a primary choice for intermediate treatment due to its satisfactory improvement rate and lower requirement for replacement, especially up to two times.

Background: Due to the associated hypertension and cardiovascular disease in patients with ESRD hemodynamic changes during operations are detrimental and may be life-threatening. Therefore, hemodynamic stability is an important criterion in selecting the anesthetic approach. Methods: 72 ASA class III/IV, ESRD Patients were studied in randomized double blind clinical trial. They were divided into two groups by four-block randomization. A group of patients were induced and maintained by etomidate and second of patients were induced by Na thiopental and maintained by isoflurane. Systolic, diastolic and mean arterial blood pressure and heart rate were measured at interval of pre and post induction, postintubation, pre and post abdominal insufflation during and at the end of surgery and in recovery. The total BP modulators were recorded and postoperative nausea and vomiting was registered in the recovery. Data were analyzed by STATA version 12. Results: There was no significant difference in physical characteristics between two groups. There was no statistical difference between the groups in SBP and HR (P>0.05), although DBP fluctuation>20% at interval postinduction and prior to abdominal insufflation during surgery and at the end of surgery, was significantly higher in the isoflurane group of patients. (P=0.004, 0.001, 0.003 and 0.009, respectively). Also, the MAP fluctuation at interval of post induction, preinsufflation and at the end of surgery was significantly higher in isoflurane of patients. (P=0.04, 0.001, and 0.02, respectively). Conclusion: The group anesthetized with isoflurane had a higher hemodynamic fluctuation, compared to the group anesthetized with etomidate. As hemodynamic changes are critical in patients with ESRD, etomidate is a more appropriate anesthetic choice for implantation of peritoneal dialysis catheter by laparoscopic approach.